Types of BIs: BIs contain the bacterial spores used for monitoring. Sterilization monitoring usually can detect improper packaging, loading, timing, and temperature. This inadequate cleaning cannot be detected by sterilization monitoring therefore, cleaning must be performed very thoroughly. For example, improper instrument cleaning may leave debris on the instruments that can insulate underlying microbes from the heat. Some common causes of sterilization failures are listed in the sidebar, "Reasons behind sterilization failure," below left. Heat sterilization failure results when direct contact between the sterilizing agent (e.g., steam, dry heat, or hot chemical vapors) and all surfaces of the items being processed does not occur for the appropriate length of time. In addition, the CDC recommends spore-testing each dental office sterilizer at least weekly using a matching lot control BI.1 Likewise, the ADA also recommends weekly spore-testing of all dental office sterilizers.2 The CDC also recommends performing a mechanical monitoring of every sterilizer load (recording the time, temperature, and pressure) and placing a chemical indicator on the inside of every package in the load.1(p36) If this internal chemical indicator is not readily visible from outside the package, then an external indicator should be placed on the package exterior. Check with your state dental association to see whether your state has a sterilization monitoring requirement. These agencies include those in California, Florida, Indiana, Nebraska, Ohio, Oregon, and Washington. Several state dental boards or state departments of health require periodic spore-testing of dental office sterilizers. Mechanical monitoring involves observing and recording the physical aspects (e.g., temperature, pressure, or time) of the cycle when the sterilizer is being operated. This is referred to as chemical monitoring (or process monitoring). The sterilization process also can be monitored by using chemical indicators (CIs) that change color or form when exposed to specific high temperatures or to the sterilizing conditions within a sterilizer. Using bacterial spores to monitor the sterilization process is referred to as biologic monitoring (or spore-testing), and the bacterial spores used for monitoring the sterilization process are referred to as biologic indicators (BIs). Thus, demonstrating the death of bacterial spores provides the main guarantee of sterilization, because it assesses the process directly using live resistant microorganisms. Bacterial spores are more easily handled than CJD prion protein.The bacterial spores used are considered non-pathogenic.Bacterial spores are more resistant than all other disease-producing microbes.Although the Creutzfeldt-Jakob Disease (CJD) prion protein apparently is more resistant to inactivation than bacterial spores, the bacterial spores traditionally have been earmarked as the hallmark of resistance for three reasons: If so, we may assume all others have been killed as well.īacterial spores have been selected as the most resistant type of microbe, and provide the foundation for the process of sterilization. Because we can't actually test whether all microbes are killed during the sterilization process, the next best thing is to determine whether the process kills the most resistant microbe. Sterilization is a process designed to kill all microbes. Recommended by the Centers for Disease Control and Prevention (CDC) and the American Dental Association (ADA), they are mandated in some states. These sterilization monitoring procedures help ensure patient safety. Your state department of health or the state dental board contacts you asking for your sterilizer spore-testing records for the last six months.Īlthough there is no way to absolutely guarantee the sterility of every instrument you process, there are methods to monitor the effectiveness of the sterilization process and to identify instrument packages that have been processed through the sterilizer.When you enter the sterilizing room you wonder which packaged instruments are ready to use and which have not yet been processed through the sterilizer. That afternoon your assistant has to leave for a family emergency, so you have to obtain the instrument set-ups.The patient challenges, "How do you know those instruments are safe to use?" You're at chairside ready to begin with your first patient of the day and the instruments are arranged on the bracket table.Have these situations ever happened to you? Are your instruments sterile before you use them on patients? This article outlines the sterilization process, different indicators, regulations on testing office sterilizers, sterilization failure and what to do, and monitoring the overall process.
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