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Also called: Instrument cleaning, Ultrasonic cleaner, Washer-disinfector

Instrument Cleaning Before Sterilisation: Step by Step

An autoclave cannot sterilise through blood, tissue or dried debris. Cleaning decides whether sterilisation works — here is how to do it properly.

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Why cleaning comes first

Soil shields microorganisms from steam, and the heat of the autoclave bakes it onto instruments, causing stains and corrosion. Cleaning removes most of the bioburden; sterilisation deals with what is left. Rushed or skipped cleaning is the most common hidden reason a sterilisation process fails.

The reprocessing steps

1. Point of use

Wipe off gross soil straight after the procedure and keep instruments moist — with a pre-clean spray, foam or damp cover — so blood does not dry on. Dispose of sharps and single-use items at the chair or bedside.

2. Transport

Carry used instruments to the dirty zone in a closed, leak-proof container, never loose in hands or on an open tray.

3. Clean

Rinse in cool water first, because hot water fixes protein. Then brush under the water line in detergent, or load an ultrasonic cleaner or washer-disinfector.

4. Rinse and dry

Rinse off all detergent, ideally with softened or purified water for the final rinse to avoid spotting, then dry thoroughly. Water left on instruments causes wet packs.

5. Inspect, lubricate and pack

Check each instrument under good light and magnification for residue, corrosion and damage. Lubricate hinges and handpieces as their makers specify, then pouch and label.

Manual cleaning and detergents

  • Use a neutral or enzymatic detergent made for medical instruments, at the dilution and water temperature on its label.
  • Brush under water to avoid splashes; use soft nylon brushes, never steel wool or abrasive pads.
  • Match lumen brushes to the channel diameter, then flush the channel.
  • Open hinged instruments and take apart anything designed to be disassembled.
  • Replace the detergent solution when it is visibly soiled, and at least as often as its label says.
  • Wear heavy-duty gloves, a waterproof apron, and eye and face protection.

Using an ultrasonic cleaner

An ultrasonic cleaner uses cavitation — huge numbers of tiny collapsing bubbles — to lift soil from serrations, hinges and box joints that brushes miss.

  • Degas fresh solution by running the tank without instruments for a few minutes before the first load.
  • Use the basket, keep instruments fully submerged and opened, and do not overload.
  • Keep the lid closed during the cycle to contain aerosols.
  • Avoid mixing dissimilar metals in one load; some plated or aluminium items can be damaged.
  • Only put in items whose IFU allows it — many handpieces, optics and powered devices are excluded.
  • Change the solution at least daily and whenever it looks soiled, and rinse instruments afterwards.
  • Check performance regularly with a foil test or a cleaning-indicator test.

Washer-disinfectors

A washer-disinfector cleans, rinses, thermally disinfects and often dries instruments in one programme, with a cycle record. It cuts staff handling of sharps and gives consistent results. These machines are built to the ISO 15883 series, and thermal disinfection is expressed as an A0 value — a common target is A0 3000, for example 90 °C held for 5 minutes. A washer-disinfector does not replace sterilisation for critical instruments.

Read next Laying out a dirty-to-clean reprocessing roomPouches, tape and indicators

Related guides

Dental Autoclave for Malaysian Dental ClinicsWhy dental clinics need a Class B autoclave, how to size it by chairs and patients, and the daily routine that keeps handpieces safe.Clinic Sterilisation Room Setup: Dirty-to-Clean WorkflowAn autoclave only sterilises what has been properly cleaned and packed. Here is how to lay out a clinic reprocessing area that works.Autoclave Tape, Sterilization Pouches and IndicatorsWhat each autoclave consumable proves, how to choose and pack sterilisation pouches, and how to store them so instruments stay sterile.

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Frequently asked questions

Can dirty instruments go straight into the autoclave?
No. Steam cannot reliably sterilise through blood or debris, and the heat bakes soil onto the instrument. Clean, rinse and dry first.
Is enzymatic detergent necessary?
It helps break down blood and protein, especially on instruments that waited before cleaning. Use a detergent made for medical instruments at the stated dilution.
How often should ultrasonic cleaner solution be changed?
At least daily, and sooner if it looks soiled — dirty solution redeposits debris and weakens cavitation.
Should instruments be rinsed in hot water?
Rinse first in cool water. Hot water fixes blood and protein onto the surface, making them harder to remove.

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