| FAQ - Disinfection - 2013
Is it a requirement either by OSHA /EPA or recommendation to use a medium to high level disinfectant that is tuberculocidal (TB) at a Dental clinic or facility? This hospital switch to a disinfectant that is not tuberculcidal (TB). Thanks.
The 2003 CDC guidelines for infection control in dentistry states as follows:
Clinical Contact Surfaces
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
• light handles,
• dental radiograph equipment,
• dental chairside computers,
• reusable containers of dental materials,
• drawer handles,
• faucet handles,
• telephones, and
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 (260,288). 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 (1,2,288).
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 (2,244). 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 (13). To facilitate daily cleaning, treatment areas should be kept free of unnecessary equipment and supplies.
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 (289). 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
Noncritical patient-care items pose the least risk of transmission of infection, contacting only intact skin, which can serve as an effective barrier to microorganisms. In the majority of cases, cleaning, or if visibly soiled, cleaning followed by disinfection with an EPA-registered hospital disinfectant is adequate. When the item is visibly contaminated with blood or OPIM, an EPA-registered hospital disinfectant with a tuberculocidal claim (i.e., intermediate-level disinfectant) should be used (2,243,244). Cleaning or disinfection of certain noncritical patient-care items can be difficult or damage the surfaces; therefore, use of disposable barrier protection of these surfaces might be a preferred alternative.
FDA-cleared sterilant/high-level disinfectants and EPA registered disinfectants must have clear label claims for intended
use, and manufacturer instructions for use must be followed
(245). A more complete description of the regulatory framework
in the United States by which liquid chemical germicides are evaluated and regulated is included (Appendix A).
Three levels of disinfection, high, intermediate, and low, are used for patient-care devices that do not require sterility and
two levels, intermediate and low, for environmental surfaces
(242). The intended use of the patient-care item should determine
the recommended level of disinfection. Dental practices
should follow the product manufacturer’s directions regarding
concentrations and exposure time for disinfectant activity relative
to the surface to be disinfected (245). A summary of sterilization and disinfection methods is included (Appendix C).1
OSHA does reference the 2003 CDC guidelines for infection control in dentistry as it pertains to worker safety and health issues. Most states have adopted the 2003 CDC guidelines as part of their regulatory code. OSAP is not necessarily familiar with the regulations in every state. It is also recommended that you check with your State Board of Dental Examiners/Licensing Board or State Health Department/Agency for further information on the regulatory requirements regarding disinfectant use in your state.
Suggested further reading includes:
Appendices A and C to the 2003 CDC guidelines for infection control in dentistry which can be accessed at this link:
Choosing and using surface disinfectants
Sterilization and Disinfection of Dental Instruments
Q&A: All About Surface Disinfectants in the Dental Office
1) Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, Centers for Disease Control and Prevention (CDC). Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep 2003;52(RR-17):1-61. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm Accessed on July 9, 2013.
2) RDH. Choosing and using surface disinfectants. http://www.rdhmag.com/articles/print/volume-31/issue-6/columns/choosing-and-using-surface-disinfectants.html Accessed on July 10, 2013.
3) American dental Association. Sterilization and Disinfection of Dental Instruments. http://www.ada.org/sections/professionalResources/pdfs/cdc_sterilization.pdf Accessed on July 10, 2013.
4) DentalAegis – Inside Dental Assisting. Q&A: All About Surface Disinfectants in the Dental Office. https://www.dentalaegis.com/ida/2013/06/q-a-all-about-surface-disinfectants-in-the-dental-office Accessed on July 10, 2013.