elimination of large numbers of small capacity ultrasonic baths and tabletop sterilizers in each DTR can be replaced by the central sterilization approach that has larger capacity centralized equipment.

Whether a centralized or individual sterilization area is used, contaminated instruments and equipment must be processed as described next.

Management of Contaminated Instruments

Following the completion of a patient's treatment, the dental assistant will take the contaminated instruments and equipment directly to the CSR technician in the receiving area of the CSR. Figure 10-3 illustrates a contaminated instrument pack that has been placed in the designated drop-off location in the receiving area. The CSR technician should take the contaminated instruments and equipment and set them in the receiving area that has been designated as a temporary hold area until they can be processed.

Do not rinse, scrub, or unnecessarily handle contaminated instruments or materials in DTRs or other patient treatment areas. In the most extenuating circumstances, only the CO (designee) or the infection control officer (ICO) under written direction may make exceptions to this requirement. This does not include handpiece maintenance that will be performed in the CSR or DTR depending on your clinic's policy.

Instrument Cleaning

You should take contaminated instruments from the receiving area wearing heavy duty puncture- resistant gloves while handling all potentially contaminated items. Break down all packs and place disposable items and contaminated linens in appropriate containers. \All contaminated, reusable items must be decontaminated by immersion in an Enviormental Protection Agency (EPA) registered disinfectant before further handling. This step can be eliminated if these items are cleaned in an ultrasonic cleaner (bath) with an EPA-registered disinfectant that also is approved as an ultrasonic cleaning solution. Process instruments using one of the following methods. They are discussed in order of preference.

AUTOMATED WASHER PROCESSOR. - The automated washer processor is the safest method and provides an effective cleaning process. It is commonly used in hospitals or very large dental clinics. Contaminated instruments are placed in cassettes or baskets. Then they are run through the unit's cycle of cleaning, rinsing, and disinfection at temperatures high enough to provide at least a high level of disinfection. This results in a "not touch" system in which the potential for injury during instrument processing is greatly reduced.

Figure 10-3.- Contaminated instrument pack placed at the entrance of the receiving area in the CSR.