Cleaning is an essential step in any disinfection process. It involves the removal of organic or inorganic waste from an instrument or device. If visible debris is not removed, it will interfere with microbial inactivation and may compromise the disinfection or sterilization process. The physical action of scrubbing with detergents and surfactants and rinsing with water eliminates a significant number of microorganisms.
If a surface is not cleaned first, the success of the disinfection process can be jeopardized. The removal of all visible blood and organic and inorganic matter can be as critical as the germicidal activity of the disinfecting agent. When a surface cannot be properly cleaned, it must be protected with barriers. The ability to kill Mycobacterium tuberculosis is used as a reference point to measure how well a disinfectant can kill germs. Mycobacteria have one of the highest levels of resistance of all microorganisms, so any germicide with a tuberculocidal pretense is considered capable of inactivating a wide spectrum of pathogens, including the least resistant organisms, such as blood-borne pathogens. Both techniques refer to the two-step procedure used to clean and disinfect environmental surfaces.
If using a liquid disinfectant, the user would spray the surface with the disinfectant and wipe it with a disposable towel to clean the surface (“spray and clean”), followed by another “spray” to disinfect the surface. When using disposable disinfectant wipes, the process is described as wipe, discard, and wipe because the user uses one wipe to clean the surface, discards it, and uses a second wipe to disinfect the surface. Disinfectant products should not be used as cleaners unless the label states that the product is suitable for such use. Personal protective equipment (PPE) should be worn by dental health care personnel (DHCP) to avoid exposure to infectious agents or chemicals. PPE may include gloves, gowns, masks and eye protection.
Multi-purpose gloves that are resistant to chemicals and punctures offer more protection than patient examination gloves when hazardous chemicals are used. The DHCP must follow the manufacturer's instructions and review the manufacturer's safety data sheet (formerly called material safety data sheet) to verify the correct procedures for handling or working with hazardous chemicals. General purpose utility gloves are not regulated by the Food and Drug Administration because they are not promoted for medical use. Therefore, they can be washed and disinfected for reuse. Carpets and fabric furniture are more difficult to keep clean than hard, non-porous surface floors, and cannot be reliably disinfected, especially after blood and bodily substances have been shed.
Carpeted floors or upholstered furniture are not recommended for use in dental offices, laboratories, or instrument processing areas. The American Dental Association (ADA) recognizes that there is a limited need for cold chemical sterilization. However, the CDC recommends replacing heat-sensitive semicritical items with items that are heat tolerant and can withstand heat sterilization or buying disposable alternatives. In my experience visiting dental offices and dental medical schools, I have never seen cold chemical sterilization performed correctly. This puts patients at risk of contracting blood-borne pathogens and is not a reliable standard precautionary measure for preventing infections caused by a myriad of organisms. Reusable instruments must be cleaned before sterilization. Residues can prevent heat or chemical vapor from contacting the surface of the instrument and make sterilization difficult.
Reusable instruments should be cleaned with automatic, hands-free cleaning equipment, such as an ultrasonic unit. If manual scrubbing is necessary, a long-handled brush should be used to keep hands away from contaminated sharp instruments. If instruments cannot be cleaned immediately, soaking them beforehand can improve the cleaning process. When you need urgent or emergency dental care, or when performing elective dental care during the pandemic, use engineering controls to protect dental workers, patients, and visitors from potential exposure to SARS-CoV-2.To protect the health and safety of patients and dental health personnel, as well as to ensure the longevity of professional dental devices and equipment, CDC recommends using FDA-approved devices for instrument reprocessing and following the manufacturer's instructions for use. Unfortunately, dental offices and dental medical schools are not immune to faults in the processing of dental instruments. If aerosol-generating procedures are needed for dental care, use high-evacuation dental and suction systems to minimize droplet splashes and aerosols.