Instrument
reprocessing
in Dental Practices
how to do it right
3rd
Working Group
Instrument Preparation
revised edition
Reprocessing of instruments in dental practices
how to do it right
3rd revised edition 2005
Dental instruments
Previous German editions: Previous editions in other languages:
1st edition, 1986 German/English, 3rd edition 2003
2nd edition, 1995
3rd edition, 2003
These brochures are available in pdf format for free download at: www.a-k-i.org.
All rights reserved by Arbeitskreis Instrumenten-Aufbereitung
[Instrument Preparation Working Group] (c) 2005
Daimlerstraße 2
64546 Mörfelden-Walldorf, Germany
No part of this publication may be reproduced in any form.
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 3
The working group for
INSTRUMENT REPROCESSING
consists of the following members:
Product group Instruments: Product group disinfectants,
Product group disinfection
cleaning agents and main-
and cleaning devices, and as
tenance products
well as sterilizing systems
Wolfgang Fuchs Dr. rer. nat. habil Holger Biering Hans Jörg Drouin
c/o Aesculap c/o Ecolab c/o MMM
Am Aesculap-Platz Reisholzer Werftstraße 38-42 Daimlerstraße 2
D-78532 Tuttlingen D-40589 Düsseldorf D-64546 Mörfelden-Walldorf
Tel.:+49 (0)74 61-95 27 98 Tel.:+49 (0)2 11-98 93-634 Tel.: +49 (0)61 05-92 40-11
Helmi Henn Rudolf Glasmacher Robert Eibl
c/o Wolf Endoskope c/o Ecolab c/o MMM
Pforzheimer Straße 32 Reisholzer Werftstraße 38-42 Semmelweisstraße 6
D-75438 Knittlingen D-40589 Düsseldorf D-82152 Planegg
Tel.:+49 (0)70 43-3 51 44 Tel.:+49 (0)2 11-98 93-6 68 Tel.:+49 (0)89-8 99 18-3 34
Karl Leibinger Dr. rer. nat. Jürgen Staffeldt Dr. rer. nat. Winfried Michels
c/o KLS Martin Group c/o Chem. Fabrik Dr. Weigert c/o Miele
Gebrüder Martin Mühlenhagen 85 Carl-Miele-Straße 29
Kolbinger Straße 10 D-20539 Hamburg D-33332 Gütersloh
D-78570 Mühlheim Tel.:+49 (0)40-7 89 60-1 65 Tel.: +49 (0)52 41-89-14 91
Tel.: +49 (0)74 63-8 38-1 10
Michael Sedlag
Roland Maichel c/o Miele
c/o Willy Rüsch Carl-Miele-Straße 29
Willy-Rüsch-Straße 4-10 D-33332 Gütersloh
D-71394 Kernen Tel.: +49 (0)52 41-89-14 61
Tel.: +49 (0)71 51-4 06-2 30
Ursel Oelrich
c/o Aesculap
Am Aesculap-Platz
D-78532 Tuttlingen
Tel.:+49 (0)74 61-95 29 32
Claudia Schwieger
c/o Heine Optotechnik
Kientalstraße 7
D-82211 Herrsching
Tel.: +49 (0)81 52-3 83 40
4 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
In addition to the regular members of AKI, the following
Advisory cooperation
experts in the field of dental instruments have contributed:
Rolf Bahro Dr. med. dent. Jörg Weiler
Prof. Dr. med. Marianne
c/o Rolf Bahro Ringstraße 2b
Borneff-Lipp
Hager & Meisinger D-50996 Köln-Rodenkirchen
c/o Institut für Hygiene der
Hansemannstraße 10
Martin-Luther-Universität
D-41468 Neuss
Heinz Schawacht
Halle-Wittenberg
former
J.-A.-Segner-Straße 12
Eugen Eibofner MARTIN Medizin-Technik
D-06097 Halle/ Saale
c/o Kaltenbach & Voigt
Tel.: +49 (0)3 45-5 57-10 95
Bismarckring 39
Carsten Dogs
D-88396 Biberach (Riß)
former
Sigrid Krüger
Chem. Fabrik Dr. Weigert
c/o Hygiene Consulting
Herbert Opel
Minneweg 22
c/o Sirona Dental
D-21720 Grünendeich Rolf H.F. Uthmann
Fabrikstraße 31
Tel.:+49 (0)41 42-29 43 former Miele
D-64625 Bensheim
Prof. Dr. Ulrich Junghannß
Ulrich Schweickhardt
c/o Hochschule Anhalt (FH)
c/o Adolf Schweickhardt
Bernburger Str. 55
Bahnhofstraße 80
D-06366 Köthen
D-78532 Tuttlingen
Tel.: +49 (0)3496 - 67 25 3
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 5
Instrument Reprocessing in Dental
Practices how to do it right
Contents
Adresses of the AKI-members 4
Preface 7
Introduction 8
1. Water 10
2. New Instruments 11
3. Disposal/Storage of used instruments in the
treatment room 12
4. Disinfectin and cleaning instruments
in the reprocessing room 13
4.1 Manual disinfecting and cleaning 14
4.1.1 Ultrasound 15
4.1.2 Notes on specific dental instruments 16
4.2 Automatic reprocessing in disinfection
and cleaning machines 17
4.2.1 Notes on specific dental instruments 19
5. Checking, Maintenance and Care, Packaging 20
5.1 Test for special instruments 21
5.2 Correct packaging 21
6. Sterilization 22
6.1 Steam sterilization 22
6.2 Hot air sterilization 24
7. Storage 25
7.1 Storage of unsterile instruments 25
7.2 Storage of sterile instruments 25
8. Discoloration, Deposits and Corrosion 26
Discoloration Water stains 26
Discoloration Carry over 27
Discoloration Rainbow discolorations 27
Discoloration Black discoloration 28
Deposits Organic residues 28
Deposits Foreign rust 28
Corrosion Pitting 29
Corrosion Tensile crack corrosion 30
Corrosion Fissure corrosion 31
Corrosion Frictional corrosion 31
Corrosion Contact corrosion 31
Corrosion Surface corrosion 32
9. References 33
10. AKI-sales conditions 34
6 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
Preface
This brochure addresses dentists and dental staff in practices and cli-
nics.
Pursuant to the applicable European Directive and national legislati-
on, dental instruments are considered medical products, which requi-
re adequate quality assurance in reprocessing.
This brochure aims to provide detailed information on optimal instru-
ment reprocessing.
As routine work shows, ignorance of material properties, non-adhe-
rence to manufacturer's instructions and insufficient staff training have
caused problems a number of times, to the detriment of all parties
concerned.
Right from the start it is therefore important to avoid any incorrect use
of an instrument that could cause corrosion, impair the function or
eventually destroy the instrument in the long run. Hygienic risks must
also be excluded. Residual moisture on an instrument due to insuffi-
cient drying, for example, may cause growth of potentially infectious
microorganisms.
This explains why correct disinfection, cleaning and sterilization, i.e.
reprocessing the instruments is absolutely essential, for material rea-
sons and reasons of hygiene and infectology.
The Working Group on Instrument Reprocessing combines the tech-
nical knowledge of manufacturers of surgical and dental instruments,
and other medical products, producers of cleaning agents, disinfec-
tants and maintenance products, and sterilizers. It has compiled rele-
vant notes and instructions in this updated brochure, taking into
account the latest legislation, guidelines, directives and standards on
quality assurance from the perspective of modern hygiene in the den-
tal practice .
In view of the above I hope that this brochure will be widely used and
have a high level of acceptance in dental clinics and dentist's practi-
ces.
Prof. Dr. Marianne Borneff-Lipp
Director of the Institute of Hygiene
University of Halle-Wittenberg
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 7
Introduction
This is an updated brochure conforming to the latest requirements publis-
hed by the Working Group for Instrument reprocessing :
Instrument reprocessing in dental practices - How to do it right.
Instruments are now governed by the European Directive on Medical
Devices, which makes it compulsory for the manufacturer to specify how
an instrument should be (re)processed.
This brochure is intended to help you carry out the various reprocessing
steps correctly and in the right order. It will also help you to identify the
causes of damage and eliminate them.
These comments and notes are provided as supplementary information to
the currently applicable legislation, guidelines, directives and standards
from the perspective of hygiene.
%
Infectionsschutzgesetz (Infection Protection Act)
%
Medizinprodukte-Gesetz (Medical Devices Act)
%
Guideline of the Robert Koch Institute:
Hygiene requirements in dental medicine.
%
Medizinprodukte-Betreiber-Verordnung
(Directive on Users of Medical Devices)
%
Guideline of the Robert Koch Institute:
Hygiene requirements when reprocessing medical devices.
%
EN Standards for sterilizers, cleaning and disinfection devices and
disinfectants.
%
List of certified disinfectants of the Deutsche Gesellschaft für
Hygiene und Mikrobiologie (German Society for Hygiene and
Microbiology)
Although this document does not contain details of the various regulations,
their content has been taken into account in the notes and instructions.
The term dental instruments covers a wide range of products made of
different materials. This brochure will mainly deal with the reprocessing of
dental instruments such as mouth mirrors, probes, forceps and tweezers,
filling instruments, extraction forceps, elevators, parodontal (PA) instru-
ments, rotating instruments, root canal instruments, turbines, hand and
angle pieces. They are all reprocessed using basically the same methods.
The document will indicate wherever instruments require other measures
or additional procedures.
Most dental instruments are made of corrosion-resistant high-grade steels.
The requirements for the different grades of steel are defined in national
and international standards. They are adapted to meet the special functio-
nal properties and conditions of use. Good elasticity, high tensile strength
and good corrosion resistance are required for non-cutting instruments
such as tooth extracting forceps or tweezers.
Cutting instruments such as scissors or scalpels mainly require a high
degree of hardness and resistance to wear and corrosion.
If users are asked what they understand by the terms stainless steel or
corrosion-resistant high-grade steel , they often assume that so-called
stainless steel materials are physically indestructible materials that have
8 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
high chemical resistance. Many users are surprised to hear or find out
that even stainless steel can be susceptible to various types of mechani-
cal, thermal or chemical attack.
The corrosion-resistance of stainless steel materials is based on their
alloy structure, which forms passivated surface layers that in turn protect
the steel.
However, external influences can destroy these protective layers and
cause severe damage to the instruments. It is therefore extremely impor-
tant to preserve the passivated layers on the instruments by appropriate
reprocessing methods.
Apart from using steels in conformity with standards, the manufacturer's
production processes - in particular heat treatment and surface finishing -
exert a key influence on instrument quality. High-quality products will pro-
vide users with state-of-the art production processes and instruments.
They meet the theroretically determined requirements for resistance and
stability to safeguard against the wide range of attack and sources of
deterioration.
Disposable (single-use) items must never be reprocessed, due to the
obvious risks to the patient and other instruments.
Manufacturers make their contribution to meeting the reprocessing requi-
rements by selecting adequate materials and developing a satisfactory
design. However, instruments also have to be handled correctly and trea-
ted carefully by dentists and their staff.
This also includes ensuring that drugs are only in contact with instru-
ments for a short period of time. Reprocessing should also be carried out
immediately afterwards. Correct reprocessing will extend instrument usa-
bility and service life. Manufacturers provide sophisticated products, devi-
ces and processes designed to meet these requirements.
The quality of water used for cleaning and disinfection devices and the
type of sterilizer also play an important role in preventing damage.
Substances present in water such as those causing water hardness and
chlorides can cause deposits, incrustations, discoloration and corrosion.
Water treatment is therefore absolutely essential, a problem which will be
dealt with in detail.
Many years of experience have shown that in many instances damage to
instruments could have been avoided by applying more appropriate
reprocessing methods and adhering to the manufacturer's instructions.
Improved understanding of the special properties of instrument steel and
other materials can considerably prolong the service life of your instru-
ments. Knowledge of how to avoid damaging influences during use will
also be of assistance.
Instrumenten-Aufbereitung in der Zahnarztpraxis richtig gemacht, 4. Ausgabe 2005, www.a-k-i.org 9
1. Water
Drinking water may be Drinking water always contains dissolved salts and minerals. The type
of substance and its concentration in the water depend on where the
unsuitable for instrument
water comes from and how the drinking water is treated. Excessively
reprocessing
high concentrations of salts and minerals in drinking water can lead
to staining or damage to the instruments during reprocessing.
Hardening agents (lime) and chlorides are particularly critical if con-
tained in drinking water. When water dries on instruments, the dissol-
ved ingredients are deposited as salty incrustations or stains.
Calcium in hard water will form calcium deposits (kettle stone).
Stained instruments
Cause: Drying water with high salt content
High chloride content cau- Different concentrations of chloride salts are always found in drinking
ses pitting on instruments water. They cannot be eliminated by a water softening process.
In most cases, the correlation between chloride content in the water
and pitting corrosion is not obvious. It is therefore possible that under
unfavorable conditions even low chloride concentrations in the water
can cause pitting corrosion. Precise examination is required in special
cases like this.
When water dries, chlorides concentrate causing pitting corrosion at
some sites.
For information about the content of your water, please refer to your
local water supply company. Experience indicates that the probability
of pitting corrosion is low up to a chloride content of approx. 120 mg/l
(= 200 mg of sodium chloride/ liter), but the likelihood increases dra-
stically when the chloride content increases above this value.
Pitting corrosion on a trocar
Cause: High chloride content in the water
Fully desalted water As softening will not reduce the total content of dissolved salts or the
chloride, the use of fully desalted (demineralized) water is recommen-
avoids stains and pitting
ded for the final rinsing cycle in order to prevent pitting corrosion and
corrosion
drying stains.
Softened water is adequate for operations such as pre-rinsing,
cleaning, neutralization and intermediate rinsing.
Discoloration is not
Other ingredients in the water can cause brown, blue, gray, black or
corrosion rainbow-colored discolorations even at low concentrations. Such dis-
coloration can be caused e.g. by silicates/silicic acid, and by iron,
copper and manganese compounds. In general, discoloration of this
10 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
nature is not corrosion. Such discoloration can generally be removed
by immersing surgical instruments in a suitable acidic cleaning
agent, or wiping them down, in conformity with the manufacturer's
instructions.
Sometimes rust is found in drinking water in addition to the substan-
ces found naturally in water. This rust usually comes from corroded
pipework systems. This rust is deposited on instruments during
reprocessing causing rust stains (foreign rust) and subsequent cor-
rosion. This problem is eliminated e.g. by replacing the water pipes.
Discolored instruments
Foreign corrosion is critical
Lime and foreign rust on tooth forceps
2. New instruments
In the case of new or unknown instruments, always check the exi-
Follow the instruction
stence of the manufacturer's instruction manual (manual, maintenan-
manual
ce instructions) for specific information on reprocessing.
This also applies to accessories for maintenance and care.
Removing the transport/ Any packaging material used for transport and shipping should be
removed before storage. New instruments from the factory, which are
shipping packaging
not going to be used immediately, should be stored as explained
under "Storage of unsterile instruments".
Clean new instruments
New instruments from the factory must undergo the entire reproces-
from the factory before sing cycle before first use. Protection caps and protective foils must
be removed completely for this purpose.
reprocessing
Cleaning and disinfection, rinsing, maintenance and care, testing/
checking and sterilization must be carried out in conformity with the
criteria previously described for used instruments.
Sensitive instruments must be loaded in special holding devices/
racks.
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 11
3. Disposal/Storage of used instru-
ments in the treatment room
Caution! All instruments in the treatment area are deemed to be contamina-
ted following patient after treatment of the patient, even if they have
not been used. It is therefore necessary to subject them to the com-
plete instrument reprocessing procedure.
Protection of staff: Observe Contaminated instruments must always be handled with protective
gloves and/or suitable resources means (such as tweezers, forceps,
protection measures!
etc.) when preparing them for reprocessing.
Lay down instruments care- Instruments must be laid down carefully on a suitable tray or instru-
ment container. They must be disinfected and cleaned as soon as
fully, don t throw them!
possible. Incorrect handling can damage the instruments. This is
particularly true for instruments with thin and delicate distal ends,
such as tweezers, forceps, probes, scissors, in particular with sinte-
red carbide inserts (needle holders, parodontosis (PA) instruments).
Scissors with broken tip.
Cause: wrong handling (instru-
ment was dropped)
Any instrument which has been in contact with filling material or
Clean instruments soiled
etching products (such as etching gels) should be precleaned imme-
with filling materials or
diately, i.e. the residues should be wiped off with a paper cloth.
etching products immediately
Disinfection and cleaning in an ultrasonic bath is recommended for
instruments with adhering residues of filling materials, disinfection
and cleaning in an ultrasonic bath is recommended. It is therefore
necessary to check for this purpose whether the instrument is suit-
able for treatment in an ultrasonic bath (for details see chapter 4.1.1
Ultrasound for details).
Filling instruments with adhering composite Instrument with etching gel residues
materials. Cause: no absence of immediate
cleaning and reprocessing
12 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
Instruments which are designed for single use only should never be
Do not reprocess disposa-
reprocessed. Such instruments must be considered as special
ble (single-use) instruments
waste and handled according to the appropriate regulations
Stand/rack for root canal instruments
Corrosion on burrs
Cause: Reprocessing of disposable instruments
Reprocess rotating instru-
The majority of rotating instruments used in dental practices can be
ments, hand and angle
reprocessed in automatic washers / disinfectors (automatic repro-
pieces separately cessing machines) provided that the rotating instruments are safely
stored in suitable racks. These racks must be suitable for use in
automatic washers / disinfectors. The instruments should be stored
in these racks immediately after treatment. The same applies to root
canal instruments.
Store hand and angle pieces as well as turbines separately.
Reprocess preferably in automatic washers /disinfectors in conformi-
ty with the manufacturer s instructions.
If rotating instruments are reprocessed manually, they must be
immersed in a separate container for disinfection and then cleaned.
4. Disinfecting and cleaning instru-
ments in the reprocessing room
Disinfect to protect staff If there is a danger of injury during reprocessing operations, accident
prevention regulations (UVV) require disinfection prior to reproces-
from infections
sing. This is particularly the case in manual reprocessing.
Reprocess in automatic There are two different methods:
%
manual reprocessing, e.g. by immersion (soaking) using a
washers/disinfectors if
cleaning disinfectant solution in a dip bath with or without ultra-
possible!
sound.
%
machine-reprocessing in automatic disinfection and cleaning
machines.
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 13
4.1 Manual disinfection and cleaning
Before further (re)processing all instruments must be disinfected and
cleaned. Disinfection mainly serves to protect staff from infection by
microorganisms originating from the patient. Disinfection will also pre-
vent the spread of infections.
Choose suitable disinfec- Manual reprocessing requires the instruments to be immersed in a
combined disinfectant and cleaning agent solution with certified disin-
tant and cleaning agent
fecting action (e.g. DGHM certificate for Germany).
%
Observe the following: correct concentration
%
correct exposure time
%
correct temperature
When using these products the manufacturer's instructions on con-
centration, exposure time and temperature must be closely adhered.
Incorrect concentrations and excessively long exposure times will
cause product damage. Instruments should never be immersed over-
night or over the weekend.
Prepare new solutions Freshly prepared disinfectant and cleaning solutions must be used
every day. If solutions are used repeatedly the following problems may
every day
arise:
Reduced disinfection effect due to contamination load
%
Danger of corrosion from contamination/ protein load
%
Danger of corrosion due to evaporation when concentration is
increased
Completely dissolve If powders are used to prepare solutions, the powder must first be
completely dissolved in the water. Instruments should be immersed
powder products
afterwards because undissolved particles can cause discoloration on
the instruments and clog small-diameter instrument channels.
Instruments with joints/hinges must be opened before they are immer-
Open articulated
sed in solution.
instruments
Fully immerse instruments Instruments must be completely immersed in the solution. This means
it is essential not to overload soaking baths.
In general, small-diameter instruments such as suction cannulas and
No air bubbles in hollow
instruments with hollow spaces are difficult to reprocess. It is therefo-
instruments
re important that patency (free passage) is ensured and that the enti-
re internal surface is in contact with the soluton (no trapped air bub-
bles!).
14 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
After disinfection and cleaning, thoroughly rinse instruments to remove
Very important:
any residues. Rinse with clean water conforming to a minimum quality
Thoroughly rinse with
of drinking water. However, water should preferably, be fully deminerali-
water
zed to avoid water stains.
Dry instruments now.
Very important:
Dry instruments immediately
Drying with a compressed air gun is particularly gentle and very
effective, and should therefore be the drying method of choice.
4.1.1 Ultrasound
Do not reprocess hand and
Ultrasound is a suitable method for disinfecting and cleaning of small
angle pieces or turbines in instruments such as rotating and oscillating instruments and matrix
strips in order to remove incrustations successfully.
the ultrasonic bath
In principle, the same requirements apply for preparing the bath as for
Preparing the bath
manual cleaning and disinfection in a soaking bath. The following spe-
cial conditions must also be observed:
%
Observe the following: Filling height
the bath must be filled up to the mark.
%
Suitable cleaning agents and/or disinfectants
a suitable cleaning agent or cleaning disinfectant must be added
to the water.
%
Do not exceed 50 °C
%
Temperatures between 40 °C and 50 °C will enhance the
cleaning effect. Temperatures above 50 °C can cause blood
incrustations.
%
During disinfection and cleaning, follow the manufacturer's pro-
duct-related instructions on concentration, ultrasound exposure
time and temperature.
%
Timely change for the disinfectant/ cleaning solution
High contamination load in the ultrasound tank will impair the
cleaning effect and promote corrosion. It is therefore necessary to
replace the solutions regularly depending on conditions of use.
The criterion in this case is visible contamination in the solution.
Changing the bath frequently is certainly an advantage. It should
be changed at least once a day.
%
Adhere to the specified frequency
ideally 35 - 50 kHz
For cleaning, exposure times of at least 3 minutes at frequencies
of at least 35 kHz have proven successful. In the case of hard-to-
remove contamination (incrustations) longer exposure times may
have to be chosen.
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 15
%
Loading
%
Instruments must be in suitable holders or baskets when exposed
to ultrasound treatment to avoid impairing the ultrasonic effect.
%
Hollow instruments must be immersed in the ultrasonic bath,
e.g. at an angle, to de-aerate (bleed) the hollow spaces and
avoid trapped air that may prevent the cleaning effect.
%
Cutting edges must not touch metal parts
To avoid damage, delicate instruments such as instruments with
cutting edges should be locked in place in such a way that they
do not touch other metal surfaces.
Very important:
Following treatment with ultrasound, thoroughly rinse the instruments
Thorough rinsing
manually or reprocess them in an automatic washer / disinfector. This
second rinsing must be performed using drinking water to remove
cleaning agent and disinfectant residues. Fully demineralized water
can be used for final rinsing to avoid water stains.
Exception:
In the case of disinfectant solutions or cleaning solutions used for the
purpose of corrosion protection, no final rinsing of the instruments
should be carried out.
The instruments should be dried immediately after they have been
subjected to a corrosion protection bath.
4.1.2 Notes on specific dental instruments
Hand and angle pieces, tur- Do not reprocess hand and angle pieces, turbines and other drive
units in immersed condition or in an ultrasonic bath.
bines and other drive units
Rotating and oscillating
Rotating and oscillating dental instruments (such as points, steel
instruments instruments, diamond instruments, sintered carbide instruments, and
polishing equipment) may only be treated with special disinfectants
and cleaning agents. Before ultrasound treatment they should be
stored in special stands (racks) to avoid any contact damage between
the instruments (such as by sharp cutting edges, diamond grains,
etc.).
Root canal instruments Root canal instruments are sensitive to mechanical damage and must
therefore be reprocessed separately in suitable stands (racks). Root
canal instruments with colored, anodized aluminum grips are attacked
by alkaline solutions and lose their color coding.
16 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
Instruments or trays, which consist of chrome-plated brass, anodized
Chrome-plated instru-
aluminum or plastic instead of stainless steel, require special disinfec-
ments and aluminum
tants and cleaning agents.
instruments
Mouth mirrors Mouth mirrors can be damaged in the ultrasonic bath.
Caution when using cement remover
Acidic cleaners such as cement removers should only be used if
absolutely necessary because the use of such cleaning agents will
cause corrosion on the surfaces and soldering seams.
Corroded filling spatula
4.2 Automatic reprocessing in disinfection and
Cause: material attacked by acidic
cement remover
cleaning machines
Standardized cleaning and disinfection is best achieved by automatic
procedures in machines using thermal disinfection.
Thorough cleaning during instrument reprocessing mainly serves to
preserve value. Before reprocessing in automatic washers / disinfec-
tors, the instruments should preferably be stored under dry conditions
for reprocessing.
Machine-reprocess instru- In principle, instruments should be placed in the automatic washer /
disinfector immediately after use. However, instruments with normal
ments immediately after use
contamination can also be collected in the machine within a period of
on the patient
up to 6 hours. In the case of severe soiling or contamination with
etching substances, immediate treatment after use is necessary (see
chapter 3).
Danger of foaming If instruments are immersed in a disinfectant and cleaning solution
before machine reprocessing, a low-foam product should be used if
possible. If a foaming product is used, any residues must be thoroughly
washed off before reprocessing in an automatic machine. This also
applies if extremely soiled instruments, e.g. due to dried blood and
secretion or filling material residues, have to be pretreated in the ultra-
sonic bath or immersion / soaking bath.
Machine-reprocess only Only instruments which are sufficiently stable against corrosion and
thermally stable up to 93 °C may be reprocessed in automatic was-
instruments suited for this
hers/disinfectors.
procedure
Arrange instruments correctly The device baskets and racks must ensure that the instruments can
be arranged safely without damaging each other. Place the instru-
ments in the holders provided.
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 17
Do not overload perforated trays
%
Do not overload the trays to ensure that the medium has free
access to all instruments around the entire circumference.
Open instruments with joints or hinges
%
Instruments with joints or hinges must be open to ensure adequa-
te cleaning in the joint/hinge area
Instruments with hollow spaces
%
Instruments with long or narrow hollow spaces (channels, tubes,
cannulas) must also be rinsed out inside. Special racks should be
used for this purpose.
Avoid shading off spray nozzles
%
Dishes etc. must be arranged in such a way that they do not
impair the cleaning process by shading off the spray jets.
Water inlet temperature < 45 °C
Cold supply water is recommended because cold water already remo-
ves proteins. The temperature of the inlet water should not exceed 45
°C. Higher temperatures will cause protein to coagulate which results
in cleaning problems.
The manufacturer's instructions on cleaning agents should be strictly
adhered to.
Use only suitable cleaning
Only the correct dosage will guarantee perfect disinfection and provi-
agents de an optimum cleaning result with maximum protection for the mate-
rial.
Correct dosage of cleaning agent
%
perfect cleaning
%
maximum protection
Any residues from the cleaning process must be reliably removed in
Ensure thorough rinsing
subsequent rinsing cycles, otherwise stains and/or discoloration will
occur on the instruments. Additional use of a suitable neutralizing
agent will improve the result of final rinsing.
Disinfection is achieved at 93 °C
Disinfection and/or final
%
In the first process step or
rinsing
%
in connection with the final rinse
If disinfection is part of the first process step, final rinsing is carried
out at temperatures between 70 and 75 °C.
The final rinse should be performed with fully desalted water to avoid
staining and discoloration. A final rinsing agent can be added to the
final rinsing cycle.
18 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
When the program has been completed, the door of the machine should
Drying
be opened immediately to provide adequate exchange of air. This will
make optimum use of the instrument's intrinsic heat and avoid formation
of condensate that promotes corrosion. Instruments must not be left over-
night in the closed machine.
Joints and hinges of scissors should be dried using special care. Drying
with the help of a compressed air gun is effective and has a particularly
gentle effect on materials.
4.2.1 Notes on specific dental instruments
Store probes in special
Probes, parodontosis instruments and other sensitive instruments must
holders
be protected from damage by storing in special holders or racks.
Rotating and oscillating
Rotating and oscillating dental instruments (such as tips, steel instru-
instruments and root canal ments, diamond instruments, sintered carbide instruments, and polishing
equipment) and root canal instruments can be machine-reprocessed if
instruments
positioned in instrument stands (racks) suitable for use in machines.
Sintered carbide instruments may corrode during machine reprocessing
and lose their sharpness.
Burr stand (rack)
Color codes In standard machine-cleaning procedures, colored anodized aluminum
parts as well as colored ceramic instruments will lose their color and
hence their coding. It is better to use instruments with grips made of
stainless steel, colored titanium or plastic.
attacked Eloxal (anodized aluminum)
Hand and angle pieces,
Hand and angle pieces, turbines and other drives can be reprocessed in
turbines and other drive automatic washers / disinfectors if the manufacturer approves such treat-
ment. This requires special holders. Any residual moisture must be remo-
units
ved immediately after the program has been completed. Maintenance
and care measures recommended by the manufacturer must be carried
out. Hand and angle pieces with rigid light guides can be machine-repro-
cessed, equipment with other types of light guide must not be machine-
reprocessed.
Mouth mirror Mouth mirrors are always subject to wear. Silver-vapor coated substrate
mirrors with layer may become blurred during machine reprocessing.
Mouth mirrors with rhodium vapor coating have greater thermal and che-
mical stability but their surface coating renders them more sensitive to
mechanical influences.
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 19
See the manufacturer's instructions for intra-oral cameras.
Intra-oral camera
5. Checking, Maintenance and Care,
Packaging
Checking, maintenance and Instruments properly cleaned by automatic washers / disinfectors or
manually must be macroscopically clean (i.e. when checked with the
care, and packaging before
naked eye). They must be free of blood, saliva and other soiling such
sterilization
as filling materials and etching agents.
Checking cleanliness Critical structures such as grips, joints and hinges or the serrated sur-
faces of jaws must be checked particularly carefully.
Instruments with residues require additional cleaning. See Manual
cleaning and ultrasound treatment for further details.
Blood residues on a handle
Cause: insufficient cleaning
Cause of water stains, Instruments may be stained even after they have been carefully
other stains and discolora- cleaned. The stains can result for the following reasons:
tion
%
Errors in procedure, e.g. new instruments were not cleaned before
their first sterilization
%
Cleaning agents, disinfectants and maintenance products are not
compatible
%
Insufficient final rinsing
%
Non-adherence to dosage instructions for cleaning agents, disin-
fectants and maintenance products
%
Drug residues
%
Insufficient water quality, e.g. because of excessively
long regeneration cycles in ion exchangers
%
Water used for final rinsing has not been fully desalted
%
Contaminated sterilization steam
Discoloration of instruments.
%
Strips of sterilization indicators
Cause: insufficient rinsing
Lubricating joints and hinges
Joints and hinges of instruments such as those occurring in forceps
needle holders must be lubricated with a paraffin-based maintenance
product before the functional check is carried out.
The oil or spray used for this purpose must be permeable to steam,
suitable for sterilization and thermally stable.
Corrosion on scissors.
Cause of corrosion: lack of maintenance, no oil
20 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
Before the function check is performed, instruments must have cooled
Allow instruments to cool
down and must have been lubricated to avoid metal wear and abrasi-
down, then carry out function
on. Metal abrasion can cause hinge joints to seize. It can also result
check
in corrosion.
5.1 Test for special instruments
%
Grinding tips
%
Abraders/burrs
%
Root canal instruments
%
Scaling instruments
Check that the instruments are fully functional. Discard instruments
that are blunt, bent or damaged in any other way.
Special measures, such as a function check under a magnifying
Special storage of
glass, should be applied to check sensitive instruments such as
sensitive parts
microsurgical instruments, parodontal instruments or grinders.
Remove defective instru- Instruments should be stored and transported in special racks or
other suitable devices to avoid damage and sort the instruments for
ments to protect perfect
re-use. This will secure them against friction, pressure, shock and sli-
instruments
ding motion.
Perfect instruments made of stainless steel must not touch instru-
ments with damaged surfaces, e.g. rusty instruments or instruments
where the chromium or nickel layer has flaked off.
Defective, corroded and worn instruments must be removed immedia-
tely to prevent contact corrosion occurring on stainless steel instru-
ments, sterilizing accessories, the sterilizer and automatic washers/
disinfectors.
Stained instruments or instruments with discolorations can be subjec-
ted to special after-treatment.
5.2 Correct packaging
Residual moisture on the instruments can cause contact corrosion
and jeopardize the sterilization effect. The packaging has an influence
on drying quality.
Sterilization packaging must comply with applicable standards for
quality and use and must be certified for the selected sterilization
method. Please refer to DIN EN 868, parts 1-9 and DIN 58953, part 7
for further details.
Note on specific dental instruments
Diamond-coated Diamond-coated instruments do not require any special instructions
for care. The instruments can be treated like stainless steel instru-
instruments
ments.
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 21
Hand and angle pieces, The complex internal design of hand and angle pieces, and turbines
means they require special treatment in conformity with the manufactu-
turbines:
rer's instructions.
Internal design hand and angle pieces
Some burrs are made of non-stainless steel material. They must be
Applying anti-corrosives
treated with a suitable product in conformity with the manufacturer's
instructions.
Resharpening cutting Cutting instruments (peridontal instruments, excavators, devices for
beveling the gingival edge, courettes) must be reground at regular
instruments
intervals. Instruments should be resharpened after each use to ensure
sharpness and functionality.
Reground/resharpened instruments will have a reduced cross section.
If there is the danger of bending or even breakage under normal wor-
king pressure, such instruments must be removed and discarded.
Blunt peridontal instrument
6. Sterilization
Sterile instruments protect the patient! Sterilty won't replace cle-
anliness!
European standards (EN) require sterile instruments for use on or in a
patient to be cleaned and disinfected in conformity with standard pro-
cedures. They should then be sterilized in a certified standardized ste-
rilization packaging using a validated method. After sterilization, the
sterile items must be stored in conformity with the applicable rules for
sterile items.
Sterilization is the method of choice in dental practices. Different sterili-
zation methods apply to different items requiring sterilization
6.1 Steam sterilization
Check suitability and The sterilizer and sterilization methods must correspond to the valid
standards and guidelines/ directives.
functionality of sterilizer
DIN EN 13060 Small steam sterilizers defines 3 categories of
sterilizer type:
Type B (DIN EN 13060-2):
For packaged/wrapped, solid, hollow and porous products
22 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
Type N (DIN EN 13060-3)
For unpackaged, solid instruments
Type S (DIN EN 13060-4)
For products specified by the manufacturer of the small sterilizer.
Note:
Type B for universal use
For universal use in dental practices a device of type B is recommen-
ded for universal use in dental practices. The following restrictions
shall apply to other types:
%
Small N type sterilizers are not suitable for wrapped/packaged
items and are therefore not usually appropriate for reprocessing
items to be sterilized.
%
Type S sterilizers involve the user checking whether the item
requiring sterilization can be sterilized in this sterilizer.
Adhere to the specified routine checks and maintenance regulations.
Checks and maintenance
Carefully follow the manufacturer's instructions.
Only use fully deminerali- Only fully demineralized or distilled water may be used in the steam
sterilizer. Using tap water will lead to corrosion damage on the instru-
zed water!
ments and in the sterilizer.
Impure water = impure If the device has a condensate outlet, the water in this outlet must be
checked for purity on a daily basis. Contamination such as oil, chemi-
steam
cals, metal chips or rust will lead to impurities and resulting damage
to the instruments. It will also cause malfunctions in the sterilizer. It is
therefore necessary to check the water immediately. The device
should then be cleaned if any impurities or soiling is observed. After
initial setup of a new sterilizer and initial sterilization without contents,
make sure the water is changed immediately.
Only steam sterilize Always check that the items to be sterilized have been approved by
the manufacturer for steam sterilization. Rotating instruments (such
steam-sterilizable items
as burrs and abraders) are usually steam-sterilizable. Rotating instru-
ments made of non-stainless steel may only be sterilized when pak-
ked separately and individually.
Stains on the tweezers
Cause: Insufficient steam quality
When using steam sterilizers without a vacuum drying feature, the
Open sterilizer without
door must be left ajar when the program has been completed. This
vacuum drying after
ensures adequate drying for the instruments. The sterile items must
sterilization
be packaged/wrapped in conformity with the standards.
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 23
6.2 Hot air sterilization
Although hot air sterilization is no longer state of the art, this method is still
being used in some cases. The following notes are applicable until a new
sterilizer is purchased:
Hot air sterilization
%
load correctly
%
control and operate correctly
If you are using hot air sterilizers, the manufacturer's instructions
should be strictly adhered to. It is particularly important to load
the device correctly.
Maintain, but do not Paraffin oil will form resin and lose its lubricating function if temperatures
exceed 185 °C.
exceed 180 °C
Even if the nominal temperature of 180 °C is only briefly exceeded, there
is the risk of loss in hardness and impaired function. There is also a risk of
surface changes. Plastic materials (such as the colored rings on the instru-
ment) may be damaged. The manufacturer's instructions on other tempe-
rature limits should also be observed, e.g. only steam-sterilizable instru-
ments.
Do not overload sterilizer Make sure you follow the instructions on loading volume given in the ins-
truction manual of the sterilizer, in order to achieve a uniform temperature
distribution in the sterilization chamber and thus between the items to be
sterilized.
Closely follow the steriliza- Closely adhere to the sterilization time indicated. Never open the device
tion time specifications! while sterilization is taking place.
Apply paraffin oil only to
Do not apply maintenance products for general surface protection prior to
joints and hinges hot air sterilization. Sparingly lubricate only the joints and hinges of instru-
ments with pure paraffin oil when they are dry prior to hot air sterilization.
Do not use silicone oil to avoid the danger of staining.
The following items are not suitable for hot air sterilization:
%
Turbines
%
Hand and angle pieces
%
Instruments with parts made of rubber, plastic or textile materials
%
Plastic coded instruments
%
Cable and electrode handles
%
Thermally unstable packaging material
Make sure you follow the manufacturer's instructions for mouth mirrors.
24 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
7. Storage
7.1 Storage of unsterile instruments
Storage: Instruments may corrode due to storage conditions. Instruments should
be stored in a dry and dustfree environment to prevent corrosion.
- Dry
Significant temperature changes should be avoided to prevent the for-
- Protected from dust
mation of moisture (condensate) on instruments.
Separate from chemicals If in direct contact with instruments, chemicals, can destroy metal or
give off corrosive fumes. This is why instruments must not be stored
together with chemicals.
Secure sensitive parts Adequate storage is achieved by loading the instruments in suitable
systems/trays. This will ensure that the instruments are stored safely
and transparently. Such storage prevents the items damaging each
other and reduces the danger of injuries:
The clearly structured system allows quick and selective withdrawal of
Ensure easy withdrawal
instruments.
Do not store in open Closed storage systems should be preferred to ensure additional pro-
tection against microorganisms.
condition
7.2 Storage of sterile instruments
Caution: unpackaged/unwrapped instruments are unsterile
To maintain sterility of the instruments until they are used on/in the
patient, a packaging/wrapping impermeable to microorganisms and
suitable for sterilization is a basic requirement.
Unpackaged/unwrapped instruments are unsterile!
A dust-free, dry environment is essential for protected storage of ste-
Dust-free, protected storage
rile items. These conditions allow items to be stored for 6 months. See
Follow DIN 58953
table 1 of DIN 58 953 part 9 for further details.
These conditions do not apply to instruments that are sterilized but
have not been packed in sterile packaging/wrapping. In this case the
instruments must be used immediately.
Strict separation between
Sterile items must be clearly identified/
sterile and unsterile marked, e.g. with color indicators, to avoid any confusion.
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 25
8. Discoloration, Deposits and Corrosion
Instruments become discolored with time in some practices. The
colors involved and the degree to which they can be removed vary
considerably. Surface changes like this are always due to the repro-
cessing procedure. If discoloration of this nature occurs, make sure
you always proceed systematically to avoid them in the future:
%
Find cause
%
Eliminate cause
%
Remove discoloration from instruments
Removing the discoloration from the instruments without eliminating
the causes will not bring about a permanent remedy.
It is usually possible to remove discoloration by immersing the items
in a basic cleaning agent specifically for instruments. Mechanically
cleaning the surface of the instrument will definitely remove the disco-
loration. If basic cleaners are used, the manufacturer's instructions
must be adhered to.
Acidic cement remover must not be used as this will chemically attack
the instruments and cause irreparable damage.
Discoloration Water stains
Type of surface change
Water stains on an instrument
Water stains form when water containing dissolved salts/minerals
Origin & causes
dries on instruments. Irregular stains form on new instruments, often
with a clearly visible margin.
%
water in the final rinse
Preventive measures
Water stains can only be reliably avoided by using fully desalted
water (demineralized water) for the final rinsing cycle.
26 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
Discoloration Carry-over
Type of surface change
Stained instruments
Cause: Drying water
A similar appearance and comparable staining is observed if the
Origin & causes
cleaning solution and/or disinfecting solution have not been rinsed suffi-
ciently. The mineral content of these solutions dries on the surface lead-
ing to intensive staining.
This problem is eliminated by improving re-rinsing. In automatic was-
hers/disinfectors it is often sufficient to place fewer items on the trays
(reduced load).
%
Improved re-rinsing
Preventive measures
%
Reduced load on the trays in machine cleaning
Water stains and carry-over often accumulate. If this is the case, con-
sistent improvement is only achieved by improving the rinsing procedu-
re and the use of fully demineralized water in the final rinse.
Discoloration Rainbow discolorations
Type of surface change
Rainbow colors - colorful shiny
silicate coatings
Origin & causes Rainbow discolorations refer to shimmering surface discolorations wit-
hout clearly delimited margins. They are a result of silicates and/or heavy
metals in the rinsing water or sterilization steam.
Preventive measures %
Fully desalted water in the final rinse
%
Fully demineralized water for steam generation
They can only be avoided if fully desalted water is used for the final rin-
sing and for steam generation.
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 27
Discoloration Black discoloration
Instruments made of stainless chromium steel and silver-plated instru-
Origin & causes
ments can turn black. These surface changes do not cause any pro-
blem from the perspective of hygiene. They do not influence products
properties and they do not impair product service life, provided they are
not due to acid attack (etching) that has damaged the surface.
Deposits Organic residues
Type of surface change
Organic residues
In some incidences organic residues such as tissue or blood remain at
Origin & causes
sites on instruments that are difficult to access. This is due to inadequate
cleaning or dip baths not being changed frequently enough.
During sterilization, such residues become brown and are then errone-
ously identified as rust.
If you do not remove these residues, pitting corrosion will occur under
the residues with time. This can damage or even destroy the instrument.
Preventive measures
%
Sufficient cleaning
%
Changing baths regularly
Deposits Foreign rust
Type of surface change
Corrosion on burrs
Cause: Reprocessing of disposable instruments
Rust can result from water containing iron or rust itself. After repro-
Origin & causes
cessing it usually shows as a brown, in most cases locally limited,
corrosion deposit on instrument surfaces.
Steam containing rust will usually generate a finely distributed dusty
rust deposit on the inner walls of the sterilization chamber, on sterile
packaging/wrapping and on instruments.
This so-called foreign rust will react with the surface of the instru-
ments and cause damage by forming consequential rust.
28 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
The alloy used in disposable (single-use) items provides adequate pro-
tection against corrosion. The products of corrosion (e.g. rust) of such
instruments can cause irreversible damage in other high quality instru-
ments. This is one reason why disposable items must not be reproces-
sed.
%
Preventive measures Fully desalted water for generating pure steam
Corrosion
Types of corrosion:
%
Pitting corrosion
%
Tensile crack corrosion
%
Crevice corrosion
%
Frictional corrosion
%
Contact corrosion
%
Surface corrosion
The term corrosion is usually used only in conjunction with metal materi-
als. Corrosion is specific to the material and occurs in various ways on
different metals. Corrosion almost always leads to irreparable damage or
even destruction of instruments and devices.
The various types of corrosion on instruments and devices can only
occur if water, aqueous solutions or steam act on them.
Corrosion products will form irrespective of the type of corrosion. This in
turn exerts a damaging effect on the other instruments where it causes
consequential corrosion. If corrosion is observed, it is necessary to find
the causes and eliminate them. Corroded instruments must also be
removed immediately.
The following list describes the main types of corrosion and their effect in
assisting identification of the causes. Basic chemical and physical infor-
mation is not provided as this may be found in the technical literature.
Corrosion Pitting
Type of surface change
Pitting corrosion on a trocar
Cause: High chloride content in the water
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 29
Pitting corrosion (pitting) is only observed on metal materials.
Herkunft und Ursachen
Unfortunately, stainless steels are not resistant to this type of corrosion.
Pitting is caused in all types of steel and is mainly due to the effect of
chlorides (chlorine-induced pitting). Increased levels of chloride are
found in blood and tissue, in some drinking waters and drugs. Even
short exposure times may lead to a corrosive attack.
Pitting corrosion generates holes in the surface of the instruments.
Visible rust will initially emerge from these holes.
As corrosion progresses, these holes increase in size and eventually
destroy the instrument very quickly
%
Thorough cleaning immediately after use
Preventive measures
%
Using low chloride water, if possible fully desalted, for the final rin-
sing cycle
Pitting can only be prevented by carefully cleaning the instruments
immediately after use and using low chlorine water, preferably fully
desalted water for the final rinsing cycle
Corrosion Tensile crack corrosion
Tension crack corrosion is usually only observed on stainless steel
Origin & causes
instruments and may have considerable effects on the service life of
instruments.
The causes of this type of corrosion can be found in the manufactu-
ring process and in incorrect instrument handling.
Preventive measures %
Cleaning instruments in the open condition
%
Closing instruments to the first ratchet position during sterilization
All instruments should always be placed in the open condition during
the entire cleaning procedure in order to prevent damage. When they
are being sterilized these instruments should only be closed to the
first ratchet position to avoid tension cracks forming around the joints
and hinges and a reduction in the resilience of instruments with rat-
chet lock due to tensile forces occurring when instruments are heated
and cooled.
Caution:
Chloride ions in the water promote tension crack corrosion
Even minor amounts of chloride ions in the water can increase the pro-
bability of tension crack corrosion.
This should not to be confused with the appearance of a stress crack
generated by overloading an instrument if it is used incorrectly.
30 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
Corrosion Fissure corrosion
Type of surface change
Fissure corrosion
Origin & causes
Fissure corrosion is observed in narrow joints or hinge gaps due to
chemical or mechanical destruction of the natural passivated layer of
the stainless steel material. The passive layer cannot regenerate due
to lack of oxygen. This results in rust emerging from the gap or fissure
as soon as there is ingress of moisture.
Fissure corrosion is often observed in the joining gap between the two
halves of tweezers or forceps. It is easily mistaken for remaining resi-
dues.
Preventive measures
%
Adequately drying narrow gaps in joints and hinges
Corrosion Frictional corrosion
Origin & causes
Joints and hinges of instruments must be treated with maintenance
products based on medical white oil / paraffin oil to keep them from
seizing. In the absence of a thin oil film in joint gaps, metal wear and
abrasion will form leading to seizure and corrosion.
The fine abrasion can also be transferred to other instruments during
reprocessing. It will corrode on the surfaces and damage also other
instruments by depositing foreign rust.
%
Regular treatment of joints and hinges with maintenance products
Preventive measures
based on medical white oil
Corrosion Contact corrosion
Origin & causes
When instruments are machine-cleaned, contact corrosion may occa-
sionally be observed. Unfavorable conditions during cleaning and rin-
sing, for example drinking water with a high content of salt can cause
rust around points of the instrument which touch each other.
Contact corrosion is particularly severe if stainless instruments contact
non-stainless instruments (burrs, needles, diamond tips, etc.). Chrome
plated instruments with a damaged surface will also cause contact cor-
rosion.
Preventive measures %
Using low salt water for cleaning and rinsing
%
Separating stainless from non-stainless instruments
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 31
Corrosion Surface corrosion
Origin & causes
Surface corrosion involves the entire surface of a metal part being
attacked in a relatively uniform manner by chemical or electrochemi-
cal action. Products of corrosion form on the surface of the part.
Areas of corrosion will generally have a different color to that of the
undamaged surface. Corrosion in steels is rust. Surface corrosion
often occurs after immersing the instruments in cement remover.
Instruments and devices made of non-stainless steel or non-ferrous
metals are protected by layers deposited during galvanization proces-
ses. Surface corrosion will occur where these protective layers have
been damaged or chipped. Such instruments must be removed / dis-
carded as the corrosion products can irreversibly damage other
instruments.
A special form of corrosion on Eloxal and aluminum is caused by
attack as a result of alkaline media, such as alkaline cleaning agents
for machine reprocessing or softened water heated to temperatures
required for thermal disinfection. Insufficient resistance to alkalis
means that a severe attack is observed depending on the degree of
alkaline contact. In the case of colored Eloxal attacks of this nature
are already visible in the early stages due to increasing discoloration.
%
Preventive measures Removing non-stainless instruments with a damaged protective
layer
%
Thorough rinsing to eliminate cement remover
%
Not using alkaline cleaning agents in the machine cleaning of
Eloxal and aluminum
32 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
9. References
1. EN 868; Sections 1 9 11. List of disinfectants from the German Institute
(Various publication dates for individual sections) for Hygiene and Microbiology in the respective
Packaging materials and systems for medical devi- valid version:
ces requiring sterilisation
Liste of disinfection processes (incl. a process
2. DIN 58953; Sections 7 and 9 for decontaminating and hygienically washing
(Various publication dates for individual sections) hands) checked according to the guidelines for
Sterilisation Sterile supplies department testing chemical disinfectants and found to be
effective by the German Institute for Hygiene
3. DIN EN 13060: 2004
and Microbiology.
Small steam sterilisers
12. List of disinfectants and processes tested and
4. DIN 58947; Sections 1,3, 5, 6
approved by the Robert Koch Institute 14th edi-
(Section 1: 1986, Section 3/5/6: 1990
tion, as per May 31, 2003
Sterilisation Hot air sterilisation
13. Occupational safety guidelines and professional
5. DIN 58952; Sections 2, 3: 1977
trade association legislation, e.g. BGR 250,
Sterilisation Packaging for sterilisable items
BGR 206 of the professional trade association
6. German legislation on the containment of epide-
for the medical service and welfare work
mics (IfSG) in the version published on July 20,
2000, last modified on December 24, 2003, espe-
cially ż 18 IfSG
7. Medical Device Directive in the version published
on August 7, 2002, last modified on November
25, 2003
8. Medical Device Directive
on the installation, operation and use of medical
devices in the version published on August 21,
2002
9. DIN EN ISO 17664; 2004
Information to be provided by manufacturers for
the reprocessing of devices preceeding sterilisati-
on
10. Recommendations by the commission for hospi-
tal hygiene at the Robert Koch Institute
%
Hygiene standards required when reproces-
sing medical devices Recommendation;
German Health Ministry Bulletin 44/2001,
1115-1126
%
Hygiene standards required in dental practi-
ces German Health Ministry Bulletin 41/1998
no. 8, 363-369
Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org 33
10. AKI sales conditions:
1. This brochure does not replace the manufacturer's instructions on
processing medical products. The ordering party undertakes not to
use this brochure in conjunction with the marketing of medical pro-
ducts and to refrain from any activity which may suggest that the
brochures contain instructions from manufacturers.
2. AKI retains exclusive copyright and all other proprietary rights for
the brochures compiled by AKI. Duplication or the use of charts,
images and/or texts in any other electronic or printed publications is
prohibited without the express permission of AKI.
3. It is not permissible to add advertising to brochures sourced from
AKI. This also applies to flyers.
4. Any action which contravenes one or all of the obligations descri-
bed in Sections 1-3 is subject to a EUR 500 penalty and the offen-
der must immediately cease and desist from any such infringe-
ments.
34 Reprocessing of instruments in dental practices how to do it right, 3rd revised edition 2005, www.a-k-i.org
Wyszukiwarka
Podobne podstrony:
Immunonutrition in clinical practice what is the current evidenceB M Knight Marketing Action Plan for Success in Private PracticeNBAS zolta broszuraThe Use Of Touch In Aikido PracticePrivate Practice [1x09] In Which Dell Finds His Fight (XviD asd)(gardening) Roses in the Garden and Landscape Cultural Practices and Weed Control[Instrukcja] National Census of Fatal Occupation Injuries in 2010 (USA)Instructions Power Training in the ZoneCordwainer Smith Instrumentality Of Mankind 05 Scanners Live In VainAnsill Jay Practical & decorative origami (in)Chi Kung Practice And Power In Wing Chun Kung Fuwięcej podobnych podstron