Dental Practice Surface cleaning and disinfection
Surface cleaning and disinfection is critical for effective infection control measures in the dental surgery.
The practice should have a local protocol clearly outlining the surface and room-cleaning schedules. This can be in the form of an infection control policy, infection control statement and daily surgery logbook checks. The practice/contract cleaning manager should carry out regular surgery spot checks.
Bacteria, viruses and fungi may be present in the surgery and in particular on the work surfaces after treating a patient, so the cleaning and disinfection of surfaces is paramount to patient safety.
What is disinfection?
Thorough cleaning with an approved detergent diluted in water is often seen as sufficient for the environment. Disinfectants are not required unless there is risk of infection – All clinical areas face a risk of infection. To prevent growth of any remaining organisms, the surfaces must be dry.
Disinfection is a process that reduces the numbers of microorganisms to a level where they are not harmful, with the exception of spores which are not usually destroyed by this method. Decontamination using chemical disinfectants should only be carried out where other methods, such as heat or steam, are not suitable.
Surface and flooring specifications
All surfaces and flooring should be impervious and easy to clean. Careful considerations must be taken when choosing fixtures and fittings for clinical areas. Surfaces should be joint less or seams heat welded.
Floors coverings should be continuous, non-slip and joint less, with curved skirting where possible. Existing floors can be fitted with a curved sit on coving, but this requires heat welding to provide a seamless joint.
Carpets must not be used in clinical areas.
When should surfaces be cleaned and disinfected?
Surfaces should be cleaned and disinfected:
- Before clinical sessions
- Between patients
- End of clinical sessions.
HTM 01-05 and WHTM 01-05 under section 6.61:
‘The patient treatment area should be cleaned after every session using disposable cloths or clean microfiber materials – even if the area appears uncontaminated.’
Between each patient
The following areas should be cleaned between each patient:
- Work surfaces
- Dental chair (must be free from rips)
- Curing lamps
- Inspection lights and handles (should be protected with disposable coverings)
- Hand controls
- Trolleys/delivery units
- X-ray units.
Any equipment used during dental procedures should be wiped after each use and thoroughly cleaned at the end of the session.
Plastic disposable covers can be used but are not a replacement for frequent cleaning.
After every session
The following areas should be cleaned after every session:
- Drainage points
- Floor surfaces
- Around the foot of the dental chair
- Spittoons need a thorough cleaning according to manufacturer’s instruction.
Using alcohol-based wipes in a dental practice
Since the introduction of HTM 01-05 and WHTM many dental practices have been given the impression that the use of alcohol-based wipes is prohibited: this is not the case.
HTM 01-05 2013 Edition, Section 6.57:
‘The use of disinfectant or detergent will reduce the contamination on surfaces. If there is obvious blood contamination, the presence of protein will compromise the efficacy of alcohol-based wipes.’
WHTM 2014 Edition, Section 6.57:
‘The user of commercial bactericidal cleaning agents and wipes is helpful in maintaining cleanliness and may also reduce viral contamination of surfaces. Care should be taken in the user of alcohol wipes which, though effective against viruses on clean surfaces, may fix protein and biofilm. However, the careful use of water with suitable detergents, including those CE marked for clinical use, is satisfactory provided the surface is dried after such cleaning.’
HTM 01-05 and WHTM state:
‘Alcohol had been shown to bind blood and protein to stainless steel. The use of alcohol with dental instruments should therefore be avoided.’
Providing that a dental practice has a risk assessment and procedure on the use of alcohol based products, and their use does not conflict with the above exert from HTM 01-05 and WHTM, then alcohol wipes can have a place within the dental practice.
Using spray bottles in a dental practice
When using a spray it is best to spray directly into a dry wipe or microfiber cloth to minimise aerosol. Never directly spray a visibly contaminated area as this will create contaminated aerosol.
Spray bottles should be single use only and not refilled when empty.
HTM 01-05 2013 Edition, Section 6.58:
‘It is not good practice to refill spray bottles used to apply cleaning or disinfecting solutions. Bacteria can contaminate the bottles and become adapted to these solutions and grow in the spray mechanisms. Such bottles, whether supplied pre-filled or empty should be single use.’
Welsh Health Technical Memorandum does not offer any guidance on the user of spray bottles; however they have provided research by The Department of Health in England on the use of microfiber-based cleaning techniques.
WHTM 01-05 2014 Edition, Section 6.58:
‘Providing that deep cleaning is performed as an initial exercise, the subsequent use of microfiber-based techniques, essentially involving dry or wet wiping with microfiber cloth, can be helpful in achieving satisfactory removal of infectious agents from surfaces… Reprocessing or disposal must take account of the infection risk. Reprocessing takes the form of washing through a conventional laundry process. This should take place at the end of each session or when obviously contaminated.’
Ventilation grilles and extractor outlets
The national specifications for cleanliness in primary care are outlined in a document produced by the National Patient Safety Agency.
This advice states that the ventilation grilles and extractor outlets within the practice should be visibly clean with no blood or body substance, dust, dirt or cobwebs.
You must take extra care when cleaning these ventilation grilles and extractor outlets because they are usually in a high place. A risk assessment should be carried out by the practice/Contract cleaning manager and a safe cleaning protocol should be established to prevent injury to the person cleaning the vents and outlets.