Infection Control for Dental Professionals: The California Requirement _______________________________
low- to intermediate-level disinfectant after each patient. The low-level disinfectants used must be labeled effective against hepatitis B virus and HIV. Use disinfectants in accordance with the manufacturer’s instructions. Clean all housekeeping surfaces (e.g., floors, walls, sinks) with a detergent and water or a CalEPA-registered, hospital-grade disinfectant. Chemical- resistant utility gloves should be worn when handling hazard- ous chemicals [9]. Medical Waste Management Federal, state, and local guidelines and regulations specify the categories of medical waste subject to regulation and outline the requirements associated with treatment and disposal [9].
TRANSMISSION-BASED PRECAUTIONS As discussed, Transmission-Based Precautions are used in addition to Standard Precautions for patients that require additional precautions to prevent infection transmission. The three categories of Transmission-Based Precautions are Con- tact, Droplet, and Airborne Precautions; these categories may overlap, and more than one category may be used at a time [25]. CONTACT PRECAUTIONS Contact Precautions are utilized for patients with known or suspected infections that represent an increased risk for contact transmission. Contact Precautions require that practitioners [24]: • Ensure appropriate patient placement to lessen risk for other patients or employees. • Use PPE appropriately, including gloves and a gown. Donning PPE upon room entry and properly discarding before exiting the patient room is recommended to contain pathogens. • Use disposable or dedicated patient-care equipment such as blood pressure cuffs. If common equipment must be used for multiple patients, thoroughly clean and disinfect. • Prioritize cleaning and disinfection of patient rooms and contact surfaces, focusing on frequently touched surfaces and equipment and objects in the immediate vicinity of the patient. DROPLET PRECAUTIONS Use Droplet Precautions for patients that are known or sus- pected to be infected with pathogens transmitted by respiratory droplets. Droplet Precautions requires that one [24]: • Source control by putting a mask on the patient to prevent respiratory droplets from spreading. • Ensure appropriate patient placement to lessen risk for other patients or employees. • Use PPE appropriately, including gloves and a gown. Donning PPE upon rom entry and properly discarding before exiting the patient room is recommended to contain pathogens. • Limit transport and movement of patients outside of the room, and if movement is necessary, instruct patient to wear a mask and follow Respiratory Hygiene/Cough Etiquette. AIRBORNE PRECAUTIONS Airborne Precautions are used when patients are known or suspected to be infected with pathogens transmitted by airborne or aerosol route. Airborne pathogens include TB, measles, chickenpox, and herpes zoster. Airborne Precautions require [24]:
Regulated medical waste is defined as [10]: • Liquid or semi-liquid blood or OPIM
• Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed • Items that are caked with dried blood or OPIM capable of releasing these materials during handling • Contaminated sharps (e.g., needles, burs, scalpel blades, endodontic files) • Pathologic and microbiologic wastes containing blood or OPIM Regulated medical waste accounts for only 9% to 15% of total waste in hospitals and 1% to 2% of total waste in dental offices [10]. Examples of regulated waste found in dental practice set- tings are solid waste soaked or saturated with blood or saliva (e.g., gauze saturated with blood after surgery), extracted teeth, surgically removed hard and soft tissues, and contaminated sharp items, such as needles, scalpel blades, and wires [10]. General medical waste, including used gloves, masks, gowns, and lightly soiled gauze or cotton rolls, may be disposed of with ordinary waste. Regulated medical waste requires careful disposal and con- tainment before collection and consolidation for treatment. A single, leak-resistant biohazard bag is usually adequate for containment of regulated medical wastes, provided the bag is sturdy and the waste can be discarded without contaminat- ing the bag’s exterior. Contamination or puncturing of the bag requires placement into a second biohazard bag. All bags should be securely closed for disposal. Medical waste requiring storage should be kept in labeled, leak-proof, puncture-resistant containers under conditions that minimize or prevent foul odors. The storage area should be well-ventilated and inaccessible to pests. Any facility that generates regulated medical waste should have a regulated medical waste management plan to ensure health and envi- ronmental safety in accordance with federal, state, and local regulations [10; 21].
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