In-office or mail-in spore testing: how each works and what to record

What a spore test is

A spore test is the biological check on a sterilizer: the test indicator goes through a cycle, and a control biological indicator, from the same lot as the test indicator and not processed through the sterilizer, should be incubated with the test indicator (CDC, 2003 dental infection-control guidelines). The control is what makes the result readable, which is why every record below asks for the control and its result as well as the test.

How in-office spore testing works

In-office biological monitoring is available (CDC, 2003 dental infection-control guidelines). In practice the whole test stays inside your office: staff set up the test and its control, incubate them together, read the result on site, and write it down the same day. Nothing is mailed, and the person who read the result is usually the person who enters it.

How mail-in spore testing works

Mail-in sterilization monitoring services (e.g., from private companies or dental schools) can also be used to test both the biological indicator and the control (CDC, 2003 dental infection-control guidelines). In practice the steps move off site: staff run the load, prepare the test and control for the service, and send them; the service tests both and reports the result. What comes back is a report made outside your office, carrying its own dates and identifiers.

Choosing between the two

What stays the same is the test itself and its schedule: monitor sterilizers at least weekly by using a biological indicator with a matching control (i.e., biological indicator and control from same lot number) (CDC, 2003 dental infection-control guidelines). The same guidance says in-office biological monitoring is available and that mail-in services can also be used to test both the indicator and the control (CDC, 2003 dental infection-control guidelines), so choosing between them is a practice decision: how your sterilization area runs, who has time to incubate and read, and how you want the record to arrive.

How often to test

• 1Correct functioning of sterilization cycles should be verified for each sterilizer by the periodic use (at least weekly) of biological indicators (CDC, 2003 dental infection-control guidelines).
• 2Each test runs with a matching control: a biological indicator and control from the same lot number (CDC, 2003 dental infection-control guidelines).
• 3A biological indicator (i.e., spore test) is used at least weekly and with every load containing implantable items (CDC, Infection Prevention Checklist for Dental Settings).
• 4For a sterilizer that is used on a part-time basis, the guidance is silent: CDC does not provide a separate recommendation for sterilizers that are used on a part-time basis (CDC, Best Practices for Sterilization Monitoring in Dental Settings). This page does not fill that gap with a guess.

Note the wording in the first point: it is at least weekly, and this page keeps that limit. Testing more often is not ruled out.

What this guide covers

Every sentence on this page that states a rule ends with its source in plain words, and the sources named here are CDC documents. Where sources disagree, this page says so plainly and never picks a side silently; on the points covered above, the CDC documents named here agree. Where a state's rules are silent on spore testing, that state is silent, and this page does not invent a requirement to fill the silence.

What to record

Whatever route you take, the record is what proves the test happened. Whether you incubate in-house or mail the test out, a good log keeps the same fields:

• Sterilizer and cycle. The sterilizer and the cycle type the test rode in, and whether it was a routine load or a load containing an implantable device.
• The indicator. The biological indicator's product name, lot number and expiry date.
• The control. Whether the control came from the same lot (yes or no) and what its result was. A good log treats control growth as a valid test.
• The method. In-office: the incubation start time and the read time. Mail-in: the lab, the date sent, the report ID and the date received.
• The result. Negative, positive or invalid; the date it was read; and who entered the record.
• The proof. The lab report or the in-office read result, attached to the entry.

Dental Logbook will keep these fields as its default record for every spore test, whichever route the office takes. A good log carries no patient names; it traces loads by the load number, and an office that ever needs to trace patients does that in its own charts.