Make sure surfaces have been cleaned and disinfected by the beginning of the day and apply operatory surface covers where indicated.
Chris Miller, PhD
This issue continues our review of infection control procedures in the form of checklists. Previously, we`ve provided checklists on office recordkeeping, infection control training, and hepatitis B vaccinations (November 1999 RDH); post-exposure medical evaluations, barrier protection, and aseptic techniques (December 1999 RDH); and instrument processing (January 2000 RDH).
In this issue we address surface asepsis and waste management.
Surface asepsis
* Differentiate between surfaces that need to be managed between patients and those that need to be managed only at the end of the day. Surfaces needing attention between patients are those directly involved in the treatment session and are contaminated by being touched with contaminated gloves, sprayed or splashed by contaminated materials, or by contacting items to be touched or used in the patient`s mouth. These surfaces are called contact surfaces (for example, handpiece connectors and holders, air/water syringe handles, ultrasonic handles, hoses, bracket tables, and chair buttons).
Surfaces that are not touched during the appointment or do not contact items used in the patient`s mouth (noncontact surfaces) may still become contaminated. Spatter or dust, for example, may become airborne and contribute to the overall office microbial load (for example, countertops, bracket table and light arms, and floors). These surfaces need not be decontaminated between patients, but they need to be addressed at day`s end.
* Determine how contact surfaces will be managed between patients. Surfaces that are difficult to clean (for example, air/water syringe handle), should be covered with a protective barrier. Other more flat surfaces may be cleaned and disinfected.
* Document in your written Exposure Control Plan (as required by OSHA`s Bloodborne Pathogens Standard) the schedule of when and how the various sites in your office will be decontaminated. (For example, Operatory #1: light handle, air/water syringe handle [etc.] will be covered with fresh covers between each patient; bracket tray, chair arms [etc.] will be cleaned and disinfected with [list your disinfectant] between each patient).
* Determine how the noncontact surfaces in the operatory will be managed.
* Make sure surfaces have been cleaned and disinfected by the beginning of the day. Apply operatory surface covers where indicated. Wear fresh gloves if surface covers are placed on items entering a patient`s mouth (for example, camera lens). Surface covers are to be impervious to moisture.
* After each appointment, put on gloves and carefully remove all surface covers on contact surfaces without contaminating the underlying surface. Discard the covers in the regular trash unless local laws require special handling.
* After each appointment, put on utility gloves, mask, protective eyewear, and protective clothing, and clean those contact surfaces that were not covered. Use a disinfectant cleaner. Then reapply the disinfectant and let stand for the prescribed contact time.
* At the end of the day, or sooner if desired, put on gloves and carefully remove all surface covers from noncontact surfaces and discard.
* At the end of the day, or sooner if desired, put on utility gloves, mask, protective eyewear, and protective clothing, and clean those noncontact surfaces that were not covered.
* Contaminated items are cleaned and disinfected before being serviced or repaired on-site or sent out of the office for service or repair.
If portions of an item needing service or repair cannot be cleaned or disinfected, the item is labeled as a biohazard and the contaminated portions are identified.
Waste and sharps management
* Sharps containers are used that are puncture resistant, closable, and leakproof (on sides and bottom) and colored red or labeled with a biohazard symbol.
* Sharps containers are placed where sharps are used or may be found.
* Used needles and other disposable sharps are disposed of directly into a sharps container as soon as possible after use.
* A safe, one-handed procedure is used for recapping needles.
* Used needles from a nondisposable syringe are removed and placed directly into the sharps container without being bent, broken, cut, or otherwise manipulated.
* Used needles are not removed from a disposable syringe prior to disposal but are placed directly into a sharps container along with the attached disposable syringe.
* Broken glass that may be contaminated is picked up with tongs or cotton pliers and placed directly into a sharps container.
* Sharps containers are not overfilled, are maintained in an upright position, and are closed when being moved.
* Bags for nonsharp regulated waste are placed in a closable, leakproof bag or container colored red or labeled with a biohazard symbol.
* Sharps containers and bags of other regulated waste are treated on-site, then labeled, and discarded in the regular trash or are properly transported by an EPA-approved waste hauler for final disposal (according to local laws).
* Extracted teeth are managed as regulated waste or given back to patients after being decontaminated (following any special local laws).
* Liquid blood or saliva is disposed of by flushing down the sink (considering any special local laws) while wearing gloves, masks, protective eyewear, and protective clothing.
Chris Miller, PhD, is professor of oral microbiology and associate dean at the Indiana University School of Dentistry.
