Hard surfaces in the clinical and local decontamination unit (LDU) areas (e.g. work tops, equipment and containers) may become indirectly contaminated with blood, saliva, oral and other bacteria or viruses, before, during and after dental treatment episodes. Therefore, staff must reduce the risk this poses by thorough cleaning of these hard surfaces between patients.
The level of surface cleaning required should be decided after carrying out a risk assessment, taking into account the type of treatment carried out. For example more extensive cleaning will be required following an aerosol generating procedure than an examination. Routes of contamination to be considered at all times include:
- Airborne particles during and following use of rotary instruments (aerosol)
- Splatter during surgical procedures
- Droplets from coughs and sneezes
- Touching surfaces and objects with contaminated hands and gloves
Further information on the Standard Infection Control Precautions (SICPs), 'Safe Management of Care Equipment', 'Safe Management of the Care Environment' and 'Safe Management of Blood and Body Fluid Spillages', is available via NHS National Services Scotland’s National Infection Prevention and Control Manual.
Put together a written policy for cleaning the environment and ensure that staff are aware of this policy and related procedures (see Cleaning the care environment and care equipment policy and procedures template).
Keep all surfaces in the surgery as clear and clutter free as possible to give easy access for cleaning; keep as many items as possible in cupboards/drawers or covered.
Ensure cleaning products are compatible with surfaces to prevent damage.
Check all surfaces are intact and if they are not have them repaired as soon as possible.
Ensure areas are clearly zoned and defined as clean or dirty.
Clean all large surfaces, including clean and dirty zones, at the beginning and end of a session using warm water and general purpose neutral detergent.[2]
Risk assess the level of surface cleaning required between treatment episodes:
- Low risk procedures (e.g. examination only), where surfaces in the clinical area are not touched: clean surfaces using detergent wipes between patients.
- High risk procedures where aerosols are produced (e.g. restorations, surgical procedures), OR surfaces are touched (e.g. bracket table, light handles) or are used for putting contaminated instruments or equipment down during ANY procedure: clean surfaces using detergent wipes followed by disinfectant wipes between patients, or combination wipes if compatible. NHS NSS has further guidance on the choice of wipes [3].
- Blood spillage: gather all appropriate equipment; perform appropriate hand hygiene; cover cuts and grazes with waterproof dressing; wear appropriate PPE. Apply chlorine-releasing granules directly to the spill. Alternatively, contain the spillage with disposable paper towels; saturate the towels with disinfectant solution (with a concentration of 10,000ppm available chlorine) and leave in place as recommended in the manufacturers’ instructions, or for at least 3 minutes; dispose of towels as healthcare waste (orange waste stream). Clean the area with fresh disposable towels and a solution of water and general purpose neutral detergent; discard paper towels and disposable PPE as healthcare waste; and follow with appropriate hand hygiene.
Refer to the Safe Management of Blood and Body Fluids Spillages SICP for how to deal with other body fluid spillages (e.g. urine, vomit).
Have in place a schedule and instructions for the cleaning of non-clinical areas of the practice (e.g. the waiting room, patients’ toilets – see Cleaning Schedule and Records template).