| FAQ - Disinfection - 2014
I wonder if you can help me with something – We are looking for information that supports that alcohol wipes are not suitable for use in wiping down the operatory.
In general, the 2003 CDC guidelines for infection control in dentistry states as follows:
Environmental Infection Control
In the dental operatory, environmental surfaces (i.e., a surface or equipment that does not contact patients directly) can become contaminated during patient care. Certain surfaces, especially ones touched frequently (e.g., light handles, unit switches, and drawer knobs) can serve as reservoirs of microbial contamination, although they have not been associated directly with transmission of infection to either DHCP or patients. Transfer of microorganisms from contaminated environmental surfaces to patients occurs primarily through DHCP hand contact (286,287). When these surfaces are touched, microbial agents can be transferred to instruments, other environmental surfaces, or to the nose, mouth, or eyes of workers or patients. Although hand hygiene is key to minimizing this transferal, barrier protection or cleaning and disinfecting of environmental surfaces also protects against health-care–associated infections.
Environmental surfaces can be divided into clinical contact surfaces and housekeeping surfaces (249). Because housekeeping surfaces (e.g., floors, walls, and sinks) have limited risk of disease transmission, they can be decontaminated with less rigorous methods than those used on dental patient-care items and clinical contact surfaces (244). Strategies for cleaning and disinfecting surfaces in patient-care areas should consider the 1) potential for direct patient contact; 2) degree and frequency of hand contact; and 3) potential contamination of the surface with body substances or environmental sources of microorganisms (e.g., soil, dust, or water).
Cleaning is the necessary first step of any disinfection process. Cleaning is a form of decontamination that renders the environmental surface safe by removing organic matter, salts, and visible soils, all of which interfere with microbial inactivation. The physical action of scrubbing with detergents and surfactants and rinsing with water removes substantial numbers of microorganisms. If a surface is not cleaned first, the success of the disinfection process can be compromised. Removal of all visible blood and inorganic and organic matter can be as critical as the germicidal activity of the disinfecting agent (249). When a surface cannot be cleaned adequately, it should be protected with barriers (2).
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
The US Environmental Protection Agency (EPA) has information on its website regarding selected EPA-registered disinfectants which can be accessed here:
As stated above, in order to comply with the 2003 CDC guidelines:
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). 1
If the product in question is not registered as an EPA-registered disinfectant, then it does not comply with the 2003 CDC guidelines. If the specific type of alcohol that you are referencing in its isolated form (it is assumed that is what is being referred to) is not registered with the EPA for use as a surface disinfectant, then it is inappropriate for that type of use in the dental setting.
Additionally, Infection Control and Management of Hazardous Materials for the Dental Team notes:
Use of a water –based disinfectant is reported to provide better cleaning of biological material, such as blood, than use of an alcohol-based disinfectant. For dental infection control, a water-based surface disinfectant that is Environmental Protection Agency (EPA)-registered and tuberculocidal (such as iodophors, phenolics, or chlorine) is appropriate if used as directed by the manufacturer and careful precleaning is performed. 3
The US Centers for Disease Control and Prevention (CDC) in Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 offers additional information regarding alcohols which includes:
The documented shortcomings of alcohols on equipment are that they damage the shellac mountings of lensed instruments, tend to swell and harden rubber and certain plastic tubing after prolonged and repeated use, bleach rubber and plastic tiles 482 and damage tonometer tips (by deterioration of the glue) after the equivalent of 1 working year of routine use 512. Tonometer biprisms soaked in alcohol for 4 days developed rough front surfaces that potentially could cause corneal damage; this appeared to be caused by weakening of the cementing substances used to fabricate the biprisms 513. Corneal opacification has been reported when tonometer tips were swabbed with alcohol immediately before measurement of intraocular pressure 514. Alcohols are flammable and consequently must be stored in a cool, well-ventilated area. They also evaporate rapidly, making extended exposure time difficult to achieve unless the items are immersed.4
A Google search using the terms “use of alcohol as a surface disinfectant” may also provide some useful information:
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 May 16, 2014.
2. US Environmental Protection Agency. Selected EPA-registered Disinfectants. http://www.epa.gov/oppad001/chemregindex.htm Accessed on May 16, 2014.
3. Centers for Disease Control and Prevention. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. http://www.cdc.gov/hicpac/disinfection_sterilization/6_0disinfection.html Accessed on May 16, 2014.
4. US Miller CH. Infection Control and Management of Hazardous Materials for the Dental Team, 5th edition. Elsevier/Mosby Publishers. Page 159.
5. Google.com. Search terms - Use of alcohol as a surface disinfectant. https://www.google.com/#q=use+of+alcohol+as+a+surface+disinfectant+ Accessed on May 16, 2014.