by Mary Govoni, CDA, RDA, RDH, MBA
If I seem to dwell on the topic of surface disinfectants, it’s with good reason. Of all the infection-prevention procedures performed in dental facilities, disinfecting environmental surfaces is probably the most common and frequently performed.
Dental teams have so many choices of products to use, in both spray and wipe forms. In addition, the need for surface disinfection can be eliminated in many cases by the use of barriers. There are so many new or enhanced products available; it’s enough to make your head spin sometimes. It can certainly confuse team members who choose and use the products. Hopefully, the information in this column will clear up some of the confusion and make the product selection process simpler.
One of the more recent updates to disinfecting products is the EPA approval of several products as one-step disinfectants. In the past, the protocol for disinfecting environmental surfaces was “spray-wipe-spray” — spray to apply the disinfectant, wipe to clean the surface, and spray again to reapply the disinfectant for the appropriate contact time.
When the CDC updated the infection-control guidelines for dentistry in 2003, the recommendation was no longer “spray-wipe-spray.” Instead it was “clean, then disinfect.”
The premise behind cleaning prior to disinfecting is that many surface disinfectants have not been able to penetrate through blood or bioburden in order to be effective. New formulas for some disinfectants have been approved by the EPA for cleaning and disinfecting in one step because they have demonstrated the ability to penetrate a low level of bioburden.
It is important to note that the EPA still recommends that all products be used in a two-step (clean first, then disinfect) process in the presence of heavy levels of bioburden. For most dental procedures, except surgeries, there is not heavy blood or debris on environmental surfaces. This means these products may be good choices to enhance efficiency in operatory turnover.
Some readily available one-step products for dentistry include BirexSE® from Biotrol, BioSURF® from Micrylium, Dispatch® Hospital Cleaner Disinfectant and Wipes, and Clorox® Germicidal Spray and Wipes, both from Bosworth Company.
Dispatch and Clorox products are chlorine-based, and caution should be used on some equipment. The contact time for BioSURF is 50 seconds (TB kill), and 60 seconds for Clorox Germicidal Spray. This is an additional advantage. BioSURF is also approved to be used without gloves because it is not irritating to the skin; however, gloves are required when the possibility of blood or other biohazards are present on environmental surfaces.
I would never recommend using a surface disinfectant without gloves; however, exam gloves may be adequate protection when cleaning operatory surfaces rather than heavy utility gloves. Keep in mind, though, that utility gloves must be worn when handling the contaminated sharp instruments to protect from punctures.
So, how does a dental team know if team members are using the best products?
First, the decision must be based on CDC recommendations that the disinfectants be intermediate-level, hospital-grade disinfectants when there is the possibility of the presence of blood on the environmental surfaces. Once the products that meet the label claim are identified, the remainder depends on what is best for the facility.
I would make a checklist of criteria, such as contact time, whether the product is a dual- purpose cleaner/disinfectant, the format (spray or wipe), if it ready to use, if it is safe to use on equipment, and any other specific characteristics that the team is seeking.
Then compare available products. Keep in mind that if you like a particular brand name product, there may be a comparable dental supplier brand of that product. Your dental supply dealer can compare the EPA registration numbers on the products to determine if they are indeed the same product private-labeled for the dealer.
Be wise consumers, especially where patient safety is concerned.
Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Mary Govoni & Associates, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at [email protected] or www.marygovoni.com.
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