Guidelines for Infection Control in Dental Health Care Settings (AGD 148)
Presenter: Sharon K. Dickinson, CDA, CDPMA, RDA & Richard D. Bebermeyer, DDS, MBA
In 2003, the U.S. Centers for Disease Control and Prevention (CDC) published updated recommendations for dental infection control. Developed in collaboration with authorities on infection control from the CDC and other public agencies, academia, and private and professional organizations, “Guidelines for Infection Control in Dental Health-Care Settings — 2003” consolidates and expands previous CDC recommendations and incorporates the infection-control provisions of the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard. Since the 2003 CDC document, the CDC published in 2016 the “Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care.” This document summarizes the information published in the 2003 guidelines and represents infection preventions strategies for safe dental care. The summary also includes additional topics and information relevant to dental infection control and prevention published since the 2003 document. The CDC has developed a Dental Check Mobil App available for downloading at https://www.cdc.gov/oralhealth/infectioncontrol/dentalcheck.html. Dental health care personnel can use the mobile application CDC Dental Check to periodically assess practices in their facility and ensure they are meeting the minimum expectations for safe care. The 2016 summary includes topics and information related to infection prevention program administrative measures such as:
• Infection prevention education and training
• Respiratory hygiene and cough etiquette
• Updated safe injection practices
• Administrative measures for instrument processing
This document also summarizes current infection prevention recommendations and includes a checklist that can be used to evaluate compliance. The information presented here is based primarily upon the previously published 2003 guideline (see below) and CDC Summary which represents infection prevention expectations
for safe care in dental settings.
Each recommendation in the 2003 document is categorized on the basis of existing scientific data, theoretical rationale, and applicability. The CDC category designations, as described below, accompany each recommendation cited in this course.
Category IA recommendations are strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies.
Category IB recommendations are strongly recommended for implementation and supported by experimental, clinical, or epidemiologic studies and a strong theoretical rationale.
Category IC recommendations are required for implementation as mandated by federal or state regulation or standard.* When the “IC” designation is used, a second rating may be included to provide the basis of existing scientific data, theoretical rationale, and applicability.
Category II recommendations are suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale.
* The omission of a Category IC designation in the CDC document should not be construed as a definitive absence of regulations. Always check with state and local authorities to ensure compliance with all laws
that apply in your area.
The 2003 CDC guidelines address educating and protecting dental healthcare personnel; preventing transmission of bloodborne pathogens (including postexposure management); hand hygiene; personal protective equipment; contact dermatitis and latex hypersensitivity; sterilization and disinfection of patient-care items; environmental infection control (encompassing operatory surface management and medical waste); dental unit waterlines, biofilm, and water quality; dental handpieces and other devices that attach to dental unit airlines and waterlines; radiology; aseptic technique for parenteral medications; disposable devices; oral surgical procedures; handling biopsy specimens; infection control for the dental laboratory; tuberculosis in dentistry; and program evaluation. The document also discusses preprocedural mouth rinses, laser/electrosurgery plumes and surgical smoke, and prior diseases such as Creutzfeldt-Jakob disease. However, because of insufficient scientific evidence or lack of consensus regarding the efficacy of potential interventions, CDC currently designates these topics as “unresolved issues” and provides no recommendations. As such, these areas of the 2003 guidelines are not covered in this course.
Although this course provides an overview of current CDC recommendations for minimizing the potential for disease transmission during the delivery of dental care, all dental healthcare personnel are encouraged to review the complete guidelines and the summary. It includes a wealth of valuable background information
and references that promote understanding the need for a comprehensive dental infection control program. “Guidelines for Infection Control in Dental Health-Care Settings — 2003” is available free of charge and in its entirety through the CDC website: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm. The “Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care” is available free of charge through the CDC website: https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care2.pdf
Dental healthcare personnel should stay informed and regularly consult with and refer to the most current literature regarding infection control in dental practices regarding the COVID-19 protocols. While the CDC recommendations are still in effect, a practice should refer to the ADA and the CDC for COVID-19 updates. The ADA website is: https://success.ada.org/en/practice-management/patients/infectious-diseases-2019-novel-coronavirus utm_source=adaorg&utm_medium=globalheader&utm_content=coronavirus&utm_campaign=covid-19. The CDC website is: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html.
Sharon K. Dickinson, CDA, CDPMA, RDA has been actively involved in the dental profession as a chairside assistant, office manager, consultant and educator. Since 1981, Professor Dickinson has held the position of director of the Dental Assisting Program at the El Paso Community College. She is considered a curriculum expert for the Texas Coordinating Board, infection control expert serving on the infection control test development committee for the Texas State Board of Dental Examiners. Professor Dickinson is a federally authorized OSHA Outreach trainer in Occupational Safety and Health for General Industry. With more than 35 years of clinical and practical experience in dentistry, Professor Dickinson speaks and consults extensively on OSHA and infection control. In addition Professor Dickinson has published numerous articles.
Richard D. Bebermeyer, DDS, MBA serves as Clinical Professor, Department of General Practice and Dental Public Health at The University of Texas Health Science Center Houston Dental Branch. He is a general dentist with interest in infection control and prevention in dentistry. Dr. Bebermeyer received his Doctor of Dental Surgery from Washington University in St. Louis, and his Masters in Business Administration from Southern Illinois University at Edwardsville.
Upon completion of this course, the dental professional should be able to:
• differentiate between OSHA standards and CDC guidelines as they relate to dental infection control;
• outline the objectives and goals in establishing an infection control program in the dental healthcare setting;
• differentiate between universal precautions and standard precautions;
• list infectious diseases relevant to dentistry;
• identify and describe methods of disease transmission;
• discuss occupational exposures to bloodborne pathogens, including prevention, post-exposure management, and prophylaxis;
• summarize how to establish and manage an infection control program;
• identify infectious hazards in the dental setting; and
• evaluate the practice setting’s infection control program.
CONTINUING EDUCATION CREDIT
The ADAA has an obligation to disseminate knowledge in the field of dentistry. Sponsorship of a continuing education program by the ADAA does not necessarily imply endorsement of a particular philosophy, product or technique.
The ADAA cautions participants taking this course on the hazards of using limited knowledge when integrating new techniques into their practices.
Credits earned upon completion of the course may be used to meet DANB’s Recertification Requirements.
CONCERNS OR HELP
If the participant has concerns about the presentation, please contact our Education Department at CESupport@adaausa.org. If the participant has questions on how to view the presentation, please contact Tech Support at TechSupport@adaausa.org.
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