RDA (Other exams): The Failed Spore Test on a Monday Morning

The sequence matters as much as the individual facts.

1. Tag the unit out of service immediately. A positive BI means the cycle cannot be verified, so nothing processed in that chamber after the last negative BI can be assumed sterile. Attach a dated 'do not use' tag and pull the plug or lock it out so a hurried coworker cannot start a cycle.
2. Find the last documented negative BI first. That date is the boundary: instruments sterilized before it, with passing chemical/physical indicators, are usable. Everything after it is quarantined - labelled with load date, not dumped back into operatory supply.
3. Quarantine all three loads. Do not 'just run them again' from the shelf: items must be cleaned before resterilization. Bioburden left to dry over a weekend will defeat the next cycle, so treat them as contaminated and reprocess through the full clean-then-sterilize workflow once the unit is back in service.
4. Return-to-service is not one passing test. Follow manufacturer and state board guidance, which is commonly repair, then three consecutive negative BIs (with a control) before patient care resumes.
5. Protect the 8:00 crown seat. Build the case from pouches or inventory that came from a verified load. If no such inventory exists, the crown seat is elective - reschedule it. A flash cycle or a chemical soak does not substitute for a validated chamber.
6. Document the BI result, the quarantined loads, the corrective action, and the service call, and tell the dentist before the schedule is confirmed.

The question is what that patient was actually exposed to, item by item, not a blanket yes or no.

• The surgical kit is a critical item, but the procedure placed no implant, graft, or other implantable biologic. Patient-notification guidance centres on implantable items and devices, where a sterilization failure cannot be corrected afterwards by reprocessing. A used, unverifiable extraction kit creates a theoretical bloodborne-pathogen concern that is very low, and routine notification is not the standard answer.
• The decision belongs to the dentist, not the assistant, and it should be written in the chart with the load reference and the date, including the reasoning.
• Consider whether the state dental board's infection-control rules impose a notification duty - this is where the assistant should check rather than assume.
• The restorative loads and the handpiece load have no patient-level traceability at all. That gap is itself a finding to raise at the staff meeting; without load records you cannot even answer the question for the next failure.
• Say plainly in the record what is known and what is not known. Do not write an assurance the office cannot support.

Rank the options by whether the sterility claim can be verified.

1. Borrow or lease a tabletop sterilizer - but only after it passes a BI. A machine with no biological validation is no better than the failed one. Check that it can handle the pouch sizes and handpiece lumens the office uses.
2. Use only stock sterilized in verified loads, plus single-use/disposable instruments where acceptable. That may cover simple exams and some hygiene, not surgical or restorative volume.
3. Refer or reschedule elective treatment. Six patients is not a reason to lower the standard; it is a reason to call patients before they arrive.
4. Chemical sterilants are a last resort for heat-sensitive items only, with the full label immersion time, temperature, concentration monitoring, and rinsing - never a 'dip and wipe,' and never a routine replacement for a chamber.

Shortcuts that are not defensible: restarting the failed unit and guessing, using a flash/rapid cycle on an unvalidated chamber, wiping instruments with a disinfectant and calling them sterile, or using instruments from a quarantined load because the pouch 'looks sealed.' Tell the dentist the real capacity before the day's schedule is confirmed, and document the interim plan.