Transmission-based precautions Transmission-based precautions are the second tier of basic infection control and are to be used in addition to standard precautions for patients who may be infected or colonized with certain infectious agents for which additional precautions are needed to prevent infection transmission (CDC, 2016a). For example, during the COVID-19 global pandemic, CDC recommended empiric use of transmission- based precautions for patients who were exposed to COVID-19 and the implementation of these precautions to prevent transmission of COVID-19 in the dental setting. Dental healthcare personnel safety An office infection control program should also include a component to protect the health of all dental team members. The objectives are to educate and train dental personnel on the principles of infection control, identify work-related infection risks, institute preventive measures, and ensure prompt exposure management and 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.
Transmission-based precautions include: ● Contact precautions for patients with known or suspected infections that represent an increased risk for contact transmission. ● Droplet precautions for patients known or suspected to be infected with pathogens transmitted by respiratory droplets that are generated by a patient who is coughing, sneezing, or talking. ● Airborne precautions for patients known or suspected to be infected with pathogens transmitted by airborne route (e.g., tuberculosis, measles, chickenpox, disseminated herpes zoster). During the COVID-19 global pandemic, CDC provided interim guidance for managing healthcare personnel with exposure to or infection of SARS-CoV-2 (CDC, 2022j). This guidance evolved during the global pandemic as the science and understanding of COVID-19 progressed. This often led to confusion among dental team members on how to handle exposure incidents, and work restrictions related to COVID-19. For up-to-date information, dental personnel should follow CDC Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection (CDC, 2022f). members and patients (Immunize.org, 2022). Dental office immunization policies should incorporate state and federal regulations. Table 1 lists current CDC recommendations for immunizations.
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 dental team members susceptible to certain diseases and the potential for disease transmission to other team Table 1: CDC Recommended Vaccines for Healthcare Workers Vaccines Recommendations in Brief Hepatitis B
● If you don’t have documented evidence of a complete hepB vaccine series, or if you don’t have an up-to-date blood test that shows you are immune to hepatitis B (i.e., no serologic evidence of immunity or prior vaccination) then you should: ○ Get the three-dose series (dose 1 now, dose 2 in 1 month, dose 3 approximately 5 months after dose 2). ○ Get anti-HBs serologic tested 1–2 months after dose 3.
Flu (Influenza)
● Get one dose of influenza vaccine annually.
MMR (Measles, Mumps, & Rubella)
● If you were born in 1957 or later and have not had the MMR vaccine, or if you don’t have an up- to-date blood test that shows you are immune to measles or mumps (i.e., no serologic evidence of immunity or prior vaccination), get two doses of MMR (one dose now and the second dose at least 28 days later). ● If you were born in 1957 or later and have not had the MMR vaccine, or if you don’t have an up-to-date blood test that shows you are immune to rubella, only one dose of MMR is recommended. However, you may end up receiving two doses, because the rubella component is in the combination vaccine with measles and mumps. ● For HCWs born before 1957, see the MMR ACIP vaccine recommendations (CDC, 2023f). ● If you have not had chickenpox (varicella), if you haven’t had varicella vaccine, or if you don’t have an up-to-date blood test that shows you are immune to varicella (i.e., no serologic evidence of immunity or prior vaccination), get two doses of varicella vaccine, four weeks apart. ● Get a one-time dose of Tdap as soon as possible if you have not received Tdap previously (regardless of when previous dose of Td was received). ● Get Td boosters every 10 years thereafter. ● Pregnant HCWs need to get a dose of Tdap during each pregnancy. ● Those who are routinely exposed to isolates of N. meningitidis should get one dose.
Varicella (Chickenpox)
Tdap (Tetanus, Diphtheria, Pertussis)
Meningococcal
COVID-19
● If not up to date, give COVID-19 vaccine according to current CDC recommendations (CDC 2024a; CDC, 2023g; CDC, 2023d). Note. Adapted from Healthcare Personnel Vaccination Recommendations. (2022, July). Immunize.Org. https://immunize.org/wp-content/uploads/catg.d/ p2017.pdf
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