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Infection Prevention and Control in Dentistry Ellen Gambardella, CDA, RDA, FADAA, M.Ed.

POB 935 Nutting Lake, MA 01865

Suggested Resources … periodically update this handout to access the most up-to-date information. .

Centers for Disease Control and Prevention – CDC 1-800-CDC-INFO or 1-800-232-4636 E-mail: cdcinfo@cdc.gov Web: cdc.gov/oralhealth

New CDC Summary and Checklist The Centers for Disease Control and Prevention’s (CDC) Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care and Companion Checklist is a new (March 2016) document that includes several new recommendations and provides an assessment checklist to evaluate staff compliance. Table below is from http://www.osap.org/page/NewCDCSummary

What the Summary and Checklist Are: What They Are Not:

Basic infection control expectations for providing safe dental care. Based on the principles of Standard Precautions and CDC’s Guidelines for Infection Control in Dental Health-Care Settings–2003

Companion to CDC’s Guidelines for Infection Control in Dental Health-Care Settings–2003

Replacement for the current CDC Guidelines contained in Guidelines for Infection Control in Dental Health-Care Settings–2003 Summary of regulations. CDC is not a regulatory agency and does not develop any rules or regulations.

Comprehensive document that includes the

background, scientific evidence, and

rationale for each recommendation

“Guidelines for Infection Control in Dental Health‐Care Settings – 2003” Appendix A: Regulatory Framework for Disinfectants and Sterilants Includes: Decreasing Order of Resistance of Micro-organisms to Germicidal Chemical Appendix B: Immunizations Strongly Recommended for Health-Care Personnel (HCP) Appendix C: Methods for Sterilizing and Disinfecting Patient-Care Items and Environmental Surfaces www.cdc.gov/mmwr/PDF/rr/rr5217.pdf

Evidence based guidelines for “standard of care” Available online as PDF document

Latest CDC Guidelines - Key Recommendations - March 2016

Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care

Infection Prevention Checklist for Dental Settings (Print-Friendly)

Infection Prevention Checklist for Dental Settings (Fillable Form) Recommendations from the Guidelines for Infection Control in Dental Health-Care Settings, 2003 and 2016

http://www.cdc.gov/oralhealth/infectioncontrol/guidelines/

Posters - Sequence for Donning and Removing Personal Protective Equipment. This poster demonstrates the

sequence for donning and removing PPE. The poster provides key instructions to reinforce safe practices and are

intended to limit the spread of contamination.

http://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf

Cover Your Cough Flyer, for Health Care Settings

http://www.cdc.gov/flu/protect/covercough.htm

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Management of Occupational Blood Exposures to HBV, HCV, or HIV www.cdc.gov/.../occupational_exposure_HBV, HCV, HIV

Call the National Clinicians' Postexposure. Prophylaxis Hotline

(PEPline) 888-448-4911 or

(PEPline) website www.ucsf.edu/hivcntr/PEPline/index.html.

Influenza Information for Healthcare Professionals http://www.cdc.gov/flu/professionals/index.htm

CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health‐Care Settings, 2005. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm CDC Patient Safety Healthcare‐associated Infections (HAI)

http://www.cdc.gov/ncidod/dhqp/patientsafety.html Safe Injection Practices in Dentistry

Device Screening and Evaluation Forms

http://www.cdc.gov/oralhealth/infectioncontrol/forms.htm

Sterilization / Monitoring http://www.cdc.gov/oralhealth/infectioncontrol/faq/sterilization_monitoring.htm

National Institute for Occupational Safety and Health (NIOSH) (Chemicals, Nitrous Oxide, Gypsum, Latex, etc.) www.cdc.gov/OralHealth/infectioncontrol CDC Immunization Recommendations for Healthcare Workers www.cdc.gov/vaccines/spec-grps/hcw.htm

Federal OSHA Standards http://www.osha.gov/SLTC/dentistry/standards.html

http://www.osha.gov/SLTC/dentistry/index.html (1910.1030)

OSHA Poster - must be placed where employees will see it. You can download a copy or order a copy from OSHA’s website at www.osha.gov/publications or by calling (800) 321-OSHA

Bloodborne Pathogens Standard (29 CFR 1910.1030) https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051

U. S. Department of Labor Occupational Safety and Health Administration OSHA Standards: General Duty Clause”, Bloodborne Pathogens, and Hazard Communications. http://www.osha.gov/SLTC/dentistry/standards.html

Recordkeeping Regulation (29 CFR 1904)

https://www.osha.gov/recordkeeping/index.html

Personal Protective Equipment, general requirements (1910.132)

https://www.osha.gov/SLTC/personalprotectiveequipment

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Hand Protection (1910.138)

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9788

Eye and Face Protection (1910.133)

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9778

Respiratory Protection (1910.134)

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=12716

Hazard Communications Standard (1910.1200)

https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10099

Identification and chemical / physical hazards inventory (mercury, silica dust, radiation, etc. found in your work

environment.

http:/www.osha.gov/SLTC/dentistry/recognition.html

Hazard Communication Standard (supports Global Harmonization

https://www.osha.gov/dsg/hazcom/index.html Nitrous Oxide and other gases

Exposure Control Plan model organizes the required information with a fill‐in‐the‐ blank template.

http://www.osha.gov/OshDoc/Directive_pdf/CPL_2‐2_69_APPD.pdf

State OSHA Plans: Check site for states that have approved OSHA State Plans

http://www.osha.gov/dcsp/osp/index.html

Environmental Protection Agency (EPA) www.epa.gov http://www.epa.gov/epawaste/hazard/ Public law that creates the framework for the proper management of hazardous and non-hazardous solid waste. Resource Conservation and Recovery Act (RCRA) http://www.epa.gov/wastes/laws-regs/regs-haz.htm http://www.epa.gov/wastes/hazard/dsw/rulemaking.htm

Media, Training Programs, Textbooks, Other Relevant Materials If Saliva Were Red: A Visual Lesson on Infection Control (Video) https://osap.site‐ym.com/store/ViewProduct.aspx?nonssl=1&id=401466

CE 90 - Guidelines for Infection Control in Dental ... - Dentalcare.com

www.dentalcare.com/media/en-US/education/ce90/ce90.pdf

CDC Hand Hygiene Course http://www.cdc.gov/handhygiene/training/interactiveEducation/ Molinari John, Harte Jennifer Cottone's Practical Infection Control in Dentistry. Lippincott Williams & Wilkins, 3rd edition Comprehensive infection control textbook for all dental professionals

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“From Policy to Practice: OSAP’s Guide to CDC Guidelines.” OSAP – Organization for Safety and Asepsis Procedures www.osap.org https://osap.site-ym.com/store/view_product.asp?id=396090 A practical approach to Infection Control protocols. Easy to read and understand. List of Infection Control Resources assembled by K. Eklund - OSAP www.osap.org/resource/resmgr/Grant_Projects/Eklund_Infection_Control Infection Prevention and Control Resources for Dental Healthcare Settings.

Dental Assisting National Board … Infection Control Examination

danb.org

http://www.danb.org/Become-Certified/Exam-and-Certification-FAQs.aspx

Infection Control Resources - American Dental Association www.ada.org/member.../infection-control-resources Mar 29, 2016 The Organization for Safety, Asepsis and Prevention (OSAP) is a growing community of clinicians, educators, researchers, and industry representatives who advocate for safe and infection-free delivery of oral healthcare. OSAP focuses on strategies to improve compliance with safe practices and on building a strong network of recognized infection control experts. OSAP offers an extensive online collection of resources, publications, FAQs, checklists and toolkits that help dental professionals deliver the safest dental visit possible for their patients. Plus, online and live courses help advance the level of knowledge and skill for every member of the dental team. www.osap.org Portable and Mobile Dental Programs – Infection Control Resources http://www.osap.org/?page=PortableMobile

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SEQUENCE FOR PUTTING ON

PERSONAL PROTECTIVE EQUIPMENT (PPE)

The type of PPE used will vary based on the level of precautions required, such as standard and contact, droplet or airborne

infection isolation precautions. The procedure for putting on and removing PPE should be tailored to the specific type of

PPE.

1. GOWN • Fully cover torso from neck to knees, arms

to end of wrists, and wrap around the back

• Fasten in back of neck and waist

2. MASK OR RESPIRATOR • Secure ties or elastic bands at middle

of head and neck

• Fit flexible band to nose bridge

• Fit snug to face and below chin

• Fit-check respirator

3. GOGGLES OR FACE SHIELD • Place over face and eyes and adjust to fit

4. GLOVES • Extend to cover wrist of isolation gown

USE SAFE WORK PRACTICES TO PROTECT YOURSELF AND LIMIT THE SPREAD OF CONTAMINATION

• Keep hands away from face

• Limit surfaces touched

• Change gloves when torn or heavily contaminated

• Perform hand hygiene

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HOW TO SAFELY REMOVE PERSONAL PROTECTIVE EQUIPMENT (PPE) EXAMPLE 1

There are a variety of ways to safely remove PPE without contaminating your clothing, skin, or mucous membranes with

potentially infectious materials. Here is one example. Remove all PPE before exiting the patient room except a respirator, if

worn. Remove the respirator after leaving the patient room and closing the door. Remove PPE in the following sequence:

1. GLOVES • Outside of gloves are contaminated!

• If your hands get contaminated during glove removal, immediately wash your hands or use an alcohol-based hand sanitizer

• Using a gloved hand, grasp the palm area of the other gloved hand and peel off first glove

• Hold removed glove in gloved hand

• Slide fingers of ungloved hand under remaining glove at wrist and peel off second glove over first glove

• Discard gloves in a waste container

2. GOGGLES OR FACE SHIELD • Outside of goggles or face shield are contaminated!

• If your hands get contaminated during goggle or face shield removal, immediately wash your hands or use an alcohol-based hand sanitizer

• Remove goggles or face shield from the back by lifting head band or ear pieces

• If the item is reusable, place in designated receptacle for reprocessing. Otherwise, discard in a waste container

3. GOWN • Gown front and sleeves are contaminated!

• If your hands get contaminated during gown removal, immediately wash your hands or use an alcohol-based hand sanitizer

• Unfasten gown ties, taking care that sleeves don’t contact your body when reaching for ties

• Pull gown away from neck and shoulders, touching inside of gown only

• Turn gown inside out

• Fold or roll into a bundle and discard in a waste container

4. MASK OR RESPIRATOR • Front of mask/respirator is contaminated — DO NOT TOUCH!

• If your hands get contaminated during mask/respirator removal, immediately wash your hands or use an alcohol-based hand sanitizer

• Grasp bottom ties or elastics of the mask/respirator, then the ones at the top, and remove without touching the front

• Discard in a waste container

5. WASH HANDS OR USE AN

ALCOHOL-BASED HAND SANITIZER OR IMMEDIATELY AFTER REMOVING

ALL PPE

PERFORM HAND HYGIENE BETWEEN STEPS IF HANDS BECOME CONTAMINATED AND IMMEDIATELY AFTER REMOVING ALL PPE

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HOW TO SAFELY REMOVE PERSONAL PROTECTIVE EQUIPMENT (PPE) EXAMPLE 2

Here is another way to safely remove PPE without contaminating your clothing, skin, or mucous membranes with potentially

infectious materials. Remove all PPE before exiting the patient room except a respirator, if worn. Remove the respirator after

leaving the patient room and closing the door. Remove PPE in the following sequence:

1. GOWN AND GLOVES A B C

• Gown front and sleeves and the outside of gloves are contaminated!

• If your hands get contaminated during gown or glove removal, immediately wash your hands or use an alcohol-based hand sanitizer

• Grasp the gown in the front and pull away from your body so that the ties break, touching outside of gown only with gloved hands

• While removing the gown, fold or roll the gown inside-out into a bundle D E

• As you are removing the gown, peel off your gloves at the same time, only touching the inside of the gloves and gown with your bare hands. Place the gown and gloves into a waste container

2. GOGGLES OR FACE SHIELD • Outside of goggles or face shield are contaminated!

• If your hands get contaminated during goggle or face shield removal, immediately wash your hands or use an alcohol-based hand sanitizer

• Remove goggles or face shield from the back by lifting head band and without touching the front of the goggles or face shield

• If the item is reusable, place in designated receptacle for reprocessing. Otherwise, discard in a waste container

3. MASK OR RESPIRATOR • Front of mask/respirator is contaminated — DO NOT TOUCH!

• If your hands get contaminated during mask/respirator removal, immediately wash your hands or use an alcohol-based hand sanitizer

• Grasp bottom ties or elastics of the mask/respirator, then the ones at the top, and remove without touching the front

• Discard in a waste container

4. WASH HANDS OR USE AN

ALCOHOL-BASED HAND SANITIZER

IMMEDIATELY AFTER REMOVING OR

ALL PPE

PERFORM HAND HYGIENE BETWEEN STEPS IF HANDS BECOME CONTAMINATED AND IMMEDIATELY AFTER REMOVING ALL PPE

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The best time to prepare for an emergency is before it happens.

During an emergency, it's easy to become disoriented and upset, so

have all important phone numbers readily available ahead of time.

Duplicate – Laminate – Post emergency phone numbers by each phone.

Emergency Call List

911 – stay calm – allow operator to ask questions

give your phone number _________________________________ and

address where help is needed __________________________________

Hospital Emergency Room _____________________________________

Public Health Facility (for occupational exposure) __________________

Poison Control Center ________________________________________

Local Physician ______________________________________________

Police Department ___________________________________________

Fire Department _____________________________________________

Emergency Call List

911 – stay calm – allow operator to ask questions

give your phone number _________________________________ and

address where help is needed __________________________________

Hospital Emergency Room _____________________________________

Public Health Facility (for occupational exposure) __________________

Poison Control Center ________________________________________

Local Physician ______________________________________________

Police Department ___________________________________________

Fire Department _____________________________________________

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CDC Key Administrative Recommendations for Dental Settings: Facility has system for early detection and

management of potentially infectious persons at initial points of patient encounter. Post signs at entrances …