OSHA considers carpeting contaminated with blood or other potentially infectious material cannot be properly decontaminated when compared to hard-surface flooring.
Cleaning is an extremely important aspect of infection control, and a clean office may help patients feel more comfortable about the quality of the dental care received. Cleanliness (or uncleanliness) of the office can be the first thing patients notice. They can't see microbes, but they can see dust, stains, smudges, spots, splatter, and smears.
Cleaning helps reduce the spread of microbes; but if not done properly, it may enhance their spread.
Cleaning instruments and surfaces — Contaminated reusable instruments, handpieces, and other items need to be cleaned before being packaged and sterilized. This cleaning removes most of the microbes and debris so that the sterilizing agents (steam, dry heat, hot chemical vapor, for example) have the best chance to work. Instrument cleaning methods should involve mechanical devices such as ultrasonic cleaners or instrument washers that reduce the direct handling (hand-scrubbing, for example) of the contaminated sharp items.
Unprotected surfaces that become contaminated with patients' fluids during treatment (high-touch surfaces at the dental unit, for example) need to be cleaned before being disinfected. This cleaning removes most of the debris and microbes to give the subsequent disinfection step the best chance to work. A detergent with disinfecting activity should be used for the cleaning step, which will begin killing some microbes and help protect the person doing the cleaning. Also, take care not to "paint" microbes from one surface onto other surfaces to be cleaned. This can be reduced by starting with the least contaminated surfaces and by frequently changing to fresh cleaning towels.
Horizontal, nontouch surfaces (some countertops, cabinet tops, tops of X-ray view boxes, bracket table arms, and light arms) in the patient care areas should be cleaned regularly (at the end of the day, for example). They may also be covered with surface barriers, which are changed daily. While these surfaces may not be normally touched or come into contact with contaminated objects, they do collect dust and spatter particles that settle from the air. If these uncleaned surfaces are accidentally touched during patient care, or something brushes up against them, contaminates could spread.
Hard-surface floors in patient-care areas can be cleaned with detergents or detergents with low-level disinfectants. Part of the floor-cleaning strategy is to minimize contamination of the cleaning solutions and cleaning equipment. Again, take care that you don't spread microbes from one surface onto subsequent surfaces being cleaned. This can be reduced by starting with the least contaminated surfaces and by frequently changing the mopping solution. Dirty mop water should not be allowed to stay in the bucket overnight. Mop heads need to be laundered between uses and allowed to dry. One approach is to use a fresh mop head every time the cleaning solution is changed.
Carpeting — Carpeting in patient-care areas may be noise-limiting and more esthetically pleasing than hard-surface flooring. However, carpeting is more difficult to clean, especially after spills, and it takes more effort to push equipment with wheels over carpeting. Moreover, carpeting that becomes and remains wet promotes bacteria growth, which worsens the level of contamination.
Even though there is little evidence showing that carpets influence infection rates in health-care areas housing immunocompromised patients, it seems reasonable to avoid the use of carpeting in the operatory and where spills may occur.
OSHA considers carpeting contaminated with blood or other potentially infectious material cannot be properly decontaminated when compared to hard-surface flooring. (CDC. Draft guideline for environmental infection control in healthcare facilities, 2001. Federal Register Tuesday, March 6, 2001, 66(No. 44): 13539. (http://www.cdc.gov/ncidod/hip/ envior/guide.htm). Carpet cleaning can contribute to microbe proliferation and dissemination if the proper procedures are not used.
Carpet equipment
Carpet-cleaning equipment, especially those that do wet cleaning and extraction, may become colonized with bacteria (Pseudomonas aeruginosa, for example) and serve as a reservoir for these microbes if not properly maintained. Such cleaning equipment must be cleaned after use and allowed to dry before reuse, if indicated by the manufacturer.
Vacuum cleaners can be dust disseminators if they are not operating properly. Vacuums with HEPA (high-efficiency-particulate-air) filters for the exhaust should be considered. When vacuuming carpeted areas outside the operatories such as hallways and waiting rooms, consider closing the doors to the operatories (if possible) to prevent contamination from any dust that might be stirred up.
A key part of the office infection control program is cleaning all items, surfaces, and floor coverings correctly and regularly. The benefits are a more healthful environment for all, and a boost in patient satisfaction.
Chris Miller, PhD, is professor of oral microbiology and executive associate dean at the Indiana University School of Dentistry.
