Ensure the Success of Sterilization

Autoclave tape is an external indicator designed for use on the outside of packages only, and should not be placed internally. External indicators applied to the outside of a package, such as autoclave tape or special markings, change color when a specific parameter is reached, and they verify that the package has been exposed to heat. The proper storage of external indicators is critical because they can change color when left near a warm source.   Autoclave tape can be particularly problematic because it often changes to the striped pattern following a brief exposure to steam. Color changes for external indicators do not mean that sterilization has been achieved. External indicators are primarily used to identify packages that have been exposed to heat, thus preventing the accidental use of unprocessed items.1   Internal chemical indicators should be used inside each package to ensure the sterilizing agent has penetrated the packaging material and actually reached the instruments inside. A single-parameter internal chemical indicator provides information regarding only one sterilization parameter (eg, time or temperature), whereas multiparameter indicators are designed to react to two or more factors (eg, time and temperature or time, temperature, and the presence of steam). A multiparameter internal chemical indicator can provide a more reliable indication that sterilization conditions have been met,1 but they are available only for steam sterilizers (ie, autoclaves).2 Today, many pouches on the market feature built-in internal and external indicators.   The United States Centers for Disease Control and Prevention's (CDC) "Guidelines for Infection Control in Dental Health-Care Settings—2003" state the following: "Chemical indicators, internal and external, use sensitive chemicals to assess physical conditions (eg, time and temperature) during the sterilization process. Although chemical indicators do not prove sterilization has been achieved, they allow detection of certain equipment malfunctions, and they can help identify procedural errors."2 The guidelines also assert that spore testing is integral to monitoring the sterilization process because it determines whether resistant microorganisms are present instead of just noting that the parameters necessary for sterilization have been met.   Chemical indicators, as well as spore testing, are critical to ensuring that the sterilization process has been successful, thus protecting the safety of both patients and clinicians in the dental setting.   References 
Molinari JA, Harte JA. Cottone's Practical Infection Control in Dentistry. 3rd ed. Baltimore: Lippincott Williams & Wilkin; 2010:160.
Kohn WG, Collins AS, Cleveland JL, et al. Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep. 2003;52:1–61.