A 120-bed long-term care home in Ontario cut recorded cross-contamination events from seven in one quarter to two in the next by rebuilding three routines: a biological indicator for each sterilizer on every day it is used, a load log that matched every cycle, and a pouch seal check before every run. None of the changes required new sterilizers. The review below follows the home's own reprocessing logs and its infection prevention and control (IPAC) surveillance summary across 90 days. Facility identifiers are withheld at the home's request, and the figures are the home's own records rather than a benchmark for other sites.
The consumable that did most of the work was the 24-hour self-contained biological indicator. The home had been buying indicators, but it was not using them per load or recording the results in a way an inspector could follow. That gap, not equipment failure, was the root cause of most of the events in the baseline quarter.
What did the baseline review find in the first 30 days?
Three reprocessing areas served 120 residents: a treatment room, a mobile cart, and a shared utility room with two small steam sterilizers. The review team read 90 days of logs and walked every cycle type. Four findings repeated:
- Loads without a matching log line. About one in five cycles had no entry for the operator, load number or cycle type. When a nurse later needed to trace an instrument set, the paper trail stopped at the autoclave door.
- One indicator for several loads. Staff ran up to four loads before placing a single indicator, on the reasoning that the loads were “the same instruments”. They were not: wrapped sets, loose instruments and porous items were mixed.
- Pouches sealed over a fold. Seals crossed the gusset on a share of pouches, which produced channels that opened during handling. The sealer itself held temperature; the placement did not.
- Indicators stored beside the sterilizer. Vials sat on a shelf above the unit where heat and humidity are highest, which is the wrong place for a product containing live spores.
Which three changes moved the numbers?
The home chose changes it could hold to on a busy shift, rather than a full rebuild of the room.
| Change | Before | After 90 days |
|---|---|---|
| Indicator per load | 1 indicator for up to 4 loads | 1 indicator per load, with a process challenge device |
| Log completeness | 61% of cycles fully documented | 98% of cycles fully documented |
| Seal checks | Visual check only, no record | Peel check recorded at the start of each shift |
| Recorded cross-contamination events | 7 per quarter | 2 per quarter |
Staff also moved indicator storage to a closed cupboard away from the sterilizer and started a simple weekly stock check. Both actions are cheap and both are easy to audit.
How was the 90-day rollout sequenced?
Days 1 to 30: measure and clean up. The team fixed the log format first, because you cannot improve what you cannot read. Every cycle got a load number, an operator initial, a cycle type and a result field. The home used the printable sterilization log as the paper template for the first month, then moved to the log generator so fields could not be skipped.
Days 31 to 60: fix the physical workflow. Pouches were sealed at least 25 mm from the edge and never across a fold. Wrapped sets were separated from loose instruments. A quarantine shelf was marked for loads awaiting a readout, and no instrument left that shelf until the result was recorded.
Days 61 to 90: verify and train. Two staff per shift were trained on reading and recording a spore test, including what to do when a result is positive. The home ran a short drill: a deliberately positive control vial was logged, the quarantine rule was applied, and the recall path was walked through without a real failure.
What did the home get wrong at first?
Two mistakes are worth copying into any plan. First, the team initially placed the indicator on the chamber floor, where it heats faster and is not representative of a wrapped pack. A process challenge device placed in the load is the point. Second, the home tried to read 24-hour indicators at the end of the same shift. A 24-hour product needs 24 hours; squeezing the readout to fit a shift produces false reassurance, not data. Rapid-readout products exist for teams that need a faster answer, and a lab or high-volume clinic can justify them, but a small home can work with 24-hour vials if the quarantine rule is real.
For Ontario dental settings the frequency question has a clear answer: in Ontario, the RCDSO requires a biological indicator for each sterilizer on every day it is used, with results recorded in a logbook. The home in this review adopted the same daily standard for its two sterilizers, even though long-term care is inspected under a different framework, because daily monitoring is easier to staff than a mixed schedule.
Related reading
- How often should you run a spore test in a dental office in Ontario?
- Storage, shelf life and lot tracking of biological indicators
- Biological indicator failures in Canadian dental offices: what reported data shows
Download the printable sterilization log, or build a cycle sheet for your team with the log generator. Ask a Compliance Specialist at our consultation desk. Ordering for a home, clinic or lab? Wholesale and multi-site ordering covers account setup for institutional buyers. Start with a five-strip biological indicator sample request before you commit to a case quantity. Reselling? become a distributor.
Frequently Asked Questions
How often should a long-term care home run a biological indicator?
Run one for each sterilizer on every day it is used, and for each cycle type in use. That daily pattern matches the Ontario dental standard and is simple to staff. A weekly schedule is the CDC and AAMI ST79 baseline in most US states, not the Ontario expectation.
What must a sterilization log record?
Record the date, sterilizer identifier, cycle type, load number, operator, the biological indicator lot and result, and any deviation such as a wet load or an interrupted cycle. If a result cannot be traced to a load, the log is not doing its job.
Can a load be released before the spore test result is read?
Only with a documented release policy that includes quarantining the load and a recall path if the result is positive. Many homes release instruments for immediate care and hold the record; if a positive result arrives later, the items must be traced and reprocessed. Whatever rule you choose, write it down and train to it.
How long does a 90-day reprocessing review take to set up?
Plan one working day to read existing logs and walk the workflow, then 90 days to run the changes with a monthly check. The measurement work is front-loaded; the behaviour change is what takes the full quarter.
CliniEco Medical is a licensed medical device establishment (MDEL #35334).
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