Updated CDC Standards for Infection Prevention in Dental Settings
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Updated CDC Standards for
Infection Prevention in Dental Settings
Certol Intl. LLC
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 [email protected]
www.Certol.com
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