Volume 7 • 2020 • Issue 4

Provincial Associations, largely because of the differences in activities between offices (for example the different weight and numbers of instrument sets used in a surgery office compared to a restorative office). Let’s attempt this: if the most challenging (heaviest or largest) package that is sterilized in the office is a cassette made up of 14 instruments, then the test package should be the same number of instruments or equivalent in weight (but, of course, not necessarily the exact same instruments). •  One of the main questions asked—is the test package going to be a package of instruments that will be used for patient care or should it be a proxy or made up of instruments that are no longer used in patient care? Consider making it using instruments that are no longer used for patient care because they are broken or no longer used. Using patient care packages as test packages complicates instrument inventory and complicates aseptic presentation (as the package will need to be opened to remove the BI and then the package will need to be used immediately for patient care and it may not be needed immediately so will need to be reprocessed again). Therefore, it is a less resource intensive process to determine the most challenged package that is sterilized in the office and make up as many of these as there are sterilizers since each sterilizer needs to be monitored with a spore test each day that it is used and for each cycle that is used. Add the BI and a Type 5 or Type 6 chemical indicator, as required by the cycle, wrap or place the test package into a peel pouch, place it at the least accessible position according to the sterilizer MIFUs, and run with a full load in the tabletop sterilizer to complete the spore test. The Type 5 or Type 6 in the test package will allow the operator to see at a glance that parameters were adequate for sterilization which allows a non-dental implant load to be released. •  BIs and their compatible incubators are available for shorter than 24-hour incubations including 20-minute, 24-minute, 40‑minute, and 1-hour incubation times. Offices have to weigh the convenience of purchasing spore test systems (BI and incubators) utilizing short incubation times against cost. •  Sterilizers must be tested with three consecutive cycles in a loaded chamber with a PCD containing a BI after installation, packaging changes, such as newly configured cassettes, change in brands for both wrap or pouches, or even for use of tip protectors, major repairs, moving the sterilizer or after a sterilization failure. NOTE: A sterilizer is considered to have been moved when it needs to be disconnected from its power source to be relocated. This is because it is essential for sterilizers to be perfectly level in order to drain properly. Step 11: Documentation (including traceability) •  The following records are required, including but not limited to: • MIFUs for the inventory of instruments and devices in the office • Daily air removal test for pre-vacuum sterilizers • Results of daily BI results for each sterilizer and each cycle for each sterilizer • BI for loads containing dental implants • Policy for interventions associated with a positive BI result • Log with staff initial verifying successful physical parameters for each load • Load logs that document the packages in the load. The more information that the load logs provide, the easier it is to find the packages if a recall is required • Log for maintenance for all reprocessing and cleaning equipment • Policy for length of retention of sterilization logs (at least provincial dental association standard; however, consider keeping for the lifetime of the practice) •  Regarding traceability, information documented from labels make recalls possible. Recalls must be initiated when it is found that the Type 5 or Type 6 internal indicators in two or A sterilizer is considered to have beenmovedwhen it needs to be disconnected from its power source to be relocated.This is because it is essential for sterilizers to be perfectly level in order to drain properly Infection Prevention and Control at the Dental Office 28 | 2020 | Issue 4