How to clean, disinfect, and sterilize a dental operatory

Dental Assistant, The, Nov-Dec, 2004 by Curtis P. Hamann

Products used must match the task at hand. Dental assistants are often responsible for preparing treatment rooms before and after each patient, by cleaning and disinfecting surfaces, and for instrument cleaning, disinfection and sterilization. Unless the appropriate product for the task is selected, the results can potentially be damaging to instruments and equipment and dangerous for both health care workers and their patients.

Since the release of the new CDC Guidelines for Infection Control in Dental Health Care Settings, there is a renewed emphasis on infection control products and procedures. It can be difficult to sort through the various products and their claims, make product selections, establish infection control protocols, and train staff to safely implement and maintain the appropriate use of products. Part of the confusion stems from the changes in regulatory approval and registration process (particularly related to the use of disinfectants and sterilants), the broad variability in marketing claims and inconsistency in terminology used to describe the product, its efficacy and intended use. A common misconception is that one chemical will serve all purposes. As a result chemical products may be used that are not intended for the surface or task at hand.

To determine which product to use, you must first assess what you plan to treat--is it a "patient care item" or an "environmental surface"?

Patient care items are categorized as critical, semicritical and noncritical.

a. Critical: These items penetrate or contact soft tissue, bone, bloodstream and normally sterile tissue. Examples include periodontal scalars, forceps, scalpels, and surgical burs.

b. Semicritical: These items typically contact mucous membranes and nonintact skin. Examples include such items as handpieces, mouth mirrors, reusable impression trays, and amalgam condensers.

c. Noncritical: These items come in contact with intact skin such as radiograph head, blood pressure cuff, or facebow.

Environmental Surfaces are divided into two categories: clinical contact and housekeeping.

a. Clinical Contact: These include surfaces in the treatment areas contaminated during patient care by bare hands, gloved hands, saliva, blood or other body fluids. Examples include light handles, switches, x-ray equipment, countertops, chairside computers, reusable containers, drawer handles, pens, telephones, doorknobs and tables.

b. Housekeeping: Surfaces such as floors, walls and sinks require regular removal of soil, dust, and debris.

Now that you have an understanding of the different surfaces, it is time to decide the next process. The new Guidelines include clear definitions of what products are suitable for infection control of these different surfaces.

CLEANING

Cleaning Patient Care Items

Until instruments are disinfected or sterilized, they should always be treated as if they are contaminated. Workers should wear appropriate Personal Protective Equipment (PPE), including heavy duty, puncture-resistant utility gloves to handle instruments. Because splashing often occurs, masks and protective eyewear (with side shields) or a face shield should always be worn.

Manual Cleaning: Scrubbing with a brush and a surfactant or detergent with water removes debris and contaminants. (The handscrubbing technique should only be used if the automated cleaner is out of order. Your dealer will provide you with a loaner cleaning unit if repairs will take longer than an in-office service call. If handscrubbing is necessary, using a submarine technique will eliminate splatter.) If critical and noncritical items cannot be cleaned immediately after use, they should be placed in a puncture-proof, covered container and soaked in a detergent, disinfectant/detergent or an enzymatic cleaner (holding solution) until the soil is dissolved and removed. High-level disinfectants/ sterilants are not appropriate for presoaking instruments.

Automated Cleaning: UItrasonic cleaners or washer-disinfecting units are safer and are recommended because they do not require presoaking or the manual scrubbing of instruments and therefore, minimize the exposure to blood and body fluids. A noncorrosive enzymatic cleaner used in an ultrasonic cleaning unit helps to break down any remaining bioburden. Always follow the manufacturer's instructions for selection and use of enzymatic detergents.

Reminder: Critical and semicritical items should be heat sterilized after cleaning.

Cleaning Environmental Surfaces

Clinical Contact: Even when a surface is barrier protected, (e.g., plastic wrap, bags, sheets, tubing, barrier film plastic-backed paper, etc.) it can be, and often is, contaminated either through direct contact by the patient or the dental professional or by spray or splatter generated during procedures. If not appropriately cleaned and decontaminated, these surfaces can contaminate hands, gloved hands, instruments, equipment and devices.

The recommended cleaning process begins with the removal of any barrier film from the surface with gloved hands. After removal and disposal of a barrier, visibly check for contamination. It is suggested the areas/items be wiped with a saturated intermediate level disinfectant cloth. This procedure protects against any small undetected break in the barrier.