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

2. 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

3. 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

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

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

6. rinse
spray
rinse

7. 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

8. 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

9. 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

10. 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

11. 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)

12. 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

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

15. Maintenance of Vacuum Systems

16. 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.

17. 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.

18. 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).

19. 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.

20. Example of a clogged suction trap in a busy hygiene practice

21. Disposable traps in the suction pump need to be replaced periodically

22. Do’s and don’ts
Bleach
Vaccusol