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 Intravenous sedation, extraction, bone grafts, implant placement.
Setting and Year Reported Oral surgeon’s practice, 2013
Pathogens Screening
Known or Suspected Mode of Transmission Multiple procedural and infection prevention and control breaches identified: administration of intravenous sedation medications by unsupervised, unlicensed, and untrained dental assistants, improperly sterilized dental equipment, environmental contamination. Contaminated medication vials used on more than one patient was likely mode of transmission.
Hepatitis C Virus (1) 5,810
Note . Adapted from “Transmission of Blood-borne Pathogens in US Dental Health Care Settings: 2016 Update,” by J. L. Cleveland, S. K. Gray, J. A. Harte, V. A. Robison, A. C. Moorman, & B. F. Gooch, 2016, Journal of the American Dental Association, 147 (9), 729-738. doi:10.1016/j. adaj.2016.03.020. Administrative measures
include providing supplies necessary for adherence to standard precautions; the assignment of at least one trained individual to oversee the infection prevention program (the infection control coordinator ); the development and maintenance of written infection control policies and procedures based upon evidence- based guidelines, regulations, or standards; and a system for early detection and management of potentially infectious persons at initial points of patient encounter. emerge and as infection control guidelines evolve. Updates should occur at least annually, whenever an employee’s tasks change and increase their risk of occupational exposure, and after an exposure incident occurs. It should be documented that all members of the dental practice have been informed of, and trained on, any updated practices and procedures. Training records should be maintained according to state and federal requirements.
The Summary reinforces that infection prevention must be made a priority in any dental healthcare setting and at least one individual with training in infection prevention should be responsible for developing written infection prevention policies and procedures. These policies and procedures should be tailored to the individual dental setting and reassessed on a regular basis in accordance with state or federal requirements. Other key administrative recommendations for dentistry Education and training Initial and ongoing education and training are critical to ensure that dental personnel understand and follow infection control policies and procedures that are job or task specific. The policies, procedures, and guidelines contained in the office- specific plan must be clearly written, with a specific person being responsible for instituting the program. All dental healthcare professionals (DHCPs) should receive training in the office infection control policies and procedures upon initial assignment. The policies should be updated when new diseases
INFECTION TRANSMISSION
● A pathogen in adequate numbers and of sufficient virulence to cause disease. ● A source or reservoir that allows the pathogen to survive and multiply. ● A mode of transmission from the source to the host. ● A portal of entry through which the pathogen can enter the host. ● A susceptible host (one who is not immune). When all of these conditions are present and a pathogen is successfully transmitted, it is termed the chain of infection (see Figure 1). The goal of infection control is to break one or more links in this chain. medical follow-up. This written exposure plan should include methods for communicating hazards to employees, vaccination requirements, post-exposure evaluation and follow-up, and medical recordkeeping.
Basic principles of infection transmission and prevention should be provided to all dental personnel. The most common way for a bloodborne pathogen to be spread is from a patient to a DHCP, but transmission can also occur from a DHCP to a patient and from one patient to another patient. Transmission can occur through direct contact with blood or oral fluids, indirect contact with contaminated instruments or surfaces, inhalation of airborne microorganisms, and contact of eye, nose, or mouth mucosa with droplets or spatter. Transmission of infection through any of these routes requires that all of the following conditions are present: Dental healthcare personnel safety An office infection control program should include a component to protect the health of all DHCPs. The objectives are to educate and train DHCPs regarding the principles of infection control, identify work-related infection risks, institute preventive measures, and ensure prompt exposure management and
Recommended vaccinations for dental healthcare personnel Dental hygienists and all clinical personnel are at risk for exposure to, and possible infection with, infectious organisms. Immunizations reduce the number of DHCPs susceptible to certain diseases and the potential for disease transmission to other DHCPs and patients. Dental office immunization policies should incorporate state and federal regulations. Table 2 lists current CDC recommendations for immunizations.
Other key recommendations for dental healthcare personnel safety include screening all dental healthcare personnel for tuberculosis upon hire. It is also recommended that each facility have a well-defined policy concerning contact of personnel with patients when personnel have potentially transmissible conditions.
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