Guides · Dental sterilization

The Bowie-Dick test: which dental sterilizers need it, and how often

Which sterilizers need the test

A Bowie-Dick test checks one thing: air removal. It is performed in an empty dynamic-air-removal steam sterilizer to ensure air removal (CDC, 2008 disinfection and sterilization guideline). Prevacuum sterilizers are the units tested for adequate air removal (CDC, 2003 dental infection-control guidelines).

A gravity-displacement sterilizer has no dynamic air-removal step for this test to check. If you are not sure which kind you own, the cycle name in your manual is the fastest tell: a prevacuum or vacuum-assisted cycle pulls air out before steam goes in.

How often to run it

The two CDC texts differ on frequency, so here they are side by side.

• 2008 guideline: an air-removal test (Bowie-Dick Test) must be performed daily in an empty dynamic-air-removal sterilizer (e.g., prevacuum steam sterilizer) to ensure air removal (CDC, 2008 disinfection and sterilization guideline).
• 2003 dental guidelines: prevacuum sterilizers should be tested periodically for adequate air removal, as recommended by the manufacturer (CDC, 2003 dental infection-control guidelines).

CDC's dental monitoring page gives both texts as the places its sterilization-monitoring recommendations live: the 2008 guideline, and pages 24 to 25 of the 2003 dental guidelines (CDC, dental sterilization-monitoring page, 2024).

Dental Logbook treats the test as due on each day of use, before the first load — the stricter of the two readings. In the logbook, the office records the test its own manufacturer specifies: a Bowie-Dick pack or a process challenge device.

When else the test runs

The 2008 guideline also uses the test when a sterilizer is qualified: on installation, when the sterilizer is relocated or redesigned, after major repair, and after a sterilization failure has occurred (CDC, 2008 disinfection and sterilization guideline). At those events, three consecutive empty steam cycles are run with a biological and chemical indicator in an appropriate test package or tray, and each type of steam cycle used (e.g., vacuum-assisted, gravity) is tested separately (CDC, 2008 disinfection and sterilization guideline). In a prevacuum steam sterilizer, three consecutive empty cycles are also run with a Bowie-Dick test (CDC, 2008 disinfection and sterilization guideline).

Air-removal testing for prevacuum steam sterilizers is one part of a quality-control program for sterilized items, which also includes a sterilizer maintenance contract with records of service (CDC, 2008 disinfection and sterilization guideline).

If the test fails

If a sterilizer fails the air removal test, it should not be used until inspected by sterilizer maintenance personnel and it passes the test (CDC, 2003 dental infection-control guidelines). In practice that is three moves:

1. Stop using the sterilizer (CDC, 2003 dental infection-control guidelines).
2. Have it inspected by sterilizer maintenance personnel (CDC, 2003 dental infection-control guidelines).
3. Run the air-removal test again, and use the unit only once it passes (CDC, 2003 dental infection-control guidelines).

A good log keeps the failed test, the service record and the first passing retest together, so the gap in use is easy to explain later.

What your state rules add

State boards reach this guidance in different ways. New Jersey, Pennsylvania and Georgia hold dentists to CDC's infection-control recommendations, so the air-removal guidance above reaches your office through those state rules (New Jersey rule 13:30-8.5; Pennsylvania rule 49 Pa. Code 33.211; Georgia rule 150-8-.01).

Florida's dental sterilizer rule sets no air-removal schedule of its own; the 2008 CDC guideline is adopted there by reference for other parts of the rule, not for this one (Florida rules 64B5-25.002 and 64B5-25.003). New York's rules do not address air-removal testing (New York rules of the Board of Regents, 8 NYCRR part 29).

What to record

A good air-removal record is one short entry per test:

• date and time, entered before the first load of the day;
• the test used — a Bowie-Dick pack or a process challenge device — and its lot;
• pass or fail;
• the operator's name or initials;
• after a failure: the service call and the first passing retest.

Dental Logbook will ask for the day's air-removal test before the first load on each pre-vacuum unit, and keep that result beside the day's load records.