Across the globe in 2020, words like cleanliness, disinfection, and sterilization took an unprecedented spotlight in the priority list of dentists. We’ve always been concerned with protecting ourselves and our patients from the pathogens and infection that can be borne through spatter and air and touch. As we move out of the first year of life experienced through a pandemic, these priorities have simply become the new standard, with enhanced guidelines and COVID-dedicated information hubs from official resources including the Centers for Disease Control (CDC), the American Dental Association (ADA), the American Dental Hygienists’ Association (ADHA) and the Organization for Safety Asepsis and Prevention (OSAP).

How the COVID-19 Pandemic Has Changed Dental Equipment Disinfection

From arrival in the waiting room to the end of an appointment, dental practices have instilled additional precautions to protect both patient and staff. Patients are often asked to wear a mask upon entry, until they are in the dental chair. Staff not only wear gloves but masks and eyewear, as a matter of standard. Sterilization protocols have become more involved and there’s an uptick in record-keeping. Aerosol mitigation is a constant conversation, with many practices adding additional suction to help capture some contaminants before they settle on surfaces.

This article is focusing on the need for effective dental equipment disinfecting, but we’ll talk about sterilization, and aerosol mitigation, in future articles.

A Review of Cleaning, Disinfection, and Sterilization; the Distinctions and Why they Matter

Cleaning

Definition: The CDC defines dental equipment disinfection as “The physical action of scrubbing with detergents and surfactants and rinsing with water”

When: Always. It’s the first step in any disinfection process, to remove debris like organic matter, salts, and visible soils - without this step, these materials can interfere with the disinfection process.

Where: All surfaces should be cleaned, whether the process ends there or is just the first step to further decontamination. It is the primary process for what the CDC refers to as the “housekeeping” areas - floors, sinks and walls - areas that “are not directly touched during dental treatment and carry the lowest risk of disease transmission”

How: Detergent and water or an EPA-registered hospital disinfectant/detergent. When a surface cannot be cleaned adequately, it should be protected with suitable barriers.

Disinfecting

Definition: Dental disinfection destroys most pathogenic and other microorganisms (excluding bacterial spores), by physical or chemical means (usually liquid chemicals)(ref CDC)

When: After each patient on all clinical contact surfaces including equipment and tools that don’t require sterilization.

Where: Surfaces that may be directly or indirectly contaminated by spray or spatter during procedures, or by practitioner hands, including light handles, switches, dental radiograph equipment, computers, drawer handles, faucets, dental chairs, delivery units

How: Following the product directions, apply EPA-registered hospital disinfectant with a low-level to intermediate-level activity after each patient.

Sterilization

Definition: Dental sterilization destroys all pathogenic and other microorganisms, including substantial numbers of resistant bacterial spores, by heat (steam autoclave, dry heat, and unsaturated chemical vapor) or liquid chemical sterilant (ref CDC)

When: Items that penetrate soft tissue or bone, carry bioburden/ the most likely to transmit infection

Where: Surgical instruments, periodontal scalers & tips, mouth mirrors, dental handpieces & burs, reusable impression trays

How: Heat or chemical sterilization using recommended load limits and cycle time.  A good practice is to leave sterile instruments in chamber until immediately before use to minimize airborne contamination.

The Best Defense is a Strong Offense!

Knowing the CORRECT way to apply safety protocols and cleaning and disinfecting systems is critical to successfully protecting from disease transmission.

Start with smart barriers - plexi protectors at the front desk, protective eye and body wear, single use sheets to cover dental chairs all offer protection to the practitioner or patient. Consider adjusting your patient flow to limit the number of people in your waiting room and incorporate a prescreening form that asks the standard questions about COVID-like symptoms before patients arrive.

Next, don’t rush through the cleaning; as we stated earlier, proper disinfection starts with proper cleaning. Following the correct protocol for cleaning is imperative to ensuring the quality of the task isn’t compromised. Fully removing debris that can block or interfere with the ability of the disinfecting chemicals to reach the surfaces they’re tasked with tackling is imperative.

Dental disinfection compounds have specific protocols and, like anything else, have to be done according to standards, or they simply aren’t effective. Similar to mistakes commonly made like the quick hand-wiping of a shopping cart, wiping something too quickly or with a substandard mix of ingredients just won’t have the desired efficacy. Many contact antimicrobials fall into the class of quaternary ammonium compounds, usually referred to as “quats”. Some require that the cleaning material fully dries before the surface is considered clean.

It’s Only as Good as the Operator

Because the method may be different across your various surfaces and products, appropriate training for staff is key to obtaining a truly clean and safe environment. Staff should be trained regularly in the proper use of surface cleaners and disinfectants. Posting the instructions for use for common cleaners for personnel to reference is recommended. Tracking and record-keeping your office’s cleaning protocols is a good way to encourage adherence by staff and protect your entire practice.

Protecting your Investment

As you can imagine, this continuous cleaning can take a toll on your expensive equipment. Some of these cleaning and disinfecting agents can wreak havoc on your materials - upholstery and plastics on equipment can discolor, or become cracked or brittle. There’s increased concern with the ability to clean tricky surfaces like seams, hard-to-reach corners and crevices on equipment.

At DENTALEZ, we craft our products with smart, accessible designs and durable materials to withstand the rigorous cleaning protocols mandated for practices, and provide in-depth cleaning guidelines specifically for our equipment to help you protect your investment. For example, our Forest line of dental chairs offer solutions like seamless upholstery which have a single, smooth surface that makes cleaning easier. We substitute metal for plastic in many areas, and our chairs, units, lights and mounts are built with durable materials that stand up to common disinfection practices. We also provide a recommended cleaning protocol specific to our dental equipment, to help you protect your investment so it provides years of beauty and easy maintenance.

Our Takeaway?

Invest in PPE, barriers and appropriate dental cleaning and disinfection supplies.
Update your (and your staff’s!) knowledge on cleaning and disinfecting protocols for your practice.
Visibly post the guidelines for common cleaning and disinfection tasks.
Refer to DENTALEZ’s guidelines to keep your equipment functioning safely for years to come!
Consider ease of cleaning and disinfecting when choosing dental equipment for your operatory needs.
Call now or schedule a call to learn more today.

References

BESC Module 7 – Sterilization and Disinfection of Patient-Care Items and Devices

BEST PRACTICES FOR INFECTION CONTROL IN DENTAL CLINICS DURING THE COVID-19 PANDEMIC

Cleaning & Disinfecting Environmental Surfaces | FAQs | Infection Control | Division of Oral Health

Disinfection and Sterilization in Dentistry

Sterilization: Cleaning | FAQs | Infection Control | Division of Oral Health