Some hints on effective surface cleaning Dental Clinic

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© Copyright Quality Medical Innovations P/L & Majac Medical Products P/L

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CLEANING FOR INFECTION CONTROL Surface Cleaning

Some hints on effective surface cleaning

Dental Clinic

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Various professional bodies produce guidelines for cleaning and infection control.

Some details of these different guidelines contradict each other.

So which do you follow?

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Recommendations for Clinical Detergents For Cleaning Surfaces

•  Australian Standards AS/NZS 4187 & AS/NZS 4815 •  Mildly Alkaline Detergents used for Manual Cleaning of Instruments are suitable for

Environment Cleaning.

•  NHMRC Guidelines •  TGA Listed Detergent Suitable for the particular surface and soil type. •  Pre-Wet Wipes NOT Recommended for General Cleaning (only Spot Cleaning)

•  The Australia Dental Association (ADA) Guidelines •  Neutral Detergent for Cleaning Surfaces (Pre-Wet Wipes OK)

•  The New Zealand Dental Association (NZDA) Guidelines

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Some hints on effective surface cleaning

•  To clean a surface properly you should wet the surface with a clinical detergent then dry the surface with an absorbent, low lint, disposable wipe .

•  Pre-wet detergent / disinfectant wipes may be considered as an alternative method of detergent application for lightly soiled areas but not a complete cleaning system for contaminated Areas.

•  Caution – some pre-wet wipes may not wet the surface adequately for good cleaning.

•  A pre-wet wipe does not remove the need to dry the surface after application of the detergent.

•  Always clean with a Clinical Detergent then wipe the surface dry.

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Extensive Testing carried out by Du Pont on the “Wet Particle Removal Ability”

Published in their Technical Information states:

WIPE DRY = WIPE CLEAN

So what about Pre-Wet Wipes ?

“….wipers made from fabrics that have an exceptional ability to ‘wipe the surface dry’ leave the surface cleaner than those which do not, since the residual contamination resulting from a spill always lies suspended in the liquid phase left behind on the wiped surface.”

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PRE-WET WIPES

Are NOT designed to DRY the surface

•  Wet Detergent Wipes Transfer some liquid to the surface where it dilutes the Contaminating Bio-soil.

However: •  A diluted film of liquid containing bio-soil, micro-organisms & chemical residue will be

left on the surface if it is not wiped clean & dry.

After Washing a Surface Always Take extra Care to Dry the surface with an

Absorbent, “Low Lint”, Disposable Cloth.

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Pre-wet Detergent Wipes should be viewed as an applicator for detergent onto the surface and not a

complete cleaning process.

Nearly all Wet-Wipes are made of materials that do not hold sufficient liquid cleaning agents to

adequately wet the surface.

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Dental Chairs and other surfaces should be cleaned by wetting the surface with a Clinical Detergent and then wiped dry with an absorbent. “low lint”, disposable towel.

If the surface cannot be rinsed, then take care to drying the surface, pay particular attention to joints and crevices where bio-soil and detergent residues can build up.

Picture courtesy Planmeca/HSH

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These fundamental principles of cleaning & drying the surface are illustrated in the attached animated video. Refer: Learning Centre Video 2 “Surface Cleaning”

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DETERGENT APPLICATORS

•  It is recommended that “non-misting” applicators be used to avoid nebulised, air borne particles being inhaled.

•  This is why some persons recommend spraying (wetting) onto a cloth and then wiping the surface.

–  This method of application should be viewed as “being the same as creating a pre-wet detergent wipe”. If this procedure is followed, then ensure adequate cleaning solution is applied to completely wet the surface.

•  Remember you should wet the surface with a clinical detergent then remove the bio-soil by wiping clean & dry.

•  This will solubilize and lift the bio-burden plus the micro-organisms, so they can be soaked up and removed with a clean, dry cloth.

Leaving a clean, dry surface.

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The “non-misting” applicator has a “foam” mode adjustment that increases the size of the airborne solution to in excess of 5 micron particle size.

These particles are unlikely to traverse the airway.

Note:Clinidet, Plastex, Vibactum, RediClean and Clinicol have “non-misting” applicators

Spray Applicator “Misting” adjustment in tip

Not Recommended

The “Misting” applicator will nebulise the solution to under 5 micron particle size. This may

then traverse the airway into the lungs.

Special Applicator “Non-misting” Type - Foam type

Recommended

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Dilution Rates Contact Time Instructions

Safety

Warning against Mixing products

Contact Details

WORKSAFE REQUIREMENTS FOR OFFICE DISPENSER

Label impervious to chemical contents

Non-Misting Applicator Vibactum® Hospital Grade

Disinfectant

500 ml Dispenser

DIRECTIONS FOR USE:For clean & lightly soiled surfaces:To disinfect apply Vibactum® to the surface until wet, leave for 5 minutes then wipe clean & dry with a suitable lint free cloth.

For Heavily Soiled Surfaces: Clean the surface first by wetting thoroughly using Vibactum® or a clinical detergent (eg Clinidet®) then wipe clean using a suitable lint free cloth. After cleaning, disinfect as for clean & lightly soiled surfaces.

Storage: Store out of direct sunlight in a cool place.

Vibactum® & Clinidet® are Registered Trade Marks used under licence.Vibactum® & Clinidet® are products of Quality Medical Innovations Pty. Ltd. P.O. Box 5162, Port Macquarie, NSW, 2444

Safety & First Aid: Not to be taken. Keep out of reach of children. If swallowed consult a doctor. Wash eyes or skin with cold water if contact is made. If irritation persists, contact a doctor.

* Not intended to be used on therapeutic devices.* Do not mix with detergents or other chemicals.* Use undiluted TG

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For Rapid & Effective Disinfection & Cleaning Disinfectant/Cleaner

Apply Vibactum® for easy cleaning & disinfection of surfaces.

QMIQUALITY MEDICAL INNOVATIONS

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PLASTEX Plastex is a Clinical Surface Cleaner.

Plastex is specially formulated to be compatible with sensitive plastics.

Plastex is ideal for: •  All Surfaces •  Curing Lights, Dental Chairs & Equipment •  Connectors, Lines & Tubes •  Respiratory apparatus, Masks & Nebulizers.

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•  TGA Listed (passes TGA disinfectant test option B) •  No volatile solvents or fragrances (VOC’s) •  Non flammable •  No toxic phenolics, chlorine or glutaraldehyde •  Formulated for use in healthcare facilities

•  Highly recommended for use in Hospitals, Clinics, Medical, Dental, Podiatry, etc.

Vibactum Formulated to Clean & Disinfect in One Step (2 in 1)

Clinical Detergent/Hospital Grade Disinfectant

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MediClean Low Lint All-Purpose Towel

•  Very Low Lint •  Soft •  Highly absorbent •  High Wet Strength

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A Brief Word On

Disinfectants

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• Are agents for inactivation of non-sporing micro-organisms.

• Are not designed for cleaning - unless specifically formulated for this purpose.

Disinfectants

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The efficacy of a disinfectant depends on a number of factors: Kill Time: Varies dramatically depending on;

1.  concentration of disinfectant

2.  type of organism and level of contamination.

3.  type of active ingredient:

QUATs typically require from 5-20 minutes (depending on formulation) Alcohol and chlorine <5 minutes (typically 1-2 min for bacteria)

Disinfectants

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QUATS (Quaternary Ammonium Compounds)

• Narrow range of activity, effective against gram-positive bacteria, and less active against gram-negative bacteria, fungi and viruses. • Inactivated by soils, soap, anionic detergents.

Chlorine (eg Hypochlorite solutions)

• Wide spectrum of activity (kills most organisms) • Concentration sensitive (If concentration is too low then disinfection is not effective). • Inactivated by proteins, Is corrosive to metals, irritates skin, bleach and damage some materials.

Alcohol (Ethanol, Isopropanol)

• Wide spectrum of activity with Rapid kill rate. • Generally safe on hard surfaces, not corrosive. Flammable

Disinfectants - Ingredients.

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When using disinfectants ensure that you:

Know the recommended contact time

Clean the surface first (to avoid inactivation) if the surface is heavily contaminated

Disinfectants

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Read the required contact time on the label !!

Be cautious of the claims on some imported disinfectants:

A recent case in point:

1. CLAIM – “Kills 99.999% of germs. Effective from 10seconds.

2. When you look at the data sheets for this product you find that only one organism is killed in 10 seconds, for all other organisms kill times range from 1 to 5 minutes.

See following slide

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Bacteria Test Kill Time Bacteria Test Kill Time

Acinetobacter baumanii EN1276 5 min Methicillin Resistant Staphyloccus aureus (MRSA) Suspension

Test 10 sec Campylobacter jejuni EN1276 5 min Mycobacterium smegmaDs EN1276

(modified) 5 min Enterococcus hirae EN1276 1 min Pseudomonas aeruginosa EN1276 1 min Enterococcus hirae EN14561 1 min Pseudomonas aeruginosa EN14561 1 min Escherichia coli (E. coli) EN1276 1 min Salmonella typhimurium EN1276 5 min Klebsiella pneumoniae EN1276 5 min Vancomycin Resistant

Enterococcus faecalis (VRE) EN1276 5 min Listeria monocytogenes EN1276 5 min Vibrio cholerae EN1276 5 min Methicillin Resistant Staphyloccus aureus (MRSA) EN1276 1 min

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Virus Test Kill Time

Fungus Test Kill Time

Norovirus EN14476 2 min Aspergillus brasillensis EN1275 15 min HepaDDs B An<gen

Inac<va<on Test 5 min Candida albicans EN1275 5 min

HepaDDs C An<gen Inac<va<on Test 5 min

Influenza H5N1 Suspension Test 30 sec

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•  For surface disinfectants produced in Australia the product must pass the Therapeutics Goods Administration (TGA) requirements set out in the document “TGO 54”.

•  The requirements are stringent and must pass both a “suspension test” and a “surface carrier test” using several model bacteria.

•  The minimum kill time that can be quoted is the time to kill the hardest organism. (not the easiest)

The “take home message”:

• Be cautious of opportunistic “sales jargon”.

• Obtain the facts.

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Other claims made for this wet-wipe disinfectant product are:

CLAIM COMMENT

Lift soil without leaving residue Wet wipes deposit liquid onto the surface and do not dry it therefor they must leave a residue.

Low foaming surfactants eliminates the need for a drying cloth.

Because there is no foaming it may appear that the surface has little residue. However the surface will still be wet and will require drying to remove detergent and soil residues.

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A recurring theme in surface cleaning is “Dry the Surface after wetting”.

The reason for this is two fold: 1.  To remove soil residue suspended in the liquid on the surface 2.  To remove detergent residues.

The removal of disinfectant or detergent residues is particularly critical on sensitive plastic equipment because of the potential for Environmental Stress Cracking (ESC)

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What causes cracking of plastics ?

•  Environmental stress cracking (ESC) of plastics is a common and inevitable process that all hard plastics will undergo.

•  ESC occurs particularly in hard brittle plastics at points where the plastic is under stress or load. (eg. Hinges, screw or rivet holes or where a load or stress is regularly applied)

•  ESC occurs naturally with plastics over time, however, different plastics vary dramatically in their susceptibility to ESC. The majority of plastics used in the construction of quality devices are very resistant to ESC.

•  ESC can be accelerated by different stressing agents which include air (through oxidation of the polymer), light (UV is very damaging), physical pressure & heat (it is important to allow plastics to cool before cleaning)

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•  Chemical agents can also accelerate ESC, but again different plastics vary dramatically in their susceptibility to these agents.

•  Some surfactants can contribute to ESC. However there are hundreds of different surfactants with different properties to suite specific applications.

•  As would be expected, surfactants range in their ability to promote ESC from very aggressive to almost no effect.

This generalisation must be taken in light of variable plastic susceptibility as described above. Plastex has been formulated using surfactants & sequestering agents that show minimal interaction with sensitive plastics.

Take Home Message: After applying any cleaning solution wipe the surface dry taking particular attention to joints and crevices where liquid can collect.

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A case in point is a recent alert put out in the United Kingdom regarding the possible damage to plastic and sensitive equipment being caused by pre-wet wipes. MHRA – Medical Device Alert Ref: MDA 2013/019 27 March 2013 Detergent and Disinfectant wipes used on reusable medical devices with plastic surfaces. All Manufacturers

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Pre-Wet Disinfectant Wipes

The Clinical Research Associates (CRA) carried out a series of tests on commercial disinfectants. There conclusions for Pre-wet disinfectants were:

Advantages of Pre-Wet Wipes: 1. Convenience

Disadvantages of Pre-Wet Wipes: 1.  Limited germicidal activity 2.  Poor release of disinfectant to surfaces 3.  Highly variable performance 4. Evaporation & loss of disinfectant

over time. (Individual packaging did not improve antimicrobial performance.)

A major problem with pre-wet wipes is achieving intimate contact of the disinfectant with the microorganisms.

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• Formulated for rapid surface disinfection. • Non-corrosive - No alkali, chlorine or salts. • Wide germicidal activity • Contains cleaning agent to disperse & remove light soils. • Safe & effective with mist free applicator.

CLINICOL Surface Spray Disinfectant - Hospital Grade

The Ideal Disinfectant Rapid - Clean - Effective

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•  TGA Listed (passes TGA disinfectant test option B) •  No volatile solvents or fragrances (VOC’s) •  Non flammable •  No toxic phenolics, chlorine or glutaraldehyde •  Formulated for use in healthcare facilities

•  Highly recommended for use in Hospitals, Clinics, Medical, Dental, Podiatry, etc.

Vibactum Formulated to Clean & Disinfect in One Step (2 in 1) Clinical Detergent/Hospital Grade Disinfectant

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pH Confusion

•  Over the past few years many practice staff have become unnecessarily concerned about the pH of cleaning products.

•  Mildly alkaline cleaning products are neither dangerous to the operator or materials.

•  The following examples will help to put pH into perspective.

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The pH Scale

A mildly High or Low pH of a solution does not make it inherently harmful.

•  Note the pH of soft drinks, tomato juice & vinegar.

•  Note the pH range of cleaning agents.

• Most cleaning agents used in Medical & Healthcare contain mild alkaline / acidic agents.

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pH in the World of Cleaning - Every-Day Domestic Cleaners

pH = 10.5 pH = 9 pH = 9 pH = 11

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pH = 11 (1:100) pH = 10.6

pH in the World of Cleaning - Common Chlorine Disinfectants

Note: Milton is used to soak both plastic & soft rubber

pH = 11 pH = 9.2 (1:100)

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WIPE DRY = WIPE CLEAN

This removes bio-soils and the cleaning chemicals from the surface leaving it clean and dry.

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We hope this presentation is of benefit to your clinic, the staff and the patients

Majac Medical Products

Supports Continuing Education

“Let’s get it right”

Date post:	13-May-2022
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Some hints on effective surface cleaning Dental Clinic

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