How to clean, disinfect, and sterilize a dental operatory

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

Intermediate or Low Level

Quaternary ammonium-based products are EPA registered intermediate or low level disinfectants with broad spectrum activity. Ideal for noncritical surfaces such as radiograph head or environmental surfaces such as floors, walls and tables. Quaternary ammonium compounds may contain added synthetic detergents for use as a one-step cleaner and disinfectant. In spray form or single use cloth wipes, these products are widely available from a number of manufacturers. The products may cause allergic or health problems if skin or mucous membranes are exposed to them.

Iodophors are EPA registered intermediate level disinfectants used for noncritical items as well as clinical contact of environmental surfaces. These have broad spectrum disinfecting action with residual biocidal activity and few reactions. Dilution and contact time are critical and product must be discarded daily. Iodophors can discolor countertops and equipment upholstery, and for this reason they are not routinely used in dental practice settings today.

With a greater understanding of the basic product types for the various sterilization and disinfection requirements in the dental office, dental health care workers will be better equipped to select and use the right products. By minimizing the risk of cross contamination, ultimately the dentist, staff and patients will all benefit.

Patient Care and Environmental Surface Disinfection and Sterilization

Patient
Care Items       Activity           Method           Recommended

Critical &       Destroys all       High             Steam, dry heat,
Semicritical     microorganisms/    Temperature      unsaturated
Heat tolerant    bacterial spores                    chemical vapor

Critical &       Destroys all       Low              Ethylene oxide,
Semicritical     microorganisms/    Temperature      plasma
Heat sensitive   bacterial spores

Critical &       Destroys all       Immersion        FDA Registered
Semicritical     microorganisms/                     Liquid chemical
Heat sensitive   bacterial spores                    sterilants

Semicritical     Destroys all       Heat-Automated   Washer-
Heat sensitive   microorganisms                      Disinfector
                 but limited
                 bacterial spores

Semicritical     Destroys all       Immersion        EPA Registered
Heat sensitive   microorganisms                      Liquid chemical
                 but limited                         sterilant/
                 bacterial spores                    disinfectant

Noncritical      Destroys           Liquid contact   EPA Registered
with visible     vegetative                          "hospital"
blood            bacteria, most                      disinfectant with
                 fungi and                           tuberculocidal
                 viruses--                           activity.
                 inactivates
                 mycobacterium
                 bovis, not
                 necessarily
                 capable of
                 killing
                 bacterial spores

Noncritical      Destroys           Liquid contact   EPA Registered
without          vegetative                          with no
visible          bacteria, some                      tuberculocidal
blood            fungi and                           activity. OSHA
                 viruses.                            required label
                                                     of HBV and HIV
                                                     activity.

Patient                              Environmental
Care Items         Process           Surfaces

Critical &         Sterilization     Not Applicable
Semicritical
Heat tolerant

Critical &         Sterilization     Not Applicable
Semicritical
Heat sensitive

Critical &         Sterilization     Not Applicable
Semicritical
Heat sensitive

Semicritical       High Level        Not Applicable
Heat sensitive     Disinfection

Semicritical       High Level        Not Applicable
Heat sensitive     Disinfection

Noncritical        Intermediate      Clinical contact
with visible       Level             surfaces; blood
blood              Disinfection      spills on
                                     housekeeping
                                     surfaces

Noncritical        Low Level         Clinical contact
without            Disinfection      and housekeeping
visible                              surfaces
blood