Setting the record straight on infection control

Effective decontamination is the foundation of infection control and the provision of quality dental care. Preventing the spread of infection remains a top priority for every dental practice to protect both staff and patients from the danger of exposure to harmful pathogens.

All members of the dental team are required to keep their infection control knowledge and skills up to date. Every practice must have protocols in place to comply with national and local regulatory guidelines designed to prevent the spread of infection. This is also why it is essential to learn to recognise and disregard misconceptions surrounding infection control that can ultimately compromise safety and regulatory compliance.

All disinfection and cleaning products used in a dental practice are the same

Disinfection and cleaning products are not all the same; they serve different purposes and use distinct formulations designed for specific surfaces, equipment and surgical procedures unique to the clinical environment.

Cleaning refers to the removal of visible soil (organic and inorganic material) from objects and surfaces and is usually achieved using detergents or enzymatic products. Disinfection, on the other hand, is the inactivation or destruction of microorganisms that cause disease, which include viruses, bacteria and protozoans, but not bacterial spores, on inanimate objects and surfaces¹.

The cleaning and disinfection of dental instruments must comply with essential quality requirements and follow a validated decontamination process. Instrument cleaners and disinfectants should be CE (Conformité Européenne) and UK Conformity Assessed (UKCA) marked, extensively tested to meet all legal requirements and designed for both manual and ultrasonic cleaning. Different areas of the practice also require different material compatibility credentials, and combining the risk level and required efficacy with the material compatibility is a balance.

Household cleaning products are safe to use in the dental surgery

Household cleaning products should not be used to clean in dental surgeries as the efficacy of household products cannot be guaranteed. Any cleaning products, including disinfectants, used on medical devices within the practice should all carry the CE/UKCA marks that ensure a product complies with regulations and is compatible with surfaces and equipment unique to the surgery environment.

It is not essential that instruments are completely clean prior to autoclaving, the autoclave will sterilise everything anyway

Effective instrument cleaning is the first step in the decontamination process. If an instrument is not clean it cannot be sterilised. Any residual soil on the surface of equipment creates a risk that will prevent steam, generated during sterilisation, from condensing on the surface of the instrument and raising the temperature to that required to ensure sterilisation². Any organic or adherent dental materials left on instruments can also cause corrosion, restrict performance and reduce instrument lifespan.

Alcohol wipes are preferable to alcohol-free alternatives

Alcohol-based wipes are commonly used in healthcare settings to reduce bacterial contamination. However, despite being an effective disinfectant in clean conditions, alcohol is not effective as a cleaner, especially with soils consisting of or containing protein.

As stated in HTM 01-05, alcohol has been shown to bind blood and protein to stainless steel³. Rather than aiding the removal of proteinaceous material from surfaces, an alcohol wipe can make it more difficult to remove, potentially trapping microorganisms and providing additional surface roughness to assist adhesion of further soiling⁴.

Alcohol is known to be incompatible with common surgery surfaces including PMMA and vinyl or synthetic leather upholstery used on dental chairs and stools, which are vulnerable to drying and cracking when regularly exposed to alcohol-based products. Prolonged use of alcohol as a disinfectant can also cause discolouration, swelling, hardening and cracking of rubber and certain plastics⁵.

In contrast, alcohol-free wipes are less likely to cause damage to surfaces and will not bind protein to stainless steel – providing the best possible efficacy.

Hot water is more effective than cold water for washing hands

Handwashing is considered one of the simplest and most important ways to reduce the transmission of infectious agents that cause healthcare-associated infections⁶. According to medical journal The Lancet, “handwashing with soap can prevent many acute respiratory infections by mechanically removing pathogens from hands, and by rupturing many bacteria and viruses”⁷.

According to research, there is no known data to support the claim that water temperature is associated with handwashing efficacy. While heat does kill bacteria, the level of heat required to neutralise pathogens is beyond what is considered safe for prolonged human contact⁸. Most of the value of handwashing is the physical rubbing with a wash lotion or detergent and the rinsing action that dislodges bacteria, grease and dirt from the skin’s surface. Prolonged exposure to hot water, especially with soap, can also irritate the skin, leading to dryness, soreness, and cracking.

Wearing gloves is a good substitute for hand hygiene

Although gloves are worn for all clinical and decontamination procedures, they are not a substitute for hand hygiene because microorganisms can flourish under gloves and gloves can become torn, pierced or porous over time. Studies have shown that the frequency of perforations in surgeons’ gloves during outpatient oral surgical procedures range from 6% to 16%. They have also shown that dental health care providers are frequently unaware of minute tears in gloves that occur during use and that gloves developed defects in just 30 minutes to three hours, depending on the type of glove and procedure⁹.

Hands should be thoroughly washed not just when visibly soiled, but also before putting on surgical gloves and after glove removal¹⁰. Rings and other jewellery should be removed before washing as bacteria can colonise under these items. Rings can also make wearing surgical gloves more difficult and make glove tears more likely¹¹.

All surgical instruments and handpieces can be reprocessed in the same way

The cleaning and disinfection of reusable surgical instruments, handpieces and medical devices must comply with essential quality requirements and follow a validated decontamination process. Instrument cleaners and detergents should be CE/UKCA marked, extensively tested to meet all legal requirements and designed for both manual and ultrasonic cleaning. Always consult the manufacturers’ instructions for detailed advice on how to reprocess handpieces and instruments correctly.

The manual cleaning of instruments is an acceptable method in all regions of the United Kingdom

In England and Wales, the Health Technical Memorandum 01-05 (HTM 01-05) and Welsh Health Technical Memorandum (WHTM 01-05) acknowledge that manual cleaning, governed by an appropriate protocol, is an acceptable method. However, best practice recommendations state that manual cleaning should only be considered when the manufacturer specifies the instrument is not compatible with automated processes such as ultrasonic cleaning.

Manual cleaning is not an accepted validated process in Northern Ireland (DHSSPSNI)¹² and in Scotland¹³. In order to achieve a validated cleaning/washing cycle a washer disinfector must be used to clean all items where manufacturers’ instructions allow.

Be aware

Infection control protocols are constantly evolving in line with new research and understanding about pathogens and their transmission. However, the fundamentals of decontamination remain the same. Dental teams should always follow a comprehensive infection control policy, receive regular training and ensure all processes and policies are up to date in order to avoid misinformation, implementing incorrect workflows and to keep staff and patients safe at all times.