EVALUATION CRITERIA. - After the completion of the sterilization cycle, open the test pack and evaluate the dosage indicator to see if it passes or fails the cycle. If it passes, you can distribute the sterile goods and continue the biological test procedure. If it fails, follow the procedures under guidelines for internal and external indicators.

POSITIVE RESULTS. - When positive biological monitoring occurs, you must follow these guidelines:

Notify the ICO and record the test results in the sterilization log.

If another sterilizer is available, perform the following actions:

- Retrieve and resterilize all items sterilized since the last negative test of that sterilizer tested positive.

- Process a test pack with both a chemical and biological monitor and secure the sterilizer from further use until the results of the biological and chemical tests are read.

- If the results of the biological and chemical tests indicate negative growth or pass the sterilization test, the sterilizer can be placed into service.

- If the results from the test still indicate positive growth or failure of sterilization, the sterilizer must be secured and dental repair personnel notified.

If another sterilizer is not available, perform the following actions:

- Notify dental repair personnel.

- Retrieve and resterilize all items processed since the last negative test. Use a test pack with a biological and chemical monitor in each load when resterilizing all items that came up positive from the last test.

- If a chemical monitor in the test pack indicates a pass of the sterilization test, these loads can be distributed if necessary. The ideal situation is to have adequate instruments and equipment to be able to hold these items for 48 hours after a negative biological test and then distribute.

- If the biological test again fails, secure the sterilizer and notify dental repair personnel, and the ICO.

Make a narrative entry in the log of each action taken and the results as they occur.

Retest the sterilizer using biological monitors.

Confirm exposure of the biological monitor to sterilization process.

Review the sterilization log for recent repairs or maintenance.

GUIDELINES FOR INTERNAL AND EXTERNAL INDICATORS. - Use internal indicators inside and external indicators on the outside of each instrument pack. When using glass test tubes during dry heat sterilization, ensure an internal indicator is in each test tube before the screw top is secured. When any indicator of a load test pack fails, resterilize it with a new test pack containing both chemical and biological monitors. Be sure to closely monitor the temperature, pressure, and sterilizing time of the load. Watch the timer to be sure it does not start before the correct temperature is reached. Watch for steam leaks from the sterilizer during the sterilization cycle. If the indicator again fails, notify the ICO and dental repair personnel. Log in the results from the failure, and secure the sterilizer from use until the results of the biological monitor can be evaluated.

Follow the manufacturer's instructions when reading the indicators. Please be aware that internal and external indicators are not replacements for biological monitoring. Only biological monitoring can tell you whether or not sterilization has actually occurred.

LIQUID STERILANTS. - Since liquid sterilants cannot be biologically monitored, their use is discouraged. In using these agents, the key is the time that instruments and equipment are in contact with the sterilizing agents. Test strips for concentration levels must be used according to manufacturer’s instructions.

DISINFECTION

Disinfection is a less lethal process than sterilization, which kills disease causing micro- organisms. This does not include the destruction of resistant bacterial spores. Disinfection is achieved by either chemical or heat means. Selecting an appropriate chemical germicide or heat disinfection method depends on what requirements need to be met