The Positive Spore Test on a Monday Morning

Do first:

1. Take the sterilizer out of service immediately - unload nothing into circulation, place a "DO NOT USE" tag on it, and do not run a load "to see if it was a fluke."
2. Quarantine that load. Anything from Friday's run still in drawers, pouches, or the cassette comes out of circulation.
3. Notify Dr. Okafor now, by phone if necessary, before she walks into a surgical schedule. The positive result with a negative control is a genuine failure signal, not an inconclusive test.
4. Pull the Saturday records so the dentist knows which two patients received instruments from that load and which instruments they were - she needs that in front of her to make any notification decision.
5. Protect 8:00. Determine what sterile inventory is verifiably available, and tell the front desk the surgical cases may be delayed or referred.

Do not: unilaterally notify the two patients, post anything about it, or reassure anyone that "it's probably fine." Patient notification and any look-back are the dentist's call, made with the correct guidance. Your job is to make sure nothing contaminated is used and that the decision-maker has the facts.

They answer different questions, and only one answers the question that matters.

External process indicator: confirms the package went through the machine - that it was exposed to heat, steam, and time. A package can turn brown in a cycle that never reached sterilizing conditions. It detects gross operator error, such as a package that never entered the chamber.

Internal chemical indicator or integrator inside the pouch: responds to conditions within the package and can reveal a package that was penetrated poorly even in a good cycle. It is still a chemical response, not a biological one.

Biological indicator: contains resistant spores and is the only monitor that demonstrates the cycle actually killed something highly resistant. A positive BI with a negative control means the failure is in the process, not the test. (If the control itself had grown, the test would be invalid and you would not act on it - you would investigate the incubator and the test lot.)

So the strips told you the machine ran. The spore test told you it did not sterilize.

Return to service requires evidence, not a hunch. The unit should be inspected and serviced as indicated, then retested with a biological indicator alongside a control; many offices follow a protocol of consecutive negative BIs across separate cycles before resuming routine use, with the exact number set by the manufacturer and the office's written policy. Every step - the failure, the corrective action, the retest results, the date the unit went back in service - gets logged. The backup unit must not simply be substituted without verifying its own monitoring is current.

Plausible causes worth checking, in rough order of frequency:

• Overloading or overcrowding - pouches stacked flat, cassettes packed tight, trays nested so steam cannot reach every surface.
• Wrong cycle for the load; handpieces and wrapped instruments may need a different cycle than what was selected.
• Air removal failure - a pre-vacuum unit with a worn door gasket, clogged filter, or failing pump leaves air pockets that block steam.
• Packaging problems - pouches too large or double-wrapped in a way that impedes penetration and drying.
• Wet packages at the end of the cycle, which wick contaminants on handling.

Identify the cause before the first load goes back in, or you will reproduce the failure.