Course overview A comprehensive knowledge of infection prevention and control is imperative for all oral healthcare providers to protect themselves, their team members, and patients. Dental hygienists, in particular, are at increased risk of infection transmission because of their continuous exposure to bloodborne pathogens and exposure to aerosols during clinical care and numerous other non-patient-care activities. Thus, it is imperative that the dental hygienist is conscientious, competent, and up to date with guidelines, recommendations, and standards for infection control in the dental healthcare setting. This basic-level course provides an overview of infection control guidelines and recommendations published by the Centers of Disease Control and Prevention (CDC) 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 development and implementation in dental healthcare settings.
As the COVID-19 global pandemic evolved, the science and understanding of this infection unfolded, and infection control measures were modified and updated accordingly. This course will contain the most up-to-date infection control policies and protocol for COVID-19 in dental healthcare settings as of the date of publication. Dental hygienists are licensed by their state regulatory body to practice dental hygiene and should practice according to regulations and policies identified in their state dental practice acts. The hygienist must also be familiar with additional regulatory agencies that may impact their practice setting such as Occupational Health and Safety Administration (OSHA), Centers for Medicare and Medicaid Services (CMS), The Joint Commission (TJC), and others. While this course will focus upon CDC guidelines and recommendations, it is the responsibility of dental hygienists to familiarize themselves with additional regulatory and compliance requirements that impact their practice.
CDC AND THE PRACTICE OF DENTAL HYGIENE
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. Whether to implement a pre-procedural mouth rinse is an example an infection control policy where CDC provides no recommendation. CDC guidelines state that an antimicrobial mouth rinse used by patients before a dental procedure reduces the number of microorganisms released in the form of aerosols or spatter, but there is no scientific evidence that this prevents clinical infections in patients or dental personnel. Thus, the dental hygienist may or may not choose to administer a pre-procedural mouth rinse depending upon preference. However, if the dental facility for which the hygienist is employed has a policy on pre-procedural mouth rinses, the hygienist must follow this policy. CDC Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care In 2016, CDC published a condensed version of the 2003 guidelines— Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care . While the 2003 guidelines are complex, scientific, and lengthy, the Summary is 43 pages in length and is written in plain language that is easier to read. The Summary may be utilized as a reference, introduction, learning tool, or review. 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 fundamental elements needed to prevent infection transmission 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 (CDC, 2016c).
The CDC is our nation’s premier public health agency that issues health and safety recommendations to control and prevent disease, injury, and disability in the United States and worldwide. CDC also provides guidance to the dental profession on infection prevention and control that is backed by strong scientific evidence. While CDC is an advisory agency, it does not have the authority to enforce these guidelines. Yet, many local, state, and federal laws are based upon CDC recommendations. For instance, some state dental boards require dental offices to conform and comply with current recommendations and guidelines of CDC relating to infection control practices, others specify compliance with specific CDC documents, and some states do not specify either. Whether a state has adopted CDC guidelines into the board of dentistry requirements, CDC guidelines are considered best practices based on scientific evidence and are likely to be upheld in a court of law. Thus, the dental hygienist must be familiar with CDC guidelines and recommendations for infection control in dentistry. CDC Guidelines for Infection Control in Dental Healthcare Settings—2003 CDC Guidelines for Infection Control in Dental Health-Care Settings—2003 continues to be the blueprint document for dental infection control standards in the United States. 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 setting, and to improve the effectiveness and impact of public health interventions (CDC, 2003). The 2003 guidelines are divided into two main components. The first section of the document discusses the background, scientific rationale, and principles of infection control, whereas the second section contains the actual recommendations and the strength of the recommendations. When possible, the recommendations rely upon evidence-based studies. However, some infection control practices do not lend themselves to scientific
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