Infection Control - 12 hrs

Chapter Five - Chemical Disinfectants

Chapter 1: Introduction

Chapter 2: Etiology and Transmission of TB, HIV, CJD, and Hepatitis B,C

Chapter 3: Personnel and Personal Protective Attire

Chapter 4: Surfaces and Waste Disposal

Alcohol-Quaternary
Ammonium Compounds

Sodium Hypochlorite
(Bleach)

Sterilants and High Level
Disinfectants

Preprocedural
Mouthrinsing

Chapter 6: Steps in Instrument Processing

Chapter 7: Methods of Sterilization

Chapter 8: The Dental Laboratory

Chapter 9: Waterlines

Chapter 10: Ethical and Legal Considerations Regarding AIDS and HIV

Chapter 11: Summary Checklists

Bibliography and Suggested Reading List

Appendices

Internet Resources

Endnotes

Post Examination

Exit to Menu

Introduction

Decision Factors: Surface Cleaning and Disinfection
James A. Cottone, DMD, MS
University of Texas Health Science Center at San Antonio Dental School

1. Efficacy:
   
   1. Assumptions:
      
      1. EPA registered
         
         1. Hospital-level disinfectant:Staphylococcus aureus
            Salmonella choleraesuis
            Pseudomonas aeruginosa
            
   2. Tuberculocidal:
      
      1. 10 minutes or less
   3. Virucidal:
      
      1. Lipophilic virus (HIV)
      2. Hydrophilic virus (Polio, Coxsackie, Rhinovirus, Rotavirus)
      3. 10 minutes or less
   4. Efficacy verified:
      
      1. Multiple: studies, different investigators, agency recommendations
2. Choices:
   
   1. Cleaning ability: Water-based (good) vs. alcohol-based (usually poorer)
   2. Application method: Pump spray (preferable) vs. aerosol spray (less preferable)
   3. Minimize disadvantages:
      
      1. Chlorines - Corrosive; damages clothes, plastics, rubber; usually prepared daily
      2. iodophors - removable stains, prepare daily
      3. Synthetic phenols - film accumulation, damages plastics and rubber
3. Available Products:
   
   1. Water-based:
      
      1. Pump Spray
         
         1. Concentrate:Chlorines (Bleach, Exspor)
            (dilute before use)Iodophors (Iodofive)
            Synthetic phenols (OmniII, ProPhene,
            Vital Defense-D,
            Top-Cide, Asepti-phene 128)
            
         2. Pre-diluted:Chlorines (Dispatch)
            Synthetic phenols (ProSpray)
            
      2. Aerosol Spray: none
   2. Alcohol-based
      
      1. Pump Spray: (Coe Spray-The Pump, Novospray)
      2. Aerosol Spray:
         
         1. Accusol Aerosol (Lysol IC Disinfectant Spray)
         2. Standard aerosol (Citrace, Lysol IC Disinfectant Spray, Asepti-Steryl)

October 4, 1995
Reprinted by permission, OSAP Foundation

Disinfection will kill disease-producing microorganisms, but not bacterial spores. Office disinfection procedures employ a liquid chemical at room temperature to kill microorganisms. If the chemical used is not sporicidal, it is called a disinfectant (for example, iodophors, synthetic phenolics, phenols, alcohol/phenolics, sodium hypochlorite, low-concentration glutaraldehyde) and will not completely sterilize the surface. Liquid glutaraldehydes (at concentration levels for immersion sterilization) are not acceptable as surface disinfectants because of dangerous vapors and odors. Properly diluted iodophor, sodium hypochlorite, and complex phenol preparations have been shown to be superior in comparison with other disinfectants for initial precleaning.

Each dental office must take its own needs into account when selecting an appropriate surface disinfectant. Is it easy to use, economical, and compatible with the materials in the office? Is it tuberculocidal within a reasonable period of time at room temperature? What are the disposal requirements and will it cause allergic reactions in patients or staff? If it needs to be diluted, can it mix with common tap water or will you need to purchase distilled water? When comparing product costs, remember to take into account shelf life and mixing time.viii

Continue on to Iodophor Solutions