Shaping Safer Surgeries
UncategorisedPosted by: Dental Design 12th July 2023
Surface disinfection is a vital part of safety protocols inside the dental practice, protecting both patient and practitioner. Maintaining a clean and pathogen-free workplace helps minimise the risk of transmission of microorganisms to either party. It must be ensured that disinfectant is applied to surfaces safely and effectively, and that the correct product is chosen for the task at hand.
Role of disinfection
The role disinfectants play in preventing patients from infection is critical, being the most influential way to kill or inactivate harmful microorganisms.[i] The focus on preventing the spread of microorganisms was perhaps at its highest during the COVID-19 pandemic, with concerns still prevalent today. In response to the outbreak, requirements surrounding disinfecting surgeries, equipment and appropriate reusable PPE were heightened from pre-existing standards.[ii]
Though these added measures are largely no longer in use, there are still a multitude of factors to consider when finding the best disinfectant for a dental surgery. These include the effectiveness of the chosen disinfectant, how quickly it works to kill or inactivate microorganisms, and any effect on the health of patients and staff.
Options that are commonly used for surface and equipment asepsis include sodium hypochlorite, often referred to as bleach, and alcohol-based formulas, though there is an emerging force in natural disinfectants.
Bleach
As a disinfectant, bleach is incredibly strong. Sodium hypochlorite should be diluted in water, recommended by the WHO to have a concentration of one gram for every litre of water for a general all-purpose laboratory disinfectant. This should be increased to 5 g/L when dealing with biohazardous spills or large amounts of organic matter.[iii]
The active ingredient in bleach is hypochlorous acid. Its strength comes from its ability to unfold the proteins of a cell.[iv] To be effective against bacteria and viruses, an adequate concentration of diluted bleach is required, accounting for what it is aiming to disinfect.[v]
Bleach is commonly referred to as a household disinfectant. It poses various health risks including being an irritant to skin. Bleach also cannot come into contact with other cleaners or disinfectants; the Health and Safety Executive warns of the potential vapours that can be produced from mixing chemicals which would be dangerous to inhale, and advises it is used in a well-ventilated space to minimise risk of harm.[vi]
Diluting bleach appropriately can minimise these risks, but care should still be taken around its application to surfaces in areas occupied by patients and practitioners.
Alcohol-based disinfectants
Some alternatives commonly found in practices are alcohol-based disinfectants. They have been widely used in healthcare for many years, and are especially effective against viruses, such as murine norovirus, Ebola virus, and several coronaviruses.[vii] Many hand sanitisers rely on an alcohol-based formula for this reason.
Alcohol tends to be used to disinfect small surfaces and occasionally the external surfaces of equipment.[viii] With alcohol’s flammable properties its use is frequently limited and once again requires a well-ventilated area.
Prolonged use of alcohol-based disinfectants is known to potentially cause discolouration, hardening and cracking of rubber and some plastics. Research has also shown that ethanol in disinfectants can permeate examination gloves, minimal enough to avoid irritation yet its presence could possibly initiate allergic reactions.[ix]
Alongside this the Department of Health advises caution with alcohol-based disinfectants. Alcohol has been shown to bind blood and protein to stainless steel, so alcohol-based formulas will be detrimental in the presence of obvious blood spills.[x] Notes in HTM 01-05 do not state that alcohol cannot be used, but instead should be used with precaution and following the appropriate risk assessments.
Natural based disinfectants
In modern developments around disinfectants there has been a push to create natural alternatives to alcohol-based and bleach-based choices.
An area that has found success is with Citrox, a compound based on the natural bioflavonoids derived from citrus fruit. Previously, Citrox has displayed success against a range of oral bacteria, and was deemed promising in mouthwashes and oral care.[xi] However, over the past several years knowledge around it has grown exponentially, confirming its effectiveness against a wide range of bacteria, viruses and fungi, including SARS-COVID.[xii]
As research on Citrox has progressed, it is now at a point where it can compete effectively in surface disinfection too, which lead to the development of professional cleaning and disinfection products that provide a number of benefits.
Finding a solution
When deciding on the best disinfectant to use in practice for effective and safe use, dentists should consider the Citrox Protect range of surface cleaners and disinfectants. Made with Citrox bioflavonoids, this range is completely natural and hypoallergenic. It provides a plant-based and dermatologically tested answer to keeping practices safe, effectively killing up to 99.99% of bacteria and viruses[xiii] whilst offering a variety of short-term and long-term solutions for hard surfaces, textiles and air hygiene.
Any disinfectant should be considered carefully before introduction into a practice. Ensuring it is minimising the risk of infections whilst keeping the journey comfortable for the patient, and workflow effective for the practitioner, should help practices find the best choice for them.
For more details, visit Citroxbio.co.uk, call 01480 862085 or email enquiries@citroxbio.co.uk
Bio – Julia Svec
Julia Svec is the Product Development Manager for Billion Dollar Smile Cosmetics Ltd. She has spent the last ten years working in collaboration with dentists, laboratories and manufacturers in North America, Europe and Asia researching and developing effective and safe non-peroxide teeth-whitening products for professional and home use.
[i] Sandle, D. T., 2017. Cleaning and disinfection of dental practice surfaces. [Online]
Available at: https://www.dental-nursing.co.uk/features/cleaning-and-disinfection-of-dental-practice-surfaces
[Accessed April 2023].
[ii] Hartig, M., Stephens, C., Foster, A., Fontes, D., Kinzel, M. and García-Godoy, F., 2021. Stopping the COVID-19 pandemic in dental offices: A review of SARS-CoV-2 transmission and cross-infection prevention. Experimental Biology and Medicine, 246(22), pp.2381-2390.
[iii] Artasensi, A., Mazzotta, S. and Fumagalli, L., 2021. Back to Basics: Choosing the Appropriate Surface Disinfectant. Antibiotics 2021, 10(6), pp.613
[iv] Winter, J., Ilbert, M., Graf, P. C. F., Özcelik, D., Jakob, U., 2008. Bleach Activates a Redox-Regulated Chaperone by Oxidative Protein Unfolding, Cell, 135(4) pp.691-701,
[v] Artasensi, A., Mazzotta, S. and Fumagalli, L., 2021. Back to Basics: Choosing the Appropriate Surface Disinfectant. Antibiotics 2021, 10(6), pp.613
[vi] Health and Safety Executive, Methods of Decontamination. [Online] Available at: https://www.hse.gov.uk/biosafety/blood-borne-viruses/methods-of-decontamination.htm [Accessed April 2023]
[vii] Boyce, J. M., 2018. Alcohols as Surface Disinfectants in Healthcare Settings. Infection Control & Hospital Epidemiology, 39 (3), pp.323-328.
[viii] Geneva: World Health Organization, 2014. Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care. [Online]
Available at: https://www.ncbi.nlm.nih.gov/books/NBK214359/
[Accessed April 2023].
[ix] Baumann, M. A., Rath, B., Fischer, J. H. & Iffland, R., 2000. The permeability of dental procedure and examination gloves by an alcohol based disinfectant. Dental Materials, 16(2), pp. 139-144.
[x] DH, 2013. HTM 01-05: Decontamination in primary care dental practices. 2013 Version. [Online]
Available at: https://www.england.nhs.uk/wp-content/uploads/2021/05/HTM_01-05_2013.pdf
[Accessed April 2023].
[xi] Hooper, S. J., Lewis, M. A. O., Wlson, M. J. and Williams, D. W., 2011. Antimicrobial activity of Citrox® bioflavonoid preparations against oral microorganisms. British Dental Journal, 210, E22. Available at: https://doi.org/10.1038/sj.bdj.2010.1224
[Accessed April 2023]
[xii] Citrox, n.d. CIROX BIOSCIENCES TECHNOLOGY. [Online]
Available at: https://www.citroxbio.co.uk/technology/citrox-biosciences-technology/
[Accessed April 2023]
[xiii] Citrox, n.d. CITROX® TESTING AND CERTIFICATION. [Online]
Available at: https://www.citroxbio.co.uk/technology/testing-certification/
[Accessed April 2023].
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