| FAQ - Office Design & Management - 2015
I supervise several dental clinics. Space is at a premium at one of the clinics. We have been asked to install a computer sit/stand work station in one of the dental operatories where dentists can do patient charting and access patient medical info (we are still using paper charts in dental). Providers would use the station instead of the separate office they have now. I fear this could create infection control problems. What are your thoughts?
Ask OSAP can provide you with some general information on this topic. If you have infection control concerns regarding the handling of patient records and a work station, it is recommended that you discuss it with your risk management/infection control/Environment of Care etc. committee. It may also be something that you may want to discuss with the work stand manufacturer.
The 2003 CDC guidelines for infection control in dentistry does reference environmental infection control. In general, these 2003 CDC guidelines state the following regarding environmental infection control:
Environmental Infection Control
In the dental operatory, environmental surfaces (i.e., a surfaceor equipment that does not contact patients directly) canbecome contaminated during patient care. Certain surfaces,especially ones touched frequently (e.g., light handles, unitswitches, and drawer knobs) can serve as reservoirs of microbialcontamination, although they have not been associateddirectly with transmission of infection to either DHCP orpatients. Transfer of microorganisms from contaminatedenvironmental surfaces to patients occurs primarily throughDHCP hand contact (286,287). When these surfaces aretouched, microbial agents can be transferred to instruments,other environmental surfaces, or to the nose, mouth, or eyesof workers or patients. Although hand hygiene is key to minimizingthis transferal, barrier protection or cleaning and disinfectingof environmental surfaces also protects againsthealth-care–associated infections.
Environmental surfaces can be divided into clinical contactsurfaces and housekeeping surfaces (249). Because housekeepingsurfaces (e.g., floors, walls, and sinks) have limited risk ofdisease transmission, they can be decontaminated with less rigorousmethods than those used on dental patient-care itemsand clinical contact surfaces (244). Strategies for cleaning anddisinfecting surfaces in patient-care areas should consider the1) potential for direct patient contact; 2) degree and frequencyof hand contact; and 3) potential contamination of the surfacewith 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 theenvironmental surface safe by removing organic matter, salts,and visible soils, all of which interfere with microbial inactivation.The physical action of scrubbing with detergents andsurfactants and rinsing with water removes substantial numbersof microorganisms. If a surface is not cleaned first, thesuccess of the disinfection process can be compromised.Removal of all visible blood and inorganic and organic mattercan be as critical as the germicidal activity of the disinfectingagent (249). When a surface cannot be cleaned adequately, itshould be protected with barriers (2).
Clinical Contact SurfacesClinical contact surfaces can be directly contaminated frompatient materials either by direct spray or spatter generatedduring dental procedures or by contact with DHCP’s glovedhands. These surfaces can subsequently contaminate otherinstruments, 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 preventcontamination of clinical contact surfaces, but is particularlyeffective for those that are difficult to clean. Barriers includeclear plastic wrap, bags, sheets, tubing, and plastic-backedpaper or other materials impervious to moisture (260,288).Because such coverings can become contaminated, they shouldbe removed and discarded between patients, while DHCP arestill gloved. After removing the barrier, examine the surface tomake sure it did not become soiled inadvertently. The surfaceneeds to be cleaned and disinfected only if contamination isevident. Otherwise, after removing gloves and performing handhygiene, DHCP should place clean barriers on these surfacesbefore the next patient (1,2,288).
If barriers are not used, surfaces should be cleaned and disinfectedbetween patients by using an EPA-registered hospitaldisinfectant 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 whenthe surface is visibly contaminated with blood or OPIM(2,244). Also, general cleaning and disinfection are recommendedfor clinical contact surfaces, dental unit surfaces, andcountertops at the end of daily work activities and are requiredif surfaces have become contaminated since their last cleaning(13). To facilitate daily cleaning, treatment areas should bekept free of unnecessary equipment and supplies.
Manufacturers of dental devices and equipment should provideinformation regarding material compatibility with liquidchemical germicides, whether equipment can be safelyimmersed for cleaning, and how it should be decontaminatedif servicing is required (289). Because of the risks associatedwith exposure to chemical disinfectants and contaminated surfaces,DHCP who perform environmental cleaning and disinfectionshould wear gloves and other PPE to preventoccupational exposure to infectious agents and hazardouschemicals. Chemical- and puncture-resistant utility glovesoffer more protection than patient examination gloves whenusing hazardous chemicals. 1
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 September 2, 2015.
2) Dentalargis.com. Disinfection of Clinical Surfaces.
https://www.dentalaegis.com/ida/2011/10/disinfection-of-clinical-surfaces Accessed on September 2, 2015.
3) 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 September 2, 2015.
4) USAF Dental Evaluation & Consultation Service. Disinfection. http://www.airforcemedicine.af.mil/shared/media/document/AFD-130404-064.pdf Accessed on September 2, 2015.