________________________________________________________ Infection Control for Dental Professionals
METHODS FOR STERILIZING AND DISINFECTING PATIENT-CARE ITEMS AND ENVIRONMENTAL SURFACES
Process
Result
Method
Examples
Patient Care Items
Environmental Surfaces
Sterilization Destroys all
Heat-automated, high temperature
Steam, dry heat, unsaturated chemical vapor
Heat-tolerant critical and semicritical Heat-sensitive critical and semicritical
NA
forms of viable micro-organisms, including bacterial spores.
Heat-automated, low temperature
Ethylene oxide gas, plasma sterilization
Liquid immersion a Glutaraldehyde,
glutaraldehydes with phenols, hydrogen peroxide, hydrogen peroxide with peracetic acid, peracetic acid
High-level disinfection
Destroys all micro- organisms, but not necessarily high numbers of bacterial spores.
Heat-automated Washer disinfector Liquid immersion a Glutaraldehyde,
Heat-sensitive semicritical
NA
glutaraldehydes with phenols, hydrogen peroxide, hydrogen peroxide with peracetic acid, ortho- phthalaldehyde EPA-registered hospital disinfectant with label claim of tuberculocidal activity (e.g., chlorine-containing products, quaternary ammonium compounds with alcohol, phenolics, bromides, iodophors, EPA- registered chlorine-based product) EPA-registered hospital disinfectant with no label claim regarding tuberculocidal activity. OSHA also requires label claim of HIV and HBV potency for use of low-level disinfectant for use on clinical contact surfaces (e.g., quaternary ammonium compounds, some phenolics, some iodophors)
Intermediate- level disinfection
Destroys vegetative bacteria and most fungi and viruses. Inactivates Mycobacterium bovis b . Not necessarily capable of killing bacterial spores. Destroys most vegetative bacteria and certain fungi and viruses. Does
Liquid contact
Noncritical with visible blood
Clinical contact surfaces, blood spills on housekeeping surfaces
Low-level disinfection
Liquid contact
Noncritical without visible blood
Clinical contact surfaces, housekeeping surfaces
not inactivate Mycobacterium bovis.
a Contact time is the single critical variable distinguishing the sterilization process from high-level disinfection with FDA- cleared liquid chemical sterilants. High-level disinfection uses shorter submersion times. b Inactivation of the more resistant Mycobacterium bovis is used as a benchmark to measure germicidal potency. Source: [9; 10; 21] Table 2
Surface disinfection is an important part of environmental cleaning. Most bacteria and mycobacteria (e.g., TB) survive for several months on dry surfaces [20]. Respiratory viruses, such as coxsackie or influenza, can persist on surfaces for a few days. Hepatitis viruses and HIV can persist for more than
one week, and herpes viruses have been shown to persist from only a few hours up to seven days [20]. All surfaces in patient care areas should be cleaned then disinfected according to the manufacturer’s instructions and allowed to dry completely.
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