2003 CDC Guidelines for Dental Healthcare SettingsInfection Control, DA116

Review:OSHA = ________CDC = ___________________

◦OSHA Bloodborne Pathogens 1991◦CDC Guidelines 1993◦OSHA Needlestick Safety and

Prevention Act 2001◦CDC Guidelines for Infection Control in

Dental Health-Care Settings — 2003. Built on previous laws and recommendations

OSHA Needlestick Safety and Prevention Act 2001

___________ must consider using safer needle devices to prevent needle-stick injuries

____________ must be involved in identifying and choosing the new devices for office use

CDC 2003 CHANGES

2003 CDC guidelines follow previous CDC guidelines and OSHA Standards but add some details or slight changes to the original documents.

Standard Precautions

Apply to ____ patients Integrate and expand Universal

Precautions to include organisms spread by _____ and also ◦Body fluids, secretions, and excretions

except sweat, whether or not they contain blood OPIM

◦Non-intact (broken) skin◦Mucous membranes

Elements of Standard Precautions

Handwashing Use of gloves, masks, eye

protection, and gowns Injury prevention

Patient care equipment Environmental surfaces

Personnel Health ElementsVaccinations

HBV Influenza Measles, Mumps, Rubella Varicella

◦ Documentation of vaccination or immunity

◦ Baseline TB test upon employment

Post-exposure prophylaxis (PEP) to

HBV, HCV, HIV Offices should make advance

arrangements for testing and treatment with local occupational health physician so no delays in PEP occur

Continued Bloodborne Pathogens Standard compliance

Written work restriction policies for workers infected with or exposed to major infectious diseases

Annual evaluation of safety devices such as dental safety syringes

Guidance for selecting and using PPEProtective

eyewear◦ _____side shields

Thick _____ gloves◦ Instrument

cleaning and housekeeping

_______ surgeons’ gloves for oral surgery

Respirator protection◦ Patients with TB

Hand CareWhen/How to use:

◦ Plain soap◦ Antimicrobial _____◦ Alcohol-based

____________◦ Oral surgical

antisepsis Antimicrobial soaps

or alcohol rubs with persistent activity

NOTE: WASH hands for every 5-10 hand-rubs to keep hands clean

◦ ___________: Prevent/ease skin dryness Caution: type of lotion

◦ Irritant and contact dermatitis

◦ Latex (type I) hypersensitivity Establish latex-safe

environment if necessary

◦ ______ fingernails no artificial nails no finger jewelry

Sterilization and DisinfectionMore detailed than 1993

guidelines◦Sterilizer monitoring◦Sterilization of unwrapped items◦Storage of sterilized items◦Differences between types of

disinfecting chemicals◦Water quality

SPECIAL CONSIDERATIONS

CDC 2003 gives specific guidelines for several situations common to the dental office

Dental Handpieces and Other Devices

Attached to air and waterlines but removable

Permanently attached to air and waterlines

Clean and heat _______ intraoral devices that can be removed from air and waterlines

Follow manufacturer’s instructions for cleaning, lubrication, and sterilization

Do ____ use liquid germicides or ethylene oxide

Items do not enter patient’s mouth but may become contaminated

Use _______ and change between uses

Clean and intermediate-level ________ the surface of devices if visibly contaminated

Saliva Ejectors

Previously suctioned ________ might be retracted into the patient’s mouth when a seal is created

Do not advise patients to close their lips tightly around the tip of the saliva ejector

Dental Radiology

Wear gloves and other appropriate ____ as necessary

Use ______ or single-use items when possible_______ sterilize heat-tolerant radiographic

accessories Transport and handle exposed radiographs so

that they will not become contaminatedAvoid contamination of processing equipment

or computer equipment if using digital

Precautions for Parenteral Medications (medications injected into body)

_____ tubings, bags, connections, needles, and syringes are single-use, disposable

_________ dose vials◦Do not administer to

multiple patients even if the needle on the syringe is changed

◦Do not combine leftover contents for later use

Single-Use (Disposable) DevicesIntended for use on _____ patient

during a single procedureUsually ______ heat-tolerant________ be reliably cleanedExamples: Syringe needles,

prophylaxis cups, and plastic orthodontic brackets

Pre-procedural Mouth Rinses◦Have a patient use an anti-microbial

mouth rinse prior to dental procedure

________ microorganisms in the mouth, aerosol and spatter

Scientific evidence is inconclusive

Precautions for Surgical Procedures

Sterile Irrigating Solutions

Sterile Surgeon’s Gloves

Surgical Scrub

Handling Biopsy Specimens

Place biopsy in sturdy, _________ container

Avoid contaminating the outside of the container

________ with a biohazard symbol

Extracted TeethConsidered

________ medical waste◦Do not incinerate

extracted teeth containing amalgam

◦Clean and disinfect before sending to _____ for shade comparison

Can be given back to patient

Educational setting:◦ Remove visible

blood and debris ◦ Maintain

hydration◦ Autoclave (teeth

with no amalgam)◦ Use Standard

Precautions

Laser/Electrosurgery Plumes and Surgical Smoke

Destruction of tissue creates _______ that may contain harmful by-products◦ Infectious materials (HSV, HPV) may

contact mucous membranes of nose◦ No evidence of HIV/HBV transmission

Need further studies◦no specific recommendations – ◦Note: most offices use HVE to contain

fumes due to offensive odor

Dental Laboratory Dental prostheses,

appliances, and items used in their making are potential sources of contamination

Handle in a manner that protects patients and DHCP from exposure to microorganisms

Clean and disinfect prostheses and impressions

Wear appropriate PPE until disinfection has been completed

Clean and heat sterilize heat-tolerant items used in the mouth

Communicate specific information about disinfection procedures

INFECTIOUS DISEASES

Bloodborn Pathogens are still a concern but CDC 2003 also refers to TB and prion diseases

Transmission of Mycobacterium tuberculosis

Spread by __________ nuclei Healthy immune system usually _________ spread Bacteria can remain alive in the lungs for ______ years

(latent TB infection)

Risk is low in dental setting Baseline TB test recommended at initial hire

Preventing Transmission of TB in Dental Settings

Assess patients for history of ___Defer ________ dental treatmentIf patient must be treated:

◦DHCP should wear respirator mask◦Separate patient from

others/mask/tissue◦Refer to facility with proper TB

infection control precautions

Creutzfeldt-Jakob Disease (CJD) and other prion diseases

Prion: altered form of a normal cellular protein◦ Animal and

human formsLong incubation

period; very rare◦ Results in a fatal,

degenerative CNS disorder “mad cow”

Infection Control for Known CJD or vCJD Dental Patients

◦ Use single-use disposable items and equipment

◦ Consider items difficult to clean (e.g., endodontic files, broaches) as single-use disposable

◦ Keep instruments moist until cleaned

◦ Clean and autoclave at 134°C for 18 minutes

◦ Do not use flash sterilization

PROGRAM EVALUATION

• Periodic observational assessments

• Checklists to document procedures

• Routine review of occupational exposures to bloodborne pathogens