The disinfection of dental equipment, critical and semi-critical instruments, and clinical surfaces throughout the dental operatory are important components of maintaining proper infection control. As a dental care professional, you are routinely exposed to a variety of infectious organisms during the performance of your duties. By following the most current evidence-based CDC and OSHA guidelines for environmental infection control and using the proper products and procedures, you can help reduce the chances of cross contamination in the workplace.
This guide is intended to help provide a thorough overview of the steps to clean and disinfect environmental surfaces, critical and semi-critical instruments, and other workplace materials to help you the dental professional to concentrate on providing the highest quality of care to your patients. These infection control best practices are also aimed at helping your practice maintain compliance with CDC guidelines and federal statutes.
- Hand Hygiene
Hand hygiene – proper hand washing, hand antisepsis, or surgical antisepsis – is an important step in infection control. This is the first line of defense in protecting yourself and your patients from pathogens. According to the CDC, proper hand hygiene should be practiced “before patient contact; after contact with blood, body fluids or contaminated surfaces (even if gloves are worn); before invasive procedures; and after removing gloves.” Kerr has a range of hand hygiene products that help reduce the threat of cross-contamination and ensure compliance with CDC guidelines, including antimicrobial liquid soaps, antimicrobial foaming soaps, hand sanitizers and antiseptic towelettes.
- Disinfection of Clinical Surfaces
Cleaning dental equipment surfaces and environmental surfaces using disinfectant cleaners is the critical first step in the decontamination process. The CDC recommends that surfaces be “disinfected with an EPA-registered low- or intermediate-level disinfectant.” Keep in mind, protective gloves should be worn at all times during the disinfection process. A surface disinfectant can be administered as either a spray or a wipe on hard surfaces and equipment that can’t be disinfected by other means.
To use a spray disinfectant, the surface should be sprayed, then wiped vigorously with a clean towel to clean. Following this cleaning step, the surface should then be sprayed again with the surface disinfectant and the surface allowed to remain wet for the contact time as indicated on the product label. If using dental surface disinfectant wipes, the surface should be wiped first to remove debris, then wiped with a new disinfectant cleaner towelettes to ensure thorough disinfection.
Keep in mind, not all disinfectants can be used as a cleaner, so the spray-wipe-spray method may involve multiple products.
- Instrument Pre-cleaning 
Following the use of any critical and semi-critical instruments during procedures, it is important to never hold any instruments in a dry container, as this can allow for blood and debris to dry onto instruments, making cleaning difficult. If rinsing and decontamination options are not immediately available, pre-treat instruments using a foaming dual enzymatic spray, to help remove bioburden and debris. A dual enzymatic concentrate diluted per its instructions for use may also be used for instrument presoaking and pre-cleaning.
- Rinsing 
Following the presoak step, instruments should be rinsed under warm (not hot) running water to remove organic materials and debris. Rinsing will help to remove most blood fluids and tissue. Be sure to not process dissimilar metals (stainless, copper, chrome plated, etc.) together. Safety protection gear should be worn at all times as well.
- Cleaning and Disinfecting 
Following the pre-cleaning and rinsing stages, critical and semi-critical instruments should be soaked in a tepid water and detergent bath for at least 10 minutes. This step helps to further loosen any remaining bioburden on the instruments. Utilization of a dual enzymatic cleaner in the soaking process can help to break up organic soil and disinfect more readily and rapidly than conventional detergents. Brush instruments with a medium-soft bristle brush while still in the soak bath. Instruments should be rinsed under running water to remove solutions and solutions should be changed frequently.
- Sterilization 
To sterilize heat sensitive, immersible dental equipment, critical and semi-critical instruments, a chemical/cold sterilization soak should be used for disinfection. After sterilization, instruments should be rinsed with sterile water to completely remove any residue of the sterilization solution, dried completely and then used immediately or packaged in a sterile package.
- Discard Barriers and Disposable Products
Disposable dental supplies, including barriers, sleeves and covers will help to save time and reduce the risk of cross contamination for you and your patients. The CDC states, “Barrier protection… is particularly effective for those [clinical contact surfaces] that are difficult to clean.”  Disposable headrest covers, chair sleeves, instrument sleeves and sheaths, and other protective covers and barriers should be removed and properly disposed of following each patient visit to maintain a hygienic work environment. The use of operatory disposable products is recommended as part of the disinfection process and to speed the process of cleanup and room prep. Disposable filters for evacuation units and central vacuum pumps eliminate filter cleaning and offer the same performance as traditional products. (Filters for certain types of material may require special disposal processes under federal statutes.)
Effectively cleaning and disinfecting critical and semi-critical instruments and clinical surfaces is an imperative component of infection control and reducing the risk of cross contamination in the dental workplace. Educating all dental care professionals on the proper use of disinfectant cleaners and methods will help create a safe environment for both patients and dental professionals.
About the Author:
At Kerr TotalCare, we are committed to providing comprehensive and innovative solutions to dental hygienists and dental assistants, so they can offer the highest level of care while complying with infection control standards.
1 Hand Hygiene Basics. Centers for Disease Control and Prevention web site. Available at http://www.cdc.gov/handhygiene/Basics.html. Published 1 May 2014. Accessed 8 Dec 2014.
2 Rutala, W. A., & Weber, D. J. (2008). Guideline for disinfection and sterilization in healthcare facilities, 2008.
3 Collins, A. S., Cleveland, J. L., Harte, J. A., Eklund, K. J., & Malvitz, D. M. (2003). Guidelines for infection control in dental health-care settings-2003.