[…] on patient care items. Therefore, an inactivated BI signifies that other potential pathogens in the load have been killed. Include a BI each day a sterilizer is used. In addition, if a load contains implantable devices, it must be monitored with a BI, and these items should be quarantined until the test results are known. Follow the manufacturer's directions concerning the appropriate placement of the BI in the sterilizer. The daily operation of everysterilizer must be reviewed and documented. A logbook should be kept for this purpose.Any malfunction must be noted and appropriate action taken. In the event of a positive BI (i.e. failed spore test): •Remove the sterilizer from service. •Review all records of mechanical and chemical indicators since the last negative BI, as well as sterilization procedures to determine whether operator error could be responsible. In the absence of a mechanical failure, common reasons for a positive BI include overloading, failing to provide adequate package separation, and using incorrect or excessive packaging material. •Repeat the spore test immediately. This should be done after addressing any procedural problems and correctly loading the sterilizer, and by using the same cycle that produced the failure. While waiting for the repeat test results, the sterilizer should remain out of service. If the dental office does not have a second sterilizer, a colleague may be able to assist or a dental supply company may lend one. Cleaning,Disinfectionand SterilizationofPatientCareItems IMPORTANT 29 ROYAL COLLEGE OF DENTAL SURGEONS OF ONTARIO •If the repeat spore test is negative, and mechanical and chemical indicators demonstrate adequate processing, then the sterilizer may be put back into service. •If the repeat spore test is positive, and all sterilization procedures have been performed correctly, then the sterilizer should remain out of service until it has been inspected, repaired and successfully rechallenged with BI tests in three consecutive empty chamber sterilization cycles. In addition, all items from suspect loads dating back to the last negative BI should be recalled, to the extent possi- ble, and reprocessed. Storage Sterile and single-use disposable items should be stored in an enclosed space, such as closed or covered cabinets. They should not be stored under sinks or in other locations where they might become wet and contaminated. Storage practices for packaged sterilized instruments may be either date or event- related. Dating assists in the recall of instruments should concerns arise with the results of sterilization tests. Some health care facilities date every sterilized package and use shelf-life practices (e.g."first in, first out"). Others use event-related practices. The latter approach recognizes that the packaged instruments should remain sterile indefinitely, unless an event causes them to become contaminated (e.g. torn or wet packaging). Packages containing sterile instruments should be inspected before use to verify barrier integrity and dryness. If packaging is compromised, the instruments should be cleaned, packaged and sterilized again. Critical and semi-critical instruments should be processed in a manner that will maintain sterility during storage.This includes ensuring that the integrity of the package is maintained. Cleaning,Disinfectionand SterilizationofPatientCareItems IMPORTANT...
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