You must clean and disinfect the previously covered surfaces between patients

only when the integrity of the physical barriers has been com- promised or when the surface is visibly soiled. For example, if moisture is absorbed through the cover to the underlying surface, then the purpose of the barrier is defeated, and the surface must be disinfected.

Cleaning Unprotected Areas

Using the spray-wipe-spray technique, clean and disinfect all unprotected “high touch” areas with an intermediate-level, EPA-registered disinfectant. Remove all debris and particulate matter before disinfection. To be effective, the disinfectant must remain in contact with the surfaces for the time specified by the manufacturer. Do not use 2 percent glutaraldehyde as a surface disinfectant because of its caustic vapors and high cost.

Bringing Contaminated Items to the CSR

After completion of the above procedures, you can now take all metal and heat stable items to the CSR for sterilization. Ensure all instruments and equipment are handled properly and no sharp objects are protruding through packs or cassettes while transporting items to the CSR.

Preparing for the Next Patient

When you return to the DTR from the CSR and if your room is clean, remove your gloves and wash your hands and other exposed skin surfaces with an antimicrobial soap. When discarding a face mask after removing gloves and washing hands, handle the mask only by the elastic or cloth tie strings. Never touch the mask itself. Plan the above process carefully for efficient use of time. Replace clean disposable barriers and set up clean handpieces and instruments for the next patient.

EXPOSURE INCIDENT

Dental personnel who sustain percutaneous inoculation of serum or saliva by accidental puncture, or splashing while handling contaminated instruments, equipment, or supplies must receive immediate medical evaluation to comply with local military treatment facility (MTF) guidelines. Refer to the Nosocomial Infection Control Manual for Ambulatory Care Facilities, NEHC-TM89-2, and report the incident as a mishap to the command safety officer using OPNAVINST 5102.1.

SECURING THE DTR

To secure the DTR at the end of the day, follow all steps as mentioned under the “Disinfecting the DTR Between Patients” heading.

Flush the high-volume evacuator (HVE) system with at least one quart of water. Clean the system with an HVE system cleaner at least once each week.

Use the system cleaner more often if indicated by problems. Spray-wipe-spray the countertops, dental unit, chair, and dental light.

Flush each unit waterline and hose for 30 seconds. If unit has a self-contained water delivery system, follow manufacturer’s instructions for flushing and air purging the lines.

HOUSEKEEPING

Although micro-organisms are normal contaminants of walls and floors, these surfaces are rarely associated with transmitting infection to staff and patients; however, all facilities must remain clean. Any infection control instruction will determine and implement a written schedule for cleaning and a method of disinfection based upon location within the facility, type of surface, type of contaminant present, and tasks or procedures performed in a given area. The OSHA and NAVOSH requirements for housekeeping include sections on equipment, laundry, and infectious waste disposal.

Equipment

OSHA and the Navy require that all DTFs ensure a clean and sanitary workplace. Work surfaces, equipment, and other reusable items must be decontaminated with an EPA-registered disinfectant upon completion of procedures when contamination occurs through splashes, spills, or other contact with blood and OPIM. Observe and perform the following procedures:

Clean uncarpeted floor and other horizontal surfaces regularly and when spills occur. Use mops with a detergent and an EPA-registered disinfectant or a detergent with sodium hypochlorite (1:100 dilution). Mops must not be used for more than 1 day without cleaning.