by By Laura Thill
Ensuring practice-wide compliance to an infection control program can be challenging, but it’s key to ensuring a safe environment for staff and patients.
A growing awareness of breaches in infection control and the resultant health concerns, together with advances in product technology, have motivated dental clinicians to take the necessary steps to protect their staff and patients. “An increased focus on – and awareness of – infection prevention and control has been evident over the past few years, both from a clinician and patient perspective,” says Leann Keefer, RDH, MSM, director, corporate education & professional relations, Crosstex. “The highlighted issue of infection control breaches hitting the headlines has been a double-edged sword, unfortunately. Significant health concerns like the first documented patient-to-patient transmission of HCV at an oral surgeon’s office in Oklahoma, or exposure to mycobacterium at offices in California and Georgia, (resulting in nearly 100 children being hospitalized), have brought to light the importance of following infection control best practices as outlined by the CDC.”
At the same time, advances in infection control products help ensure that dentists, their staff and their patients are better protected today, notes Doug Braendle, product manager, SciCan, Inc. SciCan autoclave bags are now equipped with inner and outer sterilization indicators, as required by CDC, he points out, which means the staff needn’t take extra steps in order to comply with CDC requirements. Along the same lines, SciCan’s STATIM sterilizers now come with G4 technology, which alerts offices to any potential sterilization issues. “They get e-mail notifications and a phone call from SciCan service managers to help keep offices safe,” he explains.
Other examples of product improvement include dental unit waterline cartridges, now designed to provide continuous treatment for the delivery of safe, clean dental water, says Keefer. “Additionally, dental masks currently are available in three levels and are designed with materials that offer appropriate fluid resistance and filtration based on a procedure’s time and aerosol level. And, built in external/internal chemical indicators on sterilization pouches not only save time but offer easy compliance with guidelines. Surface disinfectants have been improved as well, with reduced dwell and contact time.” The list goes on, she points out. “Manufacturers are paying attention to the science behind the product and market based on efficacy and performance.”
A designated infection coordinator
A successful infection control program depends on how well the dental staff complies with protocols. An informed, designated infection control coordinator can provide written policies for the office, as well as educate and train the staff around compliance. “A clinician identified to coordinate infection control policies and protocols designed to help protect patients, staff and the practice is a critical component of a comprehensive infection control program,” says Keefer. “Education should be provided during orientation and annually at minimum. Training records are an important factor based on state and federal requirements.”
“At least one individual trained in infection prevention should be assigned responsibility for coordinating the infection control program,” says Braendle. “Supplies necessary for adherence to the CDC’s standard precautions should be readily available, and each facility should have a system for early detection and management of potentially infectious persons at initial points of patient encounter. Dental healthcare personnel should receive job or task-specific training on infection prevention policies and procedures, as well as the OSHA bloodborne pathogens standard, upon hire, annually, when new tasks or procedures affect [his or her] occupational exposure, and in accordance with state or federal requirements.”
The 2016 CDC dental update directs a dental facility’s designated infection control coordinator to do the following, according to Braendle:
- Provide written infection prevention policies and procedures specific for the dental setting. The policies should be available, current and based on regulations and evidence-based guidelines, such as those provided by the CDC or the Healthcare Infection Control Practices Advisory Committee [HICPAC].
- Reassess infection prevention policies and procedures at least annually or according to state or federal requirements, and update if necessary.
Not only is it important for the infection control coordinator to educate the dental staff, he or she must stay current on new products and technology and revised guidelines. That means “constant learning,” notes Keefer. “As research [sheds light on] new science, technology changes, materials improve and the microbiological world evolves, the only way to stay current is to keep learning,” she says.
“There are plenty of quality infection control classes [available to infection control coordinators],” says Braendle. But, that requires motivation and taking time to seek them out, she notes. Some states, such as California, require dental professionals to take at least two infection control CE hours every year, he points out. So, it is not uncommon to see as many as 1,700 people in the early morning infection control class offered at the California Dental Association’s annual meeting, he adds.
“Compliance versus complacency has always been a challenge,” says Keefer. “However, a lack of compliance with published infection control guidelines can result in significant risk of disease transmission and compromise patient and staff safety, as well as the reputation of the practice.
“Now more than ever, the commitment to infection prevention compliance is monumental to every dental practice’s success,” Keefer continues. “Patients trust and expect delivery of dental care to be safe. Instrument processing and treatment room cleaning and disinfection usually occur out of the sight of patients. It is in these moments, when no one is watching, that clinicians must remain diligent to ensure adherence to sterility assurance protocol.”
Indeed, the success of an infection control program is dependent on “direction from the top,” says Braendle. “Unless the doctors and management constantly reinforce the need for proper infection control, that action will never filter down. The person in charge of infection control must organize effective training and follow up with staff members on a regular basis.” Not doing so can result in a couple of issues, she notes, the first being OSHA-related. “The dental office must pay about $3700 [in fines] per needlestick injury,” he says. “If an office has too many of these issues, its [liability] insurance may be bumped to a higher rate or cut off completely.”
In addition, when patients leave a dental office and become ill, while it’s difficult to trace their sickness to their oral treatment, it does happen, leaving the office with a huge liability. “We had an [elderly, reclusive] patient in another country succumb to Legionnaire’s disease, and it was traced to a dental office waterline,” says Braendle. Had the patient been out and about more frequently, it would have been more difficult to associate her illness with the infected waterline, he adds.
The CDC offers several tools to help dental offices implement a successful infection control program. For instance, the Infection Prevention Checklist for Dental Settings is designed to:
- “Ensure the dental health care setting has appropriate infection prevention policies and practices in place, including appropriate training and education of dental health care personnel (DHCP) on infection prevention practices, and adequate supplies to allow DHCP to provide safe care and a safe working environment.”
- “Systematically assess personnel compliance with the expected infection prevention practices and to provide feedback to DHCP regarding performance. Assessment of compliance should be conducted by direct observation of DHCP during the performance of their duties.”
For more information and to view the checklist visit https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care-checklist.pdf.
