Chapter 14: Surface and Equipment Asepsis

Copyright © 2017, Elsevier Inc. All Rights Reserved.
Surface and Equipment Asepsis
Chapter 14
1

Learning Objectives
Surface and Equipment Asepsis
1. Differentiate between clinical contact surfaces
and housekeeping surfaces and determine
which operatory surfaces may be involved in the
patient-to-patient spread of microbes.
2. List the operatory surfaces that should be
covered with barriers before patient care and
describe how to place and remove surface
covers properly.
3. Describe the importance of precleaning before
surface disinfection and describe how to
preclean and disinfect contaminated surfaces
and equipment.
2

4. Do the following regarding the characteristics
of disinfectants:
• List the types of surface disinfectants and describe
their properties.
• Differentiate between low-, intermediate-, and high-
level disinfectants and give examples when each
should be used.
• Describe why it is important to read disinfectant
labels.
3
Learning Objectives
Surface and Equipment Asepsis (Cont.)

5. List general considerations for dental
equipment decontamination and management
of high-tech equipment in the dental office.
6. Describe how to retrieve and distribute clinical
supply items aseptically.
4
Learning Objectives
Surface and Equipment Asepsis (Cont.)

Types of Environmental Surfaces
 Two types of dental environmental surfaces
related to disease spread
 Clinical contact surfaces
• Need to be treated before each patient
 Housekeeping surfaces
• Can be treated at the end of each day
5

 What are clinical contact surfaces?
 Surfaces that may be touched frequently with
gloved hands during patient care or that may
become contaminated with blood, saliva, or other
potentially infection materials
 What are housekeeping surfaces?
 Surfaces that do not come into contact with hands
or devices used in dental procedures.
 Examples: floors, walls, and sinks
6

 What conditions influence the survival time of
microorganisms in the environment?
 Humidity, temperature, the presence of nutrients
in blood or saliva, and the surface properties of
the microorganism
7

Approaches to Surface Asepsis
 Two general approaches
 Prevent the surface from becoming contaminated
with a surface cover
 Preclean and disinfect the surface after
contamination and before each use
 Each approach has advantages and
disadvantages.
 See Table 14.1 for list of advantages and
disadvantages.
 Most offices use a combination of both
approaches.
8

Types of Surface Barriers
 Surface barriers should be impervious to
fluids to keep microorganisms in saliva,
blood, or other liquids from soaking through
to contact the surface
 Examples include:
 Clear plastic wrap
 Bags
 Tubes
 Plastic-backed paper
9

 Some plastics are designed specifically for
use as surface covers in the office in that they
have the shape of the item to be covered
(e.g., air/water syringe handle covers, hose
covers, and pen covers).
 Some sheets of plastic also have a slightly
sticky substance on one side to hold them on
the surface.
10

 Some plastic bags are available with
drawstrings that hold the bag around an item
to be protected.
 To reduce costs, one can use thin rather than thick
plastic sheets or bags as long as they are not
punctured by the surface being covered.
 Patient bibs are made of plastic-backed
paper and also can be used to cover flat
operatory surfaces, although thin plastic
sheets may be less expensive.
11

Use of Surface Barriers
 The sizes and shapes of surfaces to be
covered vary from one office to the next, but
general procedures for use of surface covers
are the same
12

 Procedure 14.1 covers the general
procedures for using surface barriers.
 Clear plastic bags are available in various
sizes and are easy to use.
 For example, if a chair has control buttons on the
side, one can use one bag to cover the headrest
and the buttons.
13

 It’s really not necessary to cover the entire
dental chair, for most of the chair (save the
arm rests) is covered with the patient’s body.
 Wraparound backs of side chairs used by the
dental team may be touched during patient
care and can be covered with a large plastic
bag.
14

Surface Barriers
15

Surface Barriers
 Figure 14.1 shows surface barriers for
handpieces and air/water connectors and hoses.
 The bracket table is easily covered, and the
handpiece and air/water syringe connectors and
hoses can be covered and secured with rubber
bands.
 Covering the air/water syringe handle with plastic
wrap to prevent contamination is better than
trying to preclean and disinfect properly around
the buttons that tend to retain debris.
16

Surface Barriers (Cont.)
17

 Figure 14.2 shows the surface barrier for a
control unit and instrument tray holder.
 If units are set up the night before, a large
bag can give overnight dust protection to the
bracket table and handpiece unit.
18

19

20

21

 Figure 14.5 shows a surface barrier for a sink
faucet.
 If the water at sinks is not controlled by elbow
levers, foot pedals, or automatic devices, the
faucet handles can be covered with plastic
bags.
22

Precleaning and Disinfection
 Precleaning reduces the number of
contaminating microorganisms and the
presence of bioburden
 Precleaning and disinfection work best on
nonelectric surfaces that are smooth and
easily accessible
 Procedure 14.2 describes general procedures
for precleaning and disinfecting surfaces.
23

Approaches to Precleaning
and Disinfection
 Spray-wipe-spray
 Using a liquid disinfectant/cleaner
 Wipe-discard-wipe
 Using a disinfectant towelette
24

Approaches to Precleaning
and Disinfection
 Disinfectant is used for both steps.
 Using a disinfectant for the precleaning step
starts the killing process early and reduces
the chances of spreading the contamination
to adjacent surfaces.
 If it is difficult to remove all of the bioburden
from a given surface, then consider protecting
it with a surface cover during future use.
25

Characteristics of Disinfectants
 The Centers for Disease Control and
Prevention has categorized disinfectants
based on their microbial spectrum of activity.
 Four general types of antimicrobial chemicals
 Antibiotics
• Kills microorganisms in or on the body
 Antiseptics
• Kills microorganisms on the skin
 Disinfectants
• Kills microorganism on environmental/inanimate surfaces
 Sterilants
• Kills microorganisms on inanimate objects
26

Categories of Disinfecting/
Sterilizing Chemicals
 High-level disinfectant (sterilant)
 Kills all microorganisms on submerged, inanimate,
heat-sensitive objects
 Intermediate-level disinfectant
 Kills vegetative bacteria, most fungi, viruses, and
Mycobacterium tuberculosis var. bovis
 Low-level disinfectant
 Kills most vegetative bacteria, some fungi, and
some viruses
27

Labeling on Antimicrobial Products
 Labels commonly include the type of
antimicrobial agent (active ingredients) and
general properties such as:
 Virucidal: Kills at least some viruses
 Bactericidal: Kills at least some bacteria
 Fungicidal: Kills at least some fungi
 Tuberculocidal: Kills the Mycobacterium
tuberculosis var. bovis bacterium
 Sporicidal: Kills bacterial spores, which means it is
a sterilant
28

Labeling on Antimicrobial Products
 Labels also commonly include the specific
microorganisms shown to be killed, directions
for use of the product, how to handle the
product, warnings for use, and how to store
the product.
 No perfect disinfectant exists that will kill all
types of disease-producing microorganisms
rapidly.
29

Ingredients in Surface Disinfectants
 Chlorine
 Iodophors
 Alcohols
 Synthetic phenolics
 Quaternary ammonium compounds
30

Ingredients in Surface Disinfectants
 Gloves, protective eyewear, a mask, and
protective clothing should be worn when using
any disinfectant.
 Chlorine compounds are intermediate-level
disinfectants that kill a wide variety of
microorganisms and are tuberculocidal.
 Iodophors are intermediate-level but less
corrosive and less irritating to tissues.
 Phenol was the first disinfectant used in hospitals.
 See Tables 14.3 and 14.4.
31

Equipment Decontamination
 In general, one should try to prevent the
equipment from becoming contaminated in
the first place
 If not possible, choose heat sterilization first
32

 If the equipment cannot be heat sterilized,
then use a liquid sterilant or an appropriate
disinfectant for decontamination. Following
the manufacturer’s directions for preventing
contamination or for cleaning, sterilization, or
disinfection of dental equipment is important.
 If the item is disposable, one should dispose
of it properly after use on one patient.
33

 If the item is reusable, one should cover the
parts that may become contaminated with an
impervious barrier to prevent contamination.
 If the item is not disposable, cannot be
covered completely, and becomes
contaminated, one should clean it, package it,
and heat sterilize it.
34

Management of High-Tech Equipment
 Some technologies may present special
infection control challenges
 Computers
 Cameras
 Digital x-ray sensors
35

Management of High-Tech
Equipment
 For computers, one should avoid their
contamination by performing hand hygiene
before use.
 Care should be taken that disinfectant wipes
used do not contain excess fluid that might enter
the base of the keyboard.
 Protective covers for the keyboard are available
as well as antimicrobial keyboards.
36

Aseptic Retrieval of Dental Supplies
 Numerous supplies are used for patient care,
and their storage and distribution present a
major challenge to infection control
 Aseptic retrieval
 Unit dosing
37

 Examples of such items include cotton balls
and rolls, gauze pads, floss, articulating
paper, retraction cord, orthodontic wire, and
tubes or bottles of dental materials, to
mention only a few.
 When storing supply items in bulk, such as a
container of cotton rolls, one must use an
aseptic retrieval system to avoid
contamination of unused items in the
container.
38

 Storing supplies in drawers at chairside lends
itself to cross-contamination of the drawer
handle (if not covered or precleaned and
disinfected) or of bulk items inside (if aseptic
retrieval is not used).
39

Aseptic Retrieval
40

Unit-Dosing
 Many types of disposable supplies can be
unit dosed, which means that the supplies are
distributed or packaged in small numbers
 This helps solve some cross-contamination
problems
41

Unit-Dosing
 You can protect supply containers, bottles,
and tubes of materials used at chairside on
more than one patient (multidose containers)
with a surface cover for each patient or in
some instances may preclean and disinfect
these between patients.
 Some supplies are unit dosed by the
manufacturers, saving office staff time.
 Unit dosing can be expensive and wasteful if
not organized properly.
42

Chapter 14: Surface and Equipment Asepsis

More Related Content

What's hot

Similar to Chapter 14: Surface and Equipment Asepsis

More from HeatherSeghi

Recently uploaded

Chapter 14: Surface and Equipment Asepsis