The continuing pressure on dental practices to comply with regulations, provide high quality clinical and customer care and at the same time run efficient and profitable practices is a daunting task for many practitioners.
Constant time pressure continues to be a reality for NHS and private practices, but the temptation to cut corners with cleaning and disinfecting procedures must be avoided at all costs. Instead, practice managers and those responsible for infection control compliance must search for a solution that delivers swift but effective cleaning and disinfection that can be embedded as part of the practice's infection control procedures.
Within the dental practice both cleaning and disinfection processes are required; cleaning involves the physical removal of soiling matter from surfaces whilst disinfection refers to the inactivation of pathogens. It is important that cleaning takes place before disinfection to ensure that bacteria, proteins and other contaminants are removed from surfaces. This is particularly important where the disinfecting agent is alcohol, a substance that has been shown to 'fix' protein and biofilm.
Section 6.57 of HTM01-05 states: "Care should be taken in the use of alcohol wipes, which – though effective against viruses on clean surfaces – may fix protein and biofilm. However, the careful use of water with suitable detergents, including those CE-marked for clinical use, is satisfactory provided the surface is dried after such cleaning.
NOTE: Alcohol has been shown to bind blood and protein to stainless steel. The use of alcohol with dental instruments should therefore be avoided."
(A demonstration of how alcohol based products may fix protein and biofilm to surfaces can be viewed at www.dentisan.co.uk).
Alcohol has been widely used as a disinfectant in dentistry for many years, a use that has been largely driven by its low cost and quick drying properties, both factors perceived as beneficial. Rapid drying helps achieve a short turn-round time between patients, a critical issue particularly in busy NHS practices. However, this fast evaporation of alcohol based products also means that when using an alcohol infused wipe, most of the alcohol evaporates before the entire surface has been treated, meaning that the areas wiped at the end of the process will not be effectively disinfected.
So despite their widespread use, alcohol based products are not suitable for single stage cleaning and disinfection in an environment where protein based soils are likely to be present and in order to ensure compliance with HTM01-05 should only form part of two-stage process; the first to clean and the second to disinfect. This however is less than desirable from an operational point of view due to the additional time required to carry out two procedures between each patient, as well as the additional cost of buying two products and the additional inventory required.
Further limitations in the use of alcohol based products such as material incompatibility and flammability (raising storage as a consideration in terms of health and safety) may lead us to the question why alcohol has been such a popular choice for dental practices. Of course the low cost and quick drying properties have been key drivers in this market but so too has the lack of a viable alternative.
The ideal properties for an infection control solution for surface decontamination is one that meets all the needs of practices in a single product:
- Remove soiling and disinfect in a single process
- Alcohol free
- Effective against HIV, HBV and TB
- Compatible with a broad range of surgery materials
- HTM01-05 compliant
Infection control procedures must be effective on a number of levels; effective in terms of their cleaning and disinfection properties and compatibility with the variety of surface materials present in the practice, but they must also be effective in terms of cost and time. So, when searching for infection control solutions, those responsible – be they practice managers, nurses or dentists, should make sure they keep abreast of new developments and product advances so they can benefit from the solutions now available.