Coming Clean

Surface disinfection is key to a safe dental environment.

Taking precautionary steps to prevent the spread of infection at the dental practice is not necessarily difficult. But it does require time, effort and mindfulness. Unless regularly disinfected to remove germs and bloodborne pathogens, some surfaces – particularly those that are frequently touched or contacted – present a risk of contamination. The good news is that surface disinfectant manufacturers have begun collaborating with other device and product companies, leaving dental professionals with an increasing number of options for preventing the spread of infection at their practice.

“The versatility of surface disinfectants has increased, enhancing product compatibility and permitting use throughout a facility,” says Joel Rich, national sales director of non-acute, GOJO Industries, Inc. “As surface disinfectant manufacturers collaborate with other device and product manufacturers, a synergistic effect has taken hold, leading to new and easier-to-use disinfectants.”

As an example, GOJO Industries, Inc. has introduced PURELL Surface Disinfectant, which features rapid kill and dry times with no glove or rinse requirements. It is said to be effective on most hard and soft surfaces, from plastics and porcelain to metals, laminate, granite, upholstery, sealed wood, vinyl and more. In additional, it has the lowest possible EPA ratings, and as such, carries no precautionary statements or warnings. “The room can be disinfected quickly and safely,” Rich points out.

“The Centers for Disease Control and Infection (CDC) guidelines encourage the proper cleaning and disinfection between patient use of shared medical devices and patient-centric areas,” says Rich. Today’s surface disinfectants make it easier for the dental staff to do so, he adds.

Clean and safe: CDC recommendations for disinfecting surfaces
Cleaning is the necessary first step of any disinfection process, according to the Centers for Disease Control and Prevention (CDC). Cleaning removes organic matter, salts and visible soils, all of which interfere with microbial inactivation. The physical action of scrubbing with detergents and surfactants and rinsing with water removes substantial numbers of microorganisms. If a surface is not cleaned first, the success of the disinfection process can be compromised. Removal of all visible blood and inorganic and organic matter can be as critical as the germicidal activity of the disinfecting agent. When a surface cannot be cleaned adequately, it should be protected with barriers.

Environmental surfaces can be divided into clinical contact surfaces and housekeeping surfaces. Clinical contact surfaces can be directly contaminated from patient materials either by direct spray or spatter generated during dental procedures or by contact with gloved hands of dental health care personnel. These surfaces can subsequently contaminate other instruments, devices, hands, or gloves. Housekeeping surfaces (e.g., walls, floors, sinks) are not directly touched during dental treatment and carry the lowest risk of disease transmission.

Recommendations for cleaning and disinfecting environmental surfaces:

Environmental Surface Type Examples  Recommendations for Cleaning and Disinfecting*
Clinical contact · Light

· Handles

· Switches

· Dental radiograph equipment


· Drawer handles

· Faucets

· Use surface barriers to protect, particularly for surfaces that are hard to clean, and change barriers between patients. Use surface barriers to speed operatory turnaround.
· Clean and disinfect surfaces that are not barrier protected using an EPA-registered hospital disinfectant with a low-level (i.e., HIV and HBV label claims) to intermediate-level (i.e., tuberculocidal claim) activity after each patient. Use an intermediate-level disinfectant if visibly contaminated with blood.
Housekeeping · Floors

· Walls

· Sinks


· Clean with a detergent and water or an EPA-registered hospital disinfectant/detergent on a routine basis, and when visibly soiled.

· Clean mops and cloths after use and allow to dry before reuse; or use single-use, disposable mop heads or cloths.

· Prepare fresh cleaning or EPA-registered disinfecting solutions daily and as instructed by the manufacturer.

· Clean walls, blinds, and window curtains in patient-care areas when they are visibly dusty or soiled.

* High-level disinfectants should never be used on environmental surfaces.

There are three levels of disinfection: high, intermediate, and low. High-level disinfectants, such as glutaraldehyde, are used as chemical sterilants and should never be used on environmental surfaces. Intermediate-level disinfectants are registered with the Environmental Protection Agency (EPA) and have a tuberculocidal claim, and low-level disinfectant are EPA-registered without a tuberculocidal claim (i.e., hepatitis B virus and HIV label claims).

The Environmental Protection Agency regulates low- and intermediate-level disinfectants that are used on environmental surfaces (clinical contact surfaces and housekeeping). The Food and Drug Administration regulates liquid chemical sterilants/high-level disinfectants (e.g., glutaraldehyde, hydrogen peroxide, and peracetic acid) used on heat-sensitive semicritical patient care devices.

When used correctly, commercially available disposable disinfectant wipes, cloths, or towelettes are effective for cleaning and disinfecting environmental surfaces in dental settings. Any disinfectant used in a dental setting should be registered by the Environmental Protection Agency (EPA) and be approved for use in health care settings (i.e., hospital grade). Dental health care personnel should always follow manufacturer recommendations for use of cleaners and EPA-registered disinfectants (e.g., amount, dilution, contact time, safe use, disposal). Disinfectant wipes that you can buy at the grocery store are not EPA-registered and are not recommended for use in a dental setting.

Other techniques refer to the two-step procedure used to clean and disinfect environmental surfaces. If using liquid disinfectant, the user would spray the surface with the disinfectant and wipe it using a disposable towel to clean the surface (“spray-wipe”), followed by another “spray” to disinfect the surface. When using disposable disinfectant wipes, the process is described as wipe-discard-wipe because the user uses one wipe to clean the surface, discards the wipe, and uses a second wipe to disinfect the surface. Disinfectant products should not be used as cleaners unless the label indicates the product is suitable for such use. The Centers for Disease Control and Prevention recommends following manufacturer recommendations for use (e.g., amount, dilution, contact time, safe use, disposal).

Source: Centers for Disease Control and Prevention, CDC 24/7: Saving Lives, Protecting People ™.

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