The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#198 Clean Like a Pro: Tips for Selecting Surface Disinfectants
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Proper surface disinfection is an important component of patient safety and minimizing disease transmission in dental settings. Not only is it discussed in the CDC Guidelines, it's also required under OSHA's Bloodborne Pathogens Standard. Listen in and ensure your products and processes are up to date.
Resources:
- CDC - Guidelines for Infection Control in Dental Health-Care Settings - 2003 https://www.cdc.gov/mmwr/pdf/rr/rr5217.pdf
- CDC Guideline for Disinfection and Sterilization in Healthcare Facilities - 2008, updated 2020 https://bit.ly/4gXbcYD
- EPA - Selected EPA-Registered Disinfectants https://bit.ly/4bjoYDC
- EPA's Registered Antimicrobial Products Effective Against Mycobacterium tuberculosis (TB) [List B] https://bit.ly/43dIDmK
Welcome. I'm Leslie Cannum. I'm Mary Gavoni. I'm Linda Harvey.
SPEAKER_02I'm Olivia Long, and together we are the Compliance Divas.
SPEAKER_03Welcome to the Compliance Divas Podcast. This is Linda Harvey, and I will be your moderator for this episode. In today's episode, the Divas are going to be talking about a very important housekeeping detail. And as the Compliance Divas, we bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. We invite you to subscribe to our podcast through your favorite podcast channel or on our website at thecompliancedivas.com. Any resources that we mentioned during this episode will be found in the show notes. And we invite you to submit your questions to support at thecompliancedevas.com. And don't forget to scroll down at the end of the podcast and leave us a note or rating or review. Today's topic is surface disinfection. We all know that proper surface disinfection is an important component of patient safety. It's a critical component for minimizing disease transmission in dental settings. And we know it's legally required under OSHA's bloodborne pathogen standard. But over the years, the Divas have come across many different variations and misconceptions about how to properly clean and disinfect the clinical contact surfaces in a dental setting. Mary, could we start off a chat together? I would love for you to discuss with our listeners some of the misconceptions related to the recap with COVID and what happened there that may have some folks, you know, heading down maybe not the best path when it comes to surface disinfection.
SPEAKER_01Absolutely, Linda. The best way I could describe what we experienced with surface disinfectants during COVID was it was the wild, wild west. You know, of course, there was panic on the part of dental team members wanting to do the right thing, wanting to protect the patients, protect themselves. And they were getting all kinds of information, updates, and information feeds from the CDC and other sources, sometimes conflicting. So it just made all of us kind of crazy for a while. So one of the things that the CDC encouraged was using products that had a label claim against emerging infectious diseases or that had a label claim for SARS or for coronaviruses. Back at the beginning of the pandemic, there weren't a lot of products on the market that we used in dentistry that actually had that label claim because these manufacturers had to go back to the Food and Drug Administration and get their label claims reviewed and approved before they could add that claim on their label. So there were, I remember, at least one product that was first probably to the market getting that label claim. And so they were telling folks, wow, you have to use our product because we're the only one that has this. And people switched products. They were mixing different products that using a spray and a wipe that even using a spray and a wipe from the same manufacturer isn't even recommended because the chemistry is different. But what a lot of people forgot was that in the CDC guidelines for infection control and dentistry, it says when there is the possibility of blood present, we are supposed to use a surface disinfectant that is tuberculosidal. And again, the what sort of got lost in the chaos was the fact that that's set as the gold standard killing microbacterium tuberculosis, because they're some of the most resistant microorganisms. Coronaviruses are at what I always say is the bottom of the food chain. They're not very resistant. So if you were using a product that already had a TB kill claim, you were okay. You didn't have to change products, although some of the marketing pitches that we saw said that we did. And then bless their hearts, the EPA actually came out with a clarification that said that you could use a product that either had a tuberculosidal kill claim that could kill the less resistant microorganisms, or use one that had that specific emerging infectious diseases claim on it. So again, people experienced problems from switching from one product to another without cleaning off their surfaces and the chemistries mixed and caused odor and caused staining. So if you're going to switch disinfecting products, you should clean all your surfaces first with hot soapy water. I always recommend Dawn because Dawn kind of gets everything off of surfaces and then start using the new product so you don't get a mixing of the chemistries. So I don't know if we start seeing more issues with um avian flu if we're going to kind of go back to that sort of panic again, like we had with surface disinfectants. I hope not. But the other thing that I think a lot of people have just kind of maybe gotten um sort of immune to for lack of better description is the fact that they can just use any kind of product that they decide is the most economical and it causes the least kind of staining. So we have to go back to our benchmark of is it tuberculosidal? And then we should be okay.
SPEAKER_03Thank you, Mary. I think that was one of the biggest misconceptions during COVID because we we panicked because we, of course, we didn't know much about that disease. We were very worried about it, and we were spreading quickly. And so we were running to whichever newest thing we heard from any sales rep or any individual without coming back to the basics that we already knew in the very beginning. TB is the gold standard. If it kills TB, it's going to kill everything else. But I think there was that interim of time, Mary, that we didn't really realize that. So that's why they were running for all these new products until we learned more about that. Leslie, if I could call on you for just a second, could you talk to us about the EPA registration? You know, Mary mentioned that, you know, that off these different companies had to get their products approved to have that new infectious disease, you know, stamp of approval on it. Could you talk to us about what the EPA is all about? I think that's a lesser-known thing by a lot of our listeners.
SPEAKER_00Well, you know, Linda, EPA means environmental protection agency. And so we have an agency where we are able to go and get resources about the various different types of disinfectants that we use in a dental setting. The list that Mary was uh talking about was list N, where APA gave information to us if we would put in the EPA registration number into a table on the EPA website. They called it, you can just Google the word list N, EPA, and the list will come up. You could see if the disinfectant that you currently use actually does have um uh potency to kill coronaviruses. Now, again, COVID hit us kind of like, you know, upside the head, and we didn't have the manufacturers uh have the long-term studies demonstrating what their disinfectants would kill. But it was assumed that if you could kill the uh coronavirus that we were acquainted with first, which was SARS, severe acute respiratory syndrome, that coronavirus, that we could kill SARS-CoV-2. So, again, like Mary said, at the bottom of the food chain, but people wanted to know in dental offices, and our patients wanted to know too, if they were safe in our care. So LISTN was a very comforting place to be able to identify disinfectants that were effective. An interesting thing, when I would go through Liszt N looking at different disinfectants, I was uh kind of surprised to see that there was a different name of a product, although the EPA number was the same. So something that might be used in a dental office could be used in a veterinarian setting and have a completely different name and a completely different label. But if the EPA number was uh the same, that it was the same formulation. And then we also had something that came out uh as well called list Q, which is the emerging viral pathogen list. Uh, we looked to that list when we first started to see the increase in MPOX cases developing about four years ago. And uh, so that again has been a great one to keep in your back pocket when there's any kind of uh increase in the various different uh type of pathogens that we see uh circulating in a community, circulating in the country. And then there's also List B. List B is for tuberculosidal products, but I think in dentistry, we're pretty lucky because almost every disinfectant that we uh use that's tuberculosidal says it has a TB kill claim that's usually right of snap dab on the front of the label. So there's not much guesswork on that one. And then last year we had a brand new list come out called List S. And List S was the list that would help us identify the disinfectants that were effective against bloodborne pathogens, such as HIV, hepatitis B, and hepatitis C viruses. So that came out a little bit, oh gosh, it's almost exactly a year ago. It was released on February 26, 2024.
SPEAKER_03Thank you, Leslie. That's so informative. And I want to share one tip with our listeners, and that that's always intrigued me about the EPA and you know, the fact that they register these surface disinfectants, but they're registered as like a pet a pesticide. But the EPA considers these surface disinfectants as antimicrobial pesticides. So in order to be sure they meet the safety standards and protect the public health, and of course, in our case, protecting patient health as well as ourselves, it has to be registered by the EPA.
SPEAKER_01Mary, do you have another thought? I did, and Leslie did such a great job of identifying all the all the places where we might look for surface disinfectants, and many of the products we might use might be listed on several of those, but the the list that we really need to go by is list B. That's the tuberculosidal products. And if a product isn't listed there, then it most likely is not the most appropriate one or not the appropriate one to be used in dentistry because we make the assumption that there always will be some blood present after our procedures.
SPEAKER_03That's a good point, yes, Mary. So we could follow to follow to list B first, and then after that, look at the other list to be sure that the product just meets all those requirements. I'd like to call on our diva, Olivia, to talk about some tips you know for selecting a product because Olivia, I think a lot of times, especially with today's economy, offices might be just grabbing whatever's on sale and they end up with multiple products in their practice. And how do you think they should manage that? And what are some tips that you can share for selecting the proper surface disinfectant?
SPEAKER_02Well, I agree, Linda, that uh when choosing a product, they should not let the price point be the deciding factor. And instead, I would suggest that they talk to their sales rep and try to obtain some samples and test them as a group and consider multiple variables. Uh, for example, what is the active ingredient? Is it alcohol or peroxide or an iodophore, which is like an iodine? Will it stain the surfaces? Will it have this strong odor? Is it toxic to humans? Is it toxic to the environment? What is uh shelf life like? And what is the contact time? You know, how quickly are we having to turn these rooms over? So I think there's multiple aspects of a product that we should evaluate in order to come up with a product line that best suits the needs of the dental office, but yet it is still on the list, as Leslie and Mary discussed, as being an approved hospital-level disinfectant with the TB kill time and uh works well with our people, not causing undue allergy or upset or strong odors and not damage the uh surfaces. I remember Linda working with a client years ago that the disinfectant stained the countertops and they had to replace all the countertops for that reason. So it's not just a matter of scrolling down an online catalog and picking the cheapest thing we find, but it's all these other aspects. And then I always encourage people to demonstrate brand loyalty because once you've selected a product, you know, we now have that product in our safety data sheet collection, we have it listed on our chemical inventory, we've provided training so we understand how to use it, what kind of PPE to wear, how to dispose of it, and so forth. And when we keep shifting products just because that's what's on sale that week or that month, then we have to address all these other compliance issues. So I think it should be a team effort in selecting a product and choosing something that works best for their practice, Linda.
SPEAKER_03Olivia, those are some outstanding points. And I love your suggestion of getting some test samples. As Mary and Leslie said, cleaning up, cleaning the surface before you try a new product on it first is important, like with the dawn dish soap soap, a light soap and water rinse, and trying the product to make sure you like it, it's gonna meet your needs. And thinking about the toxicity in a product is your one of your other tips and looking at the safety data sheet. So when you're going to test a product, get the safety data sheet so you can take a look and see in section two what are the hazards with that product? What are the ingredients? And then section eight is going to have the PPE that you must wear. Because we all know how many times offices prefer not to wear those heavy utility gloves when they're required to under multiple statutes to be wearing those for safety. So I think one of the important messages, Olivia, about your section was really for our listeners to understand and ask the question why do we choose what we're currently using? What were the reasons that we chose it and why do we like it? So we can go deeper to that level. So thank you so much, Olivia. I wanted to draw attention to our listeners to using the spray versus wipes. As Mary discussed, even when it's the same product or same line brand, it's not always the same chemistry. And when we think about using a spray, let's be reminded of the fact that we have to be in full PPE. Make sure you have a mask on because now you're going to be inhaling whatever chemical is in the surface disinfectant product that you're using. So be cautious with that, whether you're using spray or wipe, know why you're using it, and be sure that you're using it properly. Divas, does anybody have any stories they'd like to share?
SPEAKER_01Mary? Linda, I'm glad that you addressed the issue of sprays and wipes. And I know a lot of practices, especially if they have team members that have been there for a long time, and we all come from the days of spray, wipe, spray, when we were told to spray a surface, wipe it to clean it, and then spray it again to disinfect. But the CDC guidelines since 2003 have said clean first, then disinfect. They don't say spray, wipe, spray anymore. And we do have some evidence through um NIOSH that has some association between spraying of cleaners and disinfectants and asthma. And so, especially if you have team members that do have asthma, you don't want to be spraying. You might only need to have a spray disinfectant if you need to disinfect maybe an impression or something that you're going to be sending out of the office to the lab or you're going to pour up an impression. Um, but for surfaces, wipes rule. But if you have a container with wipes, you need to keep the lid closed so that the alcohol or the solution doesn't evaporate. And if about every other day or so, you should make sure the lid's closed tightly and screwed on tightly and tip it upside down. Let the liquid that pools at the bottom resaturate the wipes. And if there is liquid left in the container when you use up all the wipes, discard it. You don't pour it into the new container because that product may not be at the appropriate strength after it's been exposed to air and so forth from taking it in and out of the taking wipes out of the container all the time.
SPEAKER_03Mary, that's those are perfect points. And I want to share briefly with our listeners. I know that you all can't see us, but when Mary made the point about keeping the lid closed and shaking the container, everybody nodded their head. So be sure that's one tip along with everything else that you're learning today and be reminded of that you take back. Leslie, you had some thoughts?
SPEAKER_00Well, you know, I oftentimes see individual practices uh still storing two by twos or four by fours in uh liquid disinfectant in containers. And uh some were even told by their dental dealers to do that during our supply chain shortage. Well, I want to remind everybody that the efficacy is diminished by the activity of the uh the disinfectant and the components of the gauze. So the manufacturers do not give instructions for us to use disinfectants that way, liquid disinfectants, and and uh we could, if we wanted to, saturate a gauze at the time of use. But you know, when you think about it, gauze is so expensive when it comes, Olivia and I both know this. We both have horses, and so when when our horses get injured, we've got to spend $18 on a package of gauze. So paper towels seem to do the trick pretty well. Another thing I noticed was that uh besides the lids being opened, which is something I ask every dental office, on Monday morning, go to your office and just walk through the treatment room and any place where you have disinfectants and count the number of lids that are open and remind everyone to keep them closed. But also remind everyone to look at the expiration dates of the disinfectants. Uh, if we've stocked up on disinfectants, some of us felt that we're not getting the supplies we needed when we needed them. So we hoarded disinfectants, and some of those disinfectant white containers ran beyond their expiration date. Another thing I often see is refilling a sprayer bottle with liquid disinfectant. The sprayer bottle seems to be indestructible, and so it's used over and over and over again until you can't read it anymore, which is a problem in and of itself. But of the ones that you can read, they have an expiration date that's two, three, four years ago. So we're not transferring that expiration date to that sprayer bottle that we're continually refilling. And just one other point and things I see frequently, um, sprayer bottles that are of one product, we need to make sure that we're putting the like product in it. Because uh just came across an office the other day, and uh they had an old bottle of another product as a green and white bottle, something that used to take 10 minutes to sit on surfaces. It was still that bottle, but they had had a different, completely different uh disinfectant in it, different surface contact time, different components, different uh recommendations for personal protective equipment. So it is a lot to consider when it comes to surface disinfectants. I'm so glad that we had this podcast today.
SPEAKER_03Leslie, I echo your sentiments, and I'm so glad that we have this topic today. So I hope, listeners, that you've taken back some tips and reminders and perhaps even consider listening to this as a podcast, you know, among your team, if not at a team meeting, maybe in small groups, so that way everybody can really, as the saying goes, be on the same page when it comes to pulling those pop-up wipes and cleaning and disinfecting your clinical contact surfaces. As a compliance divas, we bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. We invite you to subscribe to our podcast through your favorite podcast channel or on our website, thecompliancedivas.com. Resources that we mentioned today will definitely be found in the show notes so you can take those back and use those in your practice as well. We invite you to submit questions to support at thecompliancedevas.com. And don't forget to scroll down to the bottom and leave us a like, a review, or a comment. We look forward to seeing you next time.