By Amy Knepshield Condrin, OSHA Review, Inc.
Disinfection and sterilization are essential for preventing transmission of infectious pathogens to patients and your staff. How do you know if you and your staff are effectively performing these tasks? The Texas Administrative Code (TAC) defines disinfection and sterilization requirements for Texas dentists . Additionally, the Centers for Disease Control and Prevention (CDC) recommends varying levels of disinfection and sterilization (determined by the type of procedure and equipment used). Using these requirements and recommendations as a guide, this article will help you and your staff determine how to properly disinfect and sterilize, and what to look for in the products you use to do the job.
Before we get started, you’ll need to be familiar with a few terms.
Cleaning is an essential first step before sterilization and disinfection. Cleaning is defined as the removal of visible soil, blood, proteins, microorganisms, and other debris from surfaces, crevices, serrations, joints, and lumens, or instruments, devices, and equipment. This step prepares items for safe handling and/or further decontamination. Debris removal is usually accomplished through use of detergent and water, or enzyme cleaner and water, by a manual or mechanical process.
Disinfection is a process that eliminates many or all pathogenic organisms, except bacterial spores. It’s usually accomplished with liquid chemicals.
A disinfectant is defined as a physical or chemical agent that removes, inactivates, or destroys pathogens on a surface or item to the point where the surface or item is no longer capable of transmitting infectious particles, thereby rendering the surface or item safe for handling, use, or disposal.
A note about disinfectants: You might assume disinfectants can be used as cleaners, or vice versa. However, unless a disinfectant is also labeled as a cleaner, it cannot be used to clean. Consider using a US Environmental Protection Agency (EPA)-registered product labeled for both cleaning and disinfecting—but be certain both steps are performed separately.
Sterilization is a process that kills all forms of microbial life.
Note: Many liquid disinfectants and sterilants are used alone or in combinations in the healthcare setting. (These include alcohols, chlorine compounds, formaldehyde, glutaraldehyde, ortho-phthalaldeyde, hydrogen peroxide, iodophors, peracetic acid, phenolics, and quaternary ammonium compounds.) Commercial formulations of these chemical mixtures are considered unique products, and are not interchangeable. Misuse can create excessive costs and/or safety hazards. Users should read labels carefully to ensure the correct product is selected for an intended use, and that it is applied properly.
Environmental Surfaces (and Equipment)
Environmental Surface Disinfection refers to the disinfection of clinical and environmental surfaces. Texas State Board of Dental Examiners (TSBDE) requires all contaminated surfaces and equipment be disinfected between each patient.
Clean. Then Disinfect.
Surfaces MUST be cleaned of debris prior to disinfection. Surfaces cannot be adequately covered with disinfecting solution if dirt and debris remain on the surfaces. After cleaning surfaces with a cleaning solution, coat with a chemical disinfectant for the recommended contact time, and then wipe dry if necessary. Dental staff must follow product label and safety data sheet (SDS) instructions for safety, efficacy and proper disinfection.
Housekeeping surfaces such as walls and floors should be cleaned using a detergent or a product that combines a cleaner and disinfectant on a regular basis, when spills occur, and when surfaces are visibly soiled. Housekeeping surfaces only need to be disinfected if they were potentially contaminated with blood or other infectious material.
Clinical contact surfaces such as countertops, dental units, should be disinfected with an EPA-registered surface disinfectant (low-level or intermediate-level), or barrier-protected and cleaned at the end of the day.
Your Surface Disinfectants (Pesticides) Should Be:
Registered with EPA and Texas Department of Agriculture.
In dentistry, antimicrobials (such as surface disinfectants, sanitizers, and dental unit waterline cleaners) designed to destroy or inactivate disease-producing bacteria and other microorganisms are considered pesticides. (The term “pesticide” encompasses any chemical intended to destroy pests, control their activity, or prevent them from causing damage.) In Texas, all pesticides must be registered and approved for use by EPA and Texas Department of Agriculture.
All surface disinfectants regulated by EPA must be labeled with an EPA registration number. Labels on EPA-approved surface disinfectants also specify: technical and safety information, indications for use (contact time, application methods), and approved efficacy claims. Only claims listed on the registered label can be made regarding a disinfectant’s efficacy.
Your surface disinfectant must have hospital-efficacy claims, which are defined by the EPA as broad-spectrum disinfectants with demonstrated efficacy against Salmonella choleraesuis, Staphylococcus aureus, and Pseudomonas aeruginosa.
Labeled as Effective Against HIV/HBV or TB.
In dental settings, a surface disinfectant should also list label claims against human immunodeficiency virus (HIV) and hepatitis B virus (HBV), or Mycobacterium bovis (TB).
Stronger disinfectants are not necessarily better, and can actually harm equipment, the environment, and your staff. It’s important to select a disinfectant that provides the least hazardous side effects, yet is still efficacious for bloodborne pathogens of concern in a dental office.
Note that care should be taken when transporting contaminated dental instruments to the central processing area. Instruments should be containerized, and staff should never reach hands into containers holding contaminated instruments or handle the instruments with their hands.
If disposable needles must be recapped, either the one-handed scoop technique or an actual recapping device must be used. Safe needle-handling practices during dental treatment are required by Occupational Safety & Health Administration (OSHA) and recommended by CDC. Disposable sharps must be disposed of in a sharps container. (OSHA’s Bloodborne Pathogens