How applicable is cold sterilization in current dental infection control?

Cold sterilization as related to dentistry refers to the practice of immersion (i.e., liquid chemical) disinfection used to reprocess reusable semicritical instruments or items for patient care. Chemical germicides used in this manner have been either glutaraldehydes, hydrogen peroxide-based, or peracetic acid solutions.

There are multiple reasons why chemical immersion sterilization is no longer considered appropriate for reprocessing heat-stable medical instruments. First and foremost, virtually every reusable available dental instrument is heat-stable and should  be appropriately cleaned, packaged, and sterilized between uses with a heat-based, biologically monitored process, such as a steam autoclave, dry heat sterilizer, or unsaturated chemical vapor sterilizer. The CDC refers to heat sterilization as the method of choice when sterilizing instruments and devices. If an item is heat sensitive, it is preferable to use a heat stable alternative or disposable item. While chemical sterilants can sterilize items that would be damaged by heat, the process to accomplish this may require 6-10 hours of immersion.

Other factors have also precluded the routine use of cold sterilization in current infection control protocols, including:

•  sterilized items must be rinsed with sterile water after removal from the solution in order to remove toxic or irritating chemical residues, and
• a sterilization process using liquid chemicals cannot be verified by biological, spore test monitors.