Practices will be familiar with the routine of decontamination of the treatment area, but with all the changes brought about by COVID-19 in the last couple of years, it is a worth a revisit to the standard infection control precautions we are returning to for most patients (those patients not on the respiratory pathway).
Starting at the beginning, practices should ensure the treatment area is:
Visibly clean and free from non-essential items and equipment to allow effective cleaning
Well maintained and in a good state of repair, and with adequate ventilation.
1. Between each patient
Areas and items of equipment local to the dental chair that need to be cleaned between each patient include:
Local work surfaces
Dental chairs
Curing lamps
Inspection lights and handles
Hand controls including replacement of covers
Trolleys/delivery units
Spittoons
Aspirators
X-ray units.
2. After each session
The patient treatment area should be cleaned after every session using disposable cloths or clean microfibre materials - even if the area appears uncontaminated.
Areas and items of equipment that need to be cleaned after each session include:
Taps
Drainage points
Splashbacks
Sinks.
NB: Spittoons and aspirating units need to be washed through at the end of a session according to manufacturers' instructions.
3. Daily
In addition to the above, cupboard doors, other exposed surfaces (such as dental inspection light fittings) and floor surfaces, including those distant from the dental chair, should be cleaned daily.
4. Weekly
This must include:
Window blinds
Accessible ventilation fittings
Other accessible surfaces such as shelving, radiators and shelves in cupboards.
5. Detergents and disinfectants
Manufacturers' advice should be sought regarding the compatibility of detergents and disinfectants with the surface materials used. Cleaning centres on simple techniques - disposable cloths wetted with clean water and a detergent - it is essential prior to disinfection.
Disinfecting aims to reduce the number of microorganisms present to a level that is unlikely to cause infection. Successful disinfection is very much dependent on the number of microorganisms initially present - hence the importance of cleaning prior to disinfection.
Manufacturers' guidance and recommended product 'contact time' should be followed for all cleaning/disinfection solutions.
There are wet two-in-one ready to use wipes available that can be used for both cleaning and disinfection - replacing the need for separate cloths and detergent/disinfecting products. These may be a more costly option but are likely to be more convenient, especially where time is of the essence - 'next patient please'!
Disinfectants are biocidal products. Such products will state: 'Use biocides safely. Always read the label and product information before use.' The HSE advises that authorised products are safe for use so long as you follow the instructions on the label.
Always assess new or first-time use products - COSHH - prior to using a new cleaning and/or disinfecting product for the first time. Inform appropriate staff and remind them of the importance of reading the label or safety data sheet of a product before first use - and to always use according to the directions for use and wear the appropriate PPE.
Ventilation recommendations
UK building regulations recommend whole building ventilation to be 10 l/s/person, and current healthcare guidance for new buildings and major refurbishments specifies that a treatment room should have at least 10 air changes per hour (ACH).
Specialist advice should be sought on how best to achieve the recommended air changes. It is recognised that transitional arrangements may need to be in place to support dental practices where air changes are unknown or below this recommended level.
Decontaminating instruments in the patient treatment area
Where instruments are cleaned in the patient treatment area this should be as far from the dental chair as is practicable. Uncontrolled procedures that generate the risk of exposure to aerosol dispersion or splashes (such as manual washing, the use of an ultrasonic cleaner without a sealed chamber (or lid) or the opening of decontamination equipment) should NOT take place while the patient is present in the treatment area.
Dental unit water lines - flushing of
Whilst the below have been shown to have only a small effect on biofilm build-up within the DUWL system, they do usefully reduce microbiological counts in the water delivery tube during the period when patients are likely to be exposed.
Flush for:
At least two minutes at the beginning and end of the day and after any significant period when they have not been used (for example, after lunch breaks)
At least 20-30 seconds between patients.