BY NOEL BRANDON KELSCH, RDHAP
I am not partial to undertaking certain housekeeping jobs in my home. I don't mind washing dishes or doing laundry, but cleaning windows and refrigerators are not my favorite things to do. Housekeeping in your dental office is much like my need to organizing tasks at home.
Your office has environmental surfaces. These are surfaces or equipment that do not contact patients directly but can become contaminated during patient care. The Centers for Disease Control and Prevention breaks up the dental environment into two categories.
Clinical contact surfaces - Certain surfaces called clinical contact surfaces are ones that are touched frequently. Light switches and levelers can become reservoirs of microbial contamination. Although they have not been associated directly with transmission of infection to either dental health care professionals (DHCP) or patients, the possibility of contamination is present.
These surfaces must be cleaned and disinfected using chemical germicide registered with the EPA as a "hospital disinfectant" and labeled for tuberculocidal (such as mycobactericidal) activity. This is recommended for disinfecting surfaces that have been soiled with patient material. As an alternative to between-patient disinfection, many practices choose to use impermeable barriers to cover and protect surfaces that would otherwise become contaminated (through touch or with droplet spatter). The barriers are simply removed, discarded, and replaced after each patient.
For more information, view "Common Errors in Surface Disinfection" and "Choosing and using surface disinfectants" in the archives at RDHmag.com. In addition, "OSAP Provides Clinical Contact Surface Disinfectant Resources" is available at the OSAP website.
Other articles by Kelsch
- Shaking hands in the dental office? Give me a high five
- Infection Control: Dentures and aspiration pneumonia
- Common Errors in Surface Disinfection
Housekeeping surfaces - These surfaces that are not likely to come in contact with patient materials and have a low risk of disease transmission.1 Keeping all surfaces in the dental environment clean is a necessary fundamental step in keeping the dental environment safe.
Because housekeeping surfaces (floors, walls, and sinks, for example) have limited risk of disease transmission, they can be decontaminated with less rigorous methods than those used on dental patient-care items and clinical contact surfaces. Strategies for cleaning and disinfecting surfaces in patient-care areas should consider:
• The potential for direct patient contact
• The degree and frequency of hand contact
• The potential contamination of the surface with body substances or environmental sources of microorganisms (soil, dust, or water).
These areas should be reviewed with all staff, and a plan for housekeeping should be put in place.1,2
With housekeeping surfaces, it may surprise you that physical removal of microorganisms and soil by wiping or scrubbing is probably as critical, if not more so, than any antimicrobial effect provided by the agent used.1 The majority of housekeeping surfaces need to be cleaned only with a detergent and water, or an EPA-registered hospital disinfectant/detergent, depending on the nature of the surface and the type and degree of contamination.
It is important to set up a schedule and that the method of cleaning matches the needs in the area (dental operatory, laboratory, bathrooms, or reception rooms), surface, and amount and type of contamination.
Floors - There should be a plan and schedule in place for maintaining the floor surfaces. Floors should be cleaned regularly, and spills should be cleaned up immediately. An EPA-registered hospital disinfectant/detergent designed for general housekeeping purposes should be used in patient-care areas if uncertainty exists regarding the nature of the soil on the surface (blood or body fluid contamination vs. routine dust or dirt).1,2
Carpet and cloth - Carpeting is really hard to keep clean and cannot be reliably disinfected especially after exposure to blood or other potentially infectious materials. Carpet can harbor fungi and be a source of bacteria. Studies have documented the presence of diverse microbial populations, primarily bacteria and fungi in carpeting.3,4 Cloth furnishings pose similar contamination risks in areas of direct patient care and places where contaminated materials are.3
Walls, windows, and drapes - When these surfaces are visibly contaminated by blood or other potentially infectious materials, prompt removal and surface disinfection is the appropriate infection-control practice and required by OSHA.5 Unless contamination is reasonably anticipated or apparent, cleaning or disinfecting walls, window drapes, and other vertical surfaces is unnecessary.2 Keeping these areas clean is a part of keeping the environment clean.
Tools for cleaning - Having the right tools and using them correctly can make all the difference in housekeeping. The goal is to minimize contamination of cleaning solutions and cleaning tools (mop heads or cleaning cloths). To do that, you have to clean the mop and cloths after each use and allow them to fully dry. Frequent laundering, or single use or disposal mops and clothes, are ideal and help avoid the spreading from one area to another.
One study looked at the fact that cleaning tools are not adequately cleaned and disinfected. If the water-disinfectant mixture is not changed regularly (such as after every three to four rooms, at no longer than 60-minute intervals), the mopping procedure actually can spread heavy microbial contamination throughout the health-care facility.6 Frequent laundering of mops (daily) is recommended.
Single-use disposable towels impregnated with a disinfectant also can be used for low-level disinfection when spot cleaning of noncritical surfaces is needed.7
Staff - Staff members who are responsible for doing the housekeeping must have OSHA bloodborne pathogen training, as well as training on the safety and materials data sheets that accompany the task. They must comply with the use of personal protective equipment, including chemical and sharps resistant utility gloves for handling chemicals (not patient exam gloves). They must match the product and procedures necessary to do tasks.
Other areas that are equally important are being aware of the need to change solutions, the need to clean the container used to hold solutions, and manufacturers' instructions for preparation and use must be followed. Making fresh cleaning solutions each day, discarding any remaining solution, cleaning the container, and allowing the container to dry will minimize bacterial contamination. Preferred cleaning methods produce minimal mists and aerosols or dispersion of dust in patient care areas.1
I now have a schedule and it has a plan when it come to the fridge and windows. Every Friday, I empty the fridge and clean it. Since I live in a two-story house, I hired someone to do my windows. Every office needs training, a schedule, and a plan for housekeeping duties. RDH
Housekeeping Reminders from the CDC
1. Clean housekeeping surfaces (floors, tabletops) on a regular basis, when spills occur, and when these surfaces are visibly soiled.
Reminder: This is a great place to have a check-off list of areas that need to be cleaned daily, weekly, and monthly.2. Follow manufacturers' instructions for proper use of disinfecting (or detergent) products, including recommended use and dilution, material compatibility, storage, shelf-life, and safe use and disposal.
Reminder: Off label of EPA-approved products is illegal. Train all staff on directions and safety data sheet information before the product is in use and periodically as a reminder.3. Clean walls, blinds, and window curtains in patient-care areas when these surfaces are visibly contaminated or soiled.
Reminder: Schedule in advance the plans for surface care4. Prepare disinfecting (or detergent) solutions as needed and replace these with fresh solution frequently (such as replacing floor mopping solutions every three patient rooms, change no less often than at 60-minute intervals), according to the CDC policy.
Reminder: Laminate and post the directions for use and care of tools and products where you store the tools and products.5. Decontaminate mop heads and cleaning cloths regularly to prevent contamination (launder and dry at least daily).
Reminder: Use disposable or make sure you are following the directions for use, including laundering and allowing to dry fully.6. Use a one-step process and an EPA-registered hospital disinfectant designed for housekeeping purposes in patient care areas where:
• Uncertainty exists about the nature of the soil on the surfaces (blood or body fluid contamination vs. routine dust or dirt)
• Uncertainty exists about the presence of multidrug resistant organisms on such surfaces
Reminder: Review the areas with the staff and determine what category each area of the operatory falls in.7. Detergent and water are adequate for cleaning surfaces in nonpatient-care areas (administrative offices). Do not use high-level disinfectants/liquid chemical sterilants for disinfection of noncritical surfaces.
Reminder: The front office and other areas such as the lunchroom should never have high-level disinfectants. These were not designed for skin contact.8. Wet/dust horizontal surfaces regularly (daily or three times per week), using clean cloths moistened with an EPA-registered hospital disinfectant (or detergent). Prepare the disinfectant (or detergent) as recommended by the manufacturer.1,2,6
Reminder: Train all staff and anyone who is making purchases on the importance of understanding label directions, personal protective equipment and different methods of cleaning.
1. http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf Accessed 1/22/2014.
2. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm Accessed 1/22/2014.
3. Sattar SA, Springthorpe VS, Karim Y, Loro P. Chemical disinfection of non-porous inanimate surfaces experimentally contaminated with four human pathogenic viruses. Epidemiol Infect 1989;102:493-505.
4. Green J, Wright PA, Gallimore CI, Mitchell O, Morgan-Capner P, Brown DWG. The role of environmental contamination with small round structured viruses in a hospital outbreak investigated by reverse-transcriptase polymerase chain reaction assay. J. Hosp. Infect. 1998;39:39-45.
5. Westwood JC, Mitchell MA, Legace S. Hospital sanitation: the massive bacterial contamination of the wet mop. Appl. Microbiol. 1971;21:693-7.
6. U.S. Department of Labor, Occupational Safety and Health Administration. 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; needlesticks and other sharps injuries; final rule. Federal Register 2001;66:5317-25. As amended from and includes 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; final rule. Federal Register 1991;56:64174-82. Available at http://www.osha.gov/SLTC/dentistry/index.html.
7. Rutala WA, White MS, Gergen MF, Weber DJ. Bacterial contamination of keyboards: Efficacy and functional impact of disinfectants. Infect Control Hosp Epidemiol 2006;27:372-7.
NOEL BRANDON KELSCH, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists' Association.