To prevent the spread of disease, reusable instruments used in skin penetration procedures must be thoroughly cleaned and then sterilised using a bench-top steriliser

Last updated: 21 March 2013

About this fact sheet

This fact sheet has been developed by NSW Health to assist practitioners sterilise their reusable instruments. This will prevent the spread of disease, as well as enable practitioners meet the requirements of the Public Health Regulation 2012.
 
Sterilisation kills micro organisms including bacteria (and their spores), fungi and viruses. According to the Public Health Regulation 2012, all re-usable instruments which penetrate the skin must be sterilised.
 

Instruments which need to be sterilised include:

  • Cuticle cutters
  • Razor scrappers (callus remover shaver)
  • Microdermabrasion heads
  • Metal nail files (if they cause skin abrasions)
  • Dermarollers
 

Single-use items

  • Instruments that penetrate the skin and cannot be adequately cleaned and/or sterilised must not be re-used, they must be 'single use'
  • Needles (including tattoo needles) must not be re-used. They must be 'single-use' and immediately disposed into an approved sharps container following use on a client
 

How do you sterilise?

  • Sterilisation must be carried out in accordance with AS/NZS 4815:2006 Office-based health care facilities - Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment
  • This Australian Standard outlines the critical steps involved in sterilisation
  • See Poster: 'Steps to Cleaning and Sterilisation'
 

What do you need to do before you sterilise your instruments?

  • Ensure the premises is designed properly
  • Processing of equipment for cleaning and sterilisation should be conducted away from clients, preferably in a separate room
  • Workflow for equipment processing should be from dirty - to clean - to sterile
 

Equipment cleaning notes:

  • To protect against aerosol exposure from washing equipment soiled with contaminated materials (e.g. blood and body fluids) wear appropriate 'Personal Protective Equipment". That is, gloves, eye protection, fluid repellent masks and fluid resistant aprons or gowns should be worn whilst cleaning
  • Equipment must be thoroughly cleaned (i.e. via scrubbing, using an instrument washer, and/or ultra-sonic cleaner) before processing through a bench-top steriliser. However plastic and similar items may not be suitable for ultra-sonic cleaning and cemented glass syringes, mirrors, and lenses may be damaged by repeated use
  • Equipment cleaning should minimise the generation of aerosols. A deep double-bowl sink is recommended
  • Equipment that is difficult to clean and sterilise, such as colonic lavage tubing should only be used once and then thrown away (single-use only)
  • The manufacturer's instructions must be followed for the use of cleaning agents on instruments
  • There should be a manual for staff on 'cleaning procedures'
  • Good quality potable water must be used for cleaning. Water with a high mineral content is not suitable for rinsing as the instruments can become damaged by the mineral deposits
 

Equipment cleaning steps:

(Instruments should be cleaned as soon as practicable after use)
 
Manual cleaning (where automatic washer units cannot be used or for difficult to clean instruments)
  1. Rinse off any visible blood and body fluids with cold warm running water
  2. Dismantle /open all items for cleaning:
    • Fill the sink with warm water and with the required cleaning agent (approved by the manufacturer). Usually a neutral pH or mildly alkaline solution is used. Mildly acidic solutions may damage some instruments
    • Place in the sink
    • Wash/scrub all surfaces under water with a soft brush, remove stubborn staining by using a non-abrasive scouring pad or soaking in an approved stain-removing solution
    • Minimise the generation of aerosols. Some instruments should be cleaned using an instrument washer and/or an ultra-sonic cleaner
    • Rinse in warm to hot running water
    • Dry all items using a drying cabinet or with a lint free cloth (Instruments must be properly dried - residue moisture may impede the sterilisation process, and can damage instruments)
 
Automated (mechanical cleaning) (using a instrument washer, washer-disinfector or an ultra-sonic cleaner)
Washer cycles should include the following:
  1. Pre-rinse with water
  2. Wash, in warm water with cleaning agent added, in accordance with the manufacturer's recommendations (All surfaces must be exposed to the action of the water spray)
  3. One or more rinses with hot (80oC-86oC) water with a drying agent added, in accordance with the manufacturer's recommendations
  4. Drain, leaving the contents at a temperature for quick drying
  5. Drying
 
Ultra-sonic cleaners
  1. Rinse off any visible blood and body fluids with warm running water
  2. Dismantle /open all items for cleaning
  3. Use the ultra-sonic cleaner in accordance with the manufacturer's instructions
  4. AS/NZS 4815:2006 titled Office-based health care facilities - Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment provides some instruction on the use of the ultra-sonic cleaner
  5. NOTE: Ultra-sonic cleaners clean but do not disinfect instruments
 

Packaging prior to sterilisation:

  • Instruments must be packaged and labelled prior to placing in a steriliser
  • Packaged items should be positioned in an upright position or in accordance with the manufacturer's instructions
  • Most packaging contains an indicator that shows that the load has been processed. This indicator does not show that the load has been sterilised
  • Class 5 indicators show that the critical parameters e.g. time, temperature and moisture have been reached
  • Class 6 indicators verify that the cycle e.g. 134°C for 3.5min in steam has been reached
  • Exposed chemical indicators may change over time, therefore it is advisable to record the result in a permanent register
  • Biological/enzymatic indicators or 'challenge tests' ensure that the sterilisation process effectively kills bacterial spores (reducing to below 10-6). Geobacillus stearothermophilus is the 'challenge test' organism used to verify sterilisation by steam under pressure. Biological indicators are usually used during performance and operational qualification and as part of recommissioning and performance requalification
 

Sterilisation and documentation requirements

  • Sterilisation must be carried out in accordance with AS/NZS 4815:2006 Office-based health care facilities - Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment
  • The bench-top steriliser must be maintained in accordance with AS 2182-1998 Sterilisers - Steam - Benchtop
  • All instruments must be wrapped and packaged prior to processing through a bench-top steriliser. This will maintain sterility and permit aseptic removal of the contents of the pack at the time of use. An exception to this requirement is if items are used immediately after processing through a bench-top steriliser
  • Equipment which is difficult to clean and sterilise, should only be used once and then thrown away (single-use only)
  • Equipment must be thoroughly cleaned before processing through a bench-top steriliser
  • There must be at least one person present at the time the steriliser is used who is adequately trained in the operation of the steriliser
  • The bench-top steriliser must have a print out facility to record the cycle parameters (i.e. temp, pressure, time), otherwise a Class 4, 5 or 6 chemical indicator must be placed in on instrument package (in every load) or there must be direct observation and recording of cycle parameters
  • Where on-site technical support is not available to achieve calibration or validation, a Class 5 or 6 indicator must placed in every instrument package (in every load) or a process challenge device must be used in every load
  • The Public Health Regulation 2012 requires that sterilisation records must be kept for 12 months showing: (a) the time and date when each article was sterilised; and (b) the length of time that the article was sterilised and the temperature and pressure levels of the bench-top steriliser
  • Other records include: the operator's name, date, steriliser number or code, and contents of the load
  • Cleaning and maintenance procedures
  • Quality Management - in accordance with AS/NZS 4815:2006 
  • Staff Training - in infection control and sterilisation management
  • Operators and maintenance manuals - should be on site at all times
  • Validation - the process of commissioning and performance qualification which is performed to evaluate the reliability of a sterilisation process. Validation must be carried out annually
 

Important NOTES for sterilising

  • If a sterilisation package (pouch) or its contents are wet, the package contents are deemed unsterile and must NOT be used
  • The efficiency of the sterilisation process must be established during the validation process
  • Instruments must be dismantled or opened to ensure that all parts of the instrument are sterilised
  • Trays used for assembly of instrument sets for steam sterilisation must be perforated
  • Steam sterilisation is widely used as the steam under pressure provides fast destructive power to kill microorganisms and their spores
  • UV light cabinets, microwave ovens, pasteurisation, disinfectants, pressure cookers, boiling and ultra-sonic cleaners DO NOT sterilise!
  • Dry heat sterilisation is only to be used for instruments which cannot be sterilised using steam under pressure (bench-top steriliser). Dry heat sterilisers (hot air type) must comply with AS 2487
  • All instruments must be wrapped and packaged prior to processing through a bench-top steriliser. This will maintain sterility and permit aseptic removal of the contents of the pack at the time of use. An exception to this requirement is if items are used immediately after processing through a bench-top steriliser
 

Steps to Cleaning and Sterilising Instruments

  
1. Dirty Instrument
  • Place instrument in dirty instrument bowl/container
  • Wear PPE (eg gloves, apron & mask
  • Transfer to cleaning area​


 
2. Cleaning
  • Open the instrument and rinse in a sink of warm water. Hot water may cause blood and other matter to stick to the items. (Soaking in some disinfectants may also cause blood to stick)
  • Use a detergent recommended by the manufacturer
  • Scrub with a brush to remove any grime (to reduce the generation of aerosols scrub underwater)​




3. Ultrasonic cleaner
  • Very efficient for cleaning
  • Suitable for some instruments
  • Carry out foil test (see AS 2773.2)
     




4. Packaging
  •  Ensure instruments are properly dried use a lint free cloth or drying cabinet
  • Open all instruments and place in package (pouch) without overlapping
  • Seal the package properly do not use staples
  • Label the package
     




5. Sterilisation
  • TGA approved bench-top steriliser with drying cycle and print out facility (Comply with AS/NZs 4815:2006
  • No overlapping of packages
  • Indicators can be placed in packages to confirm sterilisation has taken place (otherwise validation reports are required)




6. Storage
  •  Clean, dry area away from sunlight.






 

Related information and links

 

You can call 1300 066 055 to talk to your local Public Health Unit.

Page Updated: Thursday 21 March 2013