Chapter 8: Infection Control Rationale and Regulations

Copyright © 2017, Elsevier Inc. All Rights Reserved.
Infection Control Rationale
and Regulations
Chapter 8
1

Learning Objectives
Lesson 8.1: Infection Control
Rationale and Regulations
1. Describe the rationale for performing
infection control procedures, the pathways
by which microbes may be spread, and
which infection control procedures can be
used to interfere with the different pathways
of microbial spread in the dental office.
2. Describe the goal of infection control.
3. Describe the role played by governmental
and professional organizations in dental
infection control.
2

4. Summarize the bloodborne pathogens
standard from the Occupational Safety and
Health Administration.
5. Summarize the recommendations for
infection control in dentistry from the Centers
for Disease Control and Prevention.
3
Learning Objectives
Lesson 8.1: Infection Control
Rationale and Regulations (Cont.)

Pathways for Cross-Contamination
 A total office infection control program is
designed to prevent or reduce spread of disease
 Subdivisions of infection control are based on
the six pathways for cross-contamination
 Patient to dental team
• Most difficult to control
 Dental team to patient
 Patient to patient
 Dental office to community, including the dental
team’s families
 Community to patient
 Dental team to family
4

Pathways for Cross-Contamination (Cont.)
 Spread from dental team to patient is rare but could
happen if members do not follow proper
procedures
 Patient to patient occurs indirectly through
improperly prepared instruments
 Dental office to community if patient contaminates
items sent out or transported away from the office
 Impressions sent to dental lab
 Community to patient involves microorganisms in
the water that supplies the dental unit
 Hand washing of dental personnel will lessen
dental teams infecting family members.
5

Goals of Infection Control
 Three factors for infectious disease to develop
include:
 Virulence
 Dose
 Resistance
 The goal of infection control is to reduce the
dose of microorganisms that may be shared
between individuals or between individuals
and contaminated surfaces
 The more the dose is reduced, the better the
chances for preventing disease spread
6

Goals of Infection Control
 Procedures that minimize spraying or spattering of
oral fluids (e.g., rubber dam, high-volume
evacuation, and pre-procedure mouth rinse)
reduce the dose of microorganisms that escape
from the source.
 Handwashing and surface pre-cleaning and
disinfection reduce the number of microorganisms
that may be transferred to surfaces by touching.
 Barriers such as masks, gloves, and protective
eyewear and clothing reduce the number of
microorganisms that contaminate the body or other
surfaces. 7

Infection Control
Recommendations
 Recommendations are made by individuals
or groups that have no authority for
enforcement
 Regulations are made by governmental
groups or licensing boards
8

Infection Control
Recommendations
 Current infection control recommendations for
dentistry come from the Centers for Disease
Control and Prevention (CDC)
 Most infection control procedures practiced in
dentistry today are based on the 2003
recommendations, as well as the 2016
update
 The CDC is part of the Public Health Service,
a division of the U.S. Department of Health
and Human Services.
 The CDC has also published guidelines on
prevention of transmission of tuberculosis. 9

Infection Control
Recommendations (Cont.)
 Other organizations who have helped make
recommendations
 American Dental Association (ADA)
 Organization for Safety and Asepsis Procedures
(OSAP)
 Association for the Advancement of Medical
Instrumentation (AMMI)
10

 The ADA has provided detailed infection control
recommendations since the 1970s and currently
makes such recommendations through its Councils
on Scientific Affairs and Dental Practice.
 OSAP is a not-for-profit professional organization
composed of dentists, hygienists, assistants,
university professors, researchers, manufacturers,
distributors, consultants, and others interested in
infection control.
 AMMI is a voluntary organization composed of
manufacturers, distributors, researchers, regulators,
and users of medical/dental equipment.
 They are devoted to developing sterilization standards.
11

Infection Control Regulations
 Anyone may make recommendations, but
governmental groups or licensing boards in
towns, cities, counties, and states make
regulations
 State and local government
 Food and Drug Administration (FDA)
 Environmental Protection Agency (EPA)
 Occupational Safety and Health Administration
(OSHA)
12

 The FDA is a part of the U.S. Department of
Health and Human Services.
 In relation to infection control, the FDA regulates
the manufacturing and labeling of medical
devices.
 The EPA is associated with infection control
by attempting to ensure the safety and
effectiveness of disinfectants.
 OSHA is a division of the U.S. Department of
Labor, and its charge is to protect the
workers of America from physical, chemical,
or infectious hazards in the workplace.
13

Exposure Control Plan (ECP)
 The bloodborne pathogens standards is the
most important infection control law in
dentistry for protection of healthcare workers
 Each dental office, clinic, or school must
prepare a written exposure control plan
14

Exposure Control Plan
 The ECP binder should be kept in a localized area
in the office.
 The binder should contain steps, reports, and directions in
case of exposure incident.
 This plan must be reviewed and updated at least annually,
and a copy must be accessible to all employees.
 An occupational exposure is defined as any
reasonably anticipated skin, eye, mucous
membrane, or parenteral (e.g., needlestick, cut,
abrasion, or instrument puncture) contact with blood
or other potentially infectious material such as saliva
that may result from the performance of an
employee’s duties.
15

General Steps for Employer Compliance
with Bloodborne Pathogens Standard
16

OSHA Written Exposure Control Plan
 This plan must be reviewed and updated at
least annually.
 A copy must be accessible to all employees.
 Exposure determination
 Schedule of implementation
 Evaluation of exposure incidents
 Evaluation and use of safety devices
 Communication of biohazards
 Information and training
 Use of signs and labels
17

Hepatitis B Vaccination
 A very important part of the bloodborne
pathogen (BBP) standard includes necessity
for all employees to receive hepatitis B
vaccine
 Employees covered by the standard must be
offered the hepatitis B vaccination free of
charge
18

HBV
 They can get the vaccination after they have
received the training required by the OSHA
standard and within 10 days of their employment.
 If the employee received the complete vaccine
series previously, if antibody testing discloses
immunity, or if the vaccine is contraindicated for
medical reasons, vaccination need not be offered.
19

HBV
 If the employee initially declines vaccination
but at a later date, while still covered under
the standard, decides to accept the offer, the
employer must make the vaccine available at
no charge at that time.
 Employers must ensure that employees who
decline vaccination sign a specifically worded
statement of declination that is printed in the
OSHA standard.
20

Postexposure Medical
Evaluation and Follow-up
 After a report of an exposure incident, the
employer must:
 Document the exposure and confidential medical
evaluation
 Test the source individual
 Test the exposed employee
 The confidential medical evaluation and
follow-up is at no cost to the employee.
 If the source individual refuses testing, the
employer shall establish that the consent
cannot be obtained.
21

Record Keeping
 Training records must contain:
 Dates of training sessions
 Contents of training (or summary of training)
 Names/qualifications of persons conducting the
training
 Names/job titles of people attending training
 Employee medical records must include:
 Name/SSN of the employee
 Hepatitis B vaccination status
 Reports documenting occupational exposure
incidents
22

Record Keeping
 The Hepatitis B vaccination status in each
employee’s medical record must include the dates of
vaccination and the written opinion from the health
care professional regarding the vaccination or the
signed statement that the employee declined the
offer to be vaccinated.
 Employee Medical Records must be maintained for
30 years past the last date of employment.
23

Universal Precautions
 The concept that all human blood and certain
human body fluids that may contain blood are
treated as if known to be infectious for HIV
and HBV and other bloodborne pathogens
 CDC has expanded the concept of universal
precautions into what now is called “standard
precautions”
24

 Standard precautions apply not just to contact
with blood but also to
 (1) all body fluids, secretions, and excretions (except
sweat) regardless of whether they contain blood;
 (2) nonintact skin; and
 (3) mucous membranes.
 When the potential exists for occupational
exposure, the employer shall provide, at no cost
to the employee, appropriate personal protective
equipment (PPE) such as gloves, protective
clothing, masks, face shields or eye protection,
and mouthpiece, resuscitation bags, pocket
masks, or other ventilating devices.
25

Engineering and Work Practice Controls
 The standards address the following:
 Hand hygiene
 Handling of disposable and reusable
contaminated sharps
 Restricted activities in the work area
 Minimizing spatter
 Specimen containers
 Servicing of contaminated equipment
26

Engineering and Work Practice
Controls
 Engineering and work practice controls are to
be used to minimize or eliminate employee
exposure.
 If exposure still remains after institution of
these controls, personal protective equipment
(PPE) is to be used.
27

Personal Protective Equipment
 If potential for occupational exposure exists,
employer must provide (at no cost to employee)
appropriate personal protective equipment
 Gloves
 Masks, eye protection, and face shields
 Protective clothing
 Employer must maintain, clean, launder, and
dispose of all PPE
 Protective clothing must not permit blood or
saliva to pass through to the employee's work
clothes.
 Employees cannot launder the protective clothing
at home.
28

Regulated Waste
 Contaminated sharps
 Anything that could puncture skin; contains blood
or other potentially infectious materials
 Placed in sharps containers
 Other regulated waste
 Placed in containers that are leakproof, closable,
color-coded/labeled with biohazard symbol
 Example is a biohazard bag
 Several local, state, or federal laws may apply
to various aspects of waste management in
specific localities.
29

Instrument Sterilization
 An important area of infection control that is not
covered under the OSHA bloodborne pathogens
standard is instrument sterilization
 Considered patient-protective, not worker-protective
 OSHA cannot make or enforce rules that relate only
to patient protection.
 Appropriate procedures for processing reusable
dental instruments and handpieces are described in
recommendations from important organizations such
as the CDC, ADA, Organization for Safety and
Asepsis Procedures, and Association for
Advancement of Medical Instrumentation.
30

Summary of CDC’s
Recommendations for Dentistry
 Current infection control recommendations for
dentistry were published in 2003, with a 2016
update
 Many of their recommendations are the same
as those in OSHA’s bloodborne pathogens
standard with some differences
 Only those recommendations that differ from
the OSHA rules are summarized in the
textbook.
 Appendix B gives the complete list of CDC
recommendations.
31

CDC Recommendations
 Administrative measures (new in 2016)
 Infection prevention education and training (new
in 2016)
 Personnel health elements of an infection control
program
 Prevention of transmission of bloodborne
pathogens
 Prevention of exposures to blood and other
potentially infectious materials
 Hand hygiene
 Personal protective equipment
 Contact dermatitis and latex hypersensitivity
32

CDC Recommendations (Cont.)
 Respiratory hygiene/cough etiquette (new in
2016)
 Sterilization and disinfection of patient care items
 Environmental infection control
 Dental unit water lines, biofilms, and water
quality
 Boil-water notices
 Dental handpieces and other devices attached to
air and water lines
 Dental radiology
33

CDC Recommendations (Cont.)
 Aseptic technique for parenteral medications
 Single-use (disposable) devices
 Oral surgical procedures
 Handling of extracted teeth
 Dental laboratory
 Mycobacterium tuberculosis
 Program evaluation
34

CDC Recommendations
 These categories are included with
recommendations in Appendix B of the
textbook.
 Turn to Appendix B in your books and
summarize each recommendation.
35

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