| FAQ - Disinfection - Archived Through 2012
We recently heard that there have been some changes in disinfection guidelines for the dental office. Can you send us the guidelines on spray-wipe-spray –vs.- plastic barriers and which areas in the operatory should have what? We are concerned about mirror handles, air/water syringes, suction, etc.
We believe you are referring to the Centers for Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental Healthcare Settings. The CDC revised and updated the guidelines in December 2003. However, there may also be state/local regulations that OSAP would not be aware of. Therefore, you should also check with your State Board of Dental Examiners/Licensing Board for all applicable infection control requirements in your state.
OSAP would like to refer you directly to the guidelines. In part, they state the following:
Clinical contact surfaces can be directly contaminated from patient materials either by direct spray or spatter generated during dental procedures or by contact with DHCP's gloved hands. These surfaces can subsequently contaminate other instruments, devices, hands, or gloves. Examples of such surfaces include (1):
dental radiograph equipment,
dental chairside computers,
reusable containers of dental materials,
Barrier protection of surfaces and equipment can prevent contamination of clinical contact surfaces, but is particularly effective for those that are difficult to clean. Barriers include clear plastic wrap, bags, sheets, tubing, and plastic-backed paper or other materials impervious to moisture. Because such coverings can become contaminated, they should be removed and discarded between patients, while DHCP are still gloved. After removing the barrier, examine the surface to make sure it did not become soiled inadvertently. The surface needs to be cleaned and disinfected only if contamination is evident. Otherwise, after removing gloves and performing hand hygiene, DHCP should place clean barriers on these surfaces before the next patient. (1)
If barriers are not used, surfaces should be cleaned and disinfected between patients by using an EPA-registered hospital disinfectant with an HIV, HBV claim (i.e., low-level disinfectant) or a tuberculocidal claim (i.e., intermediate-level disinfectant). Intermediate-level disinfectant should be used when the surface is visibly contaminated with blood or OPIM. Also, general cleaning and disinfection are recommended for clinical contact surfaces, dental unit surfaces, and countertops at the end of daily work activities and are required if surfaces have become contaminated since their last cleaning. To facilitate daily cleaning, treatment areas should be kept free of unnecessary equipment and supplies. (1)
Manufacturers of dental devices and equipment should provide information regarding material compatibility with liquid chemical germicides, whether equipment can be safely immersed for cleaning, and how it should be decontaminated if servicing is required. Because of the risks associated with exposure to chemical disinfectants and contaminated surfaces, DHCP who perform environmental cleaning and disinfection should wear gloves and other PPE to prevent occupational exposure to infectious agents and hazardous chemicals. Chemical- and puncture-resistant utility gloves offer more protection than patient examination gloves when using hazardous chemicals. (1)
In addition, most dental practices utilize a combination of barriers and between-patient cleaning and disinfection to maintain operatory asepsis and minimize the potential for cross-contamination.
The use of protective barriers generally eliminates the need for surface disinfection during operatory turn-around. However, surfaces must be cleaned and disinfected anytime the barrier has been compromised as well as at the beginning and end of each clinic day.
Environmental surface disinfectants are supplied as concentrates, premixed solutions, sprays, foams, impregnated wipes, and tablets. Pump-sprays, however, are considered the best vehicle for delivering cleaning/disinfecting agents to contaminated surfaces.
The pump concentrates spray liquid on the surface rather than aerosolizing it, which allows the chemical to penetrate into crevices. In addition, spray bottles eliminate potential inactivation or absorption of the disinfectant by gauze, paper, or sponge applicators. (2) (3) (4)
According to dental infection control expert, Dr. Charles Palenik, disinfection is now called environmental infection control. The emphasis has gone away from the primary use of chemicals to one that uses mostly surface covers. In fact, areas that need attention (disinfection or covering) are now called clinical contact surfaces. (5)
The Authors of OSAP's From Policy to Practice: OSAP's Guide to the Guidelines. Copyright 2004, offer the following information:
For pre-cleaning clinical surfaces:
Use a low to intermediate-level disinfectant and the "spray-wipe-spray” technique to clean and disinfect clinical contact surfaces. First clean, then disinfect. Spray the surface to be cleaned with a cleaner or cleaner/disinfectant. Then, wipe vigorously using paper towels. Once cleaned, spray the surface again, this time with a disinfectant. Cover the entire surface, and allow the disinfectant to remain undisturbed on the surface for the contact time indicated on its label. (6)
The authors also offer the following alternative to pre-cleaning clinical surfaces:
Wipe a pre-moistened cleaner-disinfectant towelette over the surface to be cleaned. Check the label to be sure that the wipe is a cleaner (some disinfectant wipes may require a separate cleaner). Carefully follow label instructions. Some wipes may be effective only on a limited surface area (approximately 3 sq. ft.). (6)
After cleaning, disinfect the surface:
Spray the disinfectant over the entire surface, using towels or reduce overspray. Let the surface remain moist for the contact time stated on the disinfectant's label. Wipe the surface dry if it is still wet when ready for patient care. (6)
The authors also offer the following alternative to spraying disinfectants on clinical surfaces:
Saturate the surface using a pre-moistened disinfectant towelette (wipe). Let the surface remain moist for the contact time stated on the disinfectant's label. Wipe the surface dry if it is still wet when ready for patient care. (6)
1) Centers for Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental
2) Infection Control and Management of Hazardous Materials for the Dental Team by
Miller and Palenik. Mosby, 2005.
3) OSAP's Infection Control In Practice: Demystifying Disinfectants, August 2002 and OSAP's
Monthly Focus # 6, 1998
4) Practical Infection Control In Dentistry, 2nd. Ed. By Cottone, Terezhalmy, Molinari. Publisher,
Williams & Wilkins, 1996.
5 Dr. Charles Palenik, MS, PhD. Assistant Director of Infection Control Research and Services.
Indiana University School of Dentistry.
6. From Policy to Practice: OSAP's Guide to the Guidelines. Copyright 2004 by OSAP.