The sterilization center is the hub of any dental office, so it is essential that is fits the space, meets the legal requirements and standards and instruments flow efficiently from “dirty” to “clean”. Finding a sterilization center that ticks all three boxes can be challenging, so understanding the processes that take place and the equipment and cabinet configurations required in a steri center is very helpful to finding a workable solution.
There are 6 steps in the Instrument Processing Protocol, cleaning, inspecting, packaging, sterilization, sterile storage and quality assurance, that must be followed for the health and safety of patients and staff. These 6 steps take place within the 5 modules of a sterilization center. Once you understand the 5 modules, it’s much easier to plan out and modify a steri center that will fit the space perfectly, meet the legal requirements and efficiently process instruments.
1. Breakdown Module
– Garbage Dispenser
– Sharps Dispenser
After a procedure has been completed, the contaminated tray is brought to the sterilization center for processing. The breakdown module is the first portion of the steri center and is where the contaminated trays are received. The trays are broken down, and any sharps and trash are discarded thru the countertop dispensers. This area should be fairly small to minimize the amount of storage space for dirty trays and encourage staff to start the process immediately after bringing contaminated trays into the sterilization center. However, a buffer area is helpful for storing the cassettes which have been prepared, but are awaiting the Ultrasonic cleaner or instrument washer. The “dirty” storage area is often illuminated by red lights to signal that it contains contaminated equipment.
2. Cleaning Module
– Stainless Steel Sink & Faucet
– Glove Dispenser
– Paper Towel Dispenser
Before an instrument can be effectively sterilized, it must be cleaned first. Bacteria and viruses can survive the sterilization process because debris can prevent hear or chemical vapor from contacting the surface area of the instrument, so it is essential to remove any large particles before sterilizing. The sink cabinet should be at least 24” wide to allow for a standard 20”x20”x10” stainless steel sink and faucet. Some states/provinces allow a soap dispenser to be used, but in some states this does not meet code. Glove dispensers should be located in the cabinet above or just to the right of the sink and a paper towel dispenser mounted underneath the cabinet.
The gross cleaning of instruments generally happens in an Ultrasonic cleaner and/or an instrument washer/disinfector. If using an Ultrasonic Cleaner, it should be positioned between the garbage dispenser and the sink. This is often on a dropped down section of countertop for easy cleaning of the sterilization centre. If using an Instrument Washer/Disinfector, this would go in a 24” wide opening after the sink and before the wrap module. When designing a sterilization center, it is important to consider how you will dry the instruments. Some Instrument Washer/Disinfectors do not dry the cassettes and/or instruments after washing them, which then requires an instrument dryer or a time allowance for air drying. Putting wet instruments into an autoclave will cause corrosion and dulling of edges.
3. Wrapping Module
– 24” Wide Drawer Bank
– Open Shelf for Autoclave
The wrapping module should be 24” wide and have 2 shallow drawers to accommodate the two sizes of cassette wrap for operative and hygiene cassettes. The remaining drawers below are generally used for storing pouches and back-up wrapping paper. An open shelf above the wrapping drawers is recommended for storing the autoclave tape that seals the cassette wrap. Once the cassettes have been wrapped, they are ready for the final step in the sterilization process.
4. Sterilization Module
– Tower Unit
For ease of use and space saving, autoclave units are often positioned on pull out trays in a tower unit within the sterilization center. This allows the operator to pull the tray out to refill the unit with water more easily and also saves countertop space by stacking two units. The wrapped cassettes are loaded into the autoclave and steam sterilized for maximum asepsis and time efficiency. In order to keep the instruments flowing from “dirty” to “clean”, it is important to have a section of countertop after the tower or autoclave unit to set the sterile trays on after removing them from the autoclave unit.
5. Clean Storage
– Storage Cabinets
Once the cassettes have been sterilized, it is critical that they are stored in a way that minimizes the potential for contamination. At this stage, the instruments are ready for the next procedure, so the cupboard they are stored in is often illuminated by blue LED lights to signal sterile instruments. The processed instruments should be checked using three types of tests for quality control; Physical indicators, Chemical Indictors and Biological Indicators.
Having an understanding of the 5 different modules that make up a sterilization center and the processes that take place in each is invaluable when planning your own steri center. You can better determine which modules you might need more space in and which modules can be smaller to fit your space and the needs of your practice. With careful planning, your sterilization center can safely and efficiently process contaminated instruments so they are ready for the next procedure, while meeting the legal standards and fit perfectly in your office space.