A four-chair dental practice in Toronto's Junction area ran a self-audit of its 2025 sterilizer logs and found something uncomfortable: a biological indicator (BI) result was recorded on 71% of the days the autoclaves were actually used. Twenty-nine percent of use-days had no spore test at all. The fix, once the clinic stopped treating it as an administrative task, took about six weeks.
This is a case review drawn from the practice's own logbook and its reprocessing room layout. Names are withheld at the clinic's request. The supply numbers are real; the clinic asked us to review its monitoring consumables at the same time.
What does Ontario require for sterilizer monitoring?
In Ontario, the RCDSO expects a biological indicator inside a process challenge device for each sterilizer on every day that sterilizer is used, and for each type of cycle that is used. The expectation is daily. A once-every-seven-days cadence belongs to the US reference baseline published by CDC and AAMI ST79. That baseline does not describe what is expected here.
The distinction matters because the two cadences produce completely different consumable math. A clinic running two autoclaves five days a week is budgeting 250 to 500 BI tests a year, not 100.
| Monitoring element | Ontario expectation | Typical US reference | What it verifies |
|---|---|---|---|
| Biological indicator | Each sterilizer, each day used, each cycle type | Once every seven days | Spore kill, the closest thing to proof of sterility |
| Chemical indicator | Every load | Every load | Package-level and load-level parameter exposure |
| Physical monitoring | Every cycle, logged | Every cycle, logged | Time, temperature and pressure trace |
Where did the 29% of missing days come from?
Three causes, in order of size. A Monday-morning backlog was the largest: the Monday load was run at 7:40 a.m. before the clinical day, and staff treated the Friday kit's remaining BI as covering it. Second, the practice ran two cycle types but tested only one, so the 134C flash cycle had almost no record. Third, BI results were recorded on paper that was filed but never reconciled against the sterilizer's own cycle printout.
What did the clinic change, and in what order?
Week one was reporting, not spending. The office manager printed a one-page reconciliation sheet with one line per use-day and one column per sterilizer. Week two moved the BI storage box next to the autoclave instead of the supply closet, which sounds trivial until you watch how often the test is skipped because someone would have to walk down a hall.
Weeks three and four standardised the reorder point. The clinic had been ordering BI in 25-packs on a reactive basis; it switched to a 100-pack with a two-month buffer, which lowered the cost per test and removed the 'we ran out' excuse.
Weeks five and six added a second log column for cycle type. That single column is what caught the untested flash cycle.
What did the correction cost?
Nothing in equipment. The consumable line went up by roughly 40% because the clinic started testing the days it had previously skipped, and it dropped the per-unit cost by buying in a larger pack. The practice's own estimate was that the higher testing volume cost less than three hours of sterilizer downtime would have, which is the real comparison for a four-chair office.
What should other clinics take from this?
The transferable lesson is not 'test more'. It is that BI testing fails at the point of friction, not the point of intent. Log design, storage placement and reorder point moved the number more than any reminder email. If you want to check your own position, count the days your sterilizers were used last month and compare that against the number of BI results in the log. The gap is your starting number.
Related Reading
- How often to run a spore test: monitoring schedules
- What to do when a biological indicator fails
- Sterilization compliance hub
- RCDSO-compliant sterilization records
- Clinic Starter Bundle
Frequently Asked Questions
How often should a dental office run a spore test in Ontario?
The RCDSO expectation is a biological indicator in a process challenge device for each sterilizer on every day it is used, and for each type of cycle used. Record the result in the sterilizer log.
Can a clinic catch up on missed biological indicator tests?
No. A biological indicator verifies the load that was run, so a missed day cannot be reconstructed afterwards. The clinic in this review was already releasing instruments from the untested days; it moved to preventing the gap rather than documenting it.
Does one biological indicator cover both autoclaves?
No. Each sterilizer needs its own test on each day it is used, because sterilizer performance is unit-specific. A pass on the larger unit says nothing about the smaller unit's vacuum or drainage.
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