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Tips for Surface Disinfection

We use a variety of different surface disinfectants to clean our operatories. How do I know that I am using the best one with the correct contact time to ensure disinfection?

Disease transmission from environmental surfaces is generally low. However, it is crucial to follow prudent infection control procedures to minimize the risk of transmission.1,2 In a dental office, there are two types of environmental surfaces: housekeeping surfaces and clinical contact surfaces. Housekeeping surfaces, such as floors and walls, are not typically touched during patient care and can be cleaned instead of disinfected. On the other hand, clinical contact surfaces, such as light handles, switches, countertops, and chair controls, are frequently touched and easily contaminated — necessitating the use of barriers and surface disinfection.1,2

The ideal approach for managing clinical contact surfaces involves a combination of surface barriers and disinfection. Barriers are particularly useful for hard-to-clean surfaces like tri-syringe handles and tubing, as they reduce operatory turnaround time. After patient care, barriers can be removed and replaced without the need for disinfection, unless the surface has been contaminated. Barriers should be used only once and replaced between each patient.1

To achieve effective disinfection, disinfectants should be used on clean surfaces following the “spray-wipe-spray” method. The initial ”spray-wipe” step is aimed at cleaning the surface of blood or any other potentially infectious material (OPIM). The second “spray” applies the disinfectant, ensuring the surface remains moist for the contact time specified by the manufacturer. Always refer to the manufacturer’s label for the specific contact times.1 Pre-moistened wipes are popular options that can be used in a “wipe-discard-wipe” method, similar to cleaning before disinfection. However, the instructions on the product label must be followed, as wipes may be effective only on small surface areas.

When choosing a surface disinfectant, the most important consideration is its level of efficacy. Surface disinfectants are categorized as low level, intermediate level, and high level. High-level disinfectants are not intended for use on surfaces. They require long-term immersion to achieve sterilization, primarily for heat-intolerant items. Product labels do not explicitly state the level, so dental professionals need to determine the level based on the manufacturer’s label claims. Both low-level and intermediate-level disinfectants carry the label claim of “hospital disinfectant,” indicating their effectiveness against test organisms such as Staphylococcus aureus.

The dental operatory requires intermediate-level disinfectants on clinical contact surfaces. Intermediate-level disinfectants provide a tuberculocidal kill claim, indicating effectiveness against Mycobacterium tuberculosis.1 Intermediate-level disinfectants can effectively disinfect both housekeeping and clinical contact surfaces that are soiled with blood or OPIM. By using intermediate-level disinfectants, effective disinfection can be achieved with just one product — a cost-effective approach.

Understanding the level of efficacy of the product is key. The classifications include chlorine-based products, phenolic solutions, iodophors, and quaternary compounds. Chlorine-based products encompass household bleach, which is no longer recommended because it is not registered with the Environmental Protection Agency. Phenolic solutions can be water- or alcohol-based and are identified with prefixes such as “phenol” or “phenyl.” Iodophors are less irritating to the skin and typically contain “iodi” or “iodo.” Quaternary compounds are noncorrosive and have a lower kill spectrum.

In conclusion, clinicians need to read product labels carefully and choose appropriate disinfectants based on the specific needs of their dental office.

References

  1. Kohn W, Collins AS, Cleveland JL, et al. Guidelines for infection control in dental health-care settings-2003. MMWR Recomm Rep. 2003;52(RR-17):1–61.
  2. From Policies to Practice: OSAP’s Guide to the Guidelines Workbook. Atlanta: Organization for Safety Asepsis and Prevention; 2022.

 

The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele P. Carr, RDH, MA, EdD, on ethics and risk management; Denise Muesch Helm, RDH, EdD, on fluoride; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpen­ing; Kathleen O. Hodges, RDH, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Martha McComas, RDH, MS, on patient education; Michael W. Roberts, DDS, MScD, and Robert D. Elliott, DMD, MS, FAAPD, PA, on pediatric dentistry; Purnima Kumar DDS, PhD, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing. dimensionsofdentalhygiene.com/asktheexpert to submit your question.

From Dimensions of Dental Hygiene. June 2023; 21(6):46.

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