1. Precleaning/cleaning: Cleaning is removing visible debris (organic and inorganic) from surfaces, dental instruments, and other objects through the use of water with soap or enzymatic products.
2. Precleaning/cleaning is required before sterilization and high-level disinfection to ensure that there are no organic or inorganic materials on the surfaces of instruments that may interfere with the effectiveness of the sterilization and/or disinfection processes.
   • Ultrasonic cleaning: Placing instruments in ultrasonic solutions loosen and remove debris from instruments. “Running” the machine activates an “implosion” method to remove debris from the instruments. A proper enzymatic solution is to be used in these machines.  New solution should be placed in the machine each day and changed regularly if solution becomes cloudy during the day use.
   • Instrument washing machines: Only FDA approved machines may be used to disinfect patient care instruments. These machines subject contaminated instruments to a level of heat that destroys some not all microorganisms.
   • Hand scrub: A hand scrub is not a recommended method of cleaning, but is allowed when the use of an ultrasonic machine is not reasonable.
   • Holding solutions are bin of water and soap or other enzymatic agents that instruments “soak” in to loosen debris, but do not physically remove debris like an ultrasonic machine or hand scrubbing.
3. All proper PPE shall be worn, including HDUG, during this process

Instruments are precleaned/cleaned using one of the approved methods mentioned above.

1. 1. Properly place instruments in the instrument washer and turn on (check manufacturer’s IFUs).
   2. With the use of the ultrasonic machine, remove the basket from the machine. Gently load the instruments in the basket and place the basket back in the tank. Be certain the instruments are completely submerged in the ultrasonic solution, never overloading the basket or tank. Be certain the lid is placed firmly on top before turning the machine on.  Check the manufacturer’s IFUs to be certain of the amount of time to “run” the machine. 
   3. If hand scrubbing is required, fill a basin with water and soap.  Submerge one or two instruments at a time under the water.  Using a long-handled scrub brush, use a downward motion to scrub the instruments clean.  
   4. When the ultrasonic machine or instruments washer is done, or hand scrubbing is complete, the instruments are rinsed thoroughly with cool water.
   5. The instruments are then laid out on a clean towel to air dry.
   6. The instruments shall be carefully inspected to be certain all bioburden has been removed
   7. All proper PPE shall be worn, including HDUG, during this process