SURFACE DISINFECTION AND TREATMENT ROOM PREPARATION CHAPTER 7

Surface Barriers To prevent contamination on the surface, so that it will not have to be cleaned or disinfected between patients All should be fluid resistant, so that blood, salvia, other liquids from soaking through Types: shaped bags which fit hoses, syringes, pens, light handles, Plastic sticky tape which cover smooth surfaces, x-ray pad, mouse, touch pads See page 101, Figs: 7-2,7-3, Procedures 7-1 pg 109 discuss

Precleaning and Disinfection Precleaning: clean before disinfection, all surfaces must be precleaned, reduces the number of microbes and removes bioburden, not all disinfectants contain a precleaning agent (Table 7-1, pg. 100) Regular soap and water can be used, but a disinfectant with both detergents saves time Disinfection: intended to kill disease producing microorganisms that remain on the surface after precleaning, Spores are not killed during disinfection Disinfection is used for chemicals that are applied to surfaces (countertops & dental equipment) Antiseptic: used for antimicrobial agents that are applied to living tissue Disinfectants and Antiseptics should be never interchanged, damage can occur to tissue or equipment Procedure: 7-2 pg 110

Disinfectants Environmental Protection Agency: registers and regulates disinfectants and chemical sterilants and places them into the categories described in Table 7-2, pg. 102 In dentistry only products that are registered with the EPA, with the tuberculocidal claim, should be used to disinfect the dental area Mycobacterium Tuberculosis: organism that is killed by disinfectants that contain tuberculocidal (fig. 7-5, pg. 102)

Characteristics Of Disinfectants One that rapidly kills all types of pathogenic organisms Would be odorless Gentle to dental equipment Non-toxic Economical to use No perfect surface disinfectant, so you make informed choices: Classes of Disinfectants Several Classes of Disinfectants (Table 7-3, pg.103) discuss this See fig 7-6, pg. 102, fig. 7-7, pg. 104 (box 7-1)

Immersion Disinfectants Chemicals that can be used for sterilization and high-level disinfection When used as a sterilant, destroy all microbial life, inc. bacterial endospores Type depends on the length of sterilization from 30 hours For weaker dilutions or shorter contact, this provides high-level of disinfectant, inactivates all microorganisms except endospores See Table 7-4, pg. 104, Fig. 7-8 pg 105 Glutaraldehyde, Chlorine Dioxide, Ortho- Phthalaldehyde all high-level of immersions disinfectants: times, characteristics, cost may vary

Classifications of Instruments, Equipment and Surfaces Each are divided into Three Classifications: critical, semi-critical, non-critical to determine level of post treatment processing See Table 7-5, pg. 106 Discuss See Box 7-2, pg. 106

Additional Aseptic Techniques Unnecessary Touching of Surface: plan ahead and have all items for treatment out, reduces need to leave chair side and reaching into drawers with gloves, IF you have to leave the chair side always de-glove, Remember not to touch, rub, anything on your face with gloved hands High-volume Evacuation: use and proper placement reduce the amount of salivary aerosols and spatter from the patients mouth, HVE should be cleaned nightly and traps changed weekly, when cleaning always wear protective clothes, glasses and gloves

Additional Aseptic Techniques Rubber Dam: minimize the spatter and dental aerosols from the patients mouth Preprocedure Mouth Rinse: may rinse with a antimicrobial mouth rinse, reduces the amount of microorganisms, also may reduce the number released into the patients bloodstream Use of Disposables: items made of plastic, single use, dispose of properly and should not attempt to sterilize it for reuse on another patient

Dental Unit Water Line Contamination See Fig. 7-9 pg, 107 As water stands in the narrow dental unit water lines, some bacteria attach to and accumulate on the inside of the walls forming BIOFILM, Fig and Fig Bacteria embedded in the protective biofilm is very hard to remove As the water flows through the lines, this bacteria may be released into the water, and sprayed into the patients mouth, through the hand piece or Air/water syringe To reduce this: See Box 7-3, Pg. 107

Cleaning and Disinfection of the Laboratory Area Steps should be taken to prevent cross-contamination Countertops should be disinfected on a regular basis All lab pans cleaned before next use No eating or drinking in this area, no storing of food Impressions: wear gloves, protective eye wear, Check the manufactures recommendations for disinfection, See Procedure 7-3, pg 111 Discuss Disinfection of Casts: preferable to disinfect the impression, so that the cast will not have to be disinfected, if needed spray with iodophor or chlorine product, rinsed and allowed to dry All Lab equipment: cleaned with an Intermediate disinfectant, see fig 7-12, pg 108,

Cleaning and Disinfecting the Radiology Area Multiple opportunities for cross-contamination Surfaces that the operator touches are considered non-critical, must be cleaned with an intermediate level or low-level disinfectant after the patient is dismissed Alternative is to cover the non-critical surfaces with barrier Barriers should be placed over the headrest, countertops, extension arm, tube head, PID of the x-ray, control panel, exposure button See Fig. 7-13, a & b Watch Video on disinfection and sterilization