Administrative Considerations

Administrative measures

Infection prevention must be made a priority in any dental health care setting. At least one individual with training in infection prevention — the infection prevention coordinator — should be responsible for developing written infection prevention policies and procedures based on evidence-based guidelines, regulations, or standards. Policies and procedures should be tailored to the dental setting and reassessed on a regular basis (e.g., annually) or according to state or federal requirements. Development should take into consideration the types of services provided by dental health care personnel (DHCP) and the patient population served, extending beyond the Occupational Safety and Health Administration (OSHA) bloodborne pathogens standard to address patient safety.

The infection prevention coordinator should ensure that equipment and supplies (e.g., hand hygiene products, safer devices to reduce percutaneous injuries, and personal protective equipment) are available and should maintain communication with all staff members to address specific issues or concerns related to infection prevention. In addition, all dental settings should have policies and protocols for early detection and management of potentially infectious persons at initial points of patient encounter.

Key ADMINISTRATIVE RECOMMENDATIONS for Dental Settings

1. Develop and maintain infection prevention and occupational health programs.
2. Provide supplies necessary for adherence to Standard Precautions (e.g., hand hygiene products, safer devices to reduce percutaneous injuries, personal protective equipment).
3. Assign at least one individual trained in infection prevention responsibility for coordinating the program.
4. Develop and maintain written infection prevention policies and procedures appropriate for the services provided by the facility and based on evidence-based guidelines, regulations, or standards.
5. Facility has system for early detection and management of potentially infectious persons at initial points of patient encounter.

Infection prevention education and training

Ongoing education and training of DHCP are critical for ensuring that infection prevention policies and procedures are understood and followed. Education on the basic principles and practices for preventing the spread of infections should be provided to all DHCP. Training should include both DHCP safety (e.g., OSHA bloodborne pathogens training) and patient safety (e.g., emphasizing job- or task-specific needs).

Education and training should be provided during orientation to the setting, when new tasks or procedures are introduced and at a minimum, annually. Training records should be maintained according to state and federal requirements.

Key Recommendations for EDUCATION AND TRAINING in Dental Settings

1. Provide job- or task-specific infection prevention education and training to all DHCP.
   1. This includes those employed by outside agencies and available by contract or on a volunteer basis to the facility.
2. Provide training on principles of both DHCP safety and patient safety.
3. Provide training during orientation and at regular intervals (e.g., annually).
4. Maintain training records according to state and federal requirements.

Dental health care personnel safety

Infection prevention programs should also address occupational health needs, including vaccination of DHCP, management of exposures or infections in personnel requiring post-exposure prophylaxis or work restrictions, and compliance with OSHA bloodborne pathogens standard. Referral arrangements for medical services can be made with qualified health care professionals in an occupational health program of a hospital, with educational institutions, or with health care facilities that offer personnel health services.

Recommendations for prevention of infections in DHCP can be found in the following documents — Guidelines for Infection Control in Dental Health-Care Settings — 2003, Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP), and OSHA Bloodborne Pathogens and Needlestick Prevention.

Key Recommendations for DENTAL HEALTH CARE PERSONNEL SAFETY

1. Current CDC recommendations for immunizations, evaluation, and follow-up are available. There is a written policy regarding immunizing DHCP, including a list of all required and recommended immunizations for DHCP (e.g., hepatitis B, MMR (measles, mumps, and rubella) varicella (chickenpox), Tdap (tetanus, diphtheria, pertussis).
2. All DHCP are screened for tuberculosis (TB) upon hire regardless of the risk classification of the setting.
3. Referral arrangements are in place to qualified health care professionals (e.g., occupational health program of a hospital, educational institutions, health care facilities that offer personnel health services) to ensure prompt and appropriate provision of preventive services, occupationally-related medical services, and postexposure management with medical follow-up.
4. Facility has well-defined policies concerning contact of personnel with patients when personnel have potentially transmissible conditions.

Program evaluation

A successful infection prevention program depends on

• Developing standard operating procedures.
• Evaluating practices and providing feedback to DHCP.
• Routinely documenting adverse outcomes (e.g., occupational exposures to blood) and work-related illnesses in DHCP.
• Monitoring health care associated infections in patients.

Strategies and tools to evaluate the infection prevention program can include periodic observational assessments, checklists to document procedures, and routine review of occupational exposures to bloodborne pathogens. The Infection Prevention Checklist for Dental Settings found in the Appendix is one tool DHCP can use to evaluate their infection prevention program.

Evaluation offers an opportunity to improve the effectiveness of both the infection-prevention program and dental practice protocols. If deficiencies or problems in the implementation of infection prevention procedures are identified—further evaluation and feedback, corrective action, and training (if applicable) is needed to eliminate the problems.

Key Recommendations for PROGRAM EVALUATION in Dental Settings

1. Establish routine evaluation of the infection prevention program, including evaluation of DHCP adherence to infection prevention practices.

Risk assessment

Facilities are encouraged to use the Infection Prevention Checklist for Dental Settings (Appendix: Infection Prevention Checklist for Dental Settings)—a companion to the summary guide—to periodically assess practices in their facility and ensure they are meeting the minimum expectations for safe care. In the course of auditing practices, facilities may identify lapses in infection control. If such lapses are identified, efforts should be made to correct the practices, appropriately educate DHCP (if applicable), and determine why the correct practice was not being performed.

In addition, consideration should also be made for determining the risk posed to patients by the deficient practices. Certain infection control lapses (e.g., reuse of syringes on more than one patient or to access a medication container that is used for subsequent patients, reuse of lancets) have resulted in bloodborne pathogen transmission and should be halted immediately. Identification of such lapses warrants immediate consultation with the state or local health department and appropriate notification and testing of potentially affected patients.

Additional resources describing approaches to evaluation and management of infection control breaches identified in health care settings — including those involving lapses related to reprocessing of medical devices—can be found in CDC's Steps for Evaluating an Infection Control Breach. In addition, for circumstances warranting patient notification, CDC has developed a Patient Notification Toolkit to assist health care facilities with conducting a patient notification.