Sterilization Cassettes & Pouches

Can Sterilization pouches be used with dental instruments cassettes?

A question on every dental practitioner’s mind is whether it is best to use Sterilization Pouches or Cassettes – BREAKING NEWS – it is best to use them in conjunction with each other!

Sterilization Cassettes ease and facilitate Instrument Management, the sterilization Procedure & Practice Management whilst ensuring the highest level of hygiene and sterility.

However, once the Cassette and Instruments have been sterilized, they need to be used immediately. If however they are sterilized in the Cassette within a Pouch – and stored as such (cassette remains sealed in pouch) – then they can be kept for a longer time to be used at a later date . The pouch can be opened and the seal broken whenever you then need to use the dental instruments.


To better explain the use of Sterilization Pouches, I will demonstrate the Sterilization Cycle using Sterilization Cassettes, Pouches and an Autoclave:



  1. When the instruments have been placed inside the Cassette, it is then placed (entire Cassette) into the pouch.
  2. Once sterilized, the Cassette within the Pouch can be stored and will remain sterile until pouch is opened. The length of time it will remain sterile, depends on the autoclave and pouch used.


There are 2 main categories of Sterilization Pouches:

A.Self–adhesive sterilization pouches

B. Heat Seal Pouches

A.Self–adhesive sterilization pouches

  • Sterilization pouches are really a medical device.
  • They can be made from a variety of materials including paper, nylon, and plastic. These materials are specifically designed to allow penetration of chemicals, heat, vapor, or steam. As the material cools, it creates a sealed and sterile environment for storage.
  • Adhesive strip — The idea behind the adhesion is to create a seal after the material has expanded and contracted. A properly designed pouch allows for the 50% coverage of paper and 50% coverage of plastic with the adhesive.
  • An adequate width of adhesive material with a clean perforated fold allows for a clean, uniform fold and seal, which assures safe storage of the sterilized item
  • Do not reuse bags! The material that the bags are made from was developed to expand when exposed to the heat, moisture, and chemicals. This allows the heat and chemical to enter the bag. As it cools down, it shrinks and seals the contents from the outside atmosphere. The material was made to do this only once.
  • Each sterilizer has specific materials that are appropriate for use in it. It is important to check the directions for your sterilizer before choosing a material
  • You cannot use a tray cover, a paper towel, or any other unapproved product as a substitute.
  • Indicator — Both external and internal indicators are now required. Having one on the outside makes it simple to see if the item has been processed; having one on the inside assures that the process reached inside the bag.
  • Check indicators after sterilization before storing
  • Do not overfill the bag. This can cause problems with perforation, placement of seal, and tearing of material
  • Allow the load to dry completely before removing from sterilizer.
  • One of the most overlooked concepts with sterilization is cross–contamination. The plastic must be completely separate from the paper when tearing the pouch open
  • Do not glove up until the pouch is opened; otherwise, the contaminants on the exterior of the pouch may be transferred to your gloves, thereby contaminating the instruments and the entire procedure.
  • Do not move the pouch around multiple times before using, and store in a stable place. Repeated movement can compromise the material.

by Noel Kelsch, RDHAP

 B.Heat Seal Pouches

Provide Ease of Use and Reels Allow for Custom Sizes

  • For pouches, no scissors needed and only one end to heat seal!
  • Reels reduce waste by allowing cuts to fit instruments
  • FDA-registered medical grade paper-backed pouches with polyester/ polypropylene laminated film
  • Blue-tinted film laminate helps to identify holes or tears
  • Triple rail seal on three sides of pouch for maximum integrity
  • Pouches feature rounded corners for ease of opening and to reduce tearing
  • Designed for Steam and Ethylene Oxide autoclaves
  • To be sealed at 320° F – 390° F
  • Validated to perform per ANSI/AAMI ST7: 2006 and A1:2008, S2:2009 standards including Double Pouching
  • Indicator ink is water-based and latex-free:
    ~ Steam: pink print turns brown after processing
    ~ Ethylene Oxide: blue print turns yellow/green after processing
  • 3 year shelf life


Pitfalls in achieving sterilization 

Using the wrong types of sterilization packaging material can hinder sterilization.

  • Some packaging may prevent the sterilizing agent from reaching the instruments inside.
  • Some plastics may melt.
  • Some paper may burn or char.
  • Thick cloths may absorb too much steam.
  • Closed containers are not appropriate for steam or unsaturated chemical vapor sterilizers.
  • Cloths absorb too much chemical vapor.
  • Lint fibers may cause postoperative complication and serve as vehicles for microorganisms, increasing the risk of infection for surgical patients.
  • Interrupting the sterilization cycle, or inadequate time, temperature, or pressure
  • Inadequate pre-cleaning of instruments
  • Overloading of sterilizer
  • Inadequate drying cycle (autoclaves)
  • Faulty gaskets or seals
  • Improper packaging
  • Bulky packaging
  • Inadequate spacing of instruments
  • Improper operation of unit
  • Events that could compromise sterility include opening the pouch, instruments poking through the pouch, torn or punctured package or wrap.


Sterilization of unwrapped instruments
An unwrapped cycle (sometimes called flash sterilization) is a method for sterilizing unwrapped patient care items for immediate use. Unwrapped sterilization should be used only under certain conditions:

Thorough cleaning and drying of instruments precedes the unwrapped sterilization cycle.

  1. Mechanical monitors are checked and chemical indicators used for each cycle.
  2. Care is taken to avoid thermal injury to dental workers or patients.
  3. Items are transported aseptically to the point of use to maintain sterility.1

By  Leslie Canham, CDA, RDA


In conclusion:

  1. Dental Sterilization Cassettes ease Instrument Management
  2. Sterilization pouches used in conjunction with Cassettes ensure the highest standard of sterilization, storage and usage
  3. Ensure you use the best type of pouch specific to your needs in the correct manner with the corresponding sterilization method.