California website regularly for any changes or updates to these regulations. A thorough working knowledge of these regulations provides patient and DHCP safety, and assurance that the dental office is in compliance with the most current state dental board mandates. It should be noted that, with the arrival of the SARS- CoV-2 (COVID-19) pandemic, infection control has expanded to
the outer office, with the advent of initial patient screening and patient masking. In the operatory, use of N95 masks and face shields became more of a standard practice (Kane, 2021). As has always been the case, it is important to follow guidelines, prescribed practices, and legal requirements.
FEDERAL REGULATIONS
Occupational Safety and Health Administration With the advent of the Bloodborne Pathogens Standard [29 C.F.R. §1910.1030 (1992)], OSHA began requiring healthcare employers, including those in the dental profession to limit occupational exposure of employees to blood and other potentially infectious materials. With the emergence of HIV and the documentation that this disease was efficiently spread by contact with blood and blood products, concern about the spread of this infection in all healthcare settings began to emerge. Toward the latter part of the 1980s, there was sufficient evidence to conclude that certain health risks were associated with exposure to body fluids containing pathogenic organisms, including HIV, HBV, and HCV (CDC, 2020; CDC 2016b). Before this time, little effort was directed at eliminating or even minimizing exposure from needle sticks and other sharps. (A sharp is any object that can penetrate the skin, including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and other objects.) With the introduction of the Bloodborne Pathogens Standard in 1992, OSHA required employers to reduce or eliminate the hazards for any employees with occupational exposure (i.e., exposure to blood or to other potentially infectious material [OPIM] while performing their jobs) (OSHA, 2001). OSHA began to require each health care facility to have an exposure control plan that provides a detailed description of how to reduce or eliminate occupational hazards. Included in the exposure control plan is a requirement to implement engineering controls (devices that isolate or remove the BBP hazard) and work practice controls (practices that reduce the likelihood of exposure by changing the way a task is performed). The exposure control plan should also include identification of job categories that involve exposure to potentially infectious
materials (e.g., blood and saliva); the type and indications for the use of personal protective equipment (PPE); BBP training; exposure prevention and post-exposure management strategies; and providing HBV vaccinations for all employees with occupational exposure. Separate OSHA regulations address other safety-related items such as signs on exits, fire extinguishers, and additional safety equipment; and labels on products and chemicals used in the dental office. In April of 2001, the Bloodborne Pathogens Standard was revised to include the Needlestick Safety and Prevention Act. This revision by OSHA required employers to include provisions to eliminate or minimize employee exposure to sharps and occupational exposures in the exposure control plan. More specifically, each employer must review the latest technological changes (e.g., self-sheathing needles and scalpels) and decide whether to incorporate them into their practice. This review must be done on at least an annual basis and must include employee input. The decision to incorporate such devices into their practices is made by the clinicians using the specific devices. Decisions about whether to incorporate such devices into the practice cannot be based solely on the criterion of cost. One important aspect of the Bloodborne Pathogens Standard was the required use of universal precautions, which later evolved into the standard precautions that are practiced today. Standard precautions include major components of both universal precautions and body substance isolation precautions. Standard precautions apply to all body fluids, excretions, and secretions (with the exception of sweat) and should be observed during all patient encounters, regardless of the health status of the patient (i.e., the same way, every day, for every patient). The basic elements of the standard precautions are listed in Table 1.
Table 1: Standard vs. Universal Precautions Standard precautions combine the major features of universal precautions and body substance isolation. Universal Precautions
Standard Precautions • Standard precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting in which healthcare is delivered. These practices are designed to both protect healthcare workers (HCWs) and prevent HCWs
• This is an approach to infection control in which blood and certain body fluids are treated as if known to be infectious for: ○ HIV.
○ HBV. ○ HCV. ○ Other BBPs.
• Universal precautions were based on the concept that all blood (and body fluids that might be contaminated with blood) should be treated as infectious because patients with bloodborne infections are often asymptomatic or unaware that they are infected. Body Substance Isolation • Body substance isolation protects against pathogens that may exist in body substances and applies in all patient encounters regardless of the diagnosis (the same way, every day, for every patient). from spreading infections among patients. • Standard precautions apply to contact with: ○ Blood. ○ All body fluids, secretions, and excretions except sweat, regardless of whether they contain blood. ○ Non-intact skin. ○ Mucous membranes. • Standard precautions are employed in the care of all patients in the delivery of routine dental care and include: ○ Hand hygiene. ○ Use of PPE (e.g., gloves, gowns, masks, eye protection). ○ Safe injection practices. ○ Safe handling of potentially contaminated equipment or surfaces in the patient environment. ○ Respiratory hygiene/cough etiquette. Note: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2003, Dec. 19). Guidelines for infection control in dental health-care settings. Morbidity and Mortality Weekly Report, 52 (RR-17), 1-61. U.S. Department of Labor, Occupational Safety and Health Administration (1992). Bloodborne Pathogens Standard. 29 C.F.R. §1910.1030; U.S. Department of Labor, Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens; needlesticks and other sharps injuries; final rule . Fed. Reg. 66:5317 (2001), 25. As amended from and inclu des Bloodborne Pathogens Standard. 29 CFR §1910.1030. Occupational exposure to bloodborne pathogens; final rule . Fed. Reg. 56:64174, 82.
EliteLearning.com/Dental
Page 23
Powered by FlippingBook