Disinfection of rotary instruments: protocol and best practices

Rotary instruments (turbines, contra-angles, handpieces) are Class IIa medical devices that come into direct or indirect contact with mucous membranes—and sometimes blood. Due to the high risk of cross-contamination, their disinfection and sterilization must follow a strict protocol, in accordance with guidelines from health authorities such as HAS, ANSM, and the CDC.

1. Risks associated with inadequate disinfection

Rotary instruments are potential vectors for pathogenic microorganisms (viruses, bacteria, spores), especially if not cleaned immediately after use. Studies have shown that internal contamination with biological fluids can persist even after external surface disinfection (CDC, Guidelines for Infection Control in Dental Health-Care Settings, 2003).

Possible contaminants include:

Hepatitis viruses (HBV, HCV)

HIV

Resistant bacteria (MRSA)

Prions (low risk, but possible during bone surgery)

2. Classification and processing of rotary instruments

According to the Spaulding classification, rotary instruments are semi-critical devices, or critical in the context of implantology, and therefore require systematic sterilization after each patient.

Essential steps in the process:

a) Pre-disinfection (immediately after use)

Remove visible debris (blood, tissue) with manual wiping

Spray or immerse in an enzymatic detergent-disinfectant solution (EN 14476 for virucidal activity)

Respect the contact time according to manufacturer instructions

b) Internal and external cleaning

Use an automatic cleaning device compatible with rotary instruments (e.g. Assistina, DAC Universal)

Internally clean the tubing with air/oil to flush out biological residues

c) Lubrication

Mandatory before sterilization (as per instrument manufacturer’s recommendations)

Use sterile medical-grade oils specifically formulated for turbines and contra-angles

d) Sterilization

Package in sterile pouches or wraps (EN ISO 11607 compliant)

Steam sterilization in an autoclave at 134 °C for at least 18 minutes (Class B cycle recommended)

Verify chemical and biological indicators

e) Storage

Store in a clean, dry, dust-free environment

Sterility duration depends on the packaging used (typically 30 to 90 days)

3. Frequency and traceability

Sterilization must be performed after every patient, with no exceptions. Traceability is mandatory and includes instrument identification, date of sterilization, operator’s name, and sterilization cycle used. This process can be automated through certain autoclaves or sterilization tracking software.

4. Key considerations

Check material compatibility: some instruments may not tolerate certain detergents or sterilization cycles

Regularly test autoclave performance (Bowie-Dick, Helix, biological indicators)

Staff training is essential to prevent handling errors and ensure protocol compliance

Sur le sujet

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