Dental Tribune USA

Romancing the spore

By Patricia M. Pine, RDH
April 05, 2010

The Way We Were and Romancing the Stone are great old romantic movies. However, ‘the way we were’ in sterilization should be just a memory in dentistry. Antiquated methods like cold sterilization no longer serve us. The dental community continues to change and has gone full-throttle with new products for both clinician and patient comfort.

Sterilization techniques have kept pace with science and given professionals new ways to ‘romance the spores.’

One of the most important safety techniques a dental office can provide for its patients is proper sterilization. Until there is a fear-ridden news story, patients don’t often think about sterilization because it is a behind-the-scenes technology.

Public fears began in the ’80s with the AIDS scare in fear that HIV could be contracted in dental offices. Back then and now, the risk for transmission of HIV is small.

What the public and many professionals don’t consider are the newer more virulent risks like MRSA, C-def, and H1N1 as well as the old stand-bys such as TB.

Here is a glossary of ‘bugs’:

  • MRSA: methicillin-resistant Staphylococcus aurous
  • C-Def: Clostridium difficult infection
  • H1N1: Swine flu
  • TB: Tuberculosis

With these pathogens on the loose, one thing is clear: As oral health-care professionals, we cannot take the sterilization process for granted.

Consistency of sterilization practices requires a comprehensive program ensuring operator competence and proper methods of cleaning and wrapping instruments, loading and operating the sterilizer and monitoring the processes.

The goal in any sterilization department is to disassemble spore proteins to prevent harm. We need to romance the spores.

How to romance the spores

Warm baths, massages, thick spa towels and a bow around the package set the mood for romancing the spores. Spores are romanced through each sterilization step.

Spore-contaminated instruments are placed in the hot tub (the enzymatic bath) for a 20-minute, massage-removing bio-burden. After bathing, rinsing causes contaminated debris to sluice down the instruments.

This is followed by a natural drip-dry period on towels. This allows for visual inspection and prepares the instruments for entering the sauna.

Wrapping up for saunas is routine. Using paper pouches with inner and outer indicators is one option.

Another option is to ‘go naked’ by using cassettes still wrapped and tied with a bow (indicator tape.)

Cassettes keep instrument sets orderly, saving time and preventing accidental exposures. Both of these procedures must allow the sauna (steam) to breathe through while denuding the protein that causes diseases.

The romance is doomed to failure if the packets are stuffed together with no room to truly experience the warmth of the sauna. It becomes a competition with some packets selfishly grabbing all the heat and others enviously going without. The most important step is proper loading of the sterilizer.

There are several possible reasons for sterilization failures, including the following:

  • Improper packing: Prevents penetration of sterilizing agent.
  • Improper loading: Overloading or packages too close together.
  • Improper Timing: Not enough time at proper temperature to achieve microbial kill; or a timer malfunction.
  • Improper temperature: Not enough heat for proper time interval to achieve microbial kill.
  • Improper method of sterilization: Heat-sensitive items melt or distort.

The finale of this romance ends with the instruments free of disease-producing protein, completely dry and ready to caress the next patient safely. This sounds like a spa treatment or a made-for-TV movie, yet the consequence of messing up this romance is more than loss of a relationship; it could be loss of life.

Was it a successful romance?

The next question to answer is if the romance was successful. Are your instruments truly sterile? Authorities recognize bacterial spores, i.e., Bacillus spores, as the most resistant type of microbes, making spore testing the closest-to-ideal measure of eradication.

Routine weekly spore testing and biological monitoring of equipment for patient safety is not an option. It is a must.

The spore-test used depends on the type of sterilizer. Steam sterilizers should be tested for Geobacillus stearothermophilus. For dry heat sterilization, the test should be for Bacillus atrophaeus.

In case of a positive spore test, the sterilizer must be removed from service to review the operating procedures. If the problems are procedural, these can be corrected immediately.

A second spore test should then be performed. If the test is again positive, previously sterilized instrument packs must be removed from service. An immediate call for service on the unit is necessary and asking for a replacement sterilizer. Upon arrival of the temporary sterilizer, spore testing should be performed.

After repair of the original practice unit, there needs to be negative spore test in three consecutive empty chamber sterilization cycles.

Only then can the sterilizer be put back into service.

What does OSHA have to do with it?

The federal government requires OSHA training on an annual basis and before a new employee is hired. Use the lists and photos to assist in review of sterilization procedures as part of each new employee’s OSHA training as well as part of every employee’s annual training.

When was your last infection control training? Is everyone on the same page? Is it time to bring in a professional trainer?

True romance

Actually, the true romance isn’t really between the practice and the spore. The true romance is between the practice and the patients of record and the new patients they refer.

Eradicate patients’ spoken or unspoken fears by inviting questions about the behind-the-scenes sterilization process used in your practice by offering tours of your office.

Don’t assume patients of record already know how you effect proper sterilization. Creating trust and comfort by providing the best care on every level will result in referrals from content patients.

Methods of sterilization

  • Remove bio-burden from instruments prior to packaging via ultrasonic device.
  • Use sterilization pouches with both inner and external monitoring devices.
  • Cassettes reduce possible exposures, increase organization of instruments and eliminate the need to handle highly contaminated instruments.
  • Load pouches or cassettes into the sterilizer, leaving room for steam to circulate between each bag.
  • Place pouches on separate trays. They must not touch sides, bottom, top or inside of the sterilization chamber.
  • Place cassettes horizontal on each tray, or vertical on a special rack, with space for steam circulation.
  • Monitor sterilizers with biological test strips and control indicators at least weekly.
  • Maintain sterilization records in compliance with state and local regulations.

Editorial note: Adapted from OSAP manual From Policy to Practice 2004. A list of references is available from the publisher.

Author info

Patricia M. Pine, RDH, may be contacted through her Web site, at

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