Germicide Use in Dentistry Raghunath Puttaiah, BDS, MPH Germicidal Hand soaps Antiseptics & Mouthwash Surface & Immersion Disinfectants Liquid Sterilants & High Level Disinfectants Waterline Cleaners/Disinfectants

Germicides used in Handwash Chrorhexidine Gluconate 0.12% to 4% Parachlorometaxylenol Iodine Surgical Scrub Soap Triclosan based soaps Alcohol based hand spray (instead of handwash) All of the above in liquid or foam Handcare lotions with or without germicides

Antiseptics and Mouthwash Alcohol swabs Iodine tinctures/paints Used for cleaning and decontaminating injectable and surgical fields CHG Mouthrinse Phenolic Mouthrinse Quaternary Mouthrinse Preprocedural Antimicrobial Mouthrinse to reduce microbial load/exposure

Classification of Surface Disinfectants Phenols & Quats can be WATER or ALCOHOL based

ENVIRONMENTAL SURFACE DISINFECTION What is required for the following two processes? Sterilization process Disinfection process Spray-Wipe-Spray PRECLEANING or removal of BIOBURDEN

rinse spray rinse

ENVIRONMENTAL SURFACE DISINFECTION Registration of GERMICIDES: Environmental Protection Agency (EPA) GERMICIDES marketed as DISINFECTANTS are regulated by EPA (INANIMATE SURFACES) Food & Drug Administration GERMICIDES marketed as ANTISEPTICS, High-Level Disinfectants and Sterilants are regulated by the FDA FORMULATION FORMULATION FORMULATION

ENVIRONMENTAL SURFACE DISINFECTION MISUSE of germicides: Using ANTISEPTICS as DISINFECTANTS may not be effective as a Germicide Using DISINFECTANTS as ANTISEPTICS may cause tissue IRRITATION and TOXICITY

ENVIRONMENTAL SURFACE DISINFECTION Intermediate Level (process 5-20 min) All Kill Vegetative Bacteria Tubercle Bacillus Fungi Lipid & Medium Sized viruses Some Kill Limited number of Spores Some Non-lipid & Small Viruses

ENVIRONMENTAL SURFACE DISINFECTION Hospital Disinfectant EPA registered Kills Pseudomonas aeruginosa Staphylococcus aureus Salmonella typhimurium In addition it needs to kill Tubercle Bacillus… .....for use in dentistry

ENVIRONMENTAL SURFACE DISINFECTION In dentistry the germicide has to be an intermediate level disinfectant (Kills TB) and a Hospital Disinfectant Examples: Chlorines, Iodophors Phenols PCMX Quaternary Ammonia Compounds (new generation)

ENVIRONMENTAL SURFACE DISINFECTION Hydrophilic Viruses: (difficult to kill) Rotavirus WA Rotavirus SA 11 Poliovirus Type 2 Lipophilic Viruses: (easier to kill) Herpes Simplex - 1 Herpes Simplex - 2 Influenza A2 Human Immunodeficiency Virus

ENVIRONMENTAL SURFACE DISINFECTION Cleaning Ability: Good Quats Phenolics PCMX Chlorines Iodophors Fair Phenol Spray (alcohol based) Poor Phenol Aerosols (alcohol based)

Maintenance of Vacuum Systems

Procedures for cleaning the vacuum system 1. Use full PPE (protective eyewear, mask, gown and utility gloves) while cleaning the suction system. Take care to avoid injury or exposure.

Procedures for cleaning the vacuum system 2. Dispose the suction tips and examine suction traps at the end of each day. Suction about 1 quart of the mixed evacuation system cleaner through the HVE and SE combined. Wait 10 minutes and suction about 1 quart of tap water. If traps are blocked, replace trap before cleaning system.

Procedures for cleaning the vacuum system 3. Blocked traps can reduce efficacy of the suction apparatus. Replace traps regularly if gross contamination is seen (weekly or monthly based on frequency of chair being used for patient care).

Procedures for cleaning the vacuum system 4. Most manufacturers make inexpensive disposable suction traps. Clean suction traps help in better suctioning of the saliva and debris and prolong the live of the suction pump.

Example of a clogged suction trap in a busy hygiene practice

Disposable traps in the suction pump need to be replaced periodically

Do’s and don’ts Bleach Vaccusol