VIII Exposure Control Plan

GEORGIA STATE UNIVERSITY PERIMETER COLLEGEDENTAL HYGIENE PROGRAM EXPOSURE CONTROL PLAN

2014/2015

REVISION DATE: 3/6/14

GEORGIA STATE UNIVERSITY PERIMETER COLLEGE DENTAL HYGIENE PROGRAMBLOODBORNE PATHOGENS/HAZARD COMMUNICATION POLICY

The Dental Hygiene program at Georgia State University Perimeter College is committed to addressing issues related to bloodborne pathogens, such as Human Immunodeficiency (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) in order to protect patients, students, faculty and staff, as well as protect the rights of individuals who may have a bloodborne infectious disease. Students are required to treat all patients assigned and as a result, the potential exists for transmission of bloodborne and other infectious diseases during patient care services. The purpose of the department's Bloodborne Pathogen Policy (BPP) and Exposure Control Plan (ECP) is to minimize the risk of transmission of bloodborne pathogens, as well as, minimize the risk to other environmental hazards. Policies will be reviewed annually and changes recommended as appropriate.

Admission/EmploymentPerimeter College’s Dental Hygiene program will not discriminate against employees, students, applicants for admission or patients based solely on health status. Applicants who test positive for infectious disease or who are carriers of an infectious disease should seek counsel from their physician and the program director prior to application.

ImmunizationsThe risk for exposure to Hepatitis B is higher for Dental Health Care Providers (DHCP) than the general population, therefore, it is recommended that students start the vaccination process for Hepatitis B as soon as they receive acceptance into the program. A comprehensive medical history, physical examination, dental exam, negative Tuberculin (Mantoux) skin test (negative chest x-ray if positive or contraindicated) and immunizations are additional requirements outlined in the ECP.

HIV testing

Testing of DHCP and students for HIV is not required by the Department of Dental Hygiene. However, health care workers and students who perform exposure-prone procedures on patients are encouraged to be tested voluntarily in order to know their HIV status.

Obligation to reportA student will be allowed to continue his/her education as long as their medical condition permits patient care and other individual's health are not jeopardized or at risk. In the event that an individual poses a risk to others, the Dental Hygiene program director will assist the individual in obtaining counseling and advisement regarding their health and education.

ConfidentialityAll information regarding the health status of an individual is confidential and protected by the Family Education Rights and Privacy Act of 1994 and the 1996 Health Insurance Portability and Accountability Act .

Bloodborne Pathogen & Infection Control TrainingThe Dental Hygiene program complies with all local, state and federal infection control policies including the application of Standard Precautions as stipulated by current CDC Guidelines. Written policies and instruction on infection control protocol to minimize the risk of disease transmission is provided in courses throughout the curriculum, at yearly required bloodborne pathogen training sessions and through documents such as the Dental Hygiene Clinic Manual and the Department of Dental Hygiene Exposure Control Plan. Compliance of safety practices is evaluated throughout the students' clinical experience to ensure a safe educational and work environment. The Department of Dental Hygiene Exposure Control Plan which outlines infection control protocol is available to all applicants upon request.

Limitation of ActivityThe Dental Hygiene program will follow CDC suggested work restrictions for health-care personnel infected with or exposed to major infectious diseases in the dental hygiene clinic. A copy of work restriction recommendations is found within the ECP.

Enforcement of Practice Limitations or ModificationsAny student or DHCP who engages in unsafe and/or careless clinical practices, which create risks to the health of patients, employees, or students shall be subject to disciplinary action. When such actions are brought to the attention of the Department Chair, the students or DHCP may be suspended immediately from all patient care activities pending a full investigation of the matter.

Exposure to Bloodborne PathogensDHCP or students who are exposed to a bloodborne pathogen in the course of their clinical care are expected to follow the procedures set forth in the ECP. If a student should be exposed to a patient's body fluids in a manner that may transmit a bloodborne or infectious disease, the patient will be asked to be tested for disease.

Environmental HazardsEnvironmental hazards of dental hygiene practice include: disorders associated with repetitive activities, exposure to high decibel sounds, exposure to hazardous chemicals or substances, accidental injury, exposure to radiation and allergic reactions to latex or other chemical agents.

Communication of Bloodborne Pathogen Policy to Dental Hygiene Clinic PatientsPatients of the Dental Hygiene Clinic are informed of bloodborne pathogen policies at their initial appointments in the clinic. Patients are asked to read the Clinic Brochure which includes the "Patient Responsibilities" and "Your rights as a Patient" The patients are asked to sign the Dental Hygiene Treatment Plan which acknowledges they have received and read this information. The GPC (Perimeter College) Bloodborne Pathogens Policy and Exposure Control Plan are available upon request in the dental hygiene clinic.

Article I. Purpose Section 1.01 General

(a) The Department of Dental Hygiene at Georgia State University Perimeter College is committed to providing a safe and healthful work environment for our faculty, staff, patients and students. This Exposure Control Manual is dedicated to help you practice the highest standards of dental hygiene care - practice that is guided by sound, practical principles of infection control thereby eliminating or minimizing occupational exposure to bloodborne pathogens. Areas addressed in the ECP include:

1) Exposure Determination 2) Personal Health Elements 3) Methods of Compliance

4) Post-Exposure Evaluation & Follow-up 5) Communicating hazards to employees & Training 6) Documentation 7) Evaluation & Review

(b)  The Infection Control Coordinator shall report directly to the Department Chair. However, since one person cannot oversee the day-to-day adherence to the provisions of this manual, the faculty – especially the clinic coordinators in the dental hygiene clinic, the faculty in the pre-clinical areas, and the supervising dentists will be responsible for monitoring and assuring compliance with infection control and safety procedures set forth within.

(c)  The Infection Control Officer will have the responsibility for the written infection control protocols, implementation of the ECP, infection control training and documentation.

(d)  The Infection Control Officer will oversee the purchase of infection control supplies, PPE, engineering controls, labels and red bags.

(e)  Department infection control policies follow guidelines established by the Occupational Safety & Health Administration (OSHA), the Center for Disease Control (CDC), the Environmental Protection Agency (EPA), the Food and Drug Administration (FDA), and the American Dental Association (ADA).

Section 1.02 OSHA Bloodborne Pathogens Standard 29 CFR 1910.1030

(a) A copy of The Bloodborne Pathogens Standard is located in the Safety & Infection Control Manual in the clinic dispensary.

Section 1.03 2003 CDC Guidelines

(a) A copy of the 2003 CDC guidelines is posted in the Safety & Infection Control Manual in the clinic dispensary.

Section 1.04 Universal vs. Standard precautions

(a) The Blood borne Pathogens Standard requires that health care workers practice dentistry using the concept of Universal Precautions. According to this concept, all human blood and certain other body fluids that might be contaminated with blood, including saliva, are treated as if they are infectious of HIV, HBV and other blood borne pathogens.

(b) Standard Precautions integrate and expand the elements of universal precautions into a standard of care designed to protect HCP and patients from pathogens that can be spread by blood or any other body fluid, excretion, or secretion. Standard precautions apply to contact with 1) blood; 2) all body fluids, secretions, and excretions (except sweat), regardless of whether they contain blood; 3) non-intact skin; and 4) mucous membranes. Saliva has always been considered a potentially infectious material in dental infection control; therefore, no operational difference exists in clinical dental practice between universal precautions and standard precautions.

Article II. Employee Exposure Determination Section 2.01 Dental Health Care Professional

“Dental Health Care Professional” (DHCP) shall be used to designate anyone in the Department of Dental Hygiene, be it student, faculty or staff, who may have exposure to infectious or contaminated materials. Students, faculty and staff who are anticipated to have contact with or exposure to blood or other potentially infected materials are required to comply with the procedures and work practices outlined in this ECP.

(a)  Attending infection control training on the control of bloodborne pathogens

(b)  Reading and understanding the ECP

(c)  Planning and conducting all tasks and procedures in accordance with the ECP

(d)  Developing good personal exposure control work habits

(e)  Informing supervisors of exposure incidents and conditions or work practices they believe may cause a bloodborne pathogen exposure to themselves or others.

Section 2.02 Job Classifications/Tasks

(a) The following is a list of job classifications in which some DHCP at our establishment have anticipated occupational exposure. Included is a list of tasks and procedures, in which occupational exposure may occur for these individuals:

1) Dental Hygiene Faculty/Dentists/ 2) Students 3) Clinic Manager/Dispensary Assistant/Receptionist 4) Custodians* 5) Maintenance Personnel*

* The custodians will wear gloves when emptying the non-regulated clinic trash. Maintenance personnel will work only on equipment that has been cleaned and disinfected. Housekeeping will clean only following cleaning and disinfection of dental equipment.

(b) Tasks which could result in possible occupational exposure

1) Patient treatment procedures 2) Radiographic procedures 3) Cleaning, disinfection and sterilization of instruments 4) Environmental surface and equipment disinfection 5) Repairing dental equipment 6) Handling Contaminated laundry 7) Handling Infectious waste 8) Handling patient records 9) Handling extracted teeth

Article III. Personal Health ElementsSection 3.01 Bloodborne Pathogens encountered in dental health-care settings See Appendix A Section 3.02 HBV Vaccination

(a)  GPC vaccination, serologic testing and follow-up recommendations follow U.S. Public Health Service/ CDC recommendations.

(b)  Individuals must be tested 1-2 months after completion of the 3 dose vaccinations series.

(c)  Individuals should complete a second 3- dose vaccine series or be evaluated to determine if they are HBsAg-positive if no antibody response occurs to the primary vaccine series.

(d)  Retest for anti-HBs at the completion of the second vaccine series.

(e)  Individuals who are HBsAg-negative should be counseled regarding their susceptibility to HBV infections and precautions to take.

(f)  Hepatitis B vaccination series is available at no cost to employees and should be obtained by all clinical faculty and dental hygiene students. Should an employee choose to decline the vaccination, the employee must sign the HBV declination form (Appendix B), and may obtain the vaccination at a later date at no cost. Documentation of refusal of the vaccination shall be kept in the department’s personal employee files

Section 3.03 Immunizations

Immunizations are one method to protect DHCP from possible work-related infections. GPC requires students to submit proof of the following immunizations: measles, mumps, rubella, varicella, tetanus/diphtheria, Hep B. Additional recommended immunizations include: meningococcal conjugate, influenza, human papillomavirus series, pneumococcal polysaccharide and hepatitis A series vaccinations. Upon admission into the DH program, students must present a negative mantoux for TB or negative chest x-ray if mantoux is contraindicated or positive. (within the last twelve months)

Section 3.04 Work Restrictions

The presence of certain medical conditions may cause DHCP to be excluded from clinical duties. Decisions regarding medical restrictions shall be made by the Clinic Coordinator based upon epidemiologic evidence and CDC’s Guidelines for Infection Control in Dental Health-Care Settings 2003 (Appendix C). If you suspect you have one of these conditions, it is your responsibility to notify the clinic coordinator and seek appropriate medical care.

Section 3.05 Latex Allergy and Dermatitis

(a)  DHCP should notify clinic coordinator if you notice signs that might indicate dermatitis such as itching, redness, rash, dryness, fissures/cracking, hyperkeratosis.

(b)  DHCP with exudative lesions or weeping dermatitis will be excluded from clinical care and handling patient care equipment. Medical attention must be sought for evaluation and diagnosis in order to determine how to manage the problem and receive patient care clearance.

(c)  Patientsmayalsobeallergictolatexandshouldbeidentifiedbymedicalhistory

(d)  Identify all latex-containing products and devices to prevent their accidental introduction to the hypersensitive patient. A list of latex items utilized in patient care is posted on the clinic bulletin board and found within the program manual. These items should be removed from the designated operatory before patient treatment.

(e)  Should a life-threatening emergency occur, prompt treatment should be provided following GPC emergency protocol.

Article IV. Methods of Compliance Section 4.01 General Recommendations

(a)  Use Standard precautions (OSHA’s bloodborne pathogen standard retains the term universal precautions) for all patient encounters.

(b)  Consider sharp items that are contaminated with patient blood and saliva as potentially infective and establish engineering controls and work practices to prevent injuries

(c)  No eating or drinking in all clinical, sterilization and laboratory areas. This includes students, staff, faculty and patients.

(d)  No application of cosmetics or handling of contact lenses in dental treatment, sterilization or laboratory areas.

(e)  Do not keep food or drink in refrigerators, freezers, shelves, cabinets, or on countertops or bench tops where blood or OPIM are present.

(f)  Perform all procedures in a manner to minimize splashing, spraying, spattering or generation of droplets that might contain infectious materials.

(g)  Before servicing or shipping any dental equipment, decontaminate the equipment.

Section 4.02 Engineering Controls and Work Practices

According to OSHA BP Standard, engineering and work practice controls shall be used to minimize or eliminate exposure of DHCP to infectious diseases.

(a) Engineering controls are controls utilized to isolate or remove bloodborne pathogen hazard from the workplace. Devices utilized that will minimize handling of contaminated items at GPC include:

1) Needle re-cappers 2) Ultrasonic cleaners & IMS trays for instrument cleaning 3)  Sharps disposal containers -- Used needles and other sharps (broken metal instruments) must be placed into puncture resistant, leak proof, closable, red, plastic, “biohazard” labeled sharps containers located between each operatory. Sharps containers must remain upright throughout use. Do not overfill containers. When the sharps container is full, close the lid to prevent spillage during transport. Containers must be disposed of as regulated medical waste, placed into red biohazard bag & labeled box located in the dispensary.

(b) Work Practice controls reduce the likelihood of exposure by altering the manner in which a task is performed.

1)  When recapping a used syringe, dentists must utilize a one handed scooping technique or a mechanical device. Dentists should ensure cap is securely replaced. Uncapped syringes must not be passed to student. 2)  Shearing, bending or breaking anesthetic needles is prohibited. 3)  After using the needle for the last time, DDS should empty the carpule of anesthetic solution and recap needle 4) Following use, needles should be removed and deposited into the nearest sharps container as soon as possible. 5)  Pass instruments with sharp ends pointing away from all persons and announce instrument passes so the receiving DHCP knows a sharp object is coming. Avoid reaching across sharp objects. 6)  When retracting tissue, utilize mirror rather than fingers to avoid potential sharps exposure. Wipe contaminated instruments on 4” cotton rolls secured to bracket tray.

(c) Sharps safety devices evaluation

1) Evaluation of sharps safety devices will take place on a yearly basis at the clinic calibration meeting held in August. The infection control officer will provide information on types & brands of safer dental devices. Devices will be screened to determine whether a device is safe for use on patients, if it has a safety feature that could protect workers from a sharps injury and if it is easy and practical to use.

2) Following screening of the devices, clinic faculty or dentists will “pilot test” the device within the clinic setting and complete the Screening form for dental devices/supplies. (Appendix D) Decisions will be made based upon DDS recommendation.

Section 4.03 PPE

PPE is provided to faculty at no cost and located in the darkroom on hanging racks and in cabinets. (a) Protective Garments

1)  All students, staff and faculty are required to wear long sleeve, closable at neck, fluid resistant, knee length gowns or jackets to cover street clothes or uniforms whenever there is likely to be exposure to infectious fluids or contaminated materials. 2)  Student purchased disposable gowns are be changed when it becomes visibly soiled, when penetrated by blood or body fluids, or at the end of each clinic session. 3)  Faculty shall be provided with white, long sleeve clinic jackets, of sufficient length and size, constructed of a material that will not allow body fluids to pass through under normal conditions. Faculty jackets are to be changed daily, or when jackets are visibly soiled or penetrated by blood or body fluids. Contaminated clinic jackets are to be placed in the plastic laundry bag located in the darkroom at the end of each day. Clinic jackets will be cleaned, laundered, repaired or replaced as necessary by the laundering service. Blue jackets will be worn by faculty when there is not patient contact and will be personally laundered. 4)  All protective garments are to be removed prior to leaving the clinic area. Protective garments may not be worn into the reception area or front office. Hooks are provided in each operatory and in the alcove in order to facilitate removal for short periods of time. 5)  Removal of protective garments must take place in a manner to avoid contact with the contaminated outer surface.

(b) Gloves

1)  OSHA requires that all DHCP wear gloves when a potential exists for contacting blood, saliva, OPIM, or mucous membranes. 2)  Disposable, single use nitrile gloves shall be replaced as soon as feasible when contaminated, when they are torn or punctured, or when their ability to function as a barrier is compromised. 3)  Wear a new pair of medical gloves for each patient, gloves shall be not be washed or decontaminated for re- use. 4)  Gloves are to be removed prior to leaving the operatory. Do not leave the operatory or other treatment area (radiology room, dispensary) with gloves on, with the exception of utility gloves when transporting trays with contaminated instruments to the dispensary for processing. 5)  Faculty nitrile gloves are available in the darkroom in all sizes. Students

will purchase nitrile gloves. 6)  Puncture proof, chemical –resistant utility gloves are to be worn when processing instruments and performing housekeeping tasks involving potential contact with blood or OPIM. These gloves are cleaned, disinfected and re-used unless their barrier properties become compromised. They must be discarded if they are cracked, peeling, torn, punctured or exhibit other signs of deterioration. 7)  Plastic food handlers’ gloves or baggies may be worn over contaminated medical gloves to prevent contamination of clean objects or dental charts needing to be handled during treatment.

(c) Masks, protective eyewear and face shields

1) A surgical mask and appropriate eye protection must be utilized when splashes, sprays, spatters, or projectiles pose a hazard to the eye, nose or mouth. 2)  Protective eyewear should fit closely at the bridge, brow, cheeks and corners of the eyes. Large diameter, durable and scratch resistant glasses with side shields or a face shield are appropriate. Disposable masks with attached face shield may be utilized. 3)  Masks are to be changed between patients or during treatment if mask becomes wet. Avoid touching mask with contaminated gloves. 4)  Masks, eye and face protection must be removed prior to leaving clinical care area. Masks are not to be worn on the chin. 5)  Patients will be provided suitable eye protective glasses during treatment. Patients may utilize personal eyeglasses if they wear them. 6)  GPC recommends the use of face shields during procedures when utilizing an aerosol-generating hand piece, ultrasonic or air polishing unit. 7)  Eyewear/face shields should be cleaned daily with soap and water, or when visibly soiled, clean and disinfect reusable facial protective equipment between patients.

Section 4.04 Hand Hygiene

(a) There are hand washing facilities with foot pedals located between each operatory, which include a sink, disposable paper towel dispenser, soap and alcohol based hand sanitizer.

(b) Soap may not be added to a partially empty soap dispenser. Dispensers are to be discarded when empty.

(c) Hand washing technique:

1)  Wet hands with water 2)  Apply plain or antimicrobial soap and rub to create a lather 3)  Rub hands vigorously for at least 15 seconds, covering all surfaces

4)  Rinse hands with cool water 5)  Repeat steps 2-4 and dry hands thoroughly with a disposable towel

(d) DHCP must perform hand hygiene as follows:

1)  Wash hands with soap and water immediately at the beginning of each day, when hands are visibly dirty or soiled with blood or OPIM, after contact with inanimate objects likely to be contaminated, before eating and after using restroom. 2)  Hand hygiene must also be performed before and after treating each patient, before leaving the operatory, after contact with inanimate objects, after an interruption in treatment, before donning and after removal of gloves. Use of an alcohol-based hand rub may replace soap and water in these instances. (e)  Donning gloves is not considered a substitute for hand washing. (f)  Use of hand lotions to prevent skin dryness associated with hand washing is recommended; however consider compatibility of lotion on glove integrity during glove use. (g)  Keep fingernails short with smooth filed edges to allow thorough cleaning and prevent glove tears. Artificial fingernails are prohibited in the clinic. (h)  Avoid the use of hand jewelry that makes donning gloves difficult or compromises the integrity of the glove.

Section 4.05 Environmental Infection Control

(a) General

1) Perimeter College maintenance shall ensure that the work site floors and walls are kept clean and in sanitary condition. 2) The department of Dental Hygiene has established and implemented a written schedule for periodic maintenance, monitoring, and infection control procedures on equipment within the clinic facility which is posted in the dispensary. 3) Standard operating procedures for operatory cleaning and disinfection of housekeeping surfaces, clinical contact surfaces as well as barrier protection, prior to, and following treatment is outlined in the program manual. 4) The wipe-discard-wipe technique shall be followed at Perimeter College when decontaminating equipment and clinical contact surfaces that require disinfection.

a)  Saturate ONE 4x4 gauze square with the intermediate level hospital cleaner/disinfectant or disinfectant wipe, wipe onto surface, clean the surface and discard. b)  Saturate another 4x4 gauze, wipe the cleaner/ intermediate level

hospital disinfectant onto surfaces and allow drying for manufacturer’s recommended time.

5) Use of PPE, including protective clothing, mask, protective eyewear and utility gloves is required when cleaning and disinfecting. 6) Processing area – The dispensary is divided into receiving, cleaning and decontamination, drying, packaging, sterilization and storage area to prevent cross contamination. 7) Advise patients not to close their lips tightly around the tip of the saliva ejector when evacuating oral fluids due to the potential for backflow.

(b) Equipment/Operatory asepsis

1) Housekeeping & Clinical Contact Surfaces

a) Operatory housekeeping surfaces (except floors and walls) will be cleaned with detergent, following manufacturer’s recommendations at the start of each week. Floors and walls will be maintained by housekeeping unless contaminated with blood or OPIM in which case the same protocol will follow.

b)  Clinical Contact surfaces will be cleaned and disinfected at the start & close of each day utilizing the wipe- discard-wipe technique with an EPA registered intermediate level hospital disinfectant following manufacturer’s directions. Any clinical contact surfaces not protected by barriers and those potentially or visibly contaminated will also be cleaned and disinfected between patients. Air water syringes, although protected by a barrier will be cleaned and disinfected between each patient. Silver trays and suction holders will be cleaned and disinfected in the dispensary between each patient.

c) Chair upholstery will be cleaned with cleanser following patient care whenever ultrasonic or air polishing units are utilized. .

2) Barriers

a) Surface barriers are utilized to protect difficult to clean clinical contact surfaces as outlined in section II of the program manual and are changed between patients.

(c) Single-Use(Disposable)Devices

1) Single use disposable instruments such as sealant applicator tips are acceptable alternatives. Use single use devices for one patient only and dispose of them appropriately.

(d) Instrument Processing Protocol

1) All instruments will be processed in the dispensary area. The left side of the dispensary is designated as receiving, cleaning and decontamination. The back wall is the pre-sterilization and packaging area and the right side is the sterilization and storage area. Clean items exit the dispensary through the large window on the right 2) All items coming in contact with a patient’s body fluids are either sterilized in the autoclave or disposable. 3) All re-usable instruments that can be sterilized in heat sterilizing devices must be thoroughly cleaned in an ultrasonic bath, with the lid in place prior to being heat sterilized before use in the treatment of another patient. Ultrasonic tips and slow speed hand pieces are not placed into the ultrasonic.

4)  Hand piece Processing – Dispensary Assistant, following manufacturer’s recommendations, will oil hand piece prior to heat sterilizing. 5)  Immediately following patient care clinician will:

a)  Remove detergent/disinfectant from cabinet, wash hands and don utility gloves.

b)  Ensure all sharps are placed in the red sharps container, if this has not been already done. Empty carpules will be placed into trash. Empty syringe will remain on silver tray for transport.

c)  Ensure all instruments are returned to the cassette, which is closed, locked and placed onto silver tray. Ensure no instrument tips are protruding from cassette. Discard blue IMS wrap.

d)  Instruments packaged without IMS trays will be transported on silver operatory trays along with a labeled autoclave bag.

e)  Place all regulated medical waste into red biohazard bag on roll cart. Remove bag from side of cart, compress air out and seal. Place onto silver tray for transport.

f)  Remove and discard saliva ejector and run water from air/water syringe into saliva ejector holder for 30 seconds. Place saliva holder onto silver tray.

g)  Utility gloves will be utilized to transport instruments to dispensary.

h)  Upon return to operatory, remove remaining patient barriers & waste.

i)  Clean clinic traps on a weekly basis. See program manual.

j)  Wash utility gloves. Clean/disinfect air water syringe and clinical contact areas not protected by barriers, those visibly soiled or all clinical contact surfaces if it is end of the day.

k) At end of each clinic session, run a quart of suction cleanser through slow speed suction and then replace saliva ejector holder. Disinfect the container.

(e) Autoclave Use, Maintenance and Biological Monitoring

1)  A chemical indicator is placed inside each instrument pack and exterior chemical indicator tape is placed on the package to indicate they have been exposed to sterilizing conditions. Operators must evaluate for sterility prior to use and place strip on rolling cart for review by faculty. Each item sterilized will indicate pack contents, autoclave number and date sterilized on outside of pack. Packager of cassette is to write initial on outside wrap. 2)  Packaging materials for instruments and cassettes include Paper/plastic peel pouches, sterilization wrap for IMS cassettes and plastic lined cloth bags. Glass beakers and ultrasonic lids may be wrapped in paper towels. 3) Items should be separated prior to sterilizing (i.e. Rinn instruments) 4) Autoclaves are to be loosely loaded, based upon manufacturer’s recommendations. Monitoring time, temp & pressure is required on all autoclaves. 5) Following sterilization, packages will be allowed to dry in autoclave before being handled to avoid contamination. 6)  Storage time for sterilized instruments is event-related. Any packaging material that indicates a break in integrity of the packaging should be repackaged and re-sterilized. Packs shall be stored in appropriate location (student bins or dispensary cabinets) upon removal from autoclaves. Only handle packages when absolutely necessary.7) Biological monitoring (spore testing with a matching control) will be performed on all sterilizers on a weekly basis based upon CDC and ADA recommendations. Chemical and biological monitoring records will be maintained. Directions can be found in the Safety & Infection Control Manual.

8) In the event of a positive spore test, the following protocol will be followed:

a) Take the sterilizer out of service immediately and review procedures to evaluate for operator error. b)  Retest the sterilizer using biological, chemical and mechanical indicators after correcting any procedural problems. c)  If repeat spore test is negative and chemical and mechanical tests are normal, put sterilizer back in service. d)  If repeat spore test is positive do not use sterilizer until it has been inspected, repaired or problem identified. e)  Recall and reprocess items from suspect loads. f)  Re-test with spore tests after cause of failure has been determined and corrected.

(f) Ultrasonic Maintenance and Monitoring

1)  Ultrasonic cleaning will be utilized to pre-clean instruments prior to sterilization rather than hand scrubbing, thereby decreasing potential for exposure. 2)  Ultrasonic solution should be discarded daily or earlier if it becomes visibly soiled. 3)  The ultrasonic unit will be rinsed, disinfected, rinsed and dried at the close of the day. 4)  The ultrasonic unit will be tested once a month using the aluminum foil test. Directions are found in the Safety & Infection Control Manual located in the dispensary

(g) Infectious Waste Management Protocol

Waste within the Dental Hygiene Clinic is classified as general or non-regulated medical waste, medical waste (regulated) and hazardous waste.

1) General waste or non-regulated medical waste is to be disposed of in the regular waste cans provided in each operatory and non-clinical area. The CDC states that "the majority of soiled items in dental offices are general medical waste and thus can be disposed of with ordinary waste”. Examples include used gloves, masks, gowns, lightly soiled gauze or cotton rolls, and environmental barriers used to cover equipment during treatment." CDC furthers states that "treating all such waste as infective is neither necessary nor practical" If in doubt as to whether a particular item should be placed in a regulated waste container, err on the side of caution and treat it as regulated waste.

2) Regulated medical waste – Carries the risk of infectivity and is subject to special rules governing storage, transportation, and disposal. Medical waste products that are "soaked or saturated" with blood or OPIM, resulting from patient treatment procedures must be deposited into the red biomedical waste bags which are to be posted at each operatory. Items include soaked or saturated: cotton rolls, gauze, fluoride trays, patient bibs. Following each clinic, air should be expressed out of the red bags, sealed and placed into the large red biohazardous waste bags located in the cardboard box in the dispensary. Gloves must be worn when sealing bags and discarding into large biohazard bins. Directions for sealing regulated waste box are located in Safety & Infection Control Manual & Darkroom. Sealed boxes will be stored in darkroom until removed by contracted regulated waste agency.

3) Hazardous waste -- Waste posing a risk or peril to human beings or the environment. Amalgam waste and radiographic processing solutions will be collected and removed as hazardous waste by a contracted hazardous waste management agency.

a) Amalgam scrap (non-contaminated) shall be stored in wide-mouth, airtight container that is marked "non-contact Amalgam waste for recycling". Amalgam capsules should be stored in the same manner.

b) Radiographic film processing chemicals shall be stored in plastic labeled containers.

(h) Dental Unit Waterlines and Water Quality Monitoring

1)  To maintain waterline quality, an ICX tablet will be added every time the water bottle is empty. Secure one ICX tablet, placing into bottle without touching tablet. Water bottles will be filled with de-ionized water found in the dispensary and attached to unit.

2)  Care must be taken not to touch the pickup tube in the bottle with contaminated fingers when changing the bottle and handle the water reservoir with care to avoid cross contamination.

3) Flush all water lines at the start of each day for 1- 2 minutes to flush stagnant water from lines and between each patient for 30 seconds.

4) To ensure water quality meets EPA regulatory standards for drinking water ( less than 500CFU/mL of heterotrophic water bacteria), waterline monitoring will take place on an as needed basis utilizing an in office system. Directions are in the Safety and Infection Control Manual.

5) If water bottle appears dirty or results from waterline monitoring require, the following "shock" procedure to clean bottles will be followed:

a) Mix a solution of 1:10 mixture of ordinary household bleach.b) Pour 1/2 cup of solution into water bottle, cap bottle and shake for 5 seconds.c) Let stand 10 minutes, shake again and empty.d) Rinse two times with deionized water.

6) Procedure and results of waterline monitoring can be found in Safety & Infection Control Manual located in dispensary.

Section 4.06 Pre-Procedural mouth rinse

Antimicrobial mouth rinses used by patients before a dental procedure are intended to reduce the number of microorganisms the patient might release in the form of aerosols or spatter that subsequently can contaminate DHCP and equipment operatory surfaces. Preprocedural mouth rinses can be most beneficial before a procedure that requires using a rubber cup, air polisher or ultrasonic scaler. Scientific evidence is inconclusive that using these rinses prevents clinical infections among DHCP or patients. All patients are asked to rinse with a pre-procedural rinse for 1 minute.

Section 4.07 Handling of extracted teeth

(a)  Extracted teeth are occasionally collected for use in preclinical educational training. These teeth should be cleaned of visible blood and gross debris and maintained in a hydrated state in a well-constructed closed container during transport. The container should be labeled with the biohazard symbol.

(b)  Extracted teeth containing amalgam restorations should not be heat-sterilized because of the potential health hazard from mercury vaporization and exposure. Perimeter College will only use extracted teeth that have been processed through heat sterilization as a result, extracted teeth with Amalgam will not be utilized at Perimeter College.

(c) Extracted teeth that are being discarded are subject to the containerization and labeling provisions outlined by OSHA's bloodborne pathogens standard. OSHA considers extracted teeth to be potentially infectious material that should be disposed in medical waste containers.

Section 4.08 Eyewash stations

(a) Eyewash stations are located in the dental laboratory, dispensary, darkroom and at sinks # 1/2 and 19/20 within the Dental Hygiene Clinic. In

the event of exposure of the eye to blood, OPIM, or particles, proceed to station and flush eye with cool water prior to seeking medical care. Eyewash stations will be checked monthly.

Section 4.09 Dental Laboratory

The dental lab shall be maintained as a “clean” lab. Students are required to maintain all lab supplies in a tidy, clean, and presentable manner at all times. In order to make this possible, each student must clean-up his/her work area(s) before leaving the laboratory.

(a)  Before transporting impressions to the darkroom/lab, clean, disinfect and rinse by using a 5:1 ratio bleach solution.

(b)  Place saran to maintain cleanliness and asepsis whenever practical; discard barriers after use.

(c)  The wipe-discard-wipe technique shall be followed when decontaminating equipment and surfaces within the laboratory by using an EPA-registered hospital disinfectant with an intermediate level activity, following manufacturer’s recommendations.

(d)  Clothing should be protected from spatter and airborne debris.

(e)  Disposable single-use impression trays will be utilized in the Perimeter College Clinic.

(f)  Laboratory hand instruments such as spatulas, mixing bowls, and environmental surfaces should be cleaned and disinfected between uses.

Section 4.10 Radiographic infection control protocol

(a) The CDC includes saliva among its listing of potentially infectious body fluids. Following the concept of STANDARD PRECAUTIONS, each patient will be managed as potentially infectious and appropriate cleaning, disinfection and barriers will be utilized throughout the exposure and processing of radiographs.

(b)  Clinic attire, use of appropriate barriers, hand-washing, gowns and Gloves are required when radiology examinations are performed. Masks and glasses are optional.

(c)  Use surface barriers to protect clinical contact surfaces. See Radiographic Infection Control Protocol under

Radiographic Policies and Procedures.

(d)  Use heat-tolerant or disposable intra-oral devices. Clean and sterilize heat-tolerant devices between patients (i.e. Rinn)

(e)  Transport and process exposed radiographs in an aseptic manner to prevent contamination of developing equipment. See Radiographic Infection Control Protocol under Radiographic Policies and Procedures.

(f) Digital radiography sensors are considered semi-critical devices. The following protocol will be followed:

1) Use FDA-cleared barriers on sensor and keyboard as well as on radiographic equipment as outlined in radiology course materials.

2) To minimize potential for device-associated infections, after removing the barrier, clean and disinfect using an EPA-registered hospital disinfectant with an intermediate-level activity after each patient.

Section 4.11 Broken Glass

(a) All non-contaminated broken glass must be placed into the cardboard box lined with a plastic bag labeled “Caution - broken glass,” which is located in the pump room. Containers which will be discarded along with the broken glass must be puncture and leak proof. Once full, close the top of the box, secure with tape. Custodians will place the whole container into the general trash.

Article V. Post Exposure Evaluation and Follow-up Section 5.01 Financial Information

Should an exposure incident occur, contact Clinical Coordinator. Perimeter College Dental Hygiene Program patients, student or faculty may contact the following locations for confidential post-exposure testing. Following testing, individuals MUST obtain immediate and appropriate medical evaluation and follow-up care. A qualified healthcare provider will assess the level of risk to determine appropriate medical management.

(a)  Following an exposure, faculty, students and patients are to IMMEDIATELY report to Concentra Sandy Springs Urgent Care Center for rapid response testing. Physicians are available at the site for post-

exposure counseling. Expenses will be billed directly to the Dental Hygiene Program.

Concentra Urgent Care6334 Roswell Road NE, Ste C Sandy Springs, Ga. 30328 678-812-2277

(b)  Worker's Compensation program will cover any job-related injury. Faculty are to report an injury to supervisor immediately.

Section 5.02 Post Exposure Management Protocol

(a)  Provide immediate care to the exposure site by washing wounds with soap and water or flushing mucous membranes with water.

(b)  Report incident to clinic coordinator.

(c)  Contact Public Safety right away for them to come and document the incident. All original copies of documentation are given to Public Safety and they will forward to OSHA officer on Clarkston campus. We keep a copy of the documents.

(d)  Determine risk associated with exposure by evaluating type of fluid or OPIM and type of exposure.

(e)  Contact workers compensation if faculty.

(f)  Complete post exposure incident report form found in clinic forms including how exposure incident occurred and source patient information. (Appendix E)

(g)  Clinic Coordinator shall obtain consent and make arrangements to have the source individual tested as soon as possible to determine HIV, HCV, and HBV infectivity. If the source individual is already known to be HIV, HCV, and/or HBV positive, new testing need not be performed. Department Chair shall provide the exposed employee/student with the source individual's test results and information about applicable disclosure laws and regulations concerning the source identity and infectious status.

(h)  Arrangements shall be made to have exposed individual’s (student or faculty member) blood drawn as soon as feasible after exposure incident, and test blood for HBV, HCV and HIV serological status. Information provided to the Healthcare Professional should include:

1)  A description of the individual’s activities or duties relevant to the exposure incident.

2)  Route(s) of exposure.

3)  Circumstances of exposure.

4)  If possible, results of source individual’s blood test.

5)  Relevant individual’s (student or faculty member) medical records, including vaccination status.

6)  Copy of OSHA Bloodborne Pathogen Standard.

(i)  The exposed individual’s post-exposure evaluation records, including records pertaining to the infectivity status of the source of exposure will be stored in the Department Chair office. Following receipt of testing documentation, that information will also be forwarded to the OSHA officer. All other diagnoses must remain confidential and not be included in the written report to the College.

(j)  Department Chair records all injuries from contaminated sharps in the Sharps Injury Log.

(k)  The department chair and DH infection control officer will review the circumstances of any exposure incident to evaluate:

1)  Engineering controls in use at the time (of the incident) 2) Work practices followed 3)  A description of the device being used (including type and brand) 4)  Protective equipment or clothing that was used at the time of the exposure incident (gloves, eye shields, etc.) 5)  Procedures being performed when incident occurred 6)  Individual’s training (student or faculty member) 7)  Procedures, protocols and/or training need to be revised to prevent a re-occurrence of the incident.

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Article VI. Communication of Hazards & Training

OSHA requires employers communicate information of the hazards associated with any chemicals utilized by their employers. This information is provided by means of labels on containers, Material Safety Data Sheets and training programs to provide employees information they need to protect themselves from hazard. Specific information on Laboratory and Chemical

Safety may be found in the LABORATORY & CHEMICAL SAFETY PLAN located in the MSDS manuals.

Section 6.01 Labels & Signs

Warning labels shall be affixed to containers of regulated waste and other containers used to store, transport items contaminated with blood or OPIM, sharps, hazardous waste, radiation units and items containing chemical hazards.

(a)  All areas of potential exposure to radiation shall be posted with a “radiation symbol” label

(b)  All bags/containers storing or transporting regulated medical waste (containing blood or OPIM) that has not been decontaminated and/or sharps shall be posted with a “biohazard” symbol or label and be red/orange in color

(c)  All waste subjected to EPA or local landfill disposal restrictions shall be labeled “hazardous waste.”

(d)  Original containers of hazardous chemicals are appropriately labeled by the manufacturer and must remain intact.

(e)  All secondary containers, tubs, bottles which are filled with potentially hazardous substances shall be labeled according to OSHA's hazard communication guidelines. Chemical identification hazard labels shall include chemical name, common name if different, active ingredients, and either a number or words that indicate the specific chemical or physical hazard.

Section 6.02 MSDS

(a)  The department maintains a Material Safety Data Sheet reference for all products used in the dental laboratory and Dental Hygiene Clinic to inform DHCP of potential hazards of use.

(b)  The MSDS are housed in a notebook labeled “Material Safety Data Sheets” located on the safety corner shelf in the dispensary and lab shelf in the laboratory.

(c)  Information provided includes the chemicals present, fire and explosion hazard data, reactivity data, the associated health hazards, precautions for handling and cleanup procedures, and special PPE that needs to be in place.

Section 6.03 Yearly Training

(a)  All faculty, staff and students who have occupational exposure to bloodborne pathogens receive training at initial assignments, and at least annual training thereafter. Additional training shall be conducted when modification of task or procedures affect the occupational exposure of DHCP.

(b)  Annual training shall include:

1)  Notification on where to locate the OSHA standard and an explanation of its content

2)  General information on the epidemiology and symptoms of bloodborne diseases

3)  Information of the modes of transmission of bloodborne pathogens

4)  Explanation of the department's exposure control plan and distribution of a copy.

5)  Explanation of appropriate methods for recognizing tasks and other activities that may involve exposure to blood and OPIM.

6)  An explanation of the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls, work practices and PPE.

7)  Information on the types, proper use, location, removal, handling, decontamination and disposal of PPE.

8)  An explanation of the basis for selection of personal protective equipment.

9)  Information on the Hepatitis B vaccine, including information of its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine and vaccination will be offered free of charge.

10)  Information on the appropriate actions to take, and persons to contact in an emergency involving blood or OPIM.

11)  An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident

and the medical follow-up that the employer is required to provide for the employee following an exposure incident.

12)  Information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident.

13)  An explanation of the signs and labels and/or color coding required for hazard communication. Location of MSDS sheets, emergency phone #'s; emergency equipment location.

14)  An opportunity for interactive questions and answers with the person conducting the training session.

Article VII. Record Keeping Section 7.01 Records

(a) Faculty/staff immunization records shall be stored in department personnel files. Medical records for each employee with occupational exposure are maintained for the duration of employment and 30 years thereafter. The department chair shall ensure confidentiality of employee medical records.

(b) Medical records shall include:

1)  Hepatitis B vaccination status, including dates of vaccination. A negative mantoux for TB or negative chest x-ray if mantoux is contraindicated or positive, should be completed within the last twelve months prior to hire. (TB Exposure Control Plan. Appendix F)

2)  A copy of post-exposure medical evaluations and information provided to the physician providing medical evaluation.

(c) Tests received as a result of occupational exposure shall be stored in Department Chair's Post-exposure file.

(d) Documentation of annual training shall be maintained by Department in the Dispensary notebook for a period of three years from the date on which the training occurred and include:

1)  The name & qualification of the trainer, dates of the training 2)  Summary of the training session 3)  Names and job titles of all persons attending the training

Article VIII. Evaluation & Review

Section 8.01 This manual is to serve as the annual required updated version of the Exposure Control Plan for the Department of Dental Hygiene effective August of each year. August was chosen as the time for the annual review and update since this is the time prior to the beginning of fall clinic. The Exposure Control Plan will be modified during the year whenever new or modified procedures affect occupational exposure of the health care worker and if new job titles are created that have occupational exposure.

Article IX. Appendix

1. (a)  Bloodborne Pathogens encountered in dental health care setting. 2. (b)  Hepatitis B Vaccine Declination Form 3. (c)  Suggested Work Restrictions 4. (d)  Device Evaluation Form 5. (e)  Post Exposure Incident Report Form 6. (f)  TB Exposure Control Plan

NOTE TO STEVE: AT THIS POINT, PLEASE PICK UP FROM THE ORIGINAL EXPOSURE CONTROL PLAN at http://depts.gpc.edu/~gpcdh/documents/Section%20VIII%20ECP%202014.pdf BECAUSE IT INCLUDES FORMS AND ARTICLES THAT WILL NOT COPY AND PASTE ONTO THIS WORD DOCUMENT. USE THAT FOR THE REMAINDER OF THE EXPOSURE CONTROL PLAN. SOME UPDATING OF THE COLLEGE NAME, ETC. WILL BE NEEDED FROM THE ORIGINAL.