APPENDIX A
Definition of terms from the California code of regulations title 16 § 1005. Minimum standards for infection control 1. “Standard precautions” are a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which health care is delivered. These include hand hygiene, use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated exposure, and safe handling of sharps. Standard precautions shall be used for care of all patients regardless of their diagnoses or personal infectious status. 2. “Critical items” confer a high risk for infection if they are contaminated with any microorganism. These include all instruments, devices, and other items used to penetrate soft tissue or bone. 3. “Semi-critical items” are instruments, devices, and other items that are not used to penetrate soft tissue or bone, but contact oral mucous membranes, non-intact skin or other potentially infectious materials (OPIM). 4. “Non-critical items” are instruments, devices, equipment, and surfaces that come in contact with soil, debris, saliva, blood, OPIM, and intact skin, but not oral mucous membranes. 5. “Low-level disinfection” is the least effective disinfection process. It kills some bacteria, some viruses and fungi, but does not kill bacterial spores or Mycobacterium tuberculosis var. bovis, a laboratory test organism used to classify the strength of disinfectant chemicals. 6. “Intermediate-level disinfection” kills Mycobacterium tuberculosis var bovis indicating that many human pathogens are also killed. This process does not necessarily kill spores. 7. “High-level disinfection” kills some, but not necessarily all bacterial spores. This process kills Mycobacterium tuberculosis var. bovis, bacteria, fungi, and viruses. 8. “Germicide” is a chemical agent that can be used to disinfect items and surfaces based on the level of contamination. 9. Sterilization” is a validated process used to render a product free of all forms of viable microorganisms. References AAMI. (2017) ANSI/AAMI ST79:2017. Comprehensive guide to steam sterilization and sterility assurance in health care facilities. California Code of Regulations. (2015). Title 8, Section 5193: Bloodborne pathogens. Retrieved from https://www.dir.ca.gov/title8/5193. html California Code of Regulations. (2011). Title 16. Professional and Vocational Regulations; Division 10. Dental Board of California; Chapter 1. General Provisions Applicable to All Licensees; Article 1. General provisions; Section 1005. Minimum Standards for Infection Control. Retrieved from https://govt.westlaw.com/calregs/Document/I3F75D9A0B95D11E0A3CAA6663E6464AA? transitionType=Default&cont extData=(sc.Default) California Dental Association. (2019). Final EPA rule prohibits ‘skewering’ of pharmaceutical hazardous waste. Retrieved from https:// www.cda.org/Home/News-and-Events/Newsroom/Article-Details/final-epa-rule-prohibits-sewering-of-pharmaceutical-hazardous- waste#:~:text=Dentists%20in%20California%20will%20need,managed%20as%20regulated%20medical%20waste. California Dental Practice Act. Cal. Bus. & Prof. § 1611.5. (2019a). https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml? lawCo de=BPC&division=2.&title=&part=&chapter=4.&. California Dental Practice Act. Cal. Bus. & Prof. § 1901. (2019b). https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml? lawCode =BPC&division=2.&title=&part=&chapter=4.&. California Health and Safety Code Sections 117600-118360. Medical Waste Management Act. (2017). Retrieved from https://facilities. tu.edu/safety/NEW_MedicalWasteManagementAct-2.pdf Centers for Disease Control and Prevention. Division of Oral Health. (2016a). Infection control: Frequently asked questions – hand hygiene. Retrieved from https://www.cdc.gov/oralhealth/infectioncontrol/faqs/hand-hygiene.html Centers for Disease Control and Prevention, Division of Oral Health. (2017). Frequently asked questions – occupational exposure to blood. Retrieved from https://www.cdc.gov/oralhealth/infectioncontrol/faqs/occupational-exposure.html Centers for Disease Control and Prevention. (2003). Guidelines for infection control in dental health care settings – 2003. MMWR Recommendations and Reports, 52(RR-17), 1-68. Centers for Disease Control and Prevention. (2016b). Guide to infection prevention for outpatient settings: Minimum expectations for safe care – Appendix A: Infection prevention checklist for outpatient settings. Retrieved on July 28, 2021, from https://www.cdc.gov/ infectioncontrol/pdf/outpatient/guidechecklist.pdf Centers for Disease Control and Prevention. (2020). Healthcare-associated infections: Data portal. Retrieved on July 28, 2021, from https:// www.cdc.gov/hai/data/portal/index.html
10. “Cleaning” is the removal of visible soil (e.g., organic and inorganic material) debris and OPIM from objects and surfaces and shall be accomplished manually or mechanically using water with detergents or enzymatic products. 11. “Personal Protective Equipment” (PPE) is 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, and OPIM, and chemicals used for infection control. General work attire, such as uniforms, scrubs, pants, and shirts, is not considered to be PPE. 12. “Other Potentially Infectious Materials” (OPIM) means any one of the following: A. Human body fluids such as saliva in dental procedures and any bodily fluid that is visibly contaminated with blood, and all bodily fluids in situations where it is difficult or impossible to differentiate between body fluids. B. Any unfixed tissue or organ (other than intact skin) from a human (living or dead). C. Any of the following, if known or reasonably likely to contain or be infected with HIV, HBV, or HCV: 1. Cell, tissue, or organ cultures from humans or experimental animals; 2. Blood, organs, or other tissues from experimental animals; or 3. Culture medium or other solutions. 13. “Dental Healthcare Personnel” (DHCP) are all paid and non-paid personnel in the dental health-care setting who might be occupationally exposed to infectious materials, including body substances and contaminated supplies, equipment, environmental surfaces, water, or air. DHCP includes dentists, dental hygienists, dental assistants, dental laboratory technicians (in-office and commercial), students and trainees, contractual personnel, and other persons not directly involved in patient care but potentially exposed to infectious agents (e.g., administrative, clerical, housekeeping, maintenance, or volunteer personnel). Centers for Disease Control and Prevention. (2021). HIV in the United States and dependent area. Retrieved from https://www.cdc.gov/ hiv/statistics/overview/ataglance.html Centers for Disease Control and Prevention. (2016c). Summary of infection prevention practices in dental settings: Basic expectations for safe care. Retrieved on July 29, 2021, from https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care2.pdf Centers for Disease Control and Prevention. (2019). Viral hepatitis surveillance report, United States, 2019. Retrieved from https://www. cdc.gov/hepatitis/statistics/2019surveillance/index.htm Cleveland, J., Barker, L., Cuny, E., Panlilio, A., and The National Surveillance System for Health Care Workers (NaSH) Group. (2007). Preventing percutaneous injuries among dental health care personnel. Journal of the American Dental Association, 138(2), 169-178. Cornell College of Agriculture and Life Sciences, Department of Microbiology. (2022). Bacterial endospores. Retrieved from https://micro. cornell.edu/research/epulopiscium/bacterial-endospores Dental Board of California. (2021). Mission and Vision. https://dbc.ca.gov/about_us/mission_and_vision.shtml. Department of Consumer Affairs, S. of C. (2021). Home Page. Department of Consumer Affairs. https://www.dca.ca.gov/. Kuhar, D. T., Henderson, D. K., Struble, K. A., Heneine, W., Thomas, V., Cheever, L. W., … Panlilio, A. L. (2014). Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infection Control and Hospital Epidemiology, 34(9), 875-892. National Institute for Occupational Safety and Health. (2016). Bloodborne infectious diseases: HIV/AIDS, hepatitis B, hepatitis C: Emergency sharps information. Retrieved from http://www.cdc.gov/niosh/topics/bbp/emergnedl.html 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 includes Bloodborne Pathogens Standard. 29 CFR 1910.1030. Occupational exposure to bloodborne pathogens; final rule. Fed. Reg. 56:64174,82. Retrieved on August 4, 2021, from https://www.osha. gov/laws-regs/regulations/standardnumber/1910/1910.1030 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 includes Bloodborne Pathogens Standard. 29 CFR §1910.1030. Occupational exposure to bloodborne pathogens; final rule. Fed. Reg. 56:64174, 82. Yoo, J.-H. (2018). Review of disinfection and sterilization – Back to basics. Infection & Chemotherapy, 50(2), 101-109.
INFECTION CONTROL STANDARDS FOR CALIFORNIA DENTAL HEALTH CARE WORKERS, 6TH EDITION Final Examination Questions Select the best answer for each question and mark your answers on the Final Examination Answer Sheet found on page 170, or complete your test online at EliteLearning.com/Book 1. According to the California Code of Regulations, dental healthcare personnel (DHCP) include: a. All paid personnel who might be exposed to infectious materials. b. All paid and unpaid personnel who might be exposed to infectious materials. c. Only people directly involved in patient care. d. Only dentists, dental hygienists, and dental assistants. 2. The agency that enforces infection control requirements through the Bloodborne Pathogens Rule from Title 8, Section 5192 of the California Code of Regulations is: a. California Environmental Protection Agency (Cal/EPA). b. California Division of Occupational Safety and Health (Cal/OSHA). c. California Division of the Federal Drug Administration (CalFDA). d. Dental Board of California.
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