by Mary Govoni, CDA, RDA, RDH, MBA
It's been 10 years since the CDC released its last guidelines for infection prevention for dental care settings, and the removal of the "spray-wipe-spray" protocol in the guidelines. Current guidelines state that environmental surfaces should be cleaned and then disinfected after contamination from dental procedures. Since then, many dental teams have stopped spraying disinfectants and switched to using presaturated wipes.
These wipes are convenient to use, can cover a relatively large surface area, and are tested for effectiveness. For practices that soak gauze in a disinfecting solution to make in-house presaturated wipes, it is important to note that this is an off-label use of a disinfectant. Some studies have demonstrated that for a 24-hour period, the fibers in the gauze can bind up the active ingredients in the solution, thus rendering it ineffective.
Presaturated wipes come in various chemical disinfectant formulas, such as water-based phenols (Birex Disinfectant Wipes and ProSpray Wipes), alcohol-based phenols (DisCide Wipes), quaternary ammonium with alcohol (CaviWipes, DisCide Ultra Wipes, Opti-Cide 3 Wipes, Sanitex Plus Wipes), quaternary ammonium without alcohol (Lysol IC Wipes, Sani-Cloth AF Wipes), and sodium hypochlorite (Clorox Germicidal Wipes).
Dental suppliers, such as Patterson Dental and Henry Schein, also have "house brand" versions of some of these disinfectant wipes. For a more comprehensive list of wipes that are appropriate for use in dentistry, OSAP has a reference chart listing disinfectant products and their active ingredients. This chart is available at www.osap.org/page/SurfDisinfec.
The effectiveness of the wipes can be reduced in some cases by improper use of the product. The most common error I see in dental practices is that the cover on the container is left open, which allows the wipes to dry out. In time, some of the solution from the wipes may settle at the bottom of the container.
It is a good idea to make sure that the cover is closed tightly at the end of each day. Turn the container upside down to allow the solution to resaturate the top of the wipes. Once the wipes have been used up, any remaining solution should be discarded.
Sometimes team members are inclined to pour the solution into another container of wipes. This practice could affect the concentration of the solution in the next container.
The protocol of using wipes on contaminated surfaces is much the same as the old spray-wipe-spray technique. A wipe is used to clean any blood or debris from the surfaces. After this, a new wipe is used to reapply the disinfectant to the same surfaces in order to clean, and then disinfect.
If the surface area to be cleaned is large and/or highly contaminated with spatter, more than one wipe may be necessary for effective cleaning. Some manufacturers, such as Kerr Total Care, make wipes in an extra-large size for these types of situations.
When selecting the type of wipe that is appropriate for your practice, remember that it must make a label claim that it is tuberculocidal. If the wipes are to be used on operatory chairs, a nonalcohol or low-alcohol formula will be less drying to the upholstery. Other factors that should be considered include contact time (which may vary from one to 10 minutes), packaging (canisters or flat packs), and of course, cost.
One last thing about the use of disinfecting wipes.
Canisters of wipes are becoming commonplace at the entrance to grocery stores to wipe handles on grocery carts. I frequently observe shoppers using the wipes on the carts, as well as on their hands and faces.
I have also seen patients in dental practices do the same with the wipes in a dental office. In some cases, parents equate the disinfectant wipes with baby wipes, which can be harmful to the skin. Be careful where the wipes are placed, so that they are not within easy reach of patients.
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 firstname.lastname@example.org or www.marygovoni.com.
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