retraction valves, water quality tests, or combinations of several systems. These additional methods are not required by section 1005, but are recommended by the CDC (CDC, 2003). Lab areas A variety of laboratory procedures may be performed in dental offices, including taking impressions, adjusting prostheses, and adjusting and polishing crowns, among others. According to the California Minimum Standards for Infection Control, Section 1005, “all intraoral items such as impressions, bite registration, prosthetic and orthodontic appliances shall be cleaned and disinfected with an intermediate-level disinfectant before manipulation in the laboratory and before placement in the patient’s mouth” (California Code of Regulations, 2011). Prosthetic devices should be rinsed with clear water prior to reinsertion in the oral cavity. Rinsing is a critical step because acrylic and other materials are very porous and capable of trapping chemicals, causing a chemical burn to the mucous membranes. “Splash shields and equipment guards shall be used on dental laboratory lathes. Fresh pumice and a sterilized or new rag-wheel shall be used for each patient. Devices used to polish, trim, or adjust contaminated intraoral devices shall be disinfected or sterilized, properly packaged or wrapped, and labeled with the date and the specific sterilizer used if more than one sterilizer is utilized in the facility. If packaging is compromised, the instruments shall be recleaned, packaged in new wrap, and sterilized again. Sterilized items will be stored in a manner so as to prevent contamination” (California Code of Regulations, 2011). Compliance with these and other regulations is the first step in ensuring the safe delivery of care to patients and protecting DHCP in the workplace. It is important to note that the precautions outlined in the Dental Board of California Infection Control Regulations are consider minimum standards. Additional precautions may be necessary to prevent the transmission of infectious diseases in the oral healthcare setting—particularly when confronted with pathogens of concerns such as has been experienced with the SARS-CoV-2 virus. DHCP should frequently review the CDC website for updated infection prevention and control guidelines and update their policies and procedures accordingly. All DHCP regulated under these requirements should regularly review the Dental Board of California website for changes or updates to the requirements.
after the contaminated gloves have been removed and the hands washed. All housekeeping surfaces (e.g., floors, walls, and sinks) should be routinely cleaned with detergent and water or a Cal/EPA-registered - hospital-grade disinfectant. Products used to clean items or surfaces prior to disinfection procedures must be clearly labeled, and DCHP must follow all safety data sheet (SDS) handling and storage instructions (CDC, 2003). Schedules and methods vary according to the area and type of contamination. Protective eyewear, masks, and chemical- and puncture-resistant utility gloves must be worn when handling chemicals for disinfection. CDPH and local, state, and federal regulations cover disposal of contaminated solid waste. Appropriate disposal of contaminated waste is also presented in Section 1005, which stipulates that “contaminated solid waste shall be disposed of according to applicable local, state, and federal standards” (California Code of Regulations, 2011). Dental unit waterlines Dental unit waterlines are also regulated by Section 1005, which stipulates that “dental unit water lines shall be anti-retractive. At the beginning of each workday, dental unit lines and devices shall be purged with air or flushed with water for at least two (2) minutes prior to attaching handpieces, scalers, air water syringe tips, or other devices. The dental unit lines and devices shall be flushed between each patient for a minimum of twenty (20) seconds” (California Code of Regulations, 2011). Additional methods that are utilized for waterline maintenance include independent reservoirs, chemical treatments (continuous or intermittent), sterile water delivery, filtration systems, anti- Conclusion This course provided a review of the Dental Board of California Minimum Standards for Infection Control, Section 1005. Basic operational information was presented on instrument categories and their corresponding preparation and sterilization, including sterilizer monitoring. Also included were cleaning and disinfection recommendations for clinical and housekeeping surfaces, which contribute to a workplace that is free from occupational hazards, and waterline management, which reduces the probability of aerosol contamination. Laboratory safety, designed to prevent injury and cross-contamination, and management and disposal of contaminated waste were discussed. Management of occupational injuries and exposures, including reporting, testing, and treatment were outlined, including the use of primary protection – the HBV vaccine. Definition of terms from the California code of regulations title 16 § 1005. Minimum standards for infection control 1. “Standard precautions” 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. Standard precautions shall be used for care of all patients regardless of their diagnoses or personal infectious status. 2. “Critical items” confer a high risk for infection if they are contaminated with any microorganism. These include all instruments, devices, and other items used to penetrate soft tissue or bone. 3. “Semi-critical items” are instruments, devices, and other items that are not used to penetrate soft tissue or bone,
APPENDIX A
but contact oral mucous membranes, non-intact skin or other potentially infectious materials (OPIM). 4. “Non-critical items” are instruments, devices, equipment, and surfaces that come in contact with soil, debris, saliva, blood, OPIM, and intact skin, but not oral mucous membranes. 5. “Low-level disinfection” is the least effective disinfection process. It kills some bacteria, some viruses and fungi, but does not kill bacterial spores or Mycobacterium tuberculosis var. bovis, a laboratory test organism used to classify the strength of disinfectant chemicals. 6. “Intermediate-level disinfection” kills Mycobacterium tuberculosis var bovis indicating that many human pathogens are also killed. This process does not necessarily kill spores. 7. “High-level disinfection” kills some, but not necessarily all bacterial spores. This process kills Mycobacterium tuberculosis var. bovis, bacteria, fungi, and viruses.
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