The RCDSO is the regulatory body for dentist across Ontario. They improve and administer professional and ethical standards for all of the dentistry, and ensure public protection and safety through effective regulation. (RCDSO, 2018) It is the responsibility of all dental professionals to familiarize themselves with the rules and regulations that the documents from the RCDSO provide including standards within infection control. This article will focus on regulations using self-contained biological indicators, or, spore testing in the province of Ontario.
According to the RCDSO, biological indicators (BIs or “spore tests”) are the most accepted means for monitoring of sterilization, because they directly assess the procedure’s effectiveness in killing the most resistant microorganisms. As per the RCDSO, dental clinics in Ontario are required to conduct daily spore testing. The test is performed once per day, each day the sterilizer is being used and once with each specific cycle type that will run for that day. For example, if the sterilizer will run under a flash cycle, pouches and wraps and rubbers and plastics throughout the day, one spore test will be conducted within the first load of each cycle.Please note, a biological indicator must be included in every load containing implantable devices (e.g. dental implants, temporary anchorage devices, surgical screws/plates/staples). (RCDSO, 2018, p. 23)Any time a spore test is performed within a dental clinic, the vials used to conduct the test must go through an incubation period to ensure the efficacy of sterilization parameters. After the sterilization cycle containing the biological indicator is complete, the vial is to be crushed with a biological indicator vial crusher, and then placed into the incubator for the set time according to the manufacturer’s instructions. To test the efficacy of the incubator, an unprocessed biological indicator must be crushed and placed into the same incubator, using a different slot but for the same amount of time as the processed vial. The unprocessed vial is called the “control vial” and the processed vial is called the “test vial”. The results of both the test and control vial must be documented and kept on file for 10 years. (RCDSO, 2018, p. 24)
After the said incubation period is complete, and results are recorded as passed/failed, the vials can be discarded into the sharps container. For routine loads, items in the reprocessed load should not be released until the results of the biological indicator test are available. If quarantine pending spore test results is not possible, evaluation of type 5 (or higher) chemical indicator and the specific cycle physical parameters must be used to justify their release.
If the sterilizer has a recording device, then one process challenge device (PCD) with a Type 5 chemical indicator may be used to justify the release of the reprocessed load. If the sterilizer does not have a recording device, then a type 5 chemical indicator must be placed in every pouch to be released. However, implantable devices must be quarantined until the biological indicator test results are known. (RCDSO, 2018, p. 24)
Citation: “Infection Prevention and Control in the Dental Office.” Edited by RCDSO Council, STANDARD OF PRACTICE: Infection Prevention and Control in the Dental Office – DRAFT, Royal College of Dental Surgeons of Ontario, 18 Oct. 2018, az184419.vo.msecnd.net/rcdso/pdf/consultations/RCDSO_DRAFT_Standard of Practice_Infection Prevention_June_2018.pdf.