fumigation for dental clinic

Fumigation and Dentistry

There has been recent interests in the use of chemical fumigation in health care facilities because of concerns regarding the COVID pandemic. 

The panic from the infection has generated a demand in the market for different fumigation chemicals and required machines. 

Dental clinics are more prone to contain the aerosol generated from a COVID-19 infected patient. This news over night has bulged the market in a high demand, with authorized and unauthorized sources of supply, and potential buyers. 

It is evident that fumigation of a hospitals or clinics with high concentration of toxic chemicals can reduce microbial agents on the surfaces to control infections. But fumigation effect over "SARS CoV2" is yet under observation. 

Fumigation chemicals are much more toxic than anticipated at their minimum concentration. There has been incidents where fumigants have escaped causing illness and death to exposed workers and even the general public. Chemical fumigation in any health care facilities should be conducted only in the most controlled settings.

Fumigation procedure

Formaldehyde fumigation is the most accepted method of sterilization in a hospital or clinical set up. It is the most commonly used and cost effective than the other methods.

Formaldehyde vapor is an extremely effective biocidal agent. 

It acts as an alkaline agent, inactivating micro-organisms by reacting with carboxyl, amino, hydroxyl and sulphadryl groups of proteins and amino groups of neuclic acid bases. 

Fumigation is mostly effective at above the temperature of 20°C and in 65% humidity.

 

Site preparation protocols before fumigation

1) Thoroughly clean windows, doors, floor, walls, dental chair, working table, and all surfaces with soap and water. (Preferably detergents)

2) Seal off the area by closing all the exhaust panels, doors, windows and plumbing vents to avoid the leakage of fumes.

3)  Shut down all the electronic items, lights, Air conditioner etc.

4) Prepare the solution according to the room size in cubic feet.

Worker preparation

1) Adequate care must be taken by wearing cap, mask, foot cover, spectacle, coverall etc.

2) Fumigation chemicals are irritant to eyes and nose and it's also recognized as a potential carcinogen.

3) Isolate the area and post a notice to avoid the premises before starting the fumigation procedure.

4) Single person working is not adequate to maintain all the necessary precautions.

Fumigation

A) Electric boiler fumigation method. 

For a 1000 cubic feet room, 500ml of 40% Formaldehyde solution added in 1000ml of distilled water is used in an electric boiler. The power source must be outside the room to operate the boiler. 

After preparing the boiler leave the room, seal the area properly and switch on the boiler.

After 45minutes (depending upon the room size and efficiency of the chemical) switch off the boiler and let the room remain sealed.

B) Potassium permanganate method:

Here the heat is generated by an oxidizer chemical. Potassium permanganate which is an auto boiling agent reacts with the formalin and generate fumes of formaldehyde. 

For a 500ml formalin solution added in 1000ml of distilled water, 450gm of KMnO4 is required to fumigate 1000 cubic feet area.

After initiating the fumigation procedure leave the room for 12-18 hours before using. 

Neutralization 

1) Take out the boiler or fumigation pot out side the clinic and let the air ventilate. 

2) Formaldehyde fumes are neutralized with ammonia solutions.

3) Cotton balls soaked with 300ml of 10% ammonia solution (for 500ml of formalin solution) is dispersed on the floor at least 4hours before the sterility test

4) Formaldehyde gas reacts with the ammonia vapor and produces hexamine or 

hexa-methylene-tetra-amine which is a harmless compound.

5) Switch on the A/C or exhaust at leats 2hours before the sterility test. 

Maths behind the solution preparation

A dental clinic with Length 20feet, Width 15feet and Height 10feet is 

20x15x10= 3000 cubic feet (LxWxH)

The formula comes as follows 

(500ml formalin x 3000cubic feet)/1000cubic feet = 1500ml of formalin.

(1 / 2) x measured room volume = required formalin solution.

To nutralize 1500ml of formaldehyde in a 3000cubic feet room volume around 900ml of 10% ammonia solution is used. 

Required Guidelines.

1) A Log Book is mandatory to keep all the records of fumigation procedure. Such as date, time, total time of fumigation, total time of neutralization, details of the workers involved and the dates of sterility test visits.

2) A lay out plan of the clinic must be attached with the Log book.

3) There must be a separate dressing room for the doctors, assistants and a separate patient waiting area.

4) all sorts of plumbing, cleaning and electrical works must be completed before the fumigation starts.

5) all apparatus should be cleaned like suction machines, AC units, focus lights according to the manufacturer instructions

6) surroundings should be free of garbage, bushes, drainage wastes etc.

7) A warning notice should be handy to isolate the area prior to fumigation.

8) separate footwear should be kept inside the clinics working area. 

9) A separate dress should be kept for the working area.

10) Fumigation procedure should be done periodically depending upon the case load.

Is it worthy?

According to an article published back in 17th May 2020, stated that WHO is not recognizing the procedure of spraying disinfectants or fumigation that can help you from SARS CoV2. 

'Spraying or fumigation of outdoor spaces or health care facilities is not recommended to kill COVID-19 virus or other pathogens because disinfectants get inactive due to the dirt and other pollutants.'

It has also mentioned that "if disinfectants to be applied, it should be done with a clothe or wipe soaked with disinfectant solutions." to clean the surfaces. 

Formaldehyde allergy:

Inhalation of formaldehyde may lead to 

1) Burning sensation

2) Irritation of eyes, nose

3) Coughing

4) Wheezing

5) Tightness of throt

6) Runny Nose

7) Breathlessness. 

eventually it may lead to Pulmonary edema, pneumonia and ARDS.

Accidental exposure to Formalin.

accidental exposure of skin with formalin solution can lead to allergic reactions. Primary cares are to flush the area of exposure with clean cold water. 

If you have some how consumed formalin solution by mistake start taking lot of water and milk to dilute the solution and visit your near by hospital facility. 

Other safe alternatives to Formaldehyde.

Baccillocid

It is a formaldehyde free disinfectant cleaner with low concentration effectiveness. 

It is pocket friendly 

Good material compatibility

And excellent cleaning properties with virtually no residues

It has a good bactericidal, fungicidal and virucidal activity

Composition

1,6 Dihydroxy, 2-5 dioxahaxane 

Glutaraldehyde 

Benzalkonium chloride

Alkyl urea derivatives 

Spectrum of activity

All fungi including candida albicans

All gram positive bacteria

All gram negative bacteria

Mycobacteria

Bacterial spores

Viruses including HIV, HBV, HCV and others.

Mode of applications 

Mopping with Bacillocid special mop for 10-15minutes

Fumigation 2% Baccilocid 20ml solution with one litter of water.

Mode of action

Gluteraldehyde combines with chemically bound formaldehyde in hydrolisation with water and acts as same as formaldehyde.

Only 30% of formaldehyde is released 

Benzalkonium chloride and urea derivatives acts as surfectant. 

Advantages

No irritation

Compatible with any surface

Non corrosive

Prolonged residual effect 

Reduction in maintenance of your HEPA air purifier.

Prolonged clouser time for clinic is not required.

Virkon

Multiourpose disinfectant

Contents are

Oxone / potassium per-oxy-mono-sulphate

Sodium do-decyl-benzene-sulfonate, sulphamic acid and buffering agents

Typically used as surface cleaning agents 

Chlorine dioxide

HPV

Hydrogen Peroxide Vapors

Drawbacks:

One of the major difficulties in any infection control technique in a dental clinic is that the environmental surfaces will be constantly recontaminated. 

Thus CDC does not recommend fogging or fumigating in the routine patient care areas where isolation for longer period is not possible. There is also lack of evidence that once cleaned by chemical fogging will reduce the risk of nosocomial infection.

Fumigation is being considered as a method of sanitization because gas and vapors can permeate areas that are not reachable. 

The decision to use fumigation in a dental clinic must be carefully considered as a breach in containment can injure patients, visitors and staffs including the medical professionals. 

To avoid such errors it is best to evacuate the premises before fumigating the clinic.

Fumigation in a dental chamber should be limited to those instances where benefits clearly exceeds the risk of human exposure and other environmental damage. 

Before incorporating risky procedures simpler and safer approaches to disinfect the clinic must be considered.

Dr. Arka Bhattacharya

DantaBihanga 

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