Dental Office Decontamination Best Practices

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Infection prevention has come to play a large role in patient care facilities. Hospitals and other medical facilities have approached infection control with conventional methods for decades, but following the COVID-19 pandemic medical professionals were obligated to completely alter their strategies and implement new tactics for mitigating viral spread. A key area of practice where this has changed is in dental offices. Infection preventionists play a large role in reimagining the way dentists and other dental staff approach infection control.

In 2003, the Centers for Disease Control and Prevention published a major consolidation of its infection control recommendations in dentistry, including the management of occupational exposures, dental water-quality concerns, and more. These have since been expanded, providing a comprehensive checklist for the protection of dental care workers and their patients.

Patients and physicians are more aware than ever of the risks associated with patient care and the transmission of infectious diseases. While the pandemic is no longer a constant threat, there are numerous other transmissible diseases that dentists, dental hygienists, and other dental professionals are exposed to daily. By maintaining best practices such as proper hand hygiene, surface decontamination, water quality inspections, and other decontamination procedures, dental staff and patients can remain infection-free.

Regularly Sanitize High-Touch Surfaces

Surface decontamination is the most common best practice for maintaining a contamination-free environment. Three conditions should be considered before disinfecting surfaces and objects in a patient care facility; 1) the potential for direct patient contact; 2) the degree and frequency of hand contact; and 3) the potential contamination of the surface or area with bodily substances or environmental sources of microorganisms including soil, dust, or water.

According to the CDC, the nature and type of surface, and the extent of contamination, are determining factors for the level of chemical exposure needed to effectively decontaminate the surface. Dental patient-care equipment is categorized in three ways based on the potential risk of infection associated with their intended use: critical items, semicritical items, and noncritical patient-care items.

1. Critical Items: These patient-care items refer to surgical instruments and other equipment used in more invasive dental procedures. Critical items have the greatest risk of transmitting infectious diseases and should always be sterilized using heat.
2. Semicritical items: Mouth mirrors, reusable impression trays, and any tools or equipment that come into contact with mucous or non-intact skin still pose a risk of transmission but are lower than critical items. Semicritical items should also be sterilized using heat. However, if the item is heat-sensitive it should be replaced with the proper heat-resistant alternative.
3. Noncritical items: Noncritical patient-care items such as blood pressure cuffs, radiographic equipment, and curing lights pose the least risk of transmission. These items only come into contact with intact skin. In most cases, these objects and surfaces are protected with disposable barriers.

These surfaces and items should be disinfected at the beginning of the day, after each patient, and at the end of the day. The CDC recommends using an Environmental Protection Agency (EPA)-registered intermediate-level disinfectant for these contaminated surfaces.

Waiting rooms are equipped with multiple surfaces that can act as high transmission areas. There are several strategies for deploying EPA-registered disinfectants using decontamination technology, including electrostatic sprayers, fogging systems and more. Investing in decontamination technology is one route that can reduce sick leave among staff and provide an all-encompassing approach to infection control.

One in 31 U.S. patients contracts at least one infection associated with their healthcare every day. Adhering to these surface decontamination protocols can help to diminish this issue and lower the rates of transmissible diseases in healthcare facilities such as dental offices.

Institute Routine Water Quality Monitoring

Water tools make up a significant amount of technologies and appliances used in dental practices. Maintaining clean water lines has long since been a recommendation from the CDC for dental hygiene, and there are simple and inexpensive products available for testing bacteria and PH levels in dental water units. There are also in-office testing kits and mail-in services available.

Oral health is uniquely connected to whole-body health. This poses an even larger threat when faced with the task of infection control. Dental staff must be knowledgeable and adhere to critical guidelines for the safe practice of oral health care. The goal of infection control in dentistry is to minimize or eliminate exposure to any potentially harmful contaminants. Maintaining dental unit waterlines, including the water quality provided during dental treatments, is an integral part of infection prevention protocols.

The following tactics are CDC recommendations for effectively monitoring and maintaining water lines in dental offices:

Consult with the unit manufacturer on the need for periodic maintenance

Consult with the unit manufacturer for appropriate methods for maintaining the proper quality of dental water

Discharge water and air for a minimum of 20-30 seconds after each patient from any device connected to the dental water system

Maintaining Air Purification Standards

In addition to water quality monitoring and purification standards, air quality is another key area of infection control. Dental offices, in particular, face unique challenges due to the proximity to the oral cavity and the potential for airborne transmission of viruses and bacteria. Generally, spaces with more people are in greater need of effective ventilation. However, smaller rooms such as dental surgical rooms with unmasked patients require just as adequate of air filtration systems if not more so than larger rooms. Since the pandemic, advanced air purification systems such as HEPA filters have become commonplace in healthcare settings, including dental offices.

This cutting-edge technology utilizes a combination of HEPA filtration, UV-C light, and activated carbon to effectively remove airborne contaminants, including viruses, bacteria, and volatile organic compounds. By continuously purifying the air, these systems help mitigate the risk of cross-contamination and provide a safer breathing environment for both patients and dental professionals. Decontamination fogging systems can also help to maintain a clean air space. Foggers emit very fine, non-toxic mist enabling the aerosolized particles to disperse in difficult-to-reach places in order to decontaminate the entire space.

Implement Hand Hygiene and PPE Protocols

Lastly, proper hand hygiene and the use of personal protective equipment (PPE) are the most elementary best practices all healthcare professionals should implement; however, they can also be most effective in mitigating viral spread.

According to the American Dental Association (ADA), dental practitioners and staff should follow guidelines and regulations provided by the Occupational Safety and Health Administration (OSHA). These guidelines suggest that all dental healthcare personnel must wash their hands with water and soap or an alcohol-based hand sanitizer when performing routine exams and nonsurgical procedures.

By incorporating these best practices and innovative technologies, dental offices can enhance their decontamination protocols and provide a safer environment for their staff and the patients they care for. These advancements not only help protect against the spread of infectious diseases but also instill confidence in patients, reassuring them that their health and safety are top priorities.