Common Errors in Surface Disinfection


Below are a few sections of a much longer article by Noel Kelsche, RDHAP, BS that can be found at RDHmag.com

For the past year, I have conducted surveys online and with my speaking audiences about infection control issues in the dental office for clinicians. In the next few articles, I will review some of the findings from these surveys. I have received 2,400 responses that are both reassuring and concerning at the same time.

Many clinicians did not understand the basic concepts of the cleaning and disinfection process. When asked, “What is the minimum number of wipes it takes to process a room?” 14% thought that they could use one wipe and 20.5% stated that they did not know. Review the two-step process of cleaning and disinfection with the entire staff. Explain the importance of clean, toss, new wipe, disinfect. A study from Cardiff University clearly showed using a one-step process, as opposed to a two-step process, can simply spread the debris rather than kill the pathogens. You must clean first and then disinfect.

Questions and Solutions:

29% of the clinicians did not know if they were following the label directions or were in compliance with FDA regulations. Shockingly, 23% reported that their offices store cotton 2x2s in a jar with disinfectant or antiseptic. Storing disinfectant in a jar with 2x2s can render the disinfectant useless. The bleach in the 2x2s is known to impact the effectiveness of disinfectants. Schedule training on any new products and any old products that have changed. Ongoing training on the use of products and the precise following of directions is a simple solution to these challenges.

EPA Approved?

Surface disinfectants are required to be Environmental Protection Agency (EPA) approved and the EPA number must be listed on the label. The label will also state if it is a hospital-grade disinfectant. The EPA number lets you know that the product is either low-level (such as HIV and HBV label claims) to intermediate-level (such as tuberculocidal claim) activity. We must use an intermediate-level disinfectant for anything visibly contaminated with blood.

Questions and Solutions:

When asked if the product that they were using was an EPA hospital-grade disinfectant, the overwhelming reply (81%) was, “I do not know.” Over-the-counter items from big-box stores and grocery stores more than likely do not have EPA registration numbers as a hospital-grade disinfectant and cannot be used in the dental setting for cleaning and disinfecting. Twenty-eight percent were buying disinfectant over the counter. Check to see if your product is a hospital-grade disinfectant approved by the EPA.

Personal Protective Equipment:

A vital part of keeping the clinician safe is following OSHA regulations and CDC recommendations for using proper personal protective equipment. Sharps and chemically resistant gloves are required when using a disinfectant to break down a room or work in the sterilization area. Patient exam gloves are not designed to meet the harsh requirements when working with chemicals; they were made to work with patients. I reached out to Kimberly Clark Company and asked about their patient exam gloves and working with disinfectants. A representative from Kimberly Clark stated, “I have consulted with our technical team regarding your question about exam gloves that are chemical resistant. Our chemical gloves are different from our exam gloves and have a much thicker mil than exam gloves. However, our health-care division does have some gloves that will protect against certain chemical exposures during health-care procedures, such as chemotherapy drugs. They are not designed to work with disinfectants.

Questions and Solutions:

79% of those surveyed wear masks when working in the sterilization area or working with chemicals, and 81% wear gowns. Sadly, only 20% are consistently wearing utility gloves. Therefore, an overwhelming 80% are putting themselves at risk for sharps injuries and their organs at risk for chemical exposure by not wearing utility gloves. Exam gloves are not resistant to chemicals and can allow them to penetrate to the skin. The excuses for not wearing utility gloves remind me of when I first donned gloves in the late ‘80s: “They destroy my tactile sensitivity,” “They are too bulky,” or “I don’t have the time.” Overwhelmingly, it was stated they thought patient exam gloves were enough; they are not. Some even reported they were touching chemicals with their bare hands since they were using a disinfectant wipe that was “safe.” The disinfectant wipes are made to kill microorganisms; they are not safe for human contact! A few very honest people shared that they were just lazy. This is not an area to be lax in. Of the 80% that were not wearing utility gloves, 11.25% reported a sharps injury within the year. Of the 20% that were wearing utility gloves, only .05% reported a sharps injury! Such a significant difference!

My thoughts: Why don’t we talk about your infection control protocol and let me assist you in this important area of your practice?