_______________________________ Infection Control for Dental Professionals: The California Requirement
OCCUPATIONAL EXPOSURES An occupational exposure is defined as a percutaneous injury or contact of mucous membrane or nonintact skin with blood, tissue, or OPIM, most commonly a needlestick injury. The risk of infection depends on several factors, including [27]: • Whether the exposure was from a hollow-bore needle or other sharp instrument • Whether the exposure was to non-intact skin or mucous membranes • The amount of blood involved • The amount of contagion present in the source person’s blood If a sharps injury occurs, wash the exposed area with soap and water. Do not “milk” or squeeze the wound. There is no evidence that using antiseptics will reduce the risk of trans- mission for any bloodborne pathogens; however, the use of antiseptics is not contraindicated. In the event that the wound needs suturing, emergency treatment should be obtained. The risk of contracting HIV from this type of exposure is extremely rare. There are no documented cases of a dental healthcare professional contracting HIV from an occupational exposure. OSHA requires dental employers of an individual with an occupational exposure to a bloodborne pathogen to arrange a confidential medical evaluation and follow-up for any employee reporting an exposure incident [3]. An exposure incident is any eye, mouth, mucous membrane, nonintact skin, or other parenteral contact with blood or OPIM. Saliva in dental pro- cedures is treated as potentially infectious material. Following an exposure, the dental employer must refer the exposed employee to a licensed healthcare professional who can provide information and counseling and discuss how to prevent further spread of a potential infection. The exposed employee is entitled to appropriate follow-up and evaluation of any reported illness to determine if the symptoms may be related to HIV or hepatitis B or C infection [27]. Prompt response is necessary whenever an occupational expo- sure occurs. If possible, the patient should be interviewed to determine if any risk factors or bloodborne pathogens not previously disclosed are present. The patient may be tested along with the employee, if he or she agrees, in order to obtain the most information possible. Testing and postexposure pro- phylaxis may be conducted at an occupational injury clinic. All events leading up to and after the exposure should be documented in a written report [27]. Postexposure Prophylaxis Postexposure prophylaxis (PEP) involves the provision of medications to someone who has had a substantial exposure, usually to blood, in order to reduce the likelihood of infection. PEP is available for HIV and hepatitis B virus. Although there is no PEP recommended for hepatitis C virus, limited data
• Source control by putting a mask on the patient to prevent respiratory droplets from spreading. • Ensure appropriate patient placement in an airborne infection isolation room (AIIR) constructed according to the CDC’s Guideline for Isolation Precautions. In settings where Airborne Precautions cannot be implemented due to limited engineering resources, masking the patient and placing the patient in a private room with the door closed will reduce the likelihood of airborne transmission until the patient is either transferred to a facility with an AIIR or returned home. • Restrict susceptible healthcare personnel from entering the room of patients known or suspected to have measles, chickenpox, disseminated zoster, or smallpox if other immune healthcare personnel are available. • Use PPE appropriately, including a fit-tested NIOSH-approved N95 or higher level respirator for healthcare personnel. • Limit transport and movement of patients outside of the room, and if movement is necessary, instruct patient to wear a surgical mask and observe Respiratory Hygiene/Cough Etiquette. Healthcare personnel transporting patients who are on Airborne Precautions do not need to wear a mask or respirator during transport if the patient is wearing a mask and infectious skin lesions are covered. • Immunize susceptible persons as soon as possible
following unprotected contact with vaccine- preventable infections (e.g., measles, varicella or smallpox).
PROTECTING DENTAL HEALTHCARE WORKERS Protecting DHCP is an integral part of every dental organiza- tion’s general program for infection prevention and control. The objectives usually include [5]: • Educating personnel about the principles of infection control and emphasizing individual responsibility • Providing care to personnel for work-related illnesses or exposures • Identifying work-related infection risks and implementing appropriate preventive measures • Containing costs by preventing infectious diseases that result in absenteeism and disability
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