Infection Control for Dental Professionals ________________________________________________________
VACCINATION Due to increased risk of occupational exposure, the CDC strongly recommends that all healthcare workers, including dental care providers, receive immunizations as a preventive measure. While these are the recommendations from the CDC, state and local legislation and workplace regulations may or may not require these immunizations. Hepatitis B The hepatitis B vaccine is given in a series of three injections at 0, 1, and 6 months. If one of the injections is missed, the series does not need to be restarted. The CDC recommends if the series is interrupted, the second or third dose should be administered as soon as possible; the second and third doses should be separated by an interval of at least eight weeks [24]. No booster is necessary. Follow-up serologic testing two months after vaccination (to ensure efficacy) is recommended. The provision of employer-supplied hepatitis B vaccination may be delayed until after probable exposure for employees whose sole exposure risk is the provision of first aid. The high risk of hepatitis B virus exposure among healthcare personnel makes it imperative that clinical dental personnel be vaccinated. Vaccination can protect both workers and patients from hepatitis B virus infection and, whenever possible, should be completed when dentists or other dental care personnel are in training [10]. Influenza Influenza is primarily transmitted from person to person via large, virus-laden droplets generated when infected persons cough or sneeze. These large droplets can settle on the mucosal surfaces of the upper respiratory tracts of susceptible persons who are within 3 feet of infected persons. Transmission may also occur through direct contact or indirect contact with respiratory secretions, such as when touching surfaces contami- nated with influenza virus and then touching the eyes, nose, or mouth. The CDC strongly recommends that all healthcare personnel, especially those who have contact with patients at high risk, who have high-risk medical conditions, or who are older than 50 years of age, receive an annual (seasonal) influenza vaccination [24].
Measles, Mumps, and Rubella (MMR) Vaccination for measles, mumps, and rubella is typically given in a single combination vaccine. The CDC notes that, regardless of birth year, individuals should receive two doses of measles, two doses of mumps, and one dose of rubella live-virus vaccine to be considered protected. MMR is given in a series of two injections, at least 28 days apart. Because the vaccine is often combination, most individuals will receive two doses of rubella-containing vaccine, with no adverse effect [24]. Tetanus and Diphtheria (Toxoids) and Acellular Pertussis (Tdap) Vaccination for tetanus is recommended for all dental health- care personnel, regardless of age. The CDC recommends receiv- ing the vaccine as soon as feasible if Tdap has not already been received, and regardless of interval from the last tetanus and diphtheria (Td) immunization. Routine boosters are recom- mended every 10 years thereafter [24]. Varicella The varicella-zoster virus is responsible for chickenpox and shingles. The CDC recommends the varicella-zoster vaccine for all dental healthcare personnel who do not have evidence of immunity, defined as: written documentation of two doses of varicella vaccine; laboratory evidence of immunity or confirmation of disease; diagnosis or verification of acute disease by a health-care provider; or diagnosis or verification of herpes zoster by a healthcare provider. While the varicella vaccine is recommended, the CDC does note that serologic testing before vaccination is likely to be cost-effective, as 71% to 93% of adults without a history of varicella are immune [24]. Immunization is considered complete after a series of two doses, spaced four to eight weeks apart [24]. TRAINING AND EDUCATION Dental personnel should also fulfill all federal and state requirements for infection control training. New employees, or employees being transferred into jobs involving tasks or activities with potential exposure to blood or OPIM, must receive bloodborne pathogen training before assignment to tasks in which an occupational exposure may occur. Retraining is required annually or when changes in procedures or tasks affecting occupational exposure occur. Employees should be provided access to a qualified trainer to answer questions dur- ing the training session [9; 10].
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