Adams School of Dentistry: Infection Control Manual - Chapter 01: Introduction

Introduction

Dental procedures are performed in a septic environment that poses significant hazards to dental personnel and patients. Over the past several decades, these hazards have gradually become more complex. Risks to patients, staff, faculty and students are heightened due to the generation of aerosols that is inherent in the customary treatment procedures of the dental profession. The complexity of the instrumentation, equipment and waterlines contributes to the possibility of hazardous exposure to potentially infectious saliva, blood, and biofilm. In addition, the dental profession has seen an overall increase in patient volume, as well as a concomitant increase in the number of patients carrying life-threatening communicable diseases such as HIV, tuberculosis (TB), hepatitis B (Hep B), Acquired Immunodeficiency Syndrome (AIDS), COVID-19 and others. Contact with these pathogens may place the individual health care worker at risk for succumbing to a communicable disease or for unknowingly transmitting a communicable disease to other faculty, staff, students, residents, patients, family members, and/or human subjects. During pregnancy, the fetus may also be at risk. Aseptic techniques and procedures must be practiced and performed for every patient encounter.

Purpose

Adams School of Dentistry (ASOD) is committed to providing a safe and healthy learning environment for our students, faculty, staff, and patients. In pursuit of this endeavor, the following Infection Control Manual is provided to eliminate and/or minimize occupational exposure to bloodborne pathogens in accordance with OSHA standard 29 CRF 1910.1030, "Occupational Exposure to Bloodborne Pathogens." Further, these developed infection control guidelines assist in maintaining clinical consistency and adhering to standards set by the Centers for Disease Control and Prevention (CDC), the Federal Food and Drug Administration (FDA), Organization for Safety, Asepsis, and Prevention (OSAP), the Environmental Protection Agency (EPA), the American Dental Association (ADA), and the NC State Department of Health and Human Services Public Health Services.

General Policy Provisions

Policies on infection control of ASOD will comply with the current guidelines published by the U.S. and NC State Department of Health and Human Services Public Health Service, the CDC, OSHA, FDA, EPA, ADA, and OSAP. Guidance of this document was taken primarily from the CDC document "Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care."

Scope of Applicability

Infection control policies and procedures apply to all ASOD students and employees. ASOD employees include faculty, staff, residents, affiliates, temporary, and intermittent employees.

Responsibility

ASOD is divided into multiple areas consisting of different clinical, laboratory, research, and administrative areas. Success of any comprehensive infection control manual requires the cooperation and compliance of all division areas and individuals involved. However, each division area is unique and it may be necessary to adjust protocols listed through this manual to fit, which is acceptable provided that adjustments are completed in a safe, ethical, and aseptic manner that does not detrimentally impact patient care or student learning. Further definitions and distribution of responsibility may be reviewed below:

1. All clinical personnel share in the responsibility to ensure compliance with all infection control guidelines by all members of the clinical community: students, residents, staff, and faculty alike.
2. All dental personnel are ethically obligated to provide patient care with compassion and respect for human dignity. No dental personnel may ethically refuse to provide dental care solely because the patient has, or may have, an infectious disease such as, but not limited to, human immunodeficiency virus (HIV) infection, acquired immunodeficiency syndrome (AIDS), hepatitis B or hepatitis C infection.
3. All research personnel and clinical laboratory supervisors shall recognize their responsibility for implementing University guidelines to protect laboratory workers from hazards incumbent in handling human blood, secretions, specimens, tissues, and materials contaminated with blood or secretions.
4. Each clinical and laboratory division areas are charged with the responsibility for compliance with the policies and procedures outlines in the Infection Control Manual.
5. Lead Dental Assistants are responsible for all dental equipment and supply requirements related to infection control within their clinics. Lead Dental Assistant is required to monitory compliance of infection control standards involving dental assistants and coordinate with appropriate individuals for dental assisting students. Any issues associated with maintaining clinic standards must be reported to either the appropriate clinical lead, faculty chair, and/or Director of Clinical Compliance.
6. Faculty have primary responsibility for implementing and monitoring all patient and student activities related to infection control. It is the responsibility of each clinical preceptor to ensure that all infection control guidelines are being followed during all dental visits. Faculty are expected to evaluate students on their compliance with infection control standards at each visit. Faculty are required to report any problems in infection control compliance to faculty chair, residency program directors, and/or the Director of Clinical Compliance.
7. Division chairs are responsible for addressing infection control issues which relate to individual faculty members or students under their supervision.
8. All preclinical program directors are responsible for instructing students on proper infection control procedures related to preclinical activities.
9. Employees and non-employees are encouraged to report any problems relating to infection control, independent of course or nature, to the Director of Clinical Compliance through this form.
10. According to NC Administrative Code 10A NCAC 41A .0206, all providers who have a known diagnosis of an infectious disease such as HIV, Hepatitis A, B, or C, Measles, etc. (see the complete list at NC Administrative Code 10A NCAC 41A .0101) must report their condition to the NC State Health Director.

Definitions

Various terminology is utilized throughout this manual with the most commonly utilized words defined below:

• Bloodborne Pathogens (BBP): pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV).
• Category A: Gross error or demonstrated high-risk practice that places ASOD Personnel and/or Patients at risk.
• Category B: Breach of infection control practice or guideline with low to moderate risk of blood exposure event to ASOD Personnel and/or Patients.
• Contaminated: presence or the reasonably anticipated presence of blood or other potentially infectious materials (OPIM) on an item or surface.
• Contaminated Sharps: any contaminated object(s) that can penetrate the skin including but not limited to: needles, scalpels, broken glass, cartridges, and exposed ends of dental wires.
• Disinfection: use of a chemical agent to reduce the number of microorganisms and reduce the capability of pathogenic microorganisms to transmit disease.
• Engineering Controls: controls (e.g., sharps disposal containers) that isolate or remove the bloodborne pathogen hazard from the workplace.
• Level I: Intentional act(s) that fail to use appropriate and/or outlines infection control guidelines.
• Level II: Unintentional conduct that causes, or is likely to cause, bodily harm to self or others.
• Occupational Exposure: any reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials (OPIM) that may result from the performance of an employee’s duties.
• Other Potentially Infectious Materials (OPIM):
  • The following fluids: semen, vaginal secretions, cerebrospinal fluid (CSF), synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any bodily fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids.
  • An unfixed organ or tissue (other than intact skin) from a human.
  • HIV-containing cells or tissue cultures, organ cultures, and HIV or HIV containing culture medium or other solutions, blood, organs, or other tissues from experimental animals infected with HIV or HBV.
• Personal Protective Equipment (PPE): specialized clothing and/or equipment utilized for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts, blouses) not intended to function as protection against a hazard are not considered to be personal protective equipment.
• Regulated Waste: contaminated items that would release blood or other potentially infectious materials (OPIM) in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials.
• Standard Precautions: guidelines recommended by the Centers for Disease Control and Prevention (CDC) for reducing the risk of transmission of BBP and OPIM. Standard precautions synthesize the major features of universal precautions (designed to reduce the risk of transmission of blood-borne pathogens) and body substance isolation (designed to reduce the risk of pathogens from moist body substances) and apply them to all patients receiving care in hospitals regardless of their diagnosis or presumed infection status. Standard precautions apply to (1) blood; (2) all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain blood; (3) non-intact skin; and (4) mucous membranes. Precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals.
• Sterilization: use of physical or chemical agents to eliminate ALL microbial forms, including viruses and bacterial spores.
• Wipe / Discard / Wipe: terminology for method of cleaning and disinfection of designated areas where the first wipe removes debris, or cleans, wait for the cleaned area to dry, and a second wipe is completed to reach appropriate levels of disinfection.
• Work Practice Controls: controls that reduce the likelihood of exposure by altering the manner in which a task is performed.

Proceed to Chapter 02