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CDC GuidelinesAll dental settings, regardless of the level of care provided, must make infection prevention and control (IPC) a priority and should be equipped to observe Standard Precautions and other IPC recommendations in the CDC Guidelines for Infection Control in Dental Health-Care Settings — 2003.
Below is an overview of the nine key elements of the CDC Guidelines. Detailed information on all of these can be found in the following resources:
Additional resources with more information on specific topics are included in each section below. 1. Personnel Health Elements of an Infection-Control ProgramA written health program should be developed for dental healthcare workers. Personnel health elements covered in this program (with policies, procedures, and guidelines) include:
Resources
2. Preventing Transmission of Bloodborne PathogensThe CDC recommendations include immunization recommendations against Hepatitis B (HBV), testing post-immunization, education on the risks of HBV, counseling, and general recommendations related to standard precautions and OSHA’s Bloodborne Pathogens Standard. In addition, engineering and work controls to reduce the risk of sharps injuries are addressed, and postexposure management and prophylaxis. In accordance with OSHA requirements, all personnel with occupational risk for bloodborne pathogens must be offered Hepatitis B vaccination at no charge prior to performing tasks with potential exposure. If they decline, they must sign a Hepatitis B declination form which must be kept in the personnel records. Resources
3. Hand HygieneHand hygiene must be performed: Before donning (putting on) and after doffing (taking off) gloves; when changing gloves during a procedure; before and after ungloved skin contact with patients; following ungloved skin contact with potentially contaminated inanimate surfaces. The specific method depends on the type of procedure, presence/absence of visible contamination, and other factors. Resources4. Personal Protective Equipment (PPE)PPE protects skin, and mucous membranes of the eyes, nose, and mouth, from exposure to blood or other potentially infectious material (OPIM) via direct/indirect contact, splashes, spatter (splatter), and bacterial aerosols. PPE is required during patient care, instrument processing, and operatory clean-up. Appropriate gloves, surgical facemasks, protective eyewear, and protective clothing are also mandated by OSHA when there is an occupational risk of exposure to bloodborne pathogens. During influenza epidemics and for specific diseases (e.g., TB), NIOSH respirators should be used instead of surgical facemasks as part of transmission-based/isolation precautions. Resources
5. Contact Dermatitis and Latex HypersensitivityLatex hypersensitivity reactions and irritant and allergic contact dermatitis can be associated with frequent hand hygiene and glove use. Using products containing emollients and hand lotion helps to prevent irritation (not allergic reactions). Latex Type I hypersensitivity occurs rapidly can include itching, runny nose, asthma, difficulty breathing, and is potentially life-threatening. Non-latex gloves must be available for personnel and patients, and emergency treatment kits containing latex-free products must always be available. Resources6. Sterilization and Disinfection of Patient-Care Items (Instrument Processing)Instrument Processing is required for all reusable instruments and devices. Appropriate PPE must be worn (see above). A designated central processing area is recommended. The stages involved include 1) Transportation; 2) Sorting (critical, semi-critical, and noncritical instruments per Spaulding’s classification; 3) Cleaning (optional pre-soak) – preferably automated cleaning, which is more effective and safer; 4) Preparation and Packaging; 5) Sterilization; and, 6) Storage. Only semi-critical instruments may be sterilized unwrapped, and provided they will be used immediately. Semi-critical heat-sensitive reusable instruments (except handpieces) may be processed after the cleaning stage by using FDA-cleared, high-level sterilant/disinfectants in accordance with the instructions for use. Handpieces must be cleaned and heat-sterilized; the manufacturer’s instructions must be followed. Sterilization monitoring consists of mechanical, chemical, and biological (spore test) indicators – these are to be used in accordance with the CDC recommendations. Resources
7. Environmental Infection ControlEnvironmental surfaces consist of housekeeping surfaces and clinical contact surfaces. The requirements for clinical contact surfaces are more stringent as there is a greater risk of contact with these by personnel, patients, and instruments/devices. Requirements for clinical contact surfaces include the use of an EPA-registered intermediate-level or low-level disinfectant – an intermediate-level is required if the surface is visibly contaminated with blood. The surfaces must be cleaned prior to disinfection – if the disinfectant contains a cleaning agent (i.e., is a cleaner/disinfectant), then the same product may be used for cleaning and disinfecting. If not, a separate cleaner must be used, then the disinfectant. Appropriate PPE must be worn during cleaning and disinfecting of surfaces. Clinical contact surfaces can be treated with barrier protection replaced for each patient and are especially useful for difficult-to-clean surfaces. Resources
8. Dental Unit Waterlines, Biofilm, and Water QualityWater from dental unit waterline (DUWL) water must meet the standards for drinking water (<500 CFU/mL of heterotrophic water bacteria) for routine dental treatment output water. For routine, nonsurgical care, DUWL should be treated and maintained using a product intended for this use. Antiretraction valves/devices in the dental unit must also be maintained in accordance with the unit’s manufacturer’s recommendations. During a boil-water advisory, water from the DUWL and public water supply may not be used for patient care, rinsing, or hand hygiene. Resources
9. Special ConsiderationsThe CDC Guidelines also contain information and recommendations on other issues under “Special Considerations.” Each of these topics is listed below.
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Additional Resources
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| Last Updated on Monday, December 30, 2024 10:25 PM |
