Updated CDC Standards for

Infection Prevention in Dental Settings

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Learning Goals for this program

Review essentials for infection prevention & chemical safety in health care settings.

Use case examples to discuss application of CDC & other Guidelines.

Use CDC Summary document & checklist to review your office Exposure Control Plan.

Identify how to use infection prevention & safety to promote & market the practice.

Highlight resources including osap.org

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Who’s in Control? Guidelines, Regulations, Laws

EPA Certol Intl. LLC

Why new Summary Document?

Need to consolidate OSHA standards & CDC guidelines.

Compliance failures: Oral surgeons & multi dose vials; evidence of Hepatitis B & C transmissions; water line disease transmission.

Increased scrutiny in complex settings (VA, Fed qualified clinics, oral surgery/hospitals with CMS & Joint Commision oversight.

The Tulsa Dentist - 2012

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Summary of Infection Prevention Practices in Dental Settings

CDC Guidelines 2003

OSHA Bloodborne Pathogens Standard

CDC Guideline for Isolation

Precautions 2007

CDC Guideline for Disinfection and Sterilization in Healthcare Facilities 2008

Centers for Disease Control

Guidelines “… the recommended

infection control practices are applicable to all settings in which dental treatment is provided.”

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Summary document & checklist

Hand hygiene

PPE

Respiratory / cough etiquette

Policy to ID potential infectious patients.

Sharps safety & post exposure plan.

Safe injection, multi-dose vials

Instrument & device reprocessing

Chain of Infection

Pathogen

Source

Mode Entry

Susceptible Host

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Chain of Infection examples Pathogens – virus, bacteria, fungus

Source – patient, sharp item, water

Mode – direct touch, droplets (sneezing), indirect via surfaces, airborne (measles).

Entry – percutaneous, mucosal/eye, cuts.

Susceptible Host esp. immune deficient Certol Intl. LLC

Understand how diseases may be transmitted in the dental setting: Bloodborne Pathogens HIV Hepatitis B Hepatitis C Zika and much much more . . .

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Modes of Transmission

Direct contact with blood/body fluids.

Indirect contact with a contaminated instrument or surface.

Contact of mucosa of the eyes, nose, or mouth with droplets or spatter

Inhalation of aerosols / pathogens.

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Bug of the Month – Where is the REAL risk in dental settings?

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Where is the REAL risk in dental settings ? Virulence, mortality, prevalence, transmission

MRSA

Colds and Flu

Hepatitis A, B, C

Clostridium difficile

Measles

Tuberculosis, AIDS, Ebola, Zika . . . Certol Intl. LLC

When MRSA goes wild . . .

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Staph - Gram positive bacteria. MRSA is the methicillin resistant form

What is resistance? Does it affect surface disinfection?

The real risk: contact from dirty hands or contaminated surfaces and objects to open wounds, scratches, surgical sites.

How to prevent MRSA transmission

Cover wounds and scratches.

Wash hands frequently – especially helpful in day care / school settings.

Do not share personal care items - towels, shavers, toothbrushes, etc.

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Hepatitis B

Chronic carrier state exists High prevalence in HIV+ Vaccination HBsAg+ AND HBeAG+ = 22 – 62% infectivity

Hepatitis C

5-10 week incubation period Chronic carriers exist No vaccination presently Aprox. 3.9 million infected Infectivity after needlestick – about 2 to 3 %

Hepatitis B vaccination guideline for HCW

OSHA requirement

Vaccination, testing and follow-up for all employees with occupational exposure at no cost.

Complete entire series and follow-up.

Keep vaccination records in file.

HCW must sign declination form if refused (also good if history??) Employer keep on file.

Beyond Hep B – Other vaccinations for HCW:

Seasonal Influenza

Measles, Mumps, Rubella (MMR)

Varicella (chicken pox)

Tetanus, diptheria, pertussis (Td/Tdap)

No vaccine for HIV, Hep. C or TB

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Who Needs Immunizations ?

Everyone ! Certol Intl. LLC

The West Virginia Missions of Mercy Clinic Case 2009

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Power of Clean - Why clean first ?

For hands, surfaces, instruments remove soils first.

Soils interfere with antimicrobial action of disinfectants.

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How to Wash Hands - Soap and Water

Dispense water to wet hands; dispense soap

Dip finger tips into each palm

Disperse & interlace fingers covering all surfaces

Rinse thoroughly with cool water

Dry gently but thoroughly to reduce chapping. Use towel to turn off the faucet.

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How to Wash Hands with Alcohol Rub

Dispense enough product to keep hands wet for 15 seconds

Dip finger tips into each palm

Disperse & interlace fingers covering all surfaces

Dry – rub hands together for 15 sec. or until dry

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Tips on Hand Hygiene products

Avoid bar soap.

Let staff try out product before purchase.

Soap Dispensers should not be “topped off”.

Avoid placing automatic alcohol hand rub where it will spray clothing.

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Cough Etiquette

You Are Role Model

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CDC - Needlestick Statistics

23,000,000 hepatitis infections/ YR

260,000 HIV/AIDS infections/ YR

“80% of occupationally acquired diseases in the U.S. are transmitted

through needlestick injuries.”

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Sharps Exposure Prevention

Work Practices: scooping & recapping devices

Engineered devices: Safety syringes, safety scalpels, automated instrument cleaning.

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Post Exposure Plan Must be customized to your setting.

Must include local clinic / provider, location, phone.

Have Grab and Go packet.

Training - All staff must be familiar with the plan.

Post exposure follow-up & records Certol Intl. LLC

Clinical Contact Surfaces

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Use disinfectant correctly

Clean first.

Start with clinical contact surfaces if not covered.

Avoid “fogging” the room.

Reduce aerosols - squirt tops.

Reapply using fresh applicator to disinfect in separate step.

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What about claims for “one-step” disinfectants ??

“To maximize a product’s germicidal efficacy, surfaces should be pre-cleaned before the disinfectant is applied.

This is good practice even for those products labeled “one step”.”

ADA Profess. Product Review Vol 2 Issue 4, 2007

Should we use disinfectant wipes?

Research in medical settings shows -

Incorrect use actually transfers microorganisms to other surfaces!

Use sufficient wipes per surface area.

“Key is using products that can clean to remove bioburden . . . “

Molinari, Dental Economics, Feb. 09, p. 28

Using disinfectant wipes correctly

Use sufficient wipe(s) to clean. Depends on soil load & types of surfaces.

Change frequently for clinical touch surfaces.

Reapply using fresh wipe(s) to disinfect in separate step.

Close containers to keep wipes saturated.

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Disinfectant “Active Agents”

Alcohols at 15 to 60% combined with phenols or

quaternary ammoniums Citric Acid Hydrogen Peroxide Phenolics / Water Based Quaternary ammoniums Sodium hypochlorite (bleach) Sodium Bromide and Chlorine

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The 2012 Colorado

Oral Surgeon Case

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Surgical Procedures

Sterile Irrigating Solutions

Sterile Surgeon’s Gloves Surgical

Scrub

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Oral Surgical Procedures

Which of the following requires sterile water for irrigation, sterile gloves

and surgical hand scrub?

Gingivectomy

Extraction of impacted third molar

Soft tissue biopsy

Bony recontouring procedure Certol Intl. LLC

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PPE – Personal Protective Attire

Taking your work home with you.

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PPE for the patient

“Colo. Dentist faces $800,000 malpractice claim for

eye injury”

(Endo file fell in patient’s eye) Could be prevented with

$5 plastic goggles Certol Intl. LLC

The Georgia & California Waterline Cases

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Waterline Management

Consult with dental unit manufacturer

Bottle system, centralized silver, etc.

Do baseline and periodic water line testing

Use aseptic bottle / treatment process

Goal: less than 500 CFUs/ml

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Hazcom compliance

Inventory your major hazards & chemicals (nitrous, mercury, etc.)

Make a chemical list (or update) Organize SDS (Safety Data Sheets) Check labels on all chemicals for

required PPE & cautions Write a policy (use fill in the blank) Training

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New OSHA Hazcom Chemical Labels & SDS

Global Harmonized System Changes to Labels & Safety Data Sheets Pictograms, Signal words - Warning or

Danger Training by Dec. 1, 2013 MSDS now referred to as SDS.

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Pictograms

Health hazard

Flammable

Irritant

Gas Cylinder

Corrosion

Explosive

Acute Toxins

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Spray bottles, tubs, dispensers Secondary labels must include:

Product name, manufacturer

Hazardous and active ingredients / contents

Precautions

How to use, mixing directions.

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The Co$t of Bad Practices

Ortho / Surgical forceps Ultrasonic inserts Dental units Patient chairs Intra oral cameras Cadcam, wands, screens

Have a Sheriff & Posse for Risk Management

Exposure Control Plan (ECP)

Annual training customized for your practice.

Designated infection control coordinator.

Plan for temps, new employees.

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The essentials of compliance:

1. Office Exposure Control Plan - Use ADA notebook template or the checklist. Blanks must be filled in, dated, updated annually.

2. Name an office IC coordinator.

3. Print / electronic copies of CDC 2003 Guideline, OSHA Bloodborne & Hazard Standards, state laws.

4. Use employee charts to track vaccinations, training. Include dentists, temps, contractors.

5. Training – initial, annual, documented.

Resources ADA compliance kits & training DVDs www.ada.org CDC Guidelines for Dental Infection Control & 2016 Summary www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care.pdf Model plans & templates for Bloodborne Pathogens & Hazard

Communication Compliance: www.osha.gov/Publications/osha3186.pdf OSAP www.osap.org Non-profit group dedicated to the “Safest Dental Visit”

All sites and links updated as of October, 2016

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Certol International is pleased to provide

support for this continuing education program.

Contact Information:

Peggy Spitzer, MA.Ed, RDH, Clinical Education

1-800-843-3343 x 293 pspitzer@certol.com

www.Certol.com