Q&A

Scientific studies show that you need to scrub for 20 seconds to remove
harmful germs and chemicals from your hands. If you wash for a shorter time,
you will not remove as many germs. Make sure to scrub all areas of your hands,
including your palms, backs of your hands, between your fingers, and under
your fingernails.

Soap and water, worked into a lather, trap and remove germs and chemicals
from hands. Wetting your hands with clean water before applying soap helps
you get a better lather than applying soap to dry hands. A good lather forms
pockets called micelles that trap and remove germs, harmful chemicals, and
dirt from your hands.
Lathering with soap and scrubbing your hands for 20 seconds is important to
this process because these actions physically destroy germs and remove
germs and chemicals from your skin. When you rinse your hands, you wash the
germs and chemicals down the drain.

PPE are special coverings designed to protect dental health care personnel
(DHCP) from exposure to or contact with infectious agents. These include
gloves, face masks, protective eyewear, face shields, and protective clothing
(e.g., reusable or disposable gown, jacket, lab coat). PPE can also prevent
microorganisms from spreading from DHCP to patients. For guidance on how to
choose and use PPE in health care settings

Health care personnel should wear a surgical mask that covers both their nose
and mouth during procedures that are likely to generate splashes or sprays of
blood or body fluids and while manually cleaning instruments. A surgical mask
also protects the patient from microorganisms generated by the wearer. When
a surgical mask is used, it should be changed between patients or during
patient treatment if it becomes wet.

Health care personnel should wear protective clothing (e.g., gowns, jackets) to
prevent contamination of street clothing and to protect the skin from exposure
to blood and body fluids. Sleeves should be long enough to protect the
forearms. Protective clothing should be changed when it becomes visibly soiled
by blood or other body fluids. HCP should remove protective clothing before
leaving the work area.

Surgical face masks are cleared by the US Food and Drug Administration (FDA)
as medical devices. FDA notes that “surgical masks are not intended to be
used more than once. If your mask is damaged or soiled, or if breathing through
the mask becomes dicult, you should remove the face mask, discard it safely,
and replace it with a new one.”
According to the Food and Drug Administration a single-use device, also
referred to as a disposable device, is intended for use on one patient during a
single procedure. It is not intended to be reprocessed (i.e., cleaned and
disinfected or sterilized) and used on another patient. If a device does not have
reprocessing instructions, regardless of labeling, it should be considered
single-use and disposed of appropriately (i.e., according to federal, state, and
local regulations) after one use.

No. Gloves may have small defects that are hard to see or may be torn during
use, and hands can become contaminated during removal of gloves. In addition,
bacteria can multiply rapidly in moist environments underneath gloves; thus,
dental health care personnel should make sure hands are dry before putting on
gloves. Hand hygiene should be performed immediately before after removing
gloves. If the integrity of a glove is compromised (e.g., if the glove is
punctured), the glove should be changed as soon as possible.

The type of glove used should be based on the type of procedure to be
performed (e.g., surgical vs. nonsurgical, housekeeping procedures). Medicalgrade nonsterile examination gloves and sterile surgical gloves are regulated by
the Food and Drug Administration (FDA) as medical devices. Sterile surgical
gloves must meet FDA standards for sterility assurance and are less likely than
nonsterile examination gloves to harbor pathogens that may contaminate an
operative wound. General purpose utility gloves are not regulated by FDA
because they are not promoted for medical use.

Cleaning is the necessary rst step of any disinfection process. Cleaning
removes organic matter, salts, and visible soils, all of which interfere with
microbial inactivation. The physical action of scrubbing with detergents and
surfactants and rinsing with water removes substantial numbers of
microorganisms. If a surface is not cleaned rst, the success of the disinfection
process can be compromised. Removal of all visible blood and inorganic and
organic matter can be as critical as the germicidal activity of the disinfecting
agent. When a surface cannot be cleaned adequately, it should be protected
with barriers.

Disinfection destroys most pathogenic and other microorganisms by physical or
chemical means. In contrast, sterilization destroys all microorganisms, including
substantial numbers of resistant bacterial spores, by heat (steam autoclave, dry
heat, and unsaturated chemical vapor) or liquid chemical sterilants. Disinfection
does not ensure the degree of safety associated with sterilization processes.

Environmental surfaces can be divided into clinical contact surfaces and
housekeeping surfaces. Clinical contact surfaces can be directly contaminated
from patient materials either by direct spray or spatter generated during dental
procedures or by contact with gloved hands of dental health care personnel.
These surfaces can subsequently contaminate other instruments, devices,
hands, or gloves. Housekeeping surfaces (e.g., walls, doors, sinks) are not
directly touched during dental treatment and carry the lowest risk of disease
transmission.
Recommendations for Cleaning and Disinfecting Environmental Surfaces

There are three levels of disinfection: high, intermediate, and low. High-level
disinfectants, such as glutaraldehyde, are used as chemical sterilants and
should never be used on environmental surfaces. Intermediate-level
disinfectants are registered with the Environmental Protection Agency (EPA)
and have a tuberculocidal claim, and low-level disinfectant are EPA-registered
without a tuberculocidal claim (i.e., hepatitis B virus and HIV label claims).

The Environmental Protection Agency regulates low- and intermediate-level
disinfectants that are used on environmental surfaces (clinical contact surfaces
and housekeeping). The Food and Drug Administration regulates liquid
chemical sterilants/high-level disinfectants (e.g., glutaraldehyde, hydrogen
peroxide, and peracetic acid) used on heat-sensitive semicritical patient care
devices.

CDC does not test, evaluate, or otherwise recommend specic chemical
germicides. The CDC dental guidelines [PDF-1.2M] provide overall guidance
for dental health care personnel to choose from among general classes of
products based on infection prevention and control principles. This guidance
recommends appropriate application of liquid chemical disinfectants registered
with the Environmental Protection Agency (EPA) for use in dental health care
settings.
The EPA maintains a list of selected EPA-registered disinfectants

The ability to kill Mycobacterium tuberculosis is used as a benchmark to
measure how well a disinfectant can kill germs. Mycobacteria have among the
highest levels of resistance of all microorganisms. Therefore, any germicide
with a tuberculocidal claim is considered capable of inactivating a broad
spectrum of pathogens, including less resistant organisms such as bloodborne
pathogens (e.g., hepatitis B and C viruses, HIV). The use of such products on
environmental surfaces plays no role in preventing the spread of tuberculosis
(which is airborne).

When used correctly, commercially available disposable disinfectant wipes,
cloths, or towelettes are eective for cleaning and disinfecting environmental
surfaces in dental settings. Any disinfectant used in a dental setting should be
registered by the Environmental Protection Agency (EPA) and be approved for
use in health care settings (i.e., hospital grade). Dental health care personnel
should always follow manufacturer recommendations for use of cleaners and
EPA-registered disinfectants (e.g., amount, dilution, contact time, safe use,
disposal). Disinfectant wipes that you can buy at the grocery store are not EPAregistered and are not recommended for use in a dental setting.

Both techniques refer to the two-step procedure used to clean and disinfect
environmental surfaces. If using liquid disinfectant, the user would spray the
surface with the disinfectant and wipe it using a disposable towel to clean the
surface (“spray-wipe”), followed by another “spray” to disinfect the surface.
When using disposable disinfectant wipes, the process is described as wipediscard-wipe because the user uses one wipe to clean the surface, discards the
wipe, and uses a second wipe to disinfect the surface. Disinfectant products
should not be used as cleaners unless the label indicates the product is
suitable for such use. The Centers for Disease Control and Prevention
recommends following manufacturer recommendations for use (e.g., amount,
dilution, contact time, safe use, disposal).

Because of the risks associated with exposure to chemical disinfectants and
contaminated surfaces, dental health care personnel (DHCP) should wear
appropriate PPE to prevent exposure to infectious agents or chemicals PPE can
include gloves, gowns, masks, and eye protection. Chemical- and punctureresistant utility gloves oer more protection than patient examination gloves
when using hazardous chemicals. DHCP should follow manufacturer
instructions and review the manufacturer Safety Data Sheet (formerly called
Material Safety Data Sheet) regarding 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. Thus, they can
be washed and disinfected for reuse.

Consult the manufacturer about appropriate barrier use and disinfection/
sterilization procedures for electronic equipment. In the absence of a
manufacturer’s cleaning instructions, use barrier protective coverings as
appropriate for noncritical equipment surfaces that are 1) touched frequently
with gloved hands during patient care, 2) likely to become contaminated with
blood or body substances, or 3) hard to clean (e.g., computer keyboards).

Radiography equipment such as the radiograph tube head/cone/arm and
control panel should be protected with surface barriers that are changed after
each patient. If barriers are not used, equipment that has come into contact
with gloved hands of dental health care personnel or contaminated lm packets
should be cleaned and then disinfected after each patient use.

Digital radiography sensors are considered semicritical and should be
protected with a Food and Drug Administration- (FDA-) cleared barrier to
reduce contamination during use, followed by cleaning and heat sterilization or
high-level disinfection between patients. If the item cannot tolerate these
procedures then, at a minimum, it should be protected with an FDA-cleared
barrier and cleaned and disinfected with an Environmental Protection Agencyregistered hospital disinfectant with intermediate-level (i.e., tuberculocidal
claim) activity, between patients. Because these items vary by manufacturer,
refer to manufacturer instructions for reprocessing.

Carpeting and cloth furnishings are harder to keep clean than nonporous, hard-
surface ooring, and cannot be reliably disinfected, especially after spills of
blood and body substances. Carpeted ooring and upholstered furnishings are
not recommended for use in dental operatories, laboratories, or instrument
processing areas.