Cetylcide and Disinfecting
We have a problem with the assistants disinfecting our operatories. They douse chairs, counters and lightsbasically everything with Cetylcide. Surfaces are soaking and puddled. This ruins the doctors equipment. We use rags that sit in Cetylcide we wash after each use. We want them to ring out the excess liquid, but they feel it doesn’t do the job. I have been looking for literature that shows the surfaces do not have to be soaking and dripping to be clean. Am I right and where can I find an article to show them?
Thank you for your questions. I have included a copy of the 2003 CDC Guidelines for Infection Control in Dental Health-Care Settings, and it can be viewed here: CDC guidelines. Although the guidelines are from 2003, they are still the most current gold standard of practice and a resource every dental office should have. The CDC guidelines were developed after numerous literature reviews were conducted on a variety of topics by a large group of infection control experts. The guidelines will answer many of your questions, however I will further explain based on your questions.
Pages 25-27 of the CDC guidelines will be helpful in answering this question. Barriers and/or surface disinfectants should be used on clinical contact surfaces that might become contaminated with blood or OPIM. Dental offices should use an “intermediate level” disinfectant (one that carries a Tuberculocidal-TB kill claim) on clinical contact surfaces. If it does not carry a TB kill claim, then it is NOT an intermediate level disinfectant. Each disinfectant carries an EPA registration. You will want to closely follow the manufactures instructions. Other uses not listed on the label are considered “off-label” uses that cannot guarantee the efficacy of the product. The disinfectant label will list the “contact time.” (ie; the time it has to stay wet/damp). A fine mist or quick spray should be sufficient to reach the contact time. It does NOT need to be dripping/soaking wet. As long as the surface stays damp for the contact time, you are fine. Contact time can range anywhere from one to ten minutes. Soaking with harsh chemicals such as disinfectants can lead to equipment damage in the electrical switches and cracking of the upholstery over time which actually could be a reservoir for harmful pathogens. You will want to contact the chair/dental unit manufacturer to see what cleaning method is best for the upholstery. You might consider using plastic barriers on the light switches & upholstery to avoid the issue of “dripping wet” surfaces. Think of the places that are more easily contaminated (light handles, switches) and consider using impervious plastic barriers to avoid so much chemical disinfection. That might help solve the issue. Also PPE such as masks, eye protection & heavy duty utility type gloves must be worn when working with chemicals according to OSHA’s Hazard Communication Standard to avoid chemical splashes to mucous membranes.
With surface disinfectants, you will use a two step procedure. Either a “spray-wipe-spray” technique with paper towels or 4×4 gauze or a “wipe-discard-wipe” technique (with the commercially prepared pre-moistened pop-up type wipes) with your disinfectant. The first spray & wipe, or wipe & discard is the “cleaning” step to remove bioburden. The second “spray” or “wipe” is the disinfection step that remains on the surface for the contact time. Your current practice of “soaking rags” would be considered an off label use. If the label does not list this as an acceptable use, then you cannot do this with guaranteed efficacy. Paper towels or gauze (not soaked rags) are your best choices for wiping the surfaces as they can be thrown away (one time use) and the potential for cross contamination is reduced. Page 26 of the CDC guidelines states “mops or cloths should be cleaned after use and allowed to dry before re-use, or single-use, disposable cloths should be used to avoid spreading contamination.” My guess is that these soaking rags in your office are not allowed to dry after use and you could be doing more harm than good with this method. I would suggest eliminating this procedure and closely following the manufacturers recommendations. Furthermore, offices SHOULD NOT “make your own” wipes by soaking gauze in the disinfectant as that would be an “off-label” use and the cotton fibers may inactivate the ingredients in the disinfectant rendering it ineffective (Miller & Palenik; Infection Control and Management of Hazardous Materials for the Dental Team, 5th Edition).