Correct Procedures for Opening Sterile Packages

Question:  Would you review the correct procedures for opening sterile packages–both for nonsurgical and surgical
dental procedures? One of the things we want to know is whether or not we should wear gloves when opening the package?

Answer:  The following sequence of procedures may vary based upon the dental procedure, products used, and local
policies, but in general to maintain the sterility of the dental instruments, it is recommended that you carefully open
the sterile package(s) of instruments after seating the patient. Alternatively, if you know the patient has arrived in
the dental clinic you can open the package(s), as described below, and immediately cover the instruments with a sterile
drape before seating the patient.

If Instruments for nonsurgical proceduresthe instruments are to be used for a nonsurgical procedure:

a. Check to ensure the packaging material is not torn or punctured.
b. Don protective clothing, mask, and protective eyewear.
c. Open sterile package(s) of instruments with clean, ungloved hands and without directly touching the contents.
   (If you open the packages with gloved hands, the gloves will become contaminated from microorganisms on the
   outside of the package.) If opening a wrapped cassette, be careful not to touch the inside of the wrapping
   material because it can serve as a sterile field for the instruments.
d. Wash and dry your hands and don gloves.
e. Proceed with opening the cassette and/or arranging the instruments for the procedure.

The general principles are the same for surgical procedures. If the instruments are to be used for a surgical
procedure:

a. Check to Instruments for surgical proceduresensure the packaging material is not torn or punctured.
b. Don protective clothing, mask, and protective eyewear.
c. Surgical instruments are double wrapped which enhances sterility maintenance. The outer wrapping can be
   removed with clean, ungloved hands and discarded—be careful not to touch the inner wrapped package.
   This removes any contamination on the package from storage or transport to the operatory.
d. Perform surgical hand antisepsis and don sterile gloves.
e. The inner packaging material can be touched with sterile gloves and can serve as a sterile field for the
   instruments.
f. Proceed with opening the cassette and/or arranging the instruments for treatment.

Selected References:

Miller CH, Palenik CJ. Instrument Processing. In: Miller CH, Palenik DJ, eds. Infection Control and Management of
Hazardous Materials for the Dental Team, 3rd ed St. Louis: Mosby: 2005: 234–235.

Miller CH, Palenik CJ. Protective Barriers. In: Miller CH, Palenik DJ, eds. Infection Control and Management of
Hazardous Materials for the Dental Team, 3rd ed St. Louis: Mosby: 2005:184–185.

Pollock R, Crawford JJ, Young JM. Operatory Preparation and Instrument Recirculation. In Cottone JA, Terezhalmy GT,
Molinari JA, eds. Practical Infection Control in Dentistry, 2nd ed. Baltimore: Williams & Wilkins, 1996:226.

- (Lt Col Harte)