| FAQ - Sterilization - Archived Through 2012
After recently introducing the spray-wipe-spray technique in our practice, many of our staff began experiencing allergic reactions from the airborne spray. Although proper precautions and PPE are being used, the staff is complaining about itchy, watery eyes, nose, and mouth irritation. My understanding is that OSHA mandates the spray-wipe-spray technique. My question is, due to the significant problems I am encountering from this technique, is there an alternative for disinfection? I could not locate any other information in the regulatory compliance manual or other OSHA safety manuals.
OSAP would like to refer you directly to the Centers for Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental Healthcare Settings (December 2003). The guidelines in part, state:
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. 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. To facilitate daily cleaning, treatment areas should be kept free of unnecessary equipment and supplies. (1)
The Centers for Disease Control and Prevention's Infection Control Guidelines for Dental Healthcare Facilities provides additional information concerning disinfectants. This report is intended to provide overall guidance for providers to select general classifications of products based on certain infection-control principles. In this report, CDC provides guidance to practitioners regarding appropriate application of EPA- and FDA-registered liquid chemical disinfectants and sterilants in dental health-care settings. CDC's Framework for Disinfectants and Sterilants may be viewed at:
CDC's Methods for Sterilizing and Disinfecting Patient Care Items and Environmental Surfaces may be viewed at:
The United States Air Force Dental Investigation Service has an excellent surface disinfecting fact sheet that may be viewed at:
Intermediate level surfaces disinfectants should be acceptable if they meet certain criteria, such as, being a chemical germicide registered with the EPA as a ‘hospital disinfectant' and labeled for tuberculocidal (i.e., mycobactericidal) activity. In addition, the chemical should have the ability to inactivate HIV and Hepatitis. It should be compatible with equipment, devices, and materials the disinfectant will contact and be suitable for use as a cleaner and a disinfectant.
You may view Appendix A: Regulatory Framework for Disinfectants and Sterilants at:
It is important to always follow the disinfectant's label and directions for proper handling, use, PPE, disposal, and other warnings associated with the product. You should also consult the product's Material Safety Data Sheet (MSDS) for further information, including any potential hazards associated with the agent (including any known health risk/hazards).
Appropriate personal protective equipment must be utilized during operatory clean-up procedures. Heavy-duty utility gloves, a mask, protective clothing, and protective eyewear should be worn when cleaning and disinfecting environmental surfaces to protect skin and mucous membranes from chemicals and hazardous or infectious materials.
As an alternative to between-patient disinfection, environmental surfaces may be covered and protected with fluid-resistant barriers. They should be considered as disposable items that are removed, discarded, and replaced between each patient. (1) (2) (3) (4)
It is a personal choice as to whether or not a practice utilizes protective barriers. If a practice chooses not to use barriers, exposed environmental surfaces subject to blood and/or saliva contamination must be cleaned and disinfected between patients.
Most dental practices utilize a combination of barriers and between-patient cleaning and disinfection to maintain operatory asepsis and minimize the potential for cross-contamination.
The use of protective barriers generally eliminates the need for surface disinfection during operatory turn-around. However, surfaces must be cleaned and disinfected anytime the barrier has been compromised as well as at the beginning and end of each clinic day. (1) (2) (3) (4)
Environmental surface disinfectants are supplied as concentrates, premixed solutions, sprays, foams, impregnated wipes, and tablets. Pump-sprays, however, are considered the best vehicle for delivering cleaning/disinfecting agents to contaminated surfaces. (2) (3) (4)
The pump concentrates spray liquid on the surface rather than aerosolizing it, which allows the chemical to penetrate into crevices. In addition, spray bottles eliminate potential inactivation or absorption of the disinfectant by gauze, paper, or sponge applicators. (2) (3) (4)
According to dental infection control expert, Dr. Charles Palenik, disinfection is now called environmental infection control. The emphasis has gone away from the primary use of chemicals to one that uses mostly surface covers. In fact, areas that need attention (disinfection or covering) are now called clinical contact surfaces. (5)
The Authors of OSAP's From Policy to Practice: OSAP's Guide to the Guidelines offer the following information:
For pre-cleaning clinical surfaces:
Use a low to intermediate-level disinfectant and the "spray-wipe-spray” technique to clean and disinfect clinical contact surfaces. First clean, then disinfect. Spray the surface to be cleaned with a cleaner or cleaner/disinfectant. Then, wipe vigorously using paper towels. Once cleaned, spray the surface again, this time with a disinfectant. Cover the entire surface, and allow the disinfectant to remain undisturbed on the surface for the contact time indicated on its label. (6)
The authors also offer the following alternative to pre-cleaning clinical surfaces:
Wipe a pre-moistened cleaner-disinfectant towelette over the surface to be cleaned. Check the label to be sure that the wipe is a cleaner (some disinfectant wipes may require a separate cleaner). Carefully follow label instructions. Some wipes may be effective only on a limited surface area (approximately 3 sq. ft.). (6)
After cleaning, disinfect the surface:
Spray the disinfectant over the entire surface, using towels or reduce overspray. Let the surface remain moist for the contact time stated on the disinfectant's label. Wipe the surface dry if it is still wet when ready for patient care. (6)
The authors also offer the following alternative to spraying disinfectants on clinical surfaces:
Saturate the surface using a pre-moistened disinfectant towelette (wipe). Let the surface remain moist for the contact time stated on the disinfectant's label. Wipe the surface dry if it is still wet when ready for patient care. (6)
United States Air Force Dental Evaluation and Consultation Service provides additional information at:
(1) Centers for Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental
Healthcare Settings (December 2003)
(2) Infection Control & Management of Hazardous Materials for the Dental Team. Third Edition.
By Miller and Palenik. Elsevier/Mosby Publishers. Copyright 2005.
(3) OSAP's Infection Control In Practice: Demystifying Disinfectants, August 2002 and OSAP's
Monthly Focus # 6, 1998
(3) Practical Infection Control In Dentistry, 2nd. Ed. By Cottone, Terezhalmy, Molinari. Publisher,
Williams & Wilkins, 1996.
(5) Dr. Charles Palenik, MS, Phd. Assistant Director of Infection Control Research and Services.
Indiana University School of Dentistry.
(6) From Policy to Practice: OSAP's Guide to the Guidelines. Copyright 2004 by OSAP.