| FAQ - Disinfection - 2015
I am trying to find a surface cleaner/disinfectant or high level sterilant that can be used in an ultrasonic that has the best kill profile. I would like to keep my instruments in this for about 10-15 min. I also want it to be economical, possibly a product that can be diluted in water. I also plan to change the solution daily. I have considered Product A but to fill an ultrasonic daily with this would be too expensive. Product B seems like a good option. I have considered Product C but I am not sure if this can be used in an ultrasonic and it seems that you have to test it daily for concentration strength. Do you have a recommendation on how all this should be done. I just want the process of cleaning and decontamination to be as streamlined and safe as possible and I would like to make sure I can maximize my disinfection before I put all of my instruments in the autoclave.
Ask OSAP does not review, evaluate, certify, recommend or endorse products. Ask OSAP also does not provide technical support for specific products. If you have further questions about procedures and specific products it is recommended that you consult with the manufacturer’s written instruction manual and/or contact the manufacturer of the product directly. Ask OSAP would also like to note that an excellent opportunity to gather information, meet with manufacturers and ask questions is during OSAP events such as the Annual Symposium and January CORE training course. Ask OSAP can provide you with some general information regarding surface disinfectants.
In general, the 2003 CDC guidelines for infection control in dentistry states the following regarding environmental infection control:
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
Appendix A to the 2003 CDC guidelines for infection control in dentistry offers general information regarding the Regulatory Framework for Disinfectants and Sterilants and can be accessed at this link:
The US Environmental Protection Agency (EPA) website has links to the following information which you may find to be helpful:
Selected EPA-registered Disinfectants
You may also find the articles below to be of interest:
Disinfection of Clinical Surfaces
Choosing and using surface disinfectants
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 January 23, 2015.
2) US Environmental Protection Agency. Selected EPA-registered Disinfectants
http://www.epa.gov/oppad001/chemregindex.htm Accessed on January 23, 2015
3) Dentalargis.com. Disinfection of Clinical Surfaces.
https://www.dentalaegis.com/ida/2011/10/disinfection-of-clinical-surfaces Accessed on January 23, 2015.
4) RDH Magazine. Choosing and using surface disinfectants.
http://www.rdhmag.com/articles/print/volume-31/issue-6/columns/choosing-and-using-surface-disinfectants.html Accessed on January 23, 2015.
5) USAF Dental Evaluation & Consultation Service. Disinfection. http://www.airforcemedicine.af.mil/shared/media/document/AFD-130404-064.pdf Accessed on January 23, 2015.