To spray or not to spray

Jan. 1, 2012
When the OSHA Bloodborne Pathogens Standard and the CDC Recommended Infection Control Practices for Dentistry were first established ...

by Mary Govoni, CDA, RDA, RDH, MBA

When the OSHA Bloodborne Pathogens Standard and the CDC Recommended Infection Control Practices for Dentistry were first established in 1991 and 1993, respectively, the CDC recommendation was to use the spray-wipe-spray technique for applying surface disinfectants.

Prior to that, many dental practices simply used 2x2 gauze sponges saturated (soaked, actually) with 70% isopropyl alcohol to clean and disinfect treatment room surfaces. We learned that straight alcohol was not a good cleaner. In fact, it actually desiccated blood and other proteinaceous debris on surfaces and equipment, making them harder to clean. If a surface is not cleaned first, the disinfection process is ineffective.

So we changed not only the type of surface disinfectant, but we used products that are cleaner/disinfectants that contain alcohol, phenol, and other compounds, as well as surfactants to remove organic debris and other soil from surfaces.

The cleaning and disinfecting process that was recommended was the spray-wipe-spray technique. The surface was sprayed, and then wiped to clean it. Then the surface was sprayed again to allow the disinfectant to wet the surface and inactivate the microbes that were present. At the time this technique was first recommended, there were not as many equipment barriers as there are today.

If an impervious barrier covers a surface or item of equipment, there is no need to disinfect it between patients. The barrier simply needs to be changed.

In addition to the lack of barriers, the surfaces of older dental equipment had many uneven or grooved surfaces that made it difficult to make sure that the disinfectant contacted the surface, except by spraying.

Today, equipment has evolved and has smoother, easier-to-clean, disinfectant surfaces. There are a variety of equipment and surface barriers available to protect from contamination and reduce the need for surface disinfectants.

Studies by the Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health demonstrate that there is a risk to health-care workers for developing occupational asthma or exacerbating existing asthma from exposure to cleaner and disinfectant sprays. These include both aerosol spray and trigger-spray dispensed products.

Given this information, with the availability of barriers and easier-to-clean surfaces, spraying surface disinfectants in treatment rooms is unnecessary, and in many cases, unsafe.

The manufacturers of many surface disinfectants have now formulated their products into premoistened wipes, which eliminates the need for spray applicators. Examples are CaviWipes from TotalCare, Birex Disinfectant Wipes from Biotrol, Clorox Germicidal Wipes (Clorox Professional from H.J. Bosworth), and ProSpray Wipes from Certol.

In addition, Biotrol has a squirt cap available to use in place of the trigger sprayer, which dispenses the product in a stream instead of droplets, which can be more easily dispersed into the air.

Some practices make their wipes from gauze saturated in a disinfectant. This is not recommended. These products have not been tested and cleared by the appropriate agency (EPA or FDA) to use in this manner, and studies have shown that the fibers in the gauze could bind up the active ingredients in the disinfectant, thus rendering it ineffective. At the very least, this would be an “off-label” use of a disinfectant, which is not a good idea in relation to infection prevention.

The manufacturers of disinfectant wipes have tested their products and had their disinfectants cleared by the FDA for use in the form of presaturated wipes. The technique for cleaning and disinfection remains the same, except application of the product is not by spraying it onto a surface. A wipe saturated with disinfectant is used to clean and remove debris from the surfaces and then it is discarded. Another wipe is used to reapply the disinfectant and achieve microbial inactivation.

Be safer and healthier. Don’t spray your disinfectant. Follow the current CDC Guidelines for Infection Control in Dental Health-Care Settings, 2003. Instead, “clean first, then disinfect.”

Your lungs will thank you for it!

Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Clinical Dynamics, 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].

Speaking at the Hinman 100th Dental Meeting March 22-24, 2012

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