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 Monitoring
Sterilizers
Overview
Along with the proper sterilization of instruments and materials,
sterilizer monitoring is an essential part
of any in-office infection control program
(for information on instrument and equipment sterilization, consult "Sterilization
and Disinfection of Dental Instruments  " in the ADA Roadmap to
CDC Guidelines for Infection Control in Dental
Health-Care Settings ).
Many factors can cause sterilization to fail-from procedural
errors that are easily remedied, like overloading,
to mechanical problems that can take your
sterilizer out of service until repairs can
be made. Since this variety of factors can
influence successful sterilization, the ADA and
CDC encourage
dentists to regularly assess the efficiency
of their in-office sterilizers. 1,2 In addition,
state or local regulations may exist regarding
frequency and record-keeping issues related
to sterilizer monitoring. Check with your
state
dental board for regulatory information.
How to monitor
Sterilization is best monitored using a combination of mechanical,
chemical, and biological indicators.
Mechanical Monitoring
- Record cycle time, temperature, and pressure as
displayed on the sterilizer gauges for
each instrument load.
Chemical Indicators
- Use chemical indicators, such as indicator
tapes, 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.
Biological Indicators:
- The ADA and CDC recommend that you monitor
sterilizers at least weekly with biological
indicators. 1,2 Check to see whether your state
dental board has
different requirements.
- Consider using biological indicators
daily if the sterilizer is used frequently
(i.e., several loads per day). Daily monitoring
allows for earlier discovery of equipment
malfunctions or procedural errors.
- Biological monitoring can be done in
two ways:
- In-office incubator and spore monitoring
strips (contact your dental supplier
for a list of products). This method
usually gives results in 24-48 hours.
- Mail-in
spore monitoring programs(PDF). This process
usually takes a week. Although it takes
longer to get results using a service,
third-party monitoring programs may offer
more credibility than in-house monitoring.
- A positive spore test result indicates
that sterilization failed.
- Maintain a log of spore test results.
Check with your state
dental board to
determine how long you need to keep spore
testing records.
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What to do when results indicate sterilization failure
If the chemical indicator does not change color or the spore test
result is positive, the following steps are recommended:
- Take the sterilizer out of service.
- Review the sterilization process being followed
in the office to rule out operator error
as the cause of failure.
- Correct any identified procedural problems, and
retest the sterilizer using biological,
mechanical, and chemical 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 biolgical indicator test is positive, or the mechanical
or chemical test results indicate failure,
the sterilizer should not be used until the reason for failure has
been identified and corrected.
- If no procedural errors are identified
or failures persist after procedural errors
are corrected, the sterilizer should not
be used until the reason for failure has
been identified and corrected.
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.
- To the extent possible, reprocess all
instruments that were sterilized since
the last negative spore test.
- Record the positive test results and
all actions taken to ensure proper functioning
of the sterilizer in the monitoring log.
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1. Centers for Disease Control and Prevention.
Guidelines for infection control in dental health-care settings-2003.
MMWR 2003;52(No. RR-17): 43. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm
2. ADA Council on Scientific Affairs, Council on Dental Practice.
Infection control recommendations for the dental office and dental
laboratory. JADA 1996;127(5):672-80.
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