MINIMUM STANDARDS FOR INFECTION CONTROL: A WRITTEN PROTOCOL
The goal of an infection control program is to minimize the transmission of pathogens in the healthcare setting. This goal can be accomplished in a variety of ways. Compliance with the California Minimum Standards for Infection Control (Section 1005) (California Code of Regulations, 2011), Infection Control Recommendations by the Centers for Disease Control and Prevention (CDC), and CDPH provides the groundwork for achieving this goal (California Health and Safety Code, 2017). The California Minimum Standards for Infection Control, Section 1005, stipulate that all DHCP must comply with infection control precautions and enforce the following minimum precautions to protect patients and themselves: 1. Standard precautions “shall be practiced in the care of all patients.” 2. A written protocol “shall be developed, maintained, and periodically updated for proper instrument processing,
operatory cleanliness, and management of injuries. The protocol shall be made available to all DHCP at the dental office” (California Code of Regulations, 2011). Examples of proper instrument processing include instrument inspection, cleaning, packaging, maintenance, sterilization, sterilizer monitoring, and proper instrument storage. Examples of operatory cleanliness include cleaning and disinfection of clinical surfaces, barrier protection for high-touch surfaces, and routine cleaning of environmental surfaces. Examples of management of injuries include policies for reporting and referral for personnel suffering occupational injuries. These policies should be updated at least annually or more often if necessary. 3. “A copy of this regulation shall be conspicuously posted in each dental office” (California Code of Regulations, 2011).
PERSONAL PROTECTIVE EQUIPMENT
Because dental professionals work in close proximity to the oral cavity, blood or other potentially infectious material (OPIM) that may contain infectious organisms can present a risk of transmission to DHCP who are not utilizing appropriate personal protective equipment (PPE). Appropriate PPE is defined in Section 1005 as “specialized clothing or equipment worn or used for protection against a hazard. PPE items may include, but are not limited to, gloves, masks, respiratory devices, protective eyewear and protective attire which are intended to prevent exposure to blood, body fluids, OPIM, and chemicals used for infection control. General work attire such as uniforms, scrubs, pants, and shirts are not considered to be PPE” (California Code of Regulations, 2011). Section 1005 defines OPIM as “human body fluids such as saliva in dental procedures and any bodily fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids” (California Code of Regulations, 2011). Also included are “any unfixed tissue or organ (other than intact skin) from a human (living or dead),” as well as any cell, tissue, or organ cultures from humans or experimental animals; blood, organs, or other tissues from experimental animals; or culture medium or other solutions, that are known or reasonably likely to contain or be infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) (California Code of Regulations, 2011). The California Minimum Standards for Infection Control, Section 1005, stipulate that in order to protect their skin and clothing from blood and OPIM, “all DHCP shall wear reusable or disposable protective attire whenever there is a potential for aerosol spray, splashing or spattering of blood, OPIM, or chemicals and germicidal agents. Protective attire must be changed daily or between patients if they should become
moist or visibly soiled” (California Code of Regulations, 2011). Protective attire used during patient care must be removed prior to leaving laboratories or areas of patient care activities. Reusable gowns must be laundered according to Cal/OSHA Bloodborne Pathogens Standard (California Code of Regulations, 2015). Protective attire must also be worn for disinfection, sterilization, and housekeeping procedures involving the use of germicides or handling contaminated items (California Code of Regulations, 2011). All DHCP must wear surgical face masks with either chin- length plastic face shields or protective eyewear whenever there is potential for aerosol spray, splashing, or spattering of droplet nuclei, blood, chemical or germicidal agents, or OPIM. Masks must be changed and disposed of after each patient. However, if a face mask becomes contaminated or wet, it should be changed during treatment. Following each patient treatment, face shields and protective eyewear shall be cleaned, disinfected, or disposed of (California Code of Regulations, 2011). Hands must be protected by wearing single-use (nonwashable), disposable, medical examination gloves whenever there is contact with mucous membranes, blood, or OPIM and during all pre-clinical, clinical, post-clinical, and laboratory procedures. Medical exam gloves must be discarded (a) when torn or punctured, (b) upon completion of treatment, and (c) before leaving laboratories or areas of patient care activities. All DHCP are required to perform hand hygiene procedures before donning gloves and after removing and discarding gloves. Gloves must not be washed before or after use (California Code of Regulations, 2011). Additionally, DHCP must wear heavy- duty utility gloves to prevent puncture wounds when processing contaminated sharp instruments, needles, and devices.
HAND HYGIENE
At the beginning and end of each workday, DHCP must thoroughly wash their hands with soap and water. DHCP must also perform hand hygiene and don new gloves before treating each patient. Between patients, if hands are not visibly soiled or contaminated, an alcohol- based hand rub may be used for hand hygiene as an alternative to soap and water. Hands must be thoroughly dried before donning gloves to prevent promotion of bacterial growth, and hand hygiene must be performed again immediately after glove removal. DHCP must refrain from providing direct patient care if hand conditions are present that may render DHCP or patients more susceptible to opportunistic infection or exposure. All DHCP who have exudative lesions or weeping dermatitis of the hand must refrain from all direct patient care and from handling patient care equipment until the condition resolves (California Code of Regulations, 2011).
Hand hygiene methods, agents, duration, and indicators include the following: 1. For routine wash : Use water and plain soap for 15 seconds before and after each patient. 2. For antiseptic wash : Use water and antiseptic soap for 15 seconds before and after each patient. 3. For antiseptic hand rub : Use alcohol-based hand rub and agitate hands until dry. Antiseptic hand rub is not to be used if the hands are visibly soiled. 4. For surgical asepsis : Use water and antimicrobial soap for 2 to 6 minutes, or water and non-antimicrobial soap for 2 to 6 minutes, followed by alcohol rub. (CDC, 2016a)
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