| FAQ - Disinfection - 2014
Do you have any information regarding the cleaning and disinfection of BP cuffs?
The 2003 CDC guidelines for infection control in dentistry states as follows:
Patient-care items (dental instruments, devices, and equipment) are categorized as critical, semicritical, or noncritical, depending on the potential risk for infection associated with their intended use (Table 4) (242). Critical items used to penetrate soft tissue or bone have the greatest risk of transmitting infection and should be sterilized by heat. Semicritical items touch mucous membranes or nonintact skin and have a lower risk of transmission; because the majority of semicritical items in dentistry are heat-tolerant, they also should be sterilized by using heat. If a semicritical item is heat-sensitive, it should, at a minimum, be processed with high-level disinfection (2).
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. 1
Definition: Contacts intact skin.
Dental instrument or item: Radiograph head/cone, blood pressure cuff, facebow, pulse oximeter 1
The CDC also states on its website:
Noncritical instruments and devices only contact intact (unbroken) skin, which serves as an effective barrier to microorganisms.
These items carry such a low risk of transmitting infections that they usually require only cleaning and low-level disinfection. If using a low-level disinfectant, according to OSHA, it must have a label claim for killing HIV and HBV. However, if an item is visibly bloody, it should be cleaned and disinfected using an intermediate-level disinfectant before use on another patient.
· Examples of instruments in this category include X-ray head/cones, facebows, pulse oximeter, and blood pressure cuff. 2
In the document Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommends:
4. Selection and Use of Low-Level Disinfectants for Noncritical Patient-Care Devices
a. Process noncritical patient-care devices using a disinfectant and the concentration of germicide listed in Table 1. Category IB. 17, 46-48, 50-52, 67, 68, 378, 382, 401
b. Disinfect noncritical medical devices (e.g., blood pressure cuff) with an EPA-registered hospital disinfectant using the label’s safety precautions and use directions. Most EPA-registered hospital disinfectants have a label contact time of 10 minutes. However, multiple scientific studies have demonstrated the efficacy of hospital disinfectants against pathogens with a contact time of at least 1 minute. By law, all applicable label instructions on EPA-registered products must be followed. If the user selects exposure conditions that differ from those on the EPA-registered product label, the user assumes liability from any injuries resulting from off-label use and is potentially subject to enforcement action under FIFRA. Category IB. 17, 47, 48, 50, 51, 53-57, 59, 60, 62-64, 355, 378, 382
c. Ensure that, at a minimum, noncritical patient-care devices are disinfected when visibly soiled and on a regular basis (such as after use on each patient or once daily or once weekly). Category II. 378, 380, 1008 3
The American Dental Association states:
3) Non-critical instruments are those that come into contact only with intact skin such as external components of x-ray heads, blood pressure cuffs and pulse oximeters. Such devices have a relatively low risk of transmitting infection; and, therefore, may be reprocessed between patients by intermediate-level or low-level disinfection. An intermediate-level disinfectant is EPA-registered as a "hospital disinfectant" and will be labeled for "tuberculocidal" activity (e.g., phenolics, iodophors, and chlorine-containing compounds). A low-level disinfectant is EPA-registered as a "hospital disinfectant" but is not labeled for "tuberculocidal" activity (e.g., quaternary ammonium compounds). The tuberculocidal claim is used as a benchmark to measure germicidal potency. Germicides labeled as "hospital disinfectant" without a tuberculocidal claim pass potency tests for activity against three representative microorganisms: Pseudomonas aeruginosa, Staphylococcus aureus, and Salmonella choleraesuis 4
In summary, a blood pressure cuff is categorized as a non-critical patient care item. Such devices have a relatively low risk of transmitting infection; and, therefore, may be reprocessed between patients by intermediate-level or low-level disinfection. 4 If you have further questions regarding specific use and maintenance procedures for a specific blood pressure cuff model, it is recommended that you contact the manufacturer of the product directly.
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 March 17, 2014.
2) US Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings—2003---Slide 56: Noncritical Instruments and Devices. http://www.cdc.gov/oralhealth/infectioncontrol/guidelines/slides/056.htm Accessed on March 17, 2014.
3) US Centers for Disease Control and Prevention. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf Accessed on March 17, 2014.
4) American Dental Association. Sterilization and Disinfection of Dental Instruments. https://www.ada.org/members/pdfs/instrument_sterilization.pdf Accessed On March 17, 2014.