This basic-level course provides an overview of these infection control guidelines with an emphasis on clinical applications for the dental hygienist. Although the target audience for this
course is primarily the dental hygienist, it is also pertinent to other dental professionals who may be involved in infection control program implementation in dental healthcare settings.
CDC AND THE PRACTICE OF DENTAL HYGIENE - BACKGROUND: INFECTION CONTROL AND THE CDC GUIDELINES
setting, and to improve the effectiveness and impact of public health interventions. The Summary highlights the Guidelines while providing basic infection-control principles, reaffirming Standard Precautions as the foundation for infection prevention, and providing links to full guidelines, source documents, and references. The Guidelines were developed by CDC staff members in collaboration with other authorities on infection control and are divided into two main components. The first component discusses the background, scientific rationale, and principles of infection control and the second component contains the actual recommendations. When possible, the recommendations rely upon evidence- based studies. However, some infection control practices do not lend themselves to scientific study because of ethical or logistical reasons. Thus, certain recommendations are based on strong theoretical rationale and suggestive evidence, committee reports, or opinions of respected authorities based on clinical experience. The lack of scientific evidence for certain infection control processes is such that no recommendations are offered.
The practice of infection control in the dental office has a long history of evolution and is ever changing. Today, the Guidelines for Infection Control in Dental Health-Care Settings, 2003 (ADA, 2020b) published by the CDC continues to be the blueprint document for dental infection control standards in the United States. The CDC is an advisory agency – not a regulatory agency. It is important to note, however, that many regulatory agencies base their infection control policies and protocol upon CDC Guidelines . Thus, the dental hygienist should be familiar with CDC Guidelines and other regulatory agencies that may impact infection control in their practice. These may include Occupational Health and Safety Administration (OSHA), state boards, Centers for Medicare and Medicaid Services (CMS), and others. A more recent CDC document provides a condensed version of infection prevention to utilize as a reference, introduction, and/or review. The 2016 Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care is based upon the 2003 Guidelines . The purpose of the CDC Guidelines is threefold: to assist in the prevention and control of infectious diseases, to address personnel health and safety concerns related to infection control in the dental
SUMMARY OF INFECTION PREVENTION PRACTICES IN DENTAL SETTINGS: BASIC EXPECTATIONS FOR SAFE CARE
background, rationale, and scientific evidence behind each recommendation (CDC, 2016). Although disease transmission in the dental setting is rare, there have been a number of breaches in infection control and reported transmissions since the release of the CDC Guidelines for Infection Control in Dental Health-Care Settings, 2003 . Table 1 shows published reports of transmission of bloodborne pathogens in dental healthcare settings from 2003 to 2015. After much investigation and scrutiny, the conclusion reached by the CDC is that the reported transmissions were a result of human error and/or lack of compliance with the existing Guidelines. As a result, the Summary notes “the need for
The Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care was published in 2016. This document is 43 pages in length, is written in plain language, and summarizes the CDC Guidelines for Infection Control in Dental Health-Care Settings, 2003 . The Summary reaffirms that Standard Precautions are the foundation for infection prevention and includes two separate but complementary sections. First, major content areas are addressed to include the six fundamental elements needed to prevent transmission of infectious agents in dental settings and key CDC recommendations. The second section consists of a two-part assessment checklist to evaluate office infection prevention practices, links to source documents, relevant recommendations published by the CDC since 2003, and selected references and additional resources by topic area. The Summary is not considered a replacement for these more extensive guidelines and readers are urged to consult the full document for additional
comprehensive training to improve understanding of underlying principles, recommended practices, their implementation, and the conditions that have to be met for disease transmission” (CDC, 2016, p. 4). Table 1: Published Reports of Transmission of Bloodborne Pathogens in Dental Healthcare Settings, 2003 to 2015
Number of People Notified for Bloodborne
Pathogen (Healthcare- Associated Infections)
Dental Treatment Provided Extractions, intravenous sedation, intravenous general anesthesia. Extractions, dental prophylaxis, restorations, restorative procedures.
Setting and Year Reported Oral surgeon’s practice, 2002
Pathogens Screening
Known or Suspected Mode of Transmission It is speculated that a lapse in cleaning environmental surfaces had occurred after the source patient was treated, leaving an area contaminated with blood, which resulted in cross- contamination. Multiple procedural and infection prevention and control breaches identified: handpieces disinfected but not heat sterilized, instruments sterilized unwrapped, patients allowed to carry partially used anesthetic carpules in metal syringes on tray to other stations.
Hepatitis B Virus (1) 27
Free dental clinic in school gymnasium, 2009
Hepatitis B Virus (5) >1,500
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