Infection Control for Dental Professionals ________________________________________________________
human immunodeficiency virus (HIV)-containing cell or tis- sue cultures, organ culture and blood, or other tissues from experimental animals [9] The OSHA Bloodborne Pathogens Standard requires that every healthcare worker who may have contact on the job with blood or other bodily fluids must receive specific annual education, which includes instruction in the basics of infection control and prevention. Training must also cover bloodborne pathogens, modes of transmission, the proper use of needles, and Transmission-Based Precautions [2; 3]. AEROSOL TRANSMISSIBLE DISEASE STANDARD In 2009, the California Division of Occupational Safety and Health (Cal/OSHA) adopted the nation’s first aerosol trans- missible disease (ATD) standard, which remains in effect today [4]. The standard is designed to protect healthcare workers from diseases spread by an airborne or droplet route. The ATD standard requires employers in health care to develop expo- sure control procedures and train employees to follow those procedures [4]. Basic exposure precautions, such as source screening, infection control, hand hygiene, and cleaning and decontamination procedures, are a fundamental part of the standard. Employees must be included in the periodic review and assessment of these procedures. As of 2024, California remains the only state with such a per- manent standard; however, the coronavirus disease (COVID) pandemic of 2019–2022 highlighted the need for a standard addressing infectious pathogens spread by aerosols or droplets. During the pandemic, OSHA did issue interim guidance for safe workplaces, and some states issued emergency temporary standards. Experts have called for these requirements to be codified in order to ensure the safety of professions and patients, but this has not yet been accomplished [15]. Although not required in other states, thorough guidance on aerosol- transmissible diseases can be found in the 2023 California Workplace Guide to Aerosol Transmissible Diseases at https:// www.dir.ca.gov/dosh/dosh_publications/ATD-Guide.pdf [4]. MODES OF TRANSMISSION Almost all pathogens are transmitted by being carried from one place to another. The mode or means of transmission is the weakest link in the chain of infection, and it is the only link that can be eliminated entirely. Most infection control efforts are aimed at preventing transmission of pathogens from a reservoir to a susceptible host. Both Standard and Transmission-Based Precautions are designed to interrupt the mode of transmission. Table 1 details the most common modes of infection transmission in dentistry [5; 6; 8]
INTRODUCTION In 2023, there were more than 751,000 jobs in dental occupa- tions in the United States [1]. Most of these dental workers come in daily contact with a variety of infectious diseases in their workplace and are at risk for both transmitting and contracting these diseases. Universal Precautions were originally developed and recom- mended by the Centers for Disease Control and Prevention (CDC) in the 1980s as an infection control approach to protect healthcare professionals from bloodborne pathogens. Under Universal Precaution recommendations, all human blood and certain bodily fluids are treated as if they are infectious, regardless of patient or setting. In 1996, the CDC expanded these recommendations and introduced Standard Precau- tions, not only to protect healthcare workers from pathogens in human blood and body fluids but also from pathogens present in bodily fluids that are not covered under Universal Precautions, including saliva during dental procedures. Stan- dard Precautions are the minimum standard of care applied to all patients, and include hand hygiene, use of specific types of personal protective equipment (PPE) based on anticipated exposure, safe injection practices, and management of con- taminated environmental items. In addition to Standard Precautions, Transmission-Based Precautions (i.e., Contact Precautions, Droplet Precautions, and Airborne Precautions) are used to prevent transmission of an infectious agent that is not interrupted by Standard Precautions alone. The type of Transmission-Based Precaution used is based on what is known or suspected about a patient’s infection. A written protocol should be developed for proper instrument processing, opera- tory cleanliness, and management of injuries, and a copy of infection control regulations should be conspicuously posted in each dental office [2]. INFECTION CONTROL REGULATIONS Legal issues first began to impact infection control practices at the beginning of the acquired immunodeficiency syndrome (AIDS) epidemic in the early 1980s. The need to protect healthcare workers from bloodborne exposures resulted in the publication of the Bloodborne Pathogens Standard by OSHA in 1991 [3]. BLOODBORNE PATHOGENS STANDARD The OSHA Standard requires employers whose employees have exposure to blood or other potentially infectious material (OPIM) to implement safe work practices, education, and barri- ers to exposure. OPIM includes saliva in dental procedures and all bodily fluid in situations where it is difficult or impossible to differentiate between bodily fluids; any unfixed tissue or organ (other than intact skin) from a human (living or dead);
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