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Asepsis of Surfaces

and Equipment
Module 4
Nancy Goodwin, CDA, RDH, MEd.
All rights reserved

Some things to think


about
How do you decide what should have a barrier
and what should be disinfected?
How do you know that the surfaces you
disinfect are really disinfected?
Are there things you touch during patient care
that are not disinfected? If so, what are they?
What happens when something doesnt get
disinfected properly (whats the big deal?)?

Objectives
Upon completion of this module, participant will be able to:
Define the difference between clinical contact surfaces and
housekeeping surfaces.
Classify the surfaces in the dental setting
Define touch, transfer, and splash/splatter surfaces
Describe the two methods used to control surface contamination
describe the clinical surfaces ordinarily protected by surface
barriers and rationales.
Name the government agency responsible for registering
disinfectants for dentistry.
List EPA-approved intermediate-level disinfectants
Describe and demonstrate the CDC guidelines fordisinfecting
clinical contact surfaces.
Describe and demonstrate the CDC guidelines for disinfecting
housekeeping surfaces.
Demonstrate the process of cleaning and disinfecting a treatment
room.
Discuss the difference between cleaning and disinfection.

Clinical vs. Housekeeping


Surfaces
The CDC classifies environmental surfaces in
the dental office into two categories:
Clinical Contact Surfaces
Housekeeping Surfaces
Classifying surfaces in the operatory is an
important step in determining the proper
protocols that will prevent crosscontamination.

Housekeeping Surfaces
do not come in contact with hands or
devices that are used during dental
procedures.
may be cleaned at the end of the day
Examples: floors, walls, sinks

Establish a schedule for cleaning


housekeeping surfaces, usually daily for
floors and sinks.
Use soap and water or an EPA-registered
detergent or low level disinfectant.
If housekeeping surfaces become visibly
contaminated between scheduled cleaning
(with blood, for example), clean and
decontaminate using an intermediate
level disinfectant as soon as possible

Clinical Application
Think about the operatory or operatories
where you practice..where are the
housekeeping surfaces?
Do you have a schedule for cleaning these
areas on a regular basis?
Are there any areas that you need to add
to the schedule?

Clinical Contact Surfaces


Defined as:
those surfaces which are touched frequently
with contaminated gloves, instruments or
devices during patient care
All surfaces that have contacted any potentially
infectious patient materials MUST be covered
with barriers or cleaned and disinfected
between patients.

Clinical Contact Surfaces


Can be further classified into:
Touch surfaces (directly touched)
Transfer surfaces (not directly touched but
may be touched by contaminated instruments).
Splash, splatter, and droplet surfaces
(are not contacted directly but may receive
spray or splatter from aerosols produced).

Clinical Application
Think about the clinical surfaces in your
practice setting.
Which ones do you regularly touch
during patient care?
Which ones are splash or splatter
surfaces? How about transfer surfaces?
What can you do to limit the surfaces you
touch during patient care?

Examples of Clinical
Contact Surfaces
Light handles/switch (touch)
Bracket table (touch and/or transfer)
Air/water syringe (touch)
Suctions and hoses (touch)
Countertops (splash/splatter)
Shade guides (touch)
X ray equipment/lead apron/exposure
buttons(touch)
ETC!

Two methods are recognized for the


treatment of clinical contact surfaces:
1. Prevent the surface from contamination
by using an appropriate surface barrier.
2. If the surface can be disinfected
thoroughly, it must be precleaned and
disinfected.

How do I decide?
Listen to this audio file which help you decide
which method is appropriate for a given
surface.

In general, if it is a smooth, hard surface, it


may be precleaned and disinfected. Otherwise,
it should be protected by a barrier.

These cultures were


taken from an unbarriered
mouse and keyboard in a dental operatory.

This is a good example


Of a surface that cannot
Be properly disinfected
And therefore should
Be barrier protected.

Keyboard and mouse with proper barrier protection

This is another example of what can be cultured from clinical contact


surfaces. The top cultures were obtained from an unbarriered x-ray
exposure button; the cultures on the lower half of the plate were obtained
from an unbarriered air water syringe. The assistant had disinfected the surface,
but as you can see, this is an inadequate treatment.

Remember
The purpose for surface
barriers and surface
disinfection is to
decrease the likelihood
of cross-contamination
from patient to patient.

Surface Barriers
Should be fluid resistant
Are specially made to adapt to many
clinical surfaces.
Prevent contamination of the surface
Save time
Reduce chemical use in the office
Are inexpensive

Barriers are
Available in
All sizes and
shapes

Surfaces typically protected


by surface barriers:
Control buttons on
patient chair
Air/water syringe
control buttons
Suction controls
Light switch/handles
Adjustment handles on
assistant/hygienist chair
Handle on light-curing
equipment

Computer
keyboard/mouse
X ray exposure control
Pens/pencils used to
write during procedures
Etc.
**Remember: if a surface
cannot be easily cleaned
and disinfected, it should
be covered by a barrier.

Surface Barriers: Placement


Apply appropriate barrier to clinical surfaces
that have been disinfected. (no gloves needed)
Placement should be secure enough to last
through the procedure
Each barrier should completely cover the
surface that it is protecting.
If the barrier fails to stay on or the surface
becomes contaminated, it must be cleaned and
disinfected before the next patient.

Surface Barriers: Removal


Wear gloves during removal
Remove carefully so the underlying
surface is not contaminated. If you are
successful, the surface does not require
cleaning and disinfection.
If you do accidentally touch the surface,
clean and disinfect.

Precleaning
Defined as the cleaning that must take
place before disinfecting.
Many dental professionals fail to carry
out this step.
Wiping a surface with a disinfecting
towlette or spraying and wiping a surface
once is not disinfection.

Remember
If a surface is not clean, it
cannot be disinfected!
Blood, saliva and other body fluids
(bioburden) must be removed before surface
disinfectants can be effective.
If this step is not performed, bioburden is just
spread around and not removed.

As shown earlier, these potential pathogens grew on a surface that


Had been disinfected by the assistant. Unfortunately, she failed
To perform the precleaning step. So, even if this was a surface that
could be effectively cleaned, it would still exhibit microbial growth.

Clinical Application
Next time you break down your operatory
after patient care, take note of how you
disinfect before the next patient is seated.
Do you carefully remove all barriers?
Do you preclean any contaminated areas
before you wipe with disinfectant?
Do you allow for the recommended kill
time for the disinfectant to work before
the next patient is treated?

This photograph provides another good example of the need for precleaning
surfaces prior to disinfection. The cultures in the top portion of this agar plate were
obtained from the clean area of the countertop in the sterilization area.
This type of surface is appropriate for surface disinfection because it is
hard and smooth. Unfortunately, just wiping the
counter with a disinfectant without the precleaning step just spreads the
microbes all around without removing them, or providing disinfection.

Precleaning procedures
Soap and water or a disinfectant that can clean
as well as disinfect may be used (best).
Mask, utility gloves and protective eyewear
should be worn.
Spray paper towel or gauze with product (or
use premoistened disinfecting towlette)
Vigorously wipe the surface (this is the step
that removes the bioburden). The surface is
now ready to be disinfected.

Disinfection
Described as the process which destroys or
inactivates most pathogenic microorganisms.
Must use an EPA-approved product that is a
tuberculocidal, Intermediate level disinfectant.
( the ability to kill mycobacterium tuberculosis
is considered the benchmark for disinfectants)
These products will destroy all
microorganisms, except spores if used as
directed.

Remember
To mix the product according to the
manufacturers directions.
To use all the product or replace it before its
expiration date.
If an item can be heat sterilized, it should be
heat sterilized, not disinfected.
To follow the CDC recommendations for
environmental infection control.

Types of disinfectants
Not recommended
Chlorine bleach-no
longer recommended
because it is not EPA
registered.
Alcohol-not effective;
not recommended by
the ADA, CDC, or
OSAP

Recommended
Quaternary
Ammonium
compounds
Complex phenols
Iodophors
Phenol-alcohol
combination
Other halogens

Link
http://www.osap.org/displaycommon.cfm?
an=1&subarticlenbr=367
from this page, click on the link:
OSAP SURFACE DISINFECTANT
REFERENCE CHART - 2006

The ideal disinfectant


Would rapidly kill a wide range of bacteria
Would have residual (long-acting) activity
Would be odorless and inexpensive
Would not damage surfaces
Would work in the presence of bioburden
Would not be harmful to personnel
Unfortunately, there is no ideal disinfectant
currently available. Therefore, each office will
choose based on advantages and disadvantages
of each available disinfectant.

Disinfection Procedures
1. Wear utility gloves, eyewear and protective
clothing (latex gloves are not appropriate
because they are compromised by many
disinfectants).
2. Only surfaces that have been previously
cleaned are ready for this step.
3. To disinfect, spray a paper towel or gauze
with the product or use an EPA approved
premoistened disinfectant towlette. Wipe the
surface thoroughly.

4. Or, you may spray the disinfectant over the


surface and leave wet.
5. In either case, let the surface remain wet with
the product for the time recommended by the
manufacturer. The kill time listed will tell
you how long the surface must remain moist
with disinfected for microorganisms to be
killed.
6. You may wipe the surface dry if it is still wet
after that time period if you are ready again
for another patients care.

Equipment asepsis
The best solution for equipment is to
keep it from becoming contaminated in
the first place.
Computers, for example, should be
protected with a barrier to avoid
contamination since they cannot be
adequately cleaned and disinfected..
Reusable keyboard covers are available.
If used, they must be precleaned and
disinfected. You may also choose an
appropriate disposable barrier.

Video or digital cameras used in the dental


office are not designed to be disinfected. Either
protect them with a barrier or do not touch
with contaminated hands.
For intraoral cameras, follow the
manufacturers instructions for disinfection.
Some are designed to be used with specially
made barriers.
Digital radiography presents unique
challenges since the sensors cannot be heat
sterilized. They should be protected by a
surface barrier. More discussion on this subject
in Module 7 .

Remember
Once you have been in a patients
mouth with gloves, they are
contaminated. Do not touch
surfaces (charts, content of
drawers, etc.) which will not be
disposed of, sterilized or
disinfected. This practice is the
difference between asepsis and
cross-contamination.

The plate above demonstrates microbial growth from two different


operatories. The cultures were obtained from cabinet and drawer knobs.
Remember never to touch surfaces with contaminated hands
unless they will be precleaned and disinfected, thrown away, or
sterilized.

Aseptic Practices
Make sterile cotton pliers a part of every
tray set up. You may use them if you need
to retrieve something out of a container
or drawer during procedure.
Some products are available in unit
doses for individual patient use. For
example, a hygienists pack might contain
gauze, floss, and prophy angle and paste.

Unit dose packs may be purchased, or an office


might make up their own trays or packs of
needed disposable supplies. This practice saves
time and can help prevent crosscontamination.
Before patient treatment, assemble all the
instruments and supplies that you will need for
that particular procedure. Use aseptic
technique to retrieve supplies if needed. If you
must leave the treatment room, unglove and
wash hands before leaving. When you return,
rewash and reglove.

To review.
Classify operatory surfaces first
Choose the most appropriate method for
clinical surfaces: barriers or disinfection
If a surface would be impossible to
thoroughly clean, you must choose
barrier protection
Preclean any contaminated surfaces
before disinfecting.

Choose an EPA-registered product and


use according to manufacturers
directions
Wear appropriate PPE for the task
If it can be heat sterilized, it
should be heat sterilized.
Prevent cross-contamination by
remembering that anything you touch
with gloves that have been in a patients
mouth becomes contaminated.

Congratulation
you are done w
Module 4!