During my trip to Italy in December, I had the privilege of learning from some of the best engineers and project managers at W&H. As we dove deep into the nuances of instrument reprocessing, one thing became clear: other countries place a significant emphasis on the cleaning step, treating it as the foundation of effective sterilization.
In the U.S., there’s often a tendency to rush this critical step. Instruments can accumulate bioburden during patient care, which, if left to dry in the operatory, becomes more difficult to remove. This increases the likelihood of missed debris during cleaning, ultimately compromising patient safety. In Italy, they prioritize cleaning and inspection as non-negotiable steps—an attitude we should adopt. If an instrument isn’t truly clean, sterilization simply cannot happen, and we risk exposing our patients to residual bioburden and bloodborne pathogens.
Why Cleaning Matters
Bioburden refers to the organic material—such as blood, tissue, and microorganisms—that remains on an instrument after use. This debris is a potential carrier for bacteria, viruses, and other pathogens. Merely running instruments through an ultrasonic cleaner isn’t always sufficient, especially if debris has dried on the surface. Proper cleaning techniques are essential to remove all bioburden and prevent infection transmission.
In Italy, cleaning is treated with the same rigor as sterilization itself. Tools like magnifying glasses and high-powered lights are standard in sterilization areas to ensure thorough cleaning. When was the last time you inspected instruments under magnification? If you’re skipping this step, you might be surprised by what you’re missing.
And, no, I’m not joking. Specialized magnifiers for sterilization areas are available and designed to help us ensure that instruments are truly clean.
How to Improve Cleaning in Your Practice
1️⃣ Use Enzymatic Sprays: Immediately after patient care, apply an enzymatic spray to instruments. This prevents debris from drying and makes it easier to remove during the cleaning process.
2️⃣ Limit Hand Scrubbing: Every time we manually scrub instruments, we increase the risk of percutaneous injuries—cuts or punctures that can expose us to pathogens. This is where engineering controls come in, such as ultrasonic cleaners and instrument washers. Let these tools do the work to keep you safe.
3️⃣ Inspect Before Sterilizing: Before loading instruments into the sterilizer, inspect them under magnification to ensure they’re completely clean. If bioburden is visible, clean the instrument again.
Engineering Controls and the Hierarchy of Control
Proper cleaning isn’t just about having the right tools—it’s about how we use them. This ties into the hierarchy of control, a framework used in infection prevention to minimize risks. Here’s how it applies:
Engineering Controls: Tools like ultrasonic cleaners and instrument washers are designed to reduce manual handling and ensure thorough cleaning. They minimize the risk of human error and injuries during cleaning.
Administrative Controls: Training your team to use these tools properly and ensuring protocols are followed consistently.
Personal Protective Equipment (PPE): Gloves, masks, and eyewear protect the user, but these are the last line of defense.
Even the best engineering controls are ineffective if not used correctly. Human behavior is a critical factor. Teams need to be trained to understand the importance of using ultrasonic cleaners or instrument washers properly, inspecting instruments thoroughly, and never skipping steps in the process.
The Italian Standard
In Italy, these steps are the norm—not the exception. If your practice feels like there isn’t enough time to incorporate these steps, it’s time to adjust the workflow—not dismiss the importance of proper cleaning. You cannot sterilize bioburden, no matter how long the autoclave cycle is.
By emphasizing proper cleaning, inspection, and the use of engineering controls, we can elevate the standard of patient care and minimize the risk of infections. It’s time we learn from Italy and start treating cleaning as the foundation of sterilization—because it is.
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