Vol. 30 No.

6 l JUNE 2014

Dr Tim Sandle compares the advantages of alcohol and non-alcohol wipes.

Disinfection and Decontamination

Keeping surfaces microbe free

Dr Tim Sandle compares the advantages of alcohol and non-alcohol wipes.

nfection control is an important

part of dental practice, particularly
in ensuring that surfaces are clean
and maintained in a hygienic state.
Hygiene in this context refers to the
elimination of potentially pathogenic
microorganisms, including the bacteria
that cause tuberculosis and MRSA
infections.
In order to achieve satisfactory
disinfection, a good quality disinfectant
is required. An ideal disinfectant should
have a high inactivating capacity for
a wide range of viruses, such as HIV
and hepatitis, as well as being effective
against bacteria, including tuberculosis.
It should be safe to use and suitable
for frequent application. Disinfectants
are typically supplied as pre-saturated
wipes which may be alcohol-based
or non-alcohol based. This article
considers the key requirements for a
surface disinfectant and examines the
comparative advantages of alcohol and
non-alcohol wipes.
Disinfection and hygiene
It is the responsibility of everyone
working in the practice to ensure that
surfaces are clean and disinfected.
The process of wiping down surfaces
between patients should be an integral
part of good practice. The General
Dental Council (GDC) recognises the
importance of disinfection by making

Dr Tim Sandle
is site microbiologist at Bio Products
Laboratory and a visiting tutor
with the School of Pharmacy and
Pharmaceutical Sciences, University
of Manchester.
60 The Dentist June 2014

it a compulsory subject for continuing

professional development (CPD) for
dentists and dental care professionals
(DCPs).
Disinfection is the process of
using a chemical with proven antibacterial, anti-virucidal and anti-fungal
characteristics to kill or to inactivate
microorganisms. International
standards are in place to assess
disinfectants in relation to their ability
to kill set numbers of microorganisms
(termed biocide efficiency), where
a population of microorganisms is
reduced to a level that should not
be harmful to patient health; and to
eliminate a wide-range of different
types of microorganisms (the spectrum
of activity). Standards for disinfection
applied to surfaces are distinct from
those that apply to the decontamination
of dental instruments.

To achieve good disinfection, there

is a choice of different formats and
different types of disinfectants. Wipes
pre-saturated with the disinfectant of
choice are usually the preferred format
in a busy dental practice as they are
convenient to use, disposable and
require less storage space than sprays.
Wipes have the added advantage
of containing the correct amount of
disinfectant.
In relation to different types of
disinfectant, there are two main types
available for wiping hard, non-porous
surfaces: those that are alcohol based
and those which are non-alcohol
based, with the latter group generally
being types of quaternary ammonium
compounds (quats).
Selecting disinfectants
There are a number of factors that need

Format
The disinfectant should be in a userfriendly format, ideally in the form of a
wipe. Wipes avoid the need to mix and
prepare solutions. They also require less
stringent health and safety measures to
be adopted (the main requirement is for
the user to wear gloves).
Safety
It is important that the disinfectants are
safe for staff to use, are compatible with
the surfaces to which they are applied
(in that they do not cause pitting or
rusting), and that they can easily be
disposed of without harming the
environment.
Spectrum of activity
When choosing a suitable disinfectant
the bactericidal, virucidal and fungicidal
properties should be carefully studied as
these are essential requirements for an
effective disinfectant. A product which
has all these properties will give the
best possible spectrum of protection.
When deciding between alcohol and
non-alcohol based disinfectants, it is the
alcohol based types that have the widest
spectrum of activity.
In recent years there has been
considerable concern with the
bacteria that cause MRSA (certain
types of Staphylococcus aureus that
are antibiotic resistant) and those that
cause tuberculosis (Mycobacterium
tuberculosis). With tuberculosis,
reports suggest that cases in the UK
have increased in the past 15 years
and the incidence in the UK is above
the European average, together with a
parallel increase in multi-drug resistant
types of the bacterium.
In cases of tuberculosis, infection
occurs through inhalation of the
bacterium which then travels to the
alveoli of the lungs. Most people
who carry the bacterium do not show
any symptoms (latent tuberculosis);
however, the condition can be
serious for people with weak immune
systems. Although the disease is
rare, dentists need to be aware of the
possible occurrence of oral lesions
of tuberculosis and consider them in
the differential diagnosis of suspicious

oral ulcers. However, in many cases

symptoms are not apparent, therefore
good disinfection practices should be in
force in-between patients. One concern
is that Mycobacteria have a tough,
waxy cell wall that helps to prevent
disinfectant entry.
With the two common types
of disinfectants used for surface
disinfection, quats are generally
regarded as ineffective against the
tuberculosis bacterium. There is some
evidence that tinctures of quats can
inhibit the growth of M. tuberculosis,
but not kill it. The effectiveness of
inhibiting TB bacteria reduces in the
presence of protein residues and the
bacteria-killing properties of quat-based
disinfectants are weakened when the
disinfectants are combined with hard
water, or materials such as cotton or
gauze pads.
In contrast, alcohols are effective
against mycobacteria, with 70 per cent
alcohol solutions the most effective
against these types of microorganisms.
Aside from the hardiest sporeforming bacteria, alcohols possess the
widest disinfectant kill ranges of the
commercially available disinfectants.
Another important consideration is
with viruses. Quat-based disinfectants
are generally virucidal against what
are termed enveloped viruses, such
as HIV and hepatitis B. However, these
chemicals are not virucidal against
the non-enveloped viruses, such as
poliovirus, rhinoviruses (which cause
the common cold) and hepatitis A. In
contrast, alcohol-based disinfectants,
especially those with high ethanol
content, can efficiently destroy viruses
of all types. One study determined that
the optimal virucidal spectrum was
with a concentration alcohol mixture
(80 per cent ethanol and five per cent
isopropanol) for the elimination of all
relevant blood-borne viruses.
Ease to of use
The disinfectants used in a busy dental
practice must be in a format that can
be applied quickly. They must also
have a short contact time. This is the
time in which the disinfectant remains
in contact with the surface in order to
kill microorganisms. Both quats and
alcohols have fairly rapid contact times,
requiring less than one minute contact
time.

Importance of cleaning
Surfaces may contain protein
residues, such as blood and pus from
the patient. It is important that the
disinfection process effectively removes
any protein present and allows the
disinfectant to work. Alcohols can, in
some circumstances, bind proteins to
stainless steel instruments. However,
this effect has only been demonstrated
after a prolonged contact time of over
10 minutes a period of time which
is far in excess of the wiping process
required to disinfect surfaces in the
practice. Very few dental practices have
surfaces that are composed of stainless
steel.
In practice alcohols are as effective
as quats on surfaces containing protein
residues, when a double-wiping
procedure is adopted. The first rub of
the surfaces with the alcohol wipe
removes the protein. The second rub
with an alcohol wipe brings the alcohol
disinfectant into contact with any
remaining microorganisms, allowing
the disinfectant to penetrate through
the microbial cell wall and to destroy
the microbe by denaturing its cellular
proteins.
Conclusion
The dental health-care setting is
an environment where disease
transmission can easily occur.
Prevention of cross infection is
therefore a crucial aspect of good
dental practice and dental professionals
need to adopt effective basic routines.
This includes disinfecting surfaces,
especially in-between patient visits
particularly for the elimination of
pathogenic microorganisms, like TB or
MRSA bacteria.
Given the array of different
disinfectant types and formats, the
article has considered the optimum
criteria for a disinfectant. This
assessment has concluded that alcohol
wipes offer the best solution for staff
and patients. While quats may act
quickly on heavily soiled surfaces, a
double-wipe with a saturated alcohol
wipe ensures that a broader range of
pathogens, including TB, are removed,
thereby offering better protection of
the patient from infection and a more
hygienic dental practice.
References available on request.
61 The Dentist June 2014

Disinfection and Decontamination

to be considered when selecting the

most appropriate type of disinfectant for
surface cleaning. These are:

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