principles and techniques of disinfection chapter 20 copyright © 2009, 2006 by saunders, an imprint...

Principles and Techniques Principles and Techniques of Disinfectionof Disinfection

Chapter 20Chapter 20

Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.


Lesson 20.1Lesson 20.1


Learning Objectives Learning Objectives

Pronounce, define, and spell the Key Terms.Pronounce, define, and spell the Key Terms. Explain why surfaces in dental treatment Explain why surfaces in dental treatment

rooms need barriers or disinfection.rooms need barriers or disinfection. Describe the guidelines of the Centers for Describe the guidelines of the Centers for

Disease Control and Prevention for the Disease Control and Prevention for the disinfection of clinical contact surfaces.disinfection of clinical contact surfaces.

Describe the two methods used to deal with Describe the two methods used to deal with surface contamination.surface contamination.

(Cont’d)(Cont’d)




List the types of surfaces in the dental office List the types of surfaces in the dental office that are typically covered with barriers.that are typically covered with barriers.

Explain the difference between disinfection Explain the difference between disinfection and sterilization.and sterilization.

Explain the difference between a disinfectant Explain the difference between a disinfectant and an antiseptic. and an antiseptic.


Introduction Introduction

During patient treatment, surfaces in equipment and During patient treatment, surfaces in equipment and treatment rooms are likely to become contaminated with saliva treatment rooms are likely to become contaminated with saliva

or by aerosol containing blood, saliva, or both. or by aerosol containing blood, saliva, or both.

Laboratory studies have shown that microorganisms may Laboratory studies have shown that microorganisms may survive on environmental survive on environmental

surfaces for varying periods. surfaces for varying periods.

Assume that if a surface has had contact with saliva, blood, or Assume that if a surface has had contact with saliva, blood, or other potentially infectious materials, other potentially infectious materials,

it contains live microorganisms.it contains live microorganisms.


Environmental Infection ControlEnvironmental Infection Control

The Centers for Disease Control and The Centers for Disease Control and Prevention (CDC) Guidelines for Infection Prevention (CDC) Guidelines for Infection Control in Dental Health-Care Settings 2003 Control in Dental Health-Care Settings 2003 divide environmental surfaces into clinical-divide environmental surfaces into clinical-contact surfaces and housekeeping surfaces. contact surfaces and housekeeping surfaces.

Housekeeping surfaces include floors, walls, Housekeeping surfaces include floors, walls, and sinks. Because they have a much lower and sinks. Because they have a much lower risk of disease transmission, cleaning and risk of disease transmission, cleaning and decontamination is not as rigorous as that for decontamination is not as rigorous as that for clinical areas and patient-treatment items.clinical areas and patient-treatment items.


Things to Consider When Cleaning and Things to Consider When Cleaning and Disinfecting Patient-Treatment Areas Disinfecting Patient-Treatment Areas Amount of direct patient contactAmount of direct patient contact Type and frequency of hand contactType and frequency of hand contact Potential amount of contamination by aerosol Potential amount of contamination by aerosol

and sprayand spray Other sources of microorganisms Other sources of microorganisms

(e.g., dust, soil, and water)(e.g., dust, soil, and water)


Clinical-Contact SurfacesClinical-Contact Surfaces

Clinical-contact surfaces can be directly Clinical-contact surfaces can be directly contaminated either by spray or spatter generated contaminated either by spray or spatter generated during dental procedures or by contact with the during dental procedures or by contact with the dental professional’s gloved hands. dental professional’s gloved hands.

Current infection-control guidelines of the Office Current infection-control guidelines of the Office Safety and Asepsis Procedures Research Foundation Safety and Asepsis Procedures Research Foundation (OSAP) recommend that clinical surfaces be (OSAP) recommend that clinical surfaces be classified and maintained under three categories:classified and maintained under three categories: Touch Touch TransferTransfer Splash, spatter, and dropletSplash, spatter, and droplet


Types of Clinical Contact SurfacesTypes of Clinical Contact Surfaces

Touch surfaces are directly touched and contaminated Touch surfaces are directly touched and contaminated during treatment procedures. They include the handles of during treatment procedures. They include the handles of dental lights, the controls of dental units, chair switches, dental lights, the controls of dental units, chair switches, chairside computers, pens, telephones, containers of chairside computers, pens, telephones, containers of dental materials, and drawer handles.dental materials, and drawer handles.

Transfer surfaces are not directly touched but often are Transfer surfaces are not directly touched but often are touched with contaminated instruments. Transfer surfaces touched with contaminated instruments. Transfer surfaces include instrument trays and handpiece holders.include instrument trays and handpiece holders.

Splash, spatter, and droplet surfaces do not actually come Splash, spatter, and droplet surfaces do not actually come into contact with the members of the dental team or the into contact with the members of the dental team or the contaminated instruments or supplies. Countertops are a contaminated instruments or supplies. Countertops are a major example.major example.


Fig. 20-1 A, Touch surfaces. B, Transfer surfaces. Fig. 20-1 A, Touch surfaces. B, Transfer surfaces. C, Splash, spatter, and droplet surfaces.C, Splash, spatter, and droplet surfaces.


Managing Surface ContaminationManaging Surface Contamination

There are two methods of dealing with There are two methods of dealing with surface contamination:surface contamination: BarriersBarriers Precleaning and disinfecting surfaces between Precleaning and disinfecting surfaces between

patientspatients


Types of Surface BarriersTypes of Surface Barriers

A wide variety of surface barriers are available on the A wide variety of surface barriers are available on the market today. market today.

All should be resistant to fluids to keep microorganisms in All should be resistant to fluids to keep microorganisms in saliva, blood, or other liquids from soaking through to the saliva, blood, or other liquids from soaking through to the surface underneath. surface underneath.

Some plastic bags are designed in the shape of items such Some plastic bags are designed in the shape of items such as the dental chair, air-water syringe, hoses, pens, and as the dental chair, air-water syringe, hoses, pens, and light handles.light handles.

Plastic-barrier tape is frequently used to protect smooth Plastic-barrier tape is frequently used to protect smooth surfaces such as touch pads on equipment, electrical surfaces such as touch pads on equipment, electrical switches on chairs, and x-ray equipment. Aluminum foil can switches on chairs, and x-ray equipment. Aluminum foil can also be used because it is easily formed around any shape.also be used because it is easily formed around any shape.


Fig. 20-3 An example of water on a fluid-resistant material.Fig. 20-3 An example of water on a fluid-resistant material.(Courtesy of Crosstex.)(Courtesy of Crosstex.)


Fig. 20-4 Surfaces touched during patient care should be covered with Fig. 20-4 Surfaces touched during patient care should be covered with protective barriers. If not protected, they must be cleaned protective barriers. If not protected, they must be cleaned

and disinfected at the end of the procedure.and disinfected at the end of the procedure.


Fig. 20-5 Rolls of plastic tubing can be cut to the desired length. Fig. 20-5 Rolls of plastic tubing can be cut to the desired length. (Courtesy of Certol.)(Courtesy of Certol.)


Fig. 20-6 Tube socks provide barrier protection Fig. 20-6 Tube socks provide barrier protection for difficult-to-clean areas. for difficult-to-clean areas.

(Courtesy of Certol.)(Courtesy of Certol.)


If a surface cannot be easily If a surface cannot be easily

and thoroughly cleaned and disinfected, and thoroughly cleaned and disinfected,

it should have barrier protection.it should have barrier protection.

RememberRemember


CDC GuidelinesCDC Guidelines

If barriers are not used, surfaces should be If barriers are not used, surfaces should be cleaned and disinfected between patients with cleaned and disinfected between patients with the use of an EPA-registered hospital the use of an EPA-registered hospital disinfectant that is claimed to eradicate HIV and disinfectant that is claimed to eradicate HIV and HBV.HBV.

Use PPE, as appropriate, when cleaning and Use PPE, as appropriate, when cleaning and disinfecting environmental surfaces. disinfecting environmental surfaces.

Such equipment might include: Such equipment might include: Gloves (e.g., puncture- and chemical-resistant utility)Gloves (e.g., puncture- and chemical-resistant utility) Protective clothing Protective clothing Protective eyewear/face shield and maskProtective eyewear/face shield and mask


Precleaning and DisinfectionPrecleaning and Disinfection

Precleaning means to clean before disinfecting.Precleaning means to clean before disinfecting. All contaminated surfaces must be precleaned All contaminated surfaces must be precleaned

before they can be disinfected. before they can be disinfected. Even if there is no visible blood on a surface, it Even if there is no visible blood on a surface, it

must be precleaned because even a thin layer of must be precleaned because even a thin layer of saliva on the surface can decrease the saliva on the surface can decrease the effectiveness of the disinfectant. effectiveness of the disinfectant.

Precleaning reduces the number of microbes and Precleaning reduces the number of microbes and removes blood and saliva (also called removes blood and saliva (also called bioburden). bioburden).



Precleaning and DisinfectionPrecleaning and Disinfection


These techniques are most effective when used on These techniques are most effective when used on contaminated surfaces that are smooth and easily contaminated surfaces that are smooth and easily accessible for cleaning.accessible for cleaning.

Always wear utility gloves, mask, protective eyewear, and Always wear utility gloves, mask, protective eyewear, and protective clothing when precleaning and disinfecting.protective clothing when precleaning and disinfecting.

Surfaces that are irregular or textured are difficult or Surfaces that are irregular or textured are difficult or impossible to clean, thereby making them difficult to impossible to clean, thereby making them difficult to disinfect as well. disinfect as well.

Regular soap and water may be used for precleaning, but Regular soap and water may be used for precleaning, but it is more efficient if you select a disinfectant that can be it is more efficient if you select a disinfectant that can be used to clean as well as to disinfect. used to clean as well as to disinfect.


The assistant shown here places clean wrap barriers on the The assistant shown here places clean wrap barriers on the handles of the operating light (Figure from Procedure 20-1).handles of the operating light (Figure from Procedure 20-1).


DisinfectionDisinfection

Disinfection is intended to kill disease-Disinfection is intended to kill disease-producing microorganisms that remain on the producing microorganisms that remain on the surface after precleaning.surface after precleaning.

Spores are not killed during disinfecting Spores are not killed during disinfecting procedures.procedures.

Do not confuse disinfection with sterilization. Do not confuse disinfection with sterilization. Sterilization is a process in which all forms of Sterilization is a process in which all forms of

life are destroyed.life are destroyed.


Disinfectants Versus AntisepticsDisinfectants Versus Antiseptics

Disinfectants are chemicals that are applied Disinfectants are chemicals that are applied to inanimate surfaces (e.g., countertops and to inanimate surfaces (e.g., countertops and dental equipment).dental equipment).

Antiseptics are antimicrobial agents that are Antiseptics are antimicrobial agents that are applied to living tissue. applied to living tissue.

Disinfectants and antiseptics should never be Disinfectants and antiseptics should never be used interchangeably because tissue toxicity used interchangeably because tissue toxicity and damage to equipment can result.and damage to equipment can result.



Lesson 20.2Lesson 20.2



Name the government agency that is Name the government agency that is responsible for registering disinfectants.responsible for registering disinfectants.

Demonstrate the process of precleaning Demonstrate the process of precleaning contaminated dental instruments.contaminated dental instruments.

Explain the precautions for the use of Explain the precautions for the use of chemical sterilants/disinfectants.chemical sterilants/disinfectants.





Identify chemical products used for Identify chemical products used for intermediate and low-level surface intermediate and low-level surface disinfection and explain the advantages and disinfection and explain the advantages and disadvantages of each.disadvantages of each.

Demonstrate the process of cleaning and Demonstrate the process of cleaning and disinfecting a treatment room.disinfecting a treatment room.

Describe the CDC guidelines for disinfecting Describe the CDC guidelines for disinfecting housekeeping surfaces.housekeeping surfaces.


DisinfectantsDisinfectants

Disinfectants are chemicals that destroy or inactivate Disinfectants are chemicals that destroy or inactivate most species of pathogenic (disease-causing) most species of pathogenic (disease-causing) microorganisms. microorganisms.

In dentistry, only those products that are EPA-In dentistry, only those products that are EPA-registered hospital disinfectants with tuberculocidal registered hospital disinfectants with tuberculocidal (kills the tuberculosis bacteria) claims should be used (kills the tuberculosis bacteria) claims should be used to disinfect dental treatment areas. to disinfect dental treatment areas.

Mycobacterium tuberculosis is highly resistant to Mycobacterium tuberculosis is highly resistant to disinfectants, and if a disinfectant will inactivate M. disinfectants, and if a disinfectant will inactivate M. tuberculosis it will most certainly inactivate the less tuberculosis it will most certainly inactivate the less resistant microbial families (e.g., bacteria, viruses, and resistant microbial families (e.g., bacteria, viruses, and most fungi) on the treated surface.most fungi) on the treated surface.


The Perfect Disinfectant?The Perfect Disinfectant?

If there were an ideal surface disinfectant, it would rapidly kill a If there were an ideal surface disinfectant, it would rapidly kill a broad spectrum of bacteria, have residual activity and minimal broad spectrum of bacteria, have residual activity and minimal toxicity, and would not damage the surfaces to be treated. In toxicity, and would not damage the surfaces to be treated. In addition, it would be odorless and inexpensive, would work on addition, it would be odorless and inexpensive, would work on surfaces with remaining bioburden, and would be simple to use.surfaces with remaining bioburden, and would be simple to use.

Unfortunately, no single disinfectant product on the market Unfortunately, no single disinfectant product on the market today meets all these criteria. today meets all these criteria.

When selecting a surface disinfectant, you must carefully When selecting a surface disinfectant, you must carefully consider the advantages and disadvantages of various consider the advantages and disadvantages of various products.products.

Often the manufacturers of dental equipment will recommend Often the manufacturers of dental equipment will recommend the type of surface disinfectant that is most appropriate for their the type of surface disinfectant that is most appropriate for their dental chairs and units. dental chairs and units.


Table 20-3 EPA-Registered Surface Disinfectants for DentistryTable 20-3 EPA-Registered Surface Disinfectants for Dentistry


Types of Chemical Surface Types of Chemical Surface DisinfectantsDisinfectants

Iodophors are EPA-registered intermediate-level Iodophors are EPA-registered intermediate-level hospital disinfectants with tuberculocidal action. hospital disinfectants with tuberculocidal action. Because iodophors contain iodine, they may corrode or Because iodophors contain iodine, they may corrode or

discolor certain metals and may temporarily cause reddish discolor certain metals and may temporarily cause reddish or yellow stains on clothing and other surfaces.or yellow stains on clothing and other surfaces.

Synthetic phenol compounds are EPA-registered Synthetic phenol compounds are EPA-registered intermediate-level hospital disinfectants with intermediate-level hospital disinfectants with broad-spectrum disinfecting action. broad-spectrum disinfecting action. Phenols can be used on metal, glass, rubber, or plastic. Phenols can be used on metal, glass, rubber, or plastic.

They may also be used as a holding solution for instruments; They may also be used as a holding solution for instruments; however, phenols leave a residual film on treated surfaces. however, phenols leave a residual film on treated surfaces. Synthetic phenol compound is prepared daily.Synthetic phenol compound is prepared daily.



Fig. 20-9 Iodophor surface disinfectant. Fig. 20-9 Iodophor surface disinfectant. (Courtesy Certol.)(Courtesy Certol.)


Fig. 20-10 Synthetic phenol surface disinfectant. Fig. 20-10 Synthetic phenol surface disinfectant. (Courtesy Certol.)(Courtesy Certol.)


Types of Chemical Surface Types of Chemical Surface DisinfectantsDisinfectants


Sodium hypochlorite (household bleach) is a fast-acting, Sodium hypochlorite (household bleach) is a fast-acting, economical, and broad-spectrum intermediate-level economical, and broad-spectrum intermediate-level disinfectant (1:100 dilution for surface decontamination).disinfectant (1:100 dilution for surface decontamination). Bleach solution is unstable, must be prepared daily, has a strong Bleach solution is unstable, must be prepared daily, has a strong

odor, and is corrosive to some metals, destructive to fabrics, and odor, and is corrosive to some metals, destructive to fabrics, and irritating to the eyes and skin; it may eventually cause plastic chair irritating to the eyes and skin; it may eventually cause plastic chair covers to crack.covers to crack.

Alcohols are not effective in the presence of blood and Alcohols are not effective in the presence of blood and saliva. They evaporate quickly and are damaging to saliva. They evaporate quickly and are damaging to certain materials such as plastics and vinyl.certain materials such as plastics and vinyl. The American Dental Association (ADA), CDC, and the Office of The American Dental Association (ADA), CDC, and the Office of

Safety and Asepsis Procedures Research Foundation (OSAP) do Safety and Asepsis Procedures Research Foundation (OSAP) do not recommend alcohol as an environmental surface disinfectant.not recommend alcohol as an environmental surface disinfectant.


Fig. 20-11 Sodium hypochloriteFig. 20-11 Sodium hypochlorite (household bleach) is a disinfectant but is (household bleach) is a disinfectant but is not EPA-registered and should not be used in dentistry as a not EPA-registered and should not be used in dentistry as a

surface disinfectant.surface disinfectant.


Immersion DisinfectantsImmersion Disinfectants

Some chemicals on the market can be used for sterilization or high-Some chemicals on the market can be used for sterilization or high-level disinfection.level disinfection.

When used as sterilants, they destroy all microbial life, including When used as sterilants, they destroy all microbial life, including bacterial endospores. Depending on the type, time for sterilization bacterial endospores. Depending on the type, time for sterilization can range from 6 hours to 30 hours. can range from 6 hours to 30 hours.

At weaker dilutions or with shorter contact time, these chemicals At weaker dilutions or with shorter contact time, these chemicals provide high-level disinfection, which inactivates all microorganisms provide high-level disinfection, which inactivates all microorganisms except endospores. except endospores.

Most of these chemicals are toxic and can irritate the eyes, skin, and Most of these chemicals are toxic and can irritate the eyes, skin, and lungs. PPE must always be worn when these chemicals are used.lungs. PPE must always be worn when these chemicals are used.

They are to be used for immersion (soaking) of heat-sensitive They are to be used for immersion (soaking) of heat-sensitive instruments and should never be used as surface disinfectants.instruments and should never be used as surface disinfectants.

Always keep the lids of containers closed to minimize the fumes. Always keep the lids of containers closed to minimize the fumes. (Cont’d)(Cont’d)


Immersion Disinfectants Immersion Disinfectants


Chlorine dioxide is an effective, rapid-acting Chlorine dioxide is an effective, rapid-acting environmental surface disinfectant (3 environmental surface disinfectant (3 minutes) or chemical sterilant (6 hours). minutes) or chemical sterilant (6 hours).

Chlorine dioxide does not readily penetrate Chlorine dioxide does not readily penetrate organic debris and must be used with a organic debris and must be used with a separate cleaner. separate cleaner.

Chlorine dioxide must be prepared fresh Chlorine dioxide must be prepared fresh daily, it must be used with good ventilation, daily, it must be used with good ventilation, and it is corrosive to aluminum containers.and it is corrosive to aluminum containers.


Fig. 20-12 Covered instrument tray for use with immersion disinfectants.Fig. 20-12 Covered instrument tray for use with immersion disinfectants. (Courtesy of Certol.)(Courtesy of Certol.)


GlutaraldehydeGlutaraldehyde

Glutaraldehyde is classified as a high-level Glutaraldehyde is classified as a high-level disinfectant/sterilant. It can also be used as a liquid disinfectant/sterilant. It can also be used as a liquid sterilant when immersion time is greatly increased.sterilant when immersion time is greatly increased.

Glutaraldehyde products are useful for plastics and other Glutaraldehyde products are useful for plastics and other items that cannot withstand heat sterilization.items that cannot withstand heat sterilization.

Glutaraldehyde is very toxic and should be handled Glutaraldehyde is very toxic and should be handled carefully to avoid the fumes.carefully to avoid the fumes.

Glutaraldehyde-treated instruments should never be used Glutaraldehyde-treated instruments should never be used on patients without first being thoroughly rinsed with water. on patients without first being thoroughly rinsed with water.

Prolonged contact of certain types of instruments with Prolonged contact of certain types of instruments with glutaraldehyde solutions can lead to discoloration and glutaraldehyde solutions can lead to discoloration and corrosion of the instruments’ surfaces and cutting edges.corrosion of the instruments’ surfaces and cutting edges.


Ortho-Phthala-Dehyde Ortho-Phthala-Dehyde Immersion DisinfectantImmersion Disinfectant

Ortho-phthala-dehyde (OPA) is classified as a high-level Ortho-phthala-dehyde (OPA) is classified as a high-level disinfectant. disinfectant.

OPA is effective in achieving high-level disinfection within OPA is effective in achieving high-level disinfection within 12 minutes at room temperature. It is more expensive than 12 minutes at room temperature. It is more expensive than glutaraldehydes but may be a good alternative for glutaraldehydes but may be a good alternative for individuals with a sensitivity to glutaraldehydes.individuals with a sensitivity to glutaraldehydes.

It has very little odor and does not require activation or It has very little odor and does not require activation or mixing.mixing.

Some disadvantages of OPA: (1) It is costly, (2) it can be Some disadvantages of OPA: (1) It is costly, (2) it can be used only half as long as most glutaraldehydes in dentistry, used only half as long as most glutaraldehydes in dentistry, (3) it may stain skin and fabrics, (4) plastics turn a blue-(3) it may stain skin and fabrics, (4) plastics turn a blue-green color where proteins have not been removed, and (5) green color where proteins have not been removed, and (5) it would require more than 30 hours to secure sterilization.it would require more than 30 hours to secure sterilization.


Fig. 20-13 Fast-acting high-level disinfectant. Fig. 20-13 Fast-acting high-level disinfectant. (Courtesy of Crosstex International.)(Courtesy of Crosstex International.)


Housekeeping SurfacesHousekeeping Surfaces

There is no scientific evidence showing that housekeeping surfaces There is no scientific evidence showing that housekeeping surfaces (e.g., floors,walls, and sinks) pose a risk for disease transmission in (e.g., floors,walls, and sinks) pose a risk for disease transmission in dental healthcare settings. dental healthcare settings.

The majority of housekeeping surfaces need to be cleaned only with The majority of housekeeping surfaces need to be cleaned only with a detergent and water or an EPA-registered hospital a detergent and water or an EPA-registered hospital disinfectant/detergent.disinfectant/detergent.

However, in the cleaning process, used solutions of detergents or However, in the cleaning process, used solutions of detergents or disinfectants—especially if prepared in dirty containers, stored for disinfectants—especially if prepared in dirty containers, stored for long periods of time, or prepared incorrectly—may be reservoirs for long periods of time, or prepared incorrectly—may be reservoirs for microorganisms.microorganisms.

Make fresh cleaning solution each day; discard any remaining Make fresh cleaning solution each day; discard any remaining solution and let the container dry to minimize bacterial contamination.solution and let the container dry to minimize bacterial contamination.

When cleaning, try to avoid producing mists and aerosols or When cleaning, try to avoid producing mists and aerosols or dispersing dust in patient-care areas. dispersing dust in patient-care areas.


Carpeting and Cloth FurnishingsCarpeting and Cloth Furnishings

Carpeting is more difficult to clean than is nonporous hard-Carpeting is more difficult to clean than is nonporous hard-surface flooring, and it cannot be reliably disinfected, surface flooring, and it cannot be reliably disinfected, especially after contamination with blood and other body especially after contamination with blood and other body substances.substances.

Studies have documented the presence of bacteria and Studies have documented the presence of bacteria and fungi in carpeting.fungi in carpeting.

Cloth furnishings pose similar contamination risks in areas Cloth furnishings pose similar contamination risks in areas where there direct patient care is performed and where where there direct patient care is performed and where contaminated materials are handled, such as an operatory contaminated materials are handled, such as an operatory or instrument-processing area.or instrument-processing area.

CDC guideline: Avoid using carpeting and cloth-CDC guideline: Avoid using carpeting and cloth-upholstered furnishings in dental operatories, laboratories, upholstered furnishings in dental operatories, laboratories, and instrument-processing areas. and instrument-processing areas.


Spills of Blood and Body SubstancesSpills of Blood and Body Substances

The majority of blood contamination in dentistry results from The majority of blood contamination in dentistry results from spatter and the use of rotary or ultrasonic instruments. spatter and the use of rotary or ultrasonic instruments.

No scientific evidence shows that HIV, HBV, or HCV has been No scientific evidence shows that HIV, HBV, or HCV has been transmitted from a housekeeping surface.transmitted from a housekeeping surface.

OSHA requires that blood spills and other body fluids be OSHA requires that blood spills and other body fluids be removed and the surfaces disinfected. removed and the surfaces disinfected.

Always wear gloves and other PPE when decontaminating Always wear gloves and other PPE when decontaminating areas of spills.areas of spills.

CDC guideline: Clean spills of blood or other potentially CDC guideline: Clean spills of blood or other potentially infectious materials and decontaminate the surface with an infectious materials and decontaminate the surface with an EPA-registered hospital disinfectant with low-level (i.e., HBV EPA-registered hospital disinfectant with low-level (i.e., HBV and HIV label claims) to intermediate (i.e., tuberculocidal claims) and HIV label claims) to intermediate (i.e., tuberculocidal claims) activity, depending on the size of the spill and the surface activity, depending on the size of the spill and the surface porosity.porosity.


principles and techniques of disinfection chapter 20 copyright © 2009, 2006 by saunders, an imprint...

Documents

clinical surfaces

clinical contact surfaces

housekeeping surfaces

types of surfaces

imprint of elsevier

divide environmental

patient treatment

dental treatment rooms