Infection Control in the Dental Setting – TIPisode with Michelle Strange, RDH (April 2020)

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This TIPisode has been transcribed for your viewing pleasure:

Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date and presented by the experts in the dental profession. Now, get ready for your unofficial TIPisode, this week brought to you by GC America.

Thanks to GC America for this TIPisode all about environmental infection control with their COEfect disinfectant spray and wipes. 

Now, if you’re like me, when I first heard “environmental infection control,” I was like, “What is that? Like, what does that mean? Outside? That’s what I know as the environment.” So, if your brain went there like mine did at first, let me clarify. When we say “environmental infection control,” we mean our dental or health care environment and all the surfaces that become contaminated when we treat patients. 

So, to ensure a clean operatory, all surfaces and equipment that have the potential to become contaminated from hand contact and aerosols and spatter — you know, all that stuff that we create — or even contact with other contaminated items, they must be cleaned and disinfected so that we can break the chain of infection. 

So, when patients are receiving dental and medical treatment, they can be infected by germs completely unrelated to their treatment, and this is known as “health care-associated infections.” And they occur in hospitals and dental settings, your urgent care centers, even mobile dental units, nursing homes, all of — anywhere — a setting where health care can be delivered. And some patients can be infected from contaminated or improperly used equipment whereas some others can just be infected because somebody didn’t clean their hands really well. So just uncleaned hands of health care workers, which is super gross. 

So contaminated surfaces can appear clean. So, y’all, don’t be fooled. For instance, OSAP, which is the Organization for Safety, Asepsis and Preventions, they have this great video called “If Saliva Were Red.” I feel like many of us experience that in school and see it during our infection control courses. It’s such a great example how surfaces can be contaminated, and we’re just not aware of it. But, if they were red, we’d be like, “Yeah. We should probably clean that.” 

So they can be invisible, that bioburden. So don’t be fooled. Surfaces must be cleaned in disinfectant, and if they can’t be, they have to be barrier wrapped so that they can — we don’t create cross-contamination. 

And, in the US, all surface disinfectants must be registered with the United States EPA. And, once a product is approved by the EPA, the manufacturer gets this registration number for that specific product, and then they’ll get instructions for that disinfectant that, you know, it’s very specific to what we’re doing in dentistry and how it can clean and disinfect any areas that have potential contamination. 

And many manufacturers provide several contact times in their instructions. So, most often, you’re going to read it, and it’s going to say there’s a contact time for bacteria, one for viruses, another for mycobacterium tuberculosis, and maybe even one for fungi. And these contact times, y’all, they are so different for every one. They vary anywhere from, like, one to ten minutes. And, because it’s impossible for us to know what’s on that surface — like, we don’t know what potential pathogen actually exist on that surface — we should disinfect that area, that surface, whatever it is, according to the longest contact time that the product says or on the instructions for use. 

So, for example, if you read the label and it says — has, like, a one-minute contact time for bacteria, a contact time of two minute for viruses, five for tuberculosis because that’s a difficult one to clean, and ten for fungi, then the total contact time for the product when used correctly is ten minutes. And what I mean by contact time is that it’s how long that surface has stayed wet. 

So, if the surface is drying out in eight minutes and you have a contact time of ten, that ain’t going to work, y’all, because we want to utilize the longest contact time. So, if it says ten, the surface has to stay ten [sic] so that we ensure all microorganisms included on that product’s label are successfully inactivated because the reality is we don’t know what we are disinfecting. It could be bacteria, or it could be fungi. Whatever it is, we have to keep it wet for the proper amount of time. And I personally look for a product that has a low contact time because I don’t usually have a spare ten minutes to give between patients. I don’t know many of us that do. 

And, if a surface has a chance to become contaminated from hand contact and aerosols and spatter and all that, we usually need to clean it first. So this is something that you might not realize. There’s a one-step process and a two-step process. So, in a two-step process, cleaning is necessary prior to disinfection or at the beginning of the clinic before you put any barriers down. And, if a clinic contact surface cannot be cleaned or disinfected, then you got to use those barrier wraps like with your keyboards. 

Keep in mind not all your disinfectant products can be used as a cleaner. So, for a disinfectant to be a good cleaner, it has to have a surfactant. Most likely, this will be stated in the directions, so products without a surfactant will state that cleaning is necessary prior to the use of that particular disinfectant. So, when we look at our technique to clean and disinfect, there — usually we were taught, you know, way back when when I was in school that we have “spray, wipe, spray” or “wipe, wipe.”

Be sure, always, to wear your PPE for this process. Super important. Start by donning your PPE, spray the surface with a product that’s meant for cleaning because remember we got to make sure that it’s meant for cleaning and disinfecting, and then once you’ve saturated the surface, you’re going to vigorously wipe that paper towel on the surface to remove that bioburden. And then you spray the surface with that disinfectant and allow it to stay on the surface for as long as the label prescribes. Remember, we got to keep it wet. If you’re using a wipe, you wipe that towelette over the surface. 

Now, with COEfect, what’s so great it’s a super large wipe, which is nice because you don’t have to use as many to remove that bioburden, and then you use a clean wipe to apply disinfectant to the surface. 

So some manufacturers may have different instructions, which should always be followed for effective disinfection. And that surface also needs — again, I’m going to say this like a broken record — it has to be wet for the correct amount of time. That means if you have a habit of leaving the lid open on your towels and they dry out, you probably need to go ahead and get a new set because it’s not going to stay wet long enough. Sometimes I turn my container upside down so I get all the towelettes evenly soaked. 

So products like COEfect line allow you to clean and disinfect in one step. So, essentially, you’re removing the bioburden with the wipe, and then there’s enough liquid on that wipe that it’ll stay on the surface and continue to disinfect. The caveat to this is that the surface needs to be saturated and wet for the proper amount of time. But, with COEfect, that’s only one minute. So, like, super fast. And COEfect wipes and spray can be used to effectively clean and disinfect a dental operatory and maybe even your instrument reprocessing area and potentially any other contaminated areas in a lot less time. Again, one minute. 

And so this one-step surface disinfectant is ethanol based, and it’s pretty low in the toxicity level. So, because it has one-minute kill time, it’s — you know, makes it more efficient to use. It is odor free, and that’s a complaint that I hear all the time that some of these ones, they just smell horrible. They’re also super compatible with your surfaces, so they’re not going to discolor any of your areas in the op. You should always test first, but most of the time, this is surface compatible. And it does have that EPA registered number, and it’s approved for bacteria, viruses, TB, and fungi all in one-minute kill time, and so this is what makes it so great. 

It also has something called like a “polyester spunlace,” which, I mean, I didn’t even know what this was, but apparently it’s this new material that provides this ability to evenly distribute the solution, but it absorbs any of the excess bioburden, which is why it makes it one step. 

So you can find out more about COEfect — and that’s C-O-E-F-E-C-T. And there’s sprays, and there’s a wipe — and you can find out more at gcamerica.com. 

Thanks for listening to another TIPisode, this week brought to you by GC America. Head over to their website or ask your dealer about some of their products. Be sure to follow us on Facebook, Instagram, and head over to our website to sign up for our newsletter. We appreciate all ratings and review. Thank you for listening to your unofficial dental hygiene podcast.