Positive Spore Test on a Full Schedule
On Friday morning, a single-doctor Montana practice learns that the previous week's biological indicator for the only steam autoclave is positive. The office has 14 patients scheduled that day, including two implant placements and a periodontal surgery. The assistant proposes to re-run the autoclave with a new spore strip and, if it passes, use instruments 'flashed' for 3 minutes. The office has no backup autoclave and no written sterilization log for the past month. Instruments processed since the last negative test have been used on at least 30 patients. The dentist asks whether he must cancel, notify patients, or report to the Board.
1. What is the immediate infection-control response to the positive spore test?
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Remove the autoclave from service immediately. Do not use it on the 14 patients. Repeat the biological indicator with a control; review loading, packaging, cycle, and maintenance. A positive test is a warning, not a 're-run until pass' event. The autoclave should stay out of service until it passes with the control and any needed repair or validation is completed. Use a backup autoclave or refer patients elsewhere. 'Flash' cycles are not a substitute for a validated sterilization process. The implant and periodontal surgery cases should be rescheduled because they are higher-risk procedures.
2. What should be done about instruments used since the last negative test and about patient notification?
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Quarantine instruments processed since the last documented negative test. Because there is no log, the window is uncertain and must be reconstructed from schedules and memory. Determine whether the failure is confirmed. If so, follow CDC and Board guidance on assessing exposure and patient notification. Notification is not automatic for every positive spore test, but if instruments were likely non-sterile and used on patients, the dentist should consult the Board and public health authorities and disclose the event to affected patients. The practice should not hide the failure or continue routine care as if nothing happened.
3. What records and monitoring must be established?
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Establish a written sterilization log recording every cycle, every biological indicator with its control, results, date, autoclave identifier, and action taken. Perform spore testing at least weekly and maintain the autoclave according to the manufacturer's instructions. Train staff on loading, packaging, and handpiece processing. Document the positive result, the removal from service, the corrective action, and the return-to-service validation. Report to the Board if required and cooperate with any investigation.