Sterilizer Monitoring In the Dental Office

Sterilizer Monitoring In the Dental Office
In 2003, the Centers for Disease Control issued Guidelines
for Infection Control in Dental Health-Care Settings.The
guidelines are intended to educate dental personnel
regarding infection control and to prevent the transmission
of bloodborne pathogens.

This comprehensive document covers: hand hygiene, personal
protective equipment, contact dermatitis/latex allergy,
disinfection/sterilization, environmental infection
control, waterlines/biofilms and special dental
considerations such as hand pieces, radiographs and
laboratory procedures.

The CDC's Guidelines for Infection Control in Dental
Settings are evidenced based and well documented. One of
the areas that must be emphasized in dental offices is
sterilization of dental instruments. Along with the proper
sterilization of instruments and materials, sterilizer
monitoring is an essential part of the infection control
program.

Many factors can cause sterilization to fail--from
procedural errors that are easily remedied, like
overloading, to mechanical problems that can take a
sterilizer out of service until repairs can be made. Since
this variety of factors can influence successful
sterilization, the CDC and the American Dental Association
encourage dentists to regularly assess the efficiency of
their in-office sterilizers.

Sterilization should be monitored using both chemical and
biological indicators. Chemical indicators, such as
indicator tapes, are to be used with each instrument load.
These indicators change color after exposure to the proper
sterilization environment.

Failure of the indicator to change color indicates that it
was not exposed to the proper sterilization environment
(e.g., proper pressure or temperature). In such cases, the
instrument load should be re-sterilized. Indicator tapes
are sterilizer-specific (i.e., tapes for steam sterilizers
cannot be used to test chemical vapor sterilizers).
Chemical indicators should not replace biological
indicators, as only a biological indicator consisting of
bacterial endospores can measure the microbial killing
power of the sterilization process.

The CDC and ADA both recommend that sterilizers be
monitored at least weekly with biological indicators. Each
state dental board may actually have a requirement for
biological monitoring.

Biological monitoring can be done in two ways. In-office
incubator and spore monitoring strips can be purchased from
dental supply houses. This method usually gives results in
24-48 hours. Mail-in spore monitoring programs are also
available. This process usually takes a week. Although it
takes longer to get results, mail-in monitoring programs
may be more reliable and credible than in-house monitoring.
A log of spore test results should be maintained in the
dental office, usually in the sterilization area.

A positive test using chemical or biological indicators
signifies that sterilization failed. If the chemical
indicator does not change color or the spore test result is
positive, the following steps are recommended. The
sterilizer should be taken out of service. Instruments that
were used after the last documented negative spore test
should not be used. The sterilization process being
followed in the office should be reviewed to rule out
operator error as the cause of failure.

Any identified procedural problems should be corrected, and
the sterilizer retested using mechanical, chemical and
biological indicators. If the repeat biological indicator
test is negative and the other test results fall within
normal limits, the sterilizer can be returned to service.
If the biological indicator test is positive, or the
chemical test results indicate failure, the sterilizer
should not be used until the reason for failure has been
identified and corrected. The dental repair company should
be contacted for a service call and possible loan of an
interim sterilizer.

Before the sterilizer can be returned to service, negative
results should be returned for biological indicator tests
conducted during three consecutive empty-chamber
sterilization cycles to ensure that the problem has been
corrected.

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Steven J. Brazis DDS is a family and cosmetic dentist in
Sacramento, CA. He has been practicing for 35 years and has
written one book and many articles on dentistry. You can
visit his web site at:
http://www.toothhaven.com