TEST PROCEDURE.-Since biological monitoring systems are designed for specific sterilization methods, you must be sure to use a system compatible with the sterilization method used. The following test procedures should be used to ensure effectiveness of the sterilization process:

The use of a "test pack" is most practical while processing an instrument pack.

Biological spore strips or ampules should be placed between several layers of folded wrapping material, and then the test pack is double-wrapped in the normal manner.

Always follow the biological monitor manufacturer's directions for the placement of the test pack within the sterilizer.

As a general rule, the biological spore strips or ampules should be placed within an area of the sterilizer that is least accessible to the sterilizing agent that is being used.

If using steam under pressure sterilizers, place the test pack in the lower front of the sterilization chamber.

If using tabletop units, place the test pack in the center of the load.

For each test, use an unprocessed monitor for a control.

Figure 10-14.\Biological incubator.

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.