Although it is practically impossible to maintain a completely sterile environment in the dental surgery, proven methods and procedures do exist that can be put into place if the surgery is to come as close as possible to bacteria-free perfection. What's more, this high level of decontamination should also be maintained throughout the entire practice and not be confined to the surgery. Dangerous pathogens can easily spread from room to room within the building, so high standards across the board are important.
Communal areas
Reception and communal waiting areas should be subjected to an equally high level of caution as in the surgery. Everyone who enters or leaves the practice is likely to stop here, so it is important it is kept as clean and tidy as possible. Offering a bottle of alcohol hand disinfectant at reception with a note advising all patients and visitors to disinfect their hands is a good idea. It is imperative toilets and bathroom areas are kept clean and well maintained. The provision of hot water, liquid soap and paper towels for hand washing is essential, and toilets should be checked regularly throughout the day and cleaned thoroughly every day.
Staff areas are often disregarded when it comes to treatment, however it is just as important to keep these rooms infection free, as staff spend time in here and in surgery. Kitchen equipment must be cleaned regularly and if a fridge is provided, it is important to remember it is not to be used for any drugs or medication. Dirty laundry from the surgery should not be kept in staff areas, and instead should be placed in a designated 'dirty' area, because pathogens picked up during treatment could easily be transferred. If outside contractors are employed to clean the public areas of the practice it is important they too are trained in the correct methods, and are familiar with the establishment's infection control guidelines.
The dental nurse should be well trained in infection control procedures and bears the responsibility for the implementation of disinfection protocols. However, the dentist or practice manager should not distance themselves from the daily infection control routine; on the contrary, every member of staff within the practice should be fully trained in and aware of the practice's regime. The very nature of infection means bacteria and pathogens are constantly evolving. With this in mind, it is recommended regular refresher courses are undertaken on this subject to update the dental nurse's skills and reinforce their existing knowledge.
Floors and walls
The surfaces within a surgery must be thoroughly cleaned if infection is to be successfully controlled. Surgery floors should be covered in a non-stick coating and need to be cleaned on a daily basis. Carpet is never advised, as it can never be disinfected adequately and a vacuum cleaner can spread pathogen contaminated air around the surgery environment and should never be used in surgery, especially if it has been used elsewhere in the practice. Any seams within the flooring should be given close attention as dust and dirt collect in these areas. The same goes for the join between the wall and the floor and it is advisable for the floor covering to come three to four inches up the wall, as this area is notoriously hard to clean (and frequently forgotten).
Walls should be wiped down daily with a disinfectant solution. Clearly label a mop and bucket which can only be used on surgery floors and deal with any spillages promptly, according to practice guidelines.
Work surfaces
Cleaning and disinfection constitute the two fundamental stages of work surface hygiene maintenance. After every patient the work surface should be cleared of all items and wiped down with a CE marked detergent, ensuring the entire area has been covered. To destroy and deactivate any remaining pathogens, the surface should then be wiped with a cleaning and disinfectant solution, such as Mikrozid wipes or liquid. Dental professionals should learn to be suspicious of any used surface, even if it appears to be uncontaminated.
In the dental surgery, worktops, sinks, dental chairs, bracket tables, chair controls and handles are all made of different materials, some of which are alcohol sensitive. Although alcohol-based surface disinfectants can be very effective at eliminating dangerous bacteria from metals, glass, Corian, ceramics and laminate surfaces, they can cause cracking or smearing if used on more sensitive materials. These surfaces include soft PVC, perspex and leather (natural and artificial).
Consider your dental chair's cleaning regime. Even if you use covers, it is still recommended the chair is cleaned and disinfected between patients. Although admittedly this can be time consuming, there are products available that clean and disinfect in one use, which are far more effective than just using soapy water. Some cleaners and disinfectants on the market, such as Mikrozid senstitive, are even effective in just one minute, especially useful for when time is tight between patients.