Introduction

Disinfection is defined as a process that eliminates many or all pathogenic microorganisms, except bacterial spores, on inanimate objects. (CDC, Atlanta)

Disinfection is always done in at least a two-step procedure

vigorous scrubbing of the surfaces to be disinfected and wiping them clean
wetting the surface with a disinfectant and leaving it wet for the time prescribed by the manufacturer

In this COVID-19 era, we need to take extra care while disinfecting our clinic and instruments. Coronavirus Disease 2019 (COVID -19) is an acute respiratory disease caused by a novel Coronavirus (SARS-CoV-2), transmitted in most instances through respiratory droplets, direct contact with cases and also through contaminated surfaces/objects. The virus gets inactivated by chemical disinfectants.

Post-COVID dentistry is different from the pre-COVID era. Recently, a 3-article series was published, written by authors from the East, the West and the Centre – a truly global guidelines on Post-COVID dentistry which you can read here.

Ideal Disinfectant

The ideal disinfectant has the following properties:

Broad spectrum activity
Acts rapidly
Non corrosive
Environment friendly
Free of volatile organic compounds
Non-toxic
Non-staining

Clinical Instruments Disinfection and Sterilisation

For this, categorise the patient care items in the clinic

1. Critical Items

Critical items penetrate soft tissue or bone and may contact the vascular or nervous system or any other normally sterile tissue, they have the greatest risk of transmitting infection. Critical items must be heat sterilised between use, or sterile single-use/disposable devices must be used.

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Example: Surgical instruments, Periodontal scalers, Implant drills

2. Semi-critical Items

Semi-critical items contact mucous membranes or non-intact skin (eg – exposed skin that is chapped, abraded or has dermatitis), they have a lower risk of transmission. Semi-critical items should be heat sterilised or high-level disinfected.

Examples: mouth mirrors, amalgam condensers, wax carvers and reusable impression trays

Note: Any heat-sensitive item is processed using high-level disinfection.

Semi-critical Items Special Considerations

Dental Handpieces – Follow manufacturer’s instructions to safely reprocess dental handpieces and accessories (eg – low-speed motor, reusable prophylaxis angles). Clean and heat sterilise between patient uses. Do not subject the handpiece to high-level disinfection and do not wipe the surface with a low-level disinfectant.

Digital Sensors – Ideally, barrier protection should be used, followed by cleaning or high-level disinfection between patients.

3. Non-critical Items

Non-critical items contact intact skin of patients, they have the lowest risk of transmission. Non-critical items can be barrier protected with cling film or cleaned and disinfected (if visibly soiled) using a low to intermediate level disinfectant.

Examples: x-ray cone, facebows, BP cuff.

Factors Affecting Disinfection

Organic and inorganic load present
Type and level of microbial contamination
Concentration of and exposure time to the germicide
Physical nature of the object (eg – crevices, hinges, lumens)
Presence of biofilms
Temperature and pH of the process
Relative humidity of the sterilization process (eg – ethylene oxide)

Types of Disinfectants

Thermal

All instrument washers and thermal disinfectants use either a detergent or a water-softening agent. It is possible for the pH of some of these chemicals to be incompatible with certain metals in dental instruments. For specific recommendations, the manufacturing instructions of the dental instruments and the instrument washer should be followed.

Also read: Surgical management of a large periradicular lesion – A case report.

Chemical

Detergent
70% Alcohol(ethyl, isopropyl, trichlorobutanol
1% Sodium hypochlorite
Bleaching powder

How to Make Clinic Disinfectants

Refer to the pictures below to understand how to make solutions of disinfectants for clinic use

Equipment

Basic equipment checklist for a clinic

Dust Mops / Sweeping tool (not broom)
Mops
Buckets
Damp cloth / Sponge / Squeeze mop

Clinic Area Disinfection

It is better to divide your clinic into areas and disinfect accordingly. Learn more about altering your clinic design into areas by clicking here.

Surfaces

Surface disinfection with 1% sodium hypochlorite (4 hourly) – High contact surfaces: Door-knobs, desks, chairs, stools, switches, etc
No sweeping or dry mopping
Three bucket technique for floor disinfection (4 hourly)

3 bucket technique

Bucket 1 – plain water
Bucket 2 – water with detergent
Bucket 3 – 1% Sodium Hypochlorite

Ceiling and Walls

Damp dusting with soap water and 1% sodium hypochlorite
Once a week or after a suspect/ confirmed case

General Instruments

Stethoscope: 70% alcohol/spirit swab before each patient
BP Instrument and cuff: wipe with 70% alcohol/spirit swab before each patient, wash the cuff with detergent
Injection and dressing trolley: clean daily with detergent and water, wipe with disinfectant after each use

Blood and Body Fluid Spill Care

Cover with absorbent paper
Cover the spill with 1% sodium hypochlorite for 10–20 minutes
Clean-up spill and discard into infectious waste bin
Mop area with soap and hot water
Clean the mop and mop area with 1% sodium hypochlorite
Wash mop with detergent and hot water

Refrigerators

Defrost, decontaminate and clean with detergent weekly

Reception Area

Floor disinfection: Three bucket technique (Twice daily)

Also read: Top 10 Ideas to Handle Dental Anxiety

Lockers, tables, cupboard, wardrobes, benches, shelves, cots, chairs and railings –

Damp dust with warm water and detergent
Surface cleaning with 1% sodium hypochlorite

Mirrors and glass, Stainless steel/ any other sink: warm water and detergent

Telephone: damp dust with warm water and detergent

Linen: Disinfect with 1% hypochlorite for 20 minutes and wash with detergent

Clinic Toilets

Toilet pot / commode & lid, taps, sink and soap dispenser: 1% Sodium hypochlorite, scrub and wash with soap water

Toilet floor: scrub and wash with detergent

Care of Mops

Detergent and 1% sodium hypochlorite

You can see the entire disinfection and PPE protocol in this video.

Conclusion

The COVID-19 pandemic is devastating but by following proper protocol for disinfection and sterilisation established by CDCP and National guidelines, we can definitely control the spread thus protecting ourselves, our hygienists, our patients and our family and make our country corona- free.

References

1. Coronavirus Disease 2019 (COVID-19): Prevention and Disinfection. IJBM: May-2020: Page No: 10-14

2. Sterilization Protocols in Dentistry – A Review . Lakshya Rani et al /J. Pharm. Sci. & Res. Vol. 8(6), 2016, 558-564.

3. Disinfection and Sterilization. Centre of Disease Control and Prevention.

4. National Guidelines For Infection Prevention And Control In Healthcare Facilities, MoHFW, Govt of India.

5. Van Doremalen N, Bushmaker T, Munster V J. Stability of Middle East respiratory syndrome coronavirus (MERS-cov) under different environmental conditions. European communicable disease bulletin. 2013 Sep 19; 18(38)

6. Otter J A, Donskey C, Yezli S, Douthwaite S, Goldenberg S D, Weber D J. Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: The possible role of dry surface contamination. The JOHI. 2016 Mar; 92(3):235-50

7. Lai M Y, Cheng P K, Lim W W. Survival of severe acute respiratory syndrome coronavirus. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2005 Oct 1; 41(7):e67-71