Dental Asia July/August 2021

User Report
she had processed a Type 5 CI within
the same cycle as her spore test.
Upon completion, she would have
immediately identified a failed cycle.
As the majority of failed spore tests
are operator related, she would have
followed CDC recommendations
for BI failures, reviewed sterilisation
procedures, and retested the steriliser
using another Type 5 integrating
indicator and additional spore test.
If the subsequent cycle passed the
integrator test, Kim would have mailed
in the spore test for processing.
Most importantly, she would have
had confidence that the processed
instruments subsequently were safe for
patient care.
FOLLOW-UP
This situation with the failed spore test
is a true story. As events unfolded, the
infection control coordinator reviewed
the autoclave instructions, and it was
determined that the door of the steriliser
was unlocked during the failed cycle.
Hence, there was not adequate steam
and pressure for sterility to occur.
A Type 5 CI with an additional BI
was then run through an additional
sterilisation cycle.
The integrating indicator passed, the
autoclave was placed back into service,
and the owner/dentist deemed it was
not necessary to notify patients. The
repeat BI test was negative for growth
of spores, as anticipated.
To prevent future operator error
sterilisation incidents, several
education and training sessions were
implemented.
CDC recommendations for instrument
processing were reviewed utilising the
checklists in the CDC Summary.
Standard operating procedures were
established regarding the use of Type 5
integrators and logs for each steriliser.
The protocol for instrument packaging
and labelling were reviewed.
Finally, a training session with a
manufacturer’s representative was
arranged to review operation of the
steriliser and routine maintenance and
cleaning. The training sessions were
documented.
LESSONS LEARNED AND
CONCLUSIONS
As the above case scenario is reviewed,
there are numerous lessons to be
learned:
• Owner’s manuals of infection
prevention equipment should be
kept in a designated location where
they can be easily retrieved, and
responsibilities for reprocessing
should be assigned to personnel
with appropriate education and
training
• Rely on the expertise of
manufacturer representatives of
dental equipment and supplies
who may troubleshoot potential
errors when experiencing technical
difficulties as well as facilitate
loaned equipment and training on
About the author
Dr Marie T. Fluent is a graduate of the University of Michigan
School of Dentistry in the United States (US). Her dental
career spans 35 years and includes roles as dentist, both as
an associate and practice owner, infection control coordinator,
office manager, and dental assistant. Additionally, she has
extensive experience and expertise as a dental inflection
control clinical instructor, educator, speaker, author, and consultant.
Dr Fluent is passionate and deeply committed to improving dental infection
control and patient safety. Through her writing, webinars, and invited lectures,
she has educated thousands of dental professionals and students nationally and
internationally. She has written numerous peer reviewed articles on infection
control in the dental setting, OSHA compliance, and responsible antibiotic
prescribing.
proper use and maintenance
• CDC’s Summary of Infection
Prevention Practices in Dental
Settings and accompanying
checklists may serve as review or
evaluation of the infection control
policies and protocols within a dental
office, while the CDC Guidelines
provide steps to take in case of a
failed spore test
• There are many fail-safes within
the reprocessing system, and the
use of Type 5 integrating indicators
adds an element of consistency,
efficiency, and quality assurance to
the sterilisation monitoring process DA
*This article and its contents are based off of
recommendations provided by the Centers
for Disease Control and Prevention (CDC) and
was originally published for the US market
REFERENCES
• CDC. Guidelines for Infection Control in
Dental Health-Care Settings - 2003
• https://www.cdc.gov/mmwr/pdf/rr/rr5217.
pdf
• CDC. Summary of Infection Prevention
Practices in Dental Settings - 2016. Basic
Expectations for Safe Care
• https://www.cdc.gov/oralhealth/
infectioncontrol/pdf/safe-care2.pdf
• CDC. Infection Prevention Checklist for
Dental Settings – 2016. Basic Expectations
for Safe Care
• https://www.cdc.gov/oralhealth/
infectioncontrol/pdf/safe-care-checklist.pdf
DENTAL ASIA JULY / AUGUST 2021 47