1. Chapter 17 Infection Control Systems Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved.

2. Infection Control Disease prevention is the role of everyone in the dental office. As an administrative assistant, you must understand both the risks and management of occupational exposures to blood borne pathogens.

3. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. The Role of the Administrative Assistant in Infection Control Responsibilities include A thorough understanding of the routes of disease transmission Maintaining an adequate inventory of acceptable disinfectants, sterilants, personal protective equipment (PPE), and barrier covers Maintaining records verifying compliance with the Occupational Safety and Health Administration (OSHA) requirements

4. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. The Role of the Administrative Assistant in Infection Control Responsibilities Transmitting spore samples to the appropriate monitoring agencies for determination of sterilization effectiveness Attending training sessions Maintaining records on employees Verifying employee compliance with OSHA Scheduling continuing education courses for the staff

5. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. The Role of the Administrative Assistant in Infection Control Responsibilities Verifying quality assurance Maintaining all Material Safety Data Sheet (MSDS) forms Arranging for the disposal of hazardous waste Providing infection control training for new employees Interacting with outside agencies

6. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Organizations Associated with Infection Control  The American Dental Association (ADA), the Organization for Safety and Asepsis Procedures (OSAP), and the Centers for Disease Control and Prevention (CDC) have established infection control and safety procedures for the dental healthcare worker (DHCW).

7. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Guidelines for Infection Control in Dental Health Care Settings Guidelines from the CDC provide recommendations on Educating and protecting dental healthcare personnel Preventing the transmission of bloodbourne pathogens Hand hygiene PPE Contact dermatitis and latex hypersensitivity

8. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Guidelines for Infection Control in Dental Health Care Settings Guidelines Sterilization/disinfection of patient care items Environmental infection control Dental unit water lines, biofilm, and water quality Special considerations (e.g., dental handpieces and other devices, radiology, parenteral medications, oral surgical procedures, and dental laboratories)

9. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Disease Transmission Diseases can be transmitted by various media during dental treatment including blood, saliva, nasal discharge, dust, hands, clothing, and hair.

10. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Types of Infections Autogenous infections are infections in which the patient is the source. When a patient has an infection in one site and it is transferred to another site Cross-infections are transferred from one person to another. When a person coughs or sneezes, the caregiver may contract the infection through airborne or droplet transmission.

11. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Routes of Infection Transmission Transmission in the dental office occurs by three general routes: Direct contact with a lesion, organisms, or debris during intraoral procedures Indirect contact through contaminated dental instruments, equipment, or records Inhalation of aerosols from a patient’s blood or saliva during the use of high-speed or ultrasonic equipment, such as a high-speed handpiece or an ultrasonic scaler

12. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Breaking the Chain of Disease Transmission Because every member of the health care team is responsible for breaking the chain of infection, you must review the cycle of disease transmission.

13. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Cycle of Disease Transmission

14. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Safe Practice Principles Practicing safely includes Obtaining a complete and accurate patient history Observing aseptic techniques including the use of PPE Adhering to sterilization procedures Practice proper disinfection and dental laboratory asepsis procedures

15. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Health Protection Program for the Dental Staff An office policy must include a health service program for the staff that covers Education and training Immunizations Exposure prevention and postexposure management Employee medical conditions, work- related illness, and any work restrictions

16. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Health Protection Program for the Dental Staff Health Protection Program Allergies or sensitivities to work-related materials, such as latex Records maintenance, data management, and confidentiality A medical physician to treat staff members for any emergencies Confidential, up-to-date medical records for all workers

17. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Standard Precautions OSHA establishes guidelines to protect workers from occupational exposure to bloodborne diseases. Regulations require that employees in direct contact with blood or infectious materials and substances use Standard Precautions.

18. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Standard Precautions Practicing standard precautions means all patients are treated as if they have a potentially infectious disease.

19. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. OSHA Task Categorization Category I Tasks that involve exposure to blood, body fluids, or tissues; dentists, hygienists, clinical assistants, and laboratory technicians are in this category Category II Tasks that involve no exposure to blood, body fluids, or tissues but may have unplanned exposure to category I tasks; may include clerical or nonprofessional workers

20. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. OSHA Task Categorization Category III Tasks that involve no exposure to blood, body fluids, or tissues; may include receptionists, bookkeepers, and insurance clerks

21. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Maintaining Regulatory Records Regulatory records that are kept in an office include: Exposure determination form Describes the office infection control program and procedures Employee training records Describes HBV vaccination availability, requirements, and implementation

22. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Sample Exposure Determination Form

23. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Sample Employee Training Record

24. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Maintaining Regulatory Records Employee medical records (Figure 17-6) Informed refusal for hepatitis B vaccination (Figure 17-7) Postexposure evaluation and follow-up training Employee informed refusal of postexposure medical evaluation (Figure 17-8) Incident report of exposure to occupational illness (Figure 17-9)

25. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Sample Employee Medical Record

26. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Sample Refusal of Hepatitis B Vaccination

27. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Sample Informed Refusal of Postexposure Medical Evaluation

28. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Incident Report of Exposure

29. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Hazard Communication Program OSHA’s hazard communication standards require all dental professionals to develop and implement a program involving Employee training A list of hazardous chemicals Maintenance of MSDSs Proper labeling of all chemicals in the office

30. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Hazard Communication Program A single coordinator of the program should be responsible for the following: Disseminating information about the program Recognizing the hazardous properties of chemicals found in the workplace Keeping up-to-date on procedures for safe handling of chemicals Implementing measures for protecting the office staff from hazardous chemicals

31. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Material Safety Data Sheet (MSDS) An MSDS is kept for all products with hazardous potential and includes The manufacturer’s name and address The product name The generic name (if applicable) Potential routes of entry The organs affected by the chemical Means of protecting against or reducing the effects of chemical exposure (e.g., eyewash)

32. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Labeling of Hazardous Materials Products purchased from dental supply companies arrive with permanently affixed information about hazardous chemicals. If chemicals are transferred to smaller containers, hazard communication labels must be put on these containers.

33. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Labeling of Hazardous Materials The label designates the hazard class, the routes of entry into the body, and the organs affected.

34. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Labeling of Hazardous Materials

35. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Equipment for Hazardous Situations Equipment that should be available for preventing or dealing with a hazardous spill include: Fire extinguisher Eyewash stations Amalgam spill kit Masks Protective clothing

36. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Equipment for Hazardous Situations Hazardous spill equipment Kitty litter, broom, and dustpan Protective nitrile gloves and glasses Bags in which to seal spilled materials and contaminated objects Well-ventilated areas for work (able to be turned off if an accident occurs) Scavenging system (for use with nitrous oxide)

37. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Aseptic Technique Procedures used to maintain asepsis and prevent cross-contamination include Use of barrier coverings when appropriate Disinfection of exposed surface Use of disposable items if items can not be disinfected or sterilized Sterilization of contaminated reusable items

38. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Aseptic Technique Aseptic procedures No touching of eyewear, masks, or hair once gloves are donned Use of pretreatment antimicrobial mouth rinse Disinfection of hands with an antimicrobial soap or alcohol rub immediately before placement and removal of gloves Obtaining a complete and comprehensive health history for every patient

39. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Personal Protection Personal protection involves two considerations: 1.Immunological protection (immunization) 2.Barrier protection

40. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Immunization Dental healthcare workers should receive all appropriate and available vaccines. Approved vaccines are available for many infectious diseases. The hepatitis B vaccine and a yearly tuberculin Mantoux test to assess exposure to tuberculosis are essential precautions for dental healthcare workers

41. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Barrier Protection Physical barriers are a fundamental component of an infection control program. Disposable examination gloves, over gloves, and utility gloves should be used. During treatment, face masks, and protective clinic attire and eyewear should be worn.

42. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Instrument Sterilization The administrative assistant may assume a major role in monitoring the efficiency of the sterilization systems.

43. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Sterilization Testing Strips A test strip is placed in the sterilization chamber with instruments. The test strip is returned to the manufacturer or a monitoring agency for verification that sterilization has occurred. The office receives written documentation that is maintained as a record.

44. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Laboratory Asepsis Items received from the laboratory should be disinfected before placement. All items must be disinfected according to product directions. The administrative assistant may prepare and receive cases from the dental laboratory, so an understanding of the recommended guidelines is essential.

45. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Waste Disposal in the Dental Office The Environmental Protection Agency (EPA) is a federal regulatory agency that oversees the handling, tracking, transportation, and disposal of medical waste.

46. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Waste Disposal in the Dental Office All infectious waste should be placed in closable, leak-proof containers or bags that are color coded or labeled appropriately. All infectious material is disposed of in accordance with federal, state, and local regulations and appropriate forms are maintained.

47. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Waste Disposal in the Dental Office Most of the regulated waste in dental offices consists of contaminated sharps and extracted teeth. Some offices may also generate a small amount of nonsharp solid medical waste such as 2 × 2s or cotton rolls saturated/caked with blood or saliva.

48. Copyright © 2011, 2006 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Educating Patients about Infection Control Programs The best course of action is to educate the staff and patients about the importance of safe practice and the use of standard precautions for all patients. The two best ways to avoid potential litigation and OSHA inspections are prevention and good documentation.