Is There a Law About Cleaning Carpets in the Dental Office?

OSHA states:1910.1030(d)(4)(i)

General. Employers shall ensure that the worksite is maintained in a clean and sanitary condition. The employer shall determine and implement an appropriate written schedule for cleaning and method of decontamination based upon the location within the facility, type of surface to be cleaned, type of soil present, and tasks or procedures being performed in the area.

These areas fall under housekeeping areas in the dental setting. Housekeeping surfaces that are not likely to come in with patient materials and have a low risk of disease transmission. Keeping all surfaces in the dental environment clean is a necessary fundamental step in the dental environment safe.

Carpet is considered a housekeeping surface. 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. Since this is one of the first things your patients see when they enter the dental environment it may be leaving a negative impression on your patients

Because housekeeping surfaces 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 1) potential for direct patient contact; 2) degree and frequency of hand contact; and 3) potential contamination of the surface with body substances or environmental sources of micro-organisms (e.g., soil, dust, or water). These areas should be reviewed with all staff and a plan for housekeeping should be put in place. There should be a schedule of carpet cleaning.

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. The majority of housekeeping surfaces need to be cleaned only with a detergent and water or a broad spectrum 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, (e.g., dental operatory, laboratory, bathrooms, or reception rooms), surface, and amount and type of contamination.

Source: Occupational Safety and Health Administration (OSHA) states that the environment must be safe and that would include pathogens. Center for Disease control on page 11 of the Recommendations from the Guidelines for Infection Control in the Dental Setting 2003 states “Avoid using carpeting and cloth-upholstered furnishings in dental operatories, laboratories and instrument processing areas.

Source: Center for Disease Control and Prevention (CDC), Infection Prevention Checklist for Dental Setting: Basic Expectations for Safe Care http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm

Source: 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. http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf

Source: US Department of Labor, Occupational Safety and Health Adminis- tration. 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.

How Do We Take Care of Sensor Covers?

First refer to the instructions for use (IFU) that came with the sensor and make sure all staff that are working with that sensor are trained to the IFU and complying with the IFU. Some basic things to keep in mind are:

a. Use a barrier specifically labeled for use on your medical and/or dental device. This means you cannot use products such as sandwich bags, plastic wrap, dry cleaning bags, and trash bags, these products are not designed to be impermeable to blood, saliva or other potentially infectious materials.

b. Follow the device manufacturers to reprocess the instrument between patients.

c. If the item cannot tolerate heat sterilization or high-level disinfection, help protect these instruments with a barrier and follow with cleaning and disinfection with an intermediate-level disinfectant between patients (as per sensor IFU).

d. Always consult with the manufacturer for methods of disinfection and sterilization of digital radiological sensors and sterilization of digital radiological sensors and for protection of associated computer hardware.

If I Am Seeing a Family, Do I Have to Change Barrier Protection Between Seeing Each Family Member?

The chance of cross-contamination between family members is very high if you use the practice of reusing barrier. Universal and standard precautions remind us that we use the same infection control standards for all patients no matter their diagnosis or relationship. Barrier protection is an essential part of infection control and helps to limit cross-contamination between patients. Page 11 of the Recommendations from the Guidelines for Infection Control in the Dental Setting states “Use surface barriers to protect clinical contact surfaces, particularly those that are difficult to clean (e.g., switches on dental chairs) and change surface barriers between patients.” Universal and standard precautions state “Standard Precautions represent the minimum infection prevention measures that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered.” All patients need to be treated the same as far as infection control standards are concerned even if they are mother and child.

Source: Center for Disease Control and Prevention (CDC), Infection Prevention Checklist for Dental Setting: Basic Expectations for Safe Care “Basic Infection Control and Prevention Plan for Outpatient Oncology Settings”, http://www.cdc.gov/HAI/settings/outpatient/basic-infection-control-prevention-plan-2011/fundamental-of-infection-prevention.html

We Use Reusable Hand Towels to Clean the Room After Patients. How Often Should Those Be Changed?

It is not recommended to use recyclable towels for hand hygiene in the dental setting. After every use of the towel it would have to be processed. In an interview with Dr. Chris Miller from OSAP he stated “Reusable cloth towels can harbor microbes that may not have been washed off your hands. If the towel is reused without washing, it can easily re-contaminate the cleaned hands of a subsequent user of the towel. Some microbes may be able to multiply on the moist towel and make things even worse.” Safety Standards and Infection Control for Dental Assistants States “Never use clothe towels because they may also harbor germs with continued use and may be a source of cross-infection.”

Source: Safety Standards and Infection Control for Dental Assistants, Ellen Dietz, Delmar, 2002, page 35

Source: RDH article “It is easy being green” by Noel Kelsch RDHAP, http://www.rdhmag.com/articles/print/volume-30/issue-9/columns/it-is-easy-being-green.html

Can I Make my Own Wipes?

No, you should not make your own wipes. Studies have shown that the bleach in the cotton fibers contained in gauze may shorten the effectiveness of some disinfecting agents when stored in containers. Germicides, especially iodophors or chlorines, may be inactivated or absorbed by the gauze.* Environmental Protection Agency registered hospital grade disinfectants require users to follow instructions of the product and are labeled with the statement “It is a violation of federal law to use this product in a manner inconsistent with its labeling”. The label directions must be followed to ensure proper effectiveness of the product. Using the product off label puts the product at risk of being ineffective. **

*Source: Cottone's Practical Infection Control in Dentistry, Dr. John A Molinari., 2nd. edition. Philadelphia: Williams & Wilkins, 1996:195.

**Source: Center for Disease Control and Prevention (CDC), Infection Prevention Checklist for Dental Setting: Basic Expectations for Safe Care, Page 18 “Cleaners and disinfectants are used in accordance with the manufacturer instructions”, https://www.cdc.gov/infectioncontrol/guidelines/disinfection/cleaning.html

I Bought a Bottle of Hand Lotion from the Local Grocery Store. Is it Suitable for the Dental Setting?

The use of hand lotion to prevent skin dryness associated with handwashing is recommended. When choosing a hand lotion, it is important to consider the compatibility of lotion. The effect of petroleum or other oil emollients on the integrity of gloves during product selection and glove use. You would have to find out if the product contains anything that could break the gloves down or impact the integrity of your skin.

Source: Center for Disease Control and Prevention (CDC), Infection Prevention Checklist for Dental Setting: Basic Expectations for Safe Care, Page 6, https://www.cdc.gov/oralhealth/infectioncontrol/faq/hand.htm

What are the CDC Recommendations Related to How Fingernails Should be Maintained?

The CDC states that fingernails should be kept short and smooth. The edges should be filed smooth too allow thorough cleaning and prevent glove tears. The CDC also recommends to not wear artificial fingernails or extenders when having direct contact with patients at high risk (e.g. those in intensive care units or operating rooms). Use of artificial nails is usually not recommended.

Is it OK if I Always Use a Hand-rub Instead of Soap and Water?

No, you cannot always use hand-rub instead of soap and water. There are very specific uses for both of these products. The CDC states that you can use a non-antimicrobial or antimicrobial soap and water when hands are visibly dry or contaminated with blood or other potentially infectious material. If hands are not visibly soiled or contaminated then you can use an alcohol based hand rub following the manufacturer’s instructions.

How Can I Prevent the Skin Irritation I Keep Getting at Work?

There are several factors that contribute to skin irritation. You will have to evaluate what is causing your irritation and use alternate products or procedures.

Reduce the temperature of the water as overly hot water can contribute to skin irritation when washing your hands.
Use a soap that is compatible with your skin type. For example if you are sensitive to Triclosan avoid Triclosan. If you have sensitive skin use a sensitive formulated soap.
Dry your hands with a paper towel rather than an air drying machine. Drying with an air dryer can dry the tissue.

Source: Center for Disease Control and Prevention (CDC), Infection Prevention “What are the different types of hand hygiene?” https://www.cdc.gov/oralhealth/infectioncontrol/faq/hand.htm

Why Do I Need to Use an Antimicrobial Soap with Persistent Activity? What’s the Difference?

It is dependent on the procedure you are performing. Defined an antimicrobial agent is any agent that kills or suppresses the growth of microorganisms. If you are doing a surgical procedure or anticipate a surgical procedure you need to use an antimicrobial soap. The CDC states that you can use a non-antimicrobial or antimicrobial soap and water when hands are visibly dry or contaminated with blood or other potentially infectious material.

Source: Center for Disease Control and Prevention (CDC), Infection Prevention “What are the different types of hand hygiene?” https://www.cdc.gov/oralhealth/infectioncontrol/faq/hand.htm

Why Do I Need to Scrub Before Surgical Procedures?

If surgical procedures are performed, appropriate supplies are available for surgical hand scrub technique (e.g., antimicrobial soap, If surgical procedures are performed, appropriate supplies are available for surgical hand scrub technique (e.g., antimicrobial soap, alcohol-based hand scrub with persistent activity) Note: Examples of surgical procedures include biopsy, periodontal surgery, apical surgery, implant surgery, and surgical extractions of teeth.

Is it Sufficient to Only Use Hand Sanitizer in the Dental Environment?

In the absence of debris or if hands are not visibly soiled hand sanitizers can be very good at killing bacteria when they have access to the bacteria. When debris is present they are not able to penetrate debris and do not work effectively.

What is the Rule for Washing Your Hands?

The Centers for Disease Control (CDC) states: DHCP are trained regarding appropriate indications for hand hygiene including handwashing, hand antisepsis, and surgical hand antisepsis Note: Use soap and water when hands are visibly soiled (e.g., blood, body fluids). Alcohol-based hand rub may be used in all other situations.” If you think there may be debris on your hands or your hands are visibly soiled you need to wash your hands.

When to Perform Hand Hygiene?

When hands are visibly soiled.
After barehanded touching of instruments, equipment, materials and other objects likely to be contaminated by blood, saliva, or respiratory secretions.
Before and after treating each patient.
Before putting on gloves.
Immediately after removing gloves.
Surgical hand scrub is performed before putting on sterile surgeon’s gloves for all surgical procedures.

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