might be occupationally exposed to infectious materials, including body substances and contaminated supplies, equipment, environmental surfaces, water, or air. DHCP include dentists, dental hygienists, dental assistants, dental laboratory technicians (in-office and commercial), students and trainees, contractual personnel, and other persons not directly involved in patient care but potentially exposed to infectious agents (e.g., administrative, clerical, housekeeping, maintenance, or volunteer personnel)” (California Code of Regulations, 2011). These regulations are enforced by the Dental Board of California. California licensees must strictly adhere to the guidelines or they may be subject to penalties. In addition to the Minimum Standards for Infection Control mandated by the Dental California Department of Public Health (CDPH). CDPH regulates the collection, storage, transport, and disposal of contaminated solid waste (California Health and Safety Code, 2017). DHCP should familiarize themselves with all of the regulations that pertain to dental practice on the federal, state, and local level. This course is limited to the Dental Board of California Minimum Standards for Infection Control. PATHOGENS OF CONCERN IN DENTAL SETTINGS AND STANDARD PRECAUTIONS Board of California, the California Division of Occupational Safety and Health (Cal/OSHA) enforces infection control requirements through the Bloodborne Pathogens Rule from Title 8, Section 5193 of the California Code of Regulations (California Code of Regulations, 2015). Another regulatory agency that impacts the dental healthcare setting is the
C is transmitted through percutaneous contact with infected body fluids. This may occur through unsafe injections (such as sharing needles), needlestick-type injuries in healthcare settings, from an HCV-infected mother to her child during birth, and rarely, through donated blood, blood products, and organs (CDC, 2019). Fortunately, HCV today is a curable infection with medication taken daily for 2-6 months. However, many people with chronic HCV may not be aware of their infection or have not yet received treatment, making transmission risk in healthcare settings a continued concern. Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). The CDC estimated that in 2019, an estimated that 1,189,700 people in the United States had HIV. Approximately 13% of people with HIV are unaware of their infection (CDC, 2021). According to Section 1005, Minimum Standards for Infection Control, standard precautions (SP), “are a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which health care is delivered. These include: hand hygiene, use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated exposure, and safe handling of sharps.” operatory cleanliness, and management of injuries. The protocol shall be made available to all DHCP at the dental office” (California Code of Regulations, 2011). Examples of proper instrument processing include instrument inspection, cleaning, packaging, maintenance, sterilization, sterilizer monitoring, and proper instrument storage. Examples of operatory cleanliness include cleaning and disinfection of clinical surfaces, barrier protection for high-touch surfaces, and routine cleaning of environmental surfaces. Examples of management of injuries include policies for reporting and referral for personnel suffering occupational injuries. These policies should be updated at least annually or more often if necessary. 3. “A copy of this regulation shall be conspicuously posted in each dental office” (California Code of Regulations, 2011).
Infection control in the dental setting is a serious concern because patients may harbor drug-resistant infections, such as methicillin-resistant Staphylococcus aureus (MRSA), or infections that may not produce symptoms, such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), making clinical detection impossible through examination or medical history alone. Hepatitis B among adults is largely an acute disease. Approximately 95% of all adults who are infected with HBV recover, and within a few months of initial infection no longer show signs of active infections and no longer pose a risk of transmission to others. However, the remaining 5% of those infected with HBV as adults develop chronic infection and can continue to pose a risk of transmission to others since the virus continues to replicate in the liver and circulate in body fluids, including blood and saliva (CDC, 2019). Estimates for the total number of persons living with chronic HBV in the United States range from 730,000 to 2.2 million people (CDC, 2019). Hepatitis C virus (HCV) is nearly always a chronic infection, with 75% to 85% of those who are infected becoming chronic carriers. The CDC estimates that 2.4 million people in the United States have chronic HCV infections. Hepatitis
Minimum standards for infection control: A written protocol The goal of an infection control program is to minimize the transmission of pathogens in the healthcare setting. This goal can be accomplished in a variety of ways. Compliance with the California Minimum Standards for Infection Control (Section 1005) (California Code of Regulations, 2011), Infection Control Recommendations by the Centers for Disease Control and Prevention (CDC), and CDPH provides the groundwork for achieving this goal (California Health and Safety Code, 2017). The California Minimum Standards for Infection Control, Section 1005, stipulate that all DHCP must comply with infection control precautions and enforce the following minimum precautions to protect patients and themselves: 1. Standard precautions “shall be practiced in the care of all patients.” 2. A written protocol “shall be developed, maintained, and periodically updated for proper instrument processing,
PERSONAL PROTECTIVE EQUIPMENT
protective attire which are intended to prevent exposure to blood, body fluids, OPIM, and chemicals used for infection control. General work attire such as uniforms, scrubs, pants, and shirts are not considered to be PPE” (California Code of Regulations, 2011). Section 1005 defines OPIM as “human body fluids such as saliva in dental procedures and 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” (California Code of
Because dental professionals work in close proximity to the oral cavity, blood or other potentially infectious material (OPIM) that may contain infectious organisms can present a risk of transmission to DHCP who are not utilizing appropriate personal protective equipment (PPE). Appropriate PPE is defined in Section 1005 as “specialized clothing or equipment worn or used for protection against a hazard. PPE items may include, but are not limited to, gloves, masks, respiratory devices, protective eyewear and
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