This review describes an anonymised composite drawn from common findings at small dental practices. Clinic details have been altered.
An eight-person dental practice ran four chairs and one Class B sterilizer. The office had spore test supplies on the shelf and a logbook by the sterilizer, so on paper the practice looked compliant. What the review found was a routine that ran on memory: the biological indicator went in on Mondays, because that was the day the previous office manager had started. Over a five-month period the log showed gaps on the busiest days of the week. This review describes what the gap looked like, why it happened, and the routine the practice adopted.
What Did the Monitoring Routine Actually Look Like?
The practice tested the sterilizer once a week, usually on Monday, and logged the result. The physical log was complete for the weeks the manager was present and blank for two weeks when she was on leave. No backlog of tests was run when she returned.
The gap matters because Ontario expectations are not weekly. A clinic cannot assume a weekly rhythm because US guidance describes one, and the source of that confusion is worth stating plainly: the weekly baseline is the CDC and AAMI ST79 standard used in most US states. When the practice reviewed its own obligation, it found the provincial expectation is tighter, and the log did not reflect it.
Why Did the Gap Stay Invisible for Months?
Three conditions let the gap persist, and all three are common.
- The task belonged to one person. When that person was away, the test was simply skipped rather than reassigned.
- The log was paper and undated by habit. Entries were sometimes written the following week, so the record looked continuous.
- Nothing else depended on the result. No load release decision was tied to the test, so a missing test never blocked work.
None of these is a training failure. They are design failures in the routine, and they are the reason a practice can pass a visual inspection while carrying a real gap.
What Should the Daily Routine Have Looked Like?
A monitoring routine holds up when each layer answers a different question and each step leaves a record the next person can see. The practical structure is short:
| Layer | Question it answers | Record |
|---|---|---|
| External indicator on every pack | Did this pack go through a cycle? | Written or printed in the load log |
| Internal indicator inside the pack | Did the inside of the pack reach conditions? | Checked at the point of use |
| Biological indicator | Did the cycle achieve microbial kill? | Incubation result logged per sterilizer |
| Air removal test | Was air removed before steam entered? | Logged on the schedule the sterilizer requires |
| Physical parameters | Were temperature, pressure and time as expected? | Printed cycle record filed |
What Did the Practice Change?
- It moved the biological indicator into the daily opening routine, tied to the same checklist that unlocks the sterilizer.
- It named a deputy, so the test happens when the primary staff member is away.
- It replaced the loose logbook with a dated sheet that has one line per sterilizer per day, so a blank gap is visibly blank.
- It recorded the incubation result with a time stamp, not just an initial.
- It reviewed the log monthly for gaps rather than waiting for an inspection.
The change cost nothing beyond stationery. The measurable difference was that a missing test now looks like a missing line, which the next person notices before the day ends.
What Should Other Small Practices Take From This?
Three takeaways transfer directly. First, attach the test to something that already happens every day, because a standalone task depends on memory. Second, always name a deputy for a monitoring step; practices rarely have a single person who is never away. Third, make the record self-revealing — a dated grid with one row per sterilizer per day turns an invisible gap into an obvious one.
If the practice had been monitoring with a fast-readout indicator and a dry block incubator, the daily step would have taken a few minutes at the start of the day rather than being deferred to a weekly slot. That is the practical argument for a routine designed around one test per sterilizer per day, on every day the sterilizer is used.
For what to do when a test fails, see our step-by-step protocol for a failed biological indicator test, and for record keeping across the two markets see our note on spore testing documentation in Canada and the US.
Related reading
Handling a failed biological indicator test · Spore testing documentation in Canada and the US · Dental compliance hub
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Frequently Asked Questions
How often should a dental office run a spore test in Ontario?
The expectation in Ontario is a biological indicator for each sterilizer on every day it is used, which is daily monitoring. The weekly interval is the CDC and AAMI ST79 baseline in most US states.
What happens if a spore test is skipped?
A skipped test leaves a gap in the record, and loads released during that period have no biological verification. The practical response is to test immediately and review which loads were released while the gap was open.
Who should be responsible for the daily spore test?
Name a primary owner and a deputy. A single owner without a backup is the most common cause of a gap during leave or a busy morning.
Does a fast-readout biological indicator change the routine?
It shortens the time to a result, which makes a daily step easier to complete inside the opening routine. The frequency of testing does not change.
CliniEco Medical is a licensed medical device establishment (MDEL #35334).
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