Infection control (IC) is one of the most important elements used by dental practices to protect patients and dental workers. The pandemic has put environmental IC and hand health in the spotlight. Patients take an active role in their health and notice IC procedures and perceived cleanliness when they enter your practice. The perception of your practice and skills often begins with their visual and sensory observations as they enter. IC recommendations and protocols have evolved over many years and extend beyond the pandemic to protect patients and provide a safe working environment for dental workers.
Environmental IC practices are a part of your protection as a dental worker and are just as important as your personal protective equipment (PPE), hand health and respiratory protection. IC protocols are sometimes a source of debate among dental team members when it comes to best practices.
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Differences of opinion can lead to a system that does not meet Centers for Disease Control and Prevention (CDC) standards for dental practices.1 Individuals often assume that all disinfectants have the same protocols and contact times to ensure disinfection success and safety, when in reality their effectiveness varies. Each office should appoint an IC Compliance Officer to research and design protocols and ensure they are maintained. Education and communication between team members ensures that IC best practices are followed. Some offices hire an IC consultant to ensure optimal performance.
Where to start?
Any environmental IC protocol should start with removing organic debris and visibly soiled material that can inhibit the effectiveness of the disinfectant solution. Preventing the transmission of potentially harmful pathogens is achievable when safety protocols are followed, which includes planning for the necessary chemical contact time. Frequently touched surfaces such as keyboards, handles, knobs and switches should be covered with barriers where appropriate and a surface disinfectant should be used when contaminated.
The CDC-accepted protocol option for surface disinfection includes spray-wipe-spray or wipe-throw-wipe sequences to ensure removal of soiled materials and adequate disinfection of surfaces.1 Wipes approved for environmental cleaning and disinfection that provide “one-step” disinfection on a visibly clean surface include Monarch by Air Techniques, among others.
A typical day in dentistry is filled with back-to-back patients, and a fast-acting surface disinfectant is essential to maintain a smooth workflow and rapid turnaround of parts. A disinfection solution with a quick one-minute contact time, such as Monarch Surface Wipes, rather than a 10-minute contact time solution, allows the office to maintain a streamlined flow and reduce the risk of contamination .
Refer to manufacturer’s instructions to ensure best practices and correct contact time, and that product is used for desired disinfection areas without damaging equipment or surfaces. For example, choose a disinfectant that is effective against a broad spectrum of viruses, but be careful and choose a disinfectant whose ingredients will not damage or discolor equipment and chairs. You can use a chair and upholstery cleaner to maintain the integrity of the material, but this does not provide disinfectant properties. According to the CDC, any disinfectant you can buy at the grocery store is not registered or approved by the Environmental Protection Agency (EPA) for use in a dental or medical setting.1
Know what you are using
Not all surface disinfectants are created equal! Read the label to evaluate ingredients and ensure a wide range of effectiveness against tuberculosis, viruses, bacteria and fungi. The ability to destroy tuberculosis is the key indicator for evaluating the capacity, effectiveness and contact time needed for a surface disinfectant.1 An ideal and effective EPA-registered disinfectant solution will kill enveloped viruses (coronavirus, hepatitis, HIV), large non-enveloped viruses (rotavirus), small non-enveloped viruses (norovirus, rhinovirus), mycobacteria (tuberculosis), pathogenic fungi and encapsulated bacteria.
Disinfectant solutions vary in ingredients and often consist of a combination of active ingredients such as alcohol, quaternary (a quaternary ammonium compound widely used for disinfection), and/or hydrogen peroxide at varying levels. Dental workers are exposed to a variety of chemicals for patient care, and to maintain a clean and sterile environment, consideration should be given to minimizing your occupational exposure risk.
Infection prevention is sometimes overlooked when dental providers are stressed, overworked, or running behind schedule. The importance of designing and maintaining a protocol that suits your practice and selecting a combination cleaning and disinfection solution or wipe that provides a one-minute contact time will accommodate the busy schedule while meeting the manufacturer’s instructions. Record keeping and reporting will ensure that all new hires are trained to the highest infection control standards and provide an annual review for all team members. Using personal safety and environmental infection prevention protocols will protect you, the patient and your practice.
The patient experience goes beyond what happens while sitting in the dental chair. Using a scent-free disinfection solution as part of your IC protocol helps reduce scents that many find objectionable. Using the same disinfectant solution or wipe that is also effective against odor-causing bacteria is a win-win solution for the practice. Gone are the days when every dental office had a strong chemical smell; today’s patient experience is as welcoming as walking into a store or a spa.
Editor’s note: This article originally appeared in the September 2022 print edition of HDR magazine. Dental hygienists in North America are eligible for a free print subscription. Register here.
- Cleaning and disinfection of environmental surfaces. Centers for Control and Prevention of Disasters. Last revised March 25, 2016. https://www.cdc.gov/oralhealth/infectioncontrol/faqs/cleaning-disinfecting-environmental-surfaces.html