Sterilization Monitoring Service 305 W. 12th Avenue, Postle Hall 3127 Order Form Columbus, OH 43210 Name of Practice/Business New Customer? SMS Number Yes (Current Customers) Street Address No

City State Zip

Phone Fax

Contact Person Business Email Address

SPORE STRIPS/BIOLOGICAL MONITORING Price Quantity TOTAL 50 TESTS (Weekly Testing) $225 per machine $

12 TESTS (Monthly Testing) $125 per machine $

INTEGRATOR STRIPS Class V Integrators – 100 Strips $29 $

Class V Integrators – 1000 Strips $250 $

WATERLINE TESTING 1-3 Tests $30 each $

4-8 Tests $27 each $

9-12 Tests $25 each $

13-25 Tests $23 each $

>26 Tests $22 each $

TOTAL AMOUNT DUE $

CHECK Mail to: Sterilization • Include “SMS” and SMS number on memo of check. Monitoring Service • Make check payable to The Ohio State University (Address above)

CREDIT CARD BILLING ZIP CODE ______Charge by Phone 614-292-6737 888-476-7678 NUMBER, EXP DATE (Month/Year) Spore Strip and Waterline Test Instructions

Spore Test Information Waterline Kit Information • Red are used to submit spore • Waterline test kits come in a 9x12 envelope tests run in steam autoclaves or chemical with a smaller padded envelope inside. The sterilizers padded envelope will include sterile sample collection tubes and an ice pack. The • Gray envelopes are used to submit spore sample tubes will be in a plastic . tests run in dry heat ovens • Place the ice pack in a freezer as soon as • The left flap is sealed and labeled you receive it. CONTROL STRIP. The left pocket contains a spore strip that is not removed and not • Do not open the sample tubes until you are sterilized. ready to collect your water sample. • The right flap is open and labeled TEST STRIP. The test strips are found in the open Waterline Sample Collection right pocket. • It is important to wear gloves for water collection. You will also need to put on a Strip Expiration Date new pair between each waterline. The strip expiration date is indicated on each • When you are ready to collect the sample, envelope. Tests run after this date will be flush the waterline for 2 minutes. It is helpful invalid. to use a timer for this step. Spore Testing Instructions • Remove the screw-top cap from the sample , and collect water into the tube. Fill the 1. Remove TEST STRIP from right pocket of tube to the top, but just enough so that the envelope. Do not remove the spore strip cap can be placed back on easily. Repeat from the glassine film. for each waterline. 2. Place test strip in bag, pouch, or cassette in • Return the sample tubes to the the middle of your sterilizer containing a and put the bag back inside the padded regular load of instruments and run the mailer. Place the ice pack inside the sterilizer. padded mailer, but outside the plastic 3. Remove test strip from the sterilizer, take . This will ensure the stay on the out of the bag, pouch, or cassette and sample tubes. replace it in the right pocket of the red • Send your samples back to SMS using the envelope. Close the flap. shipping provided. Schedule a UPS 4. Fill in the required information on envelope: pickup for the package. Test date and operator name. 1. If you have one piece of equipment, circle “1” next to the type of unit. Multiple units may then be identified as numbers 2, 3, etc. 5. Affix postage and mail the same day. SHIP TO: Sterilization Monitoring Service 305 W. 12th Avenue Postle Hall 3127 Columbus, OH 43210