Infection Control for Dental Professionals: The California Requirement _______________________________
• Bloody sputum or hemoptysis • Hoarseness • Fever • Fatigue • Chest pain
indicate that antiviral therapy might be beneficial when started early in the course of infection [28]. For employees who have not received the hepatitis B vaccine series, the vaccine (and in some circumstances hepatitis B immunoglobulin) should be offered as soon as possible (within seven days) after the expo- sure incident. The effectiveness of hepatitis B immunoglobulin administered more than seven days after exposure is unknown. PEP has been the standard of care for healthcare providers with substantial occupational exposures since 1996 and must be provided in accordance with the recommendations of the U.S. Public Health Service [28]. TUBERCULOSIS PREVENTION California has one of the highest incidence rates of TB in the country, primarily because of its large population of persons born outside of the United States [31]. In 2023, the TB infection rate in California was 13 times higher among non- U.S.-born individuals than among those born in the United States. The rates of TB among Asian and Black individuals born outside the United States were 43 and 28 times higher, respectively, than that of U.S.-born White persons [31]. To prevent the transmission of Mycobacterium tuberculosis in dental care settings, infection-control policies should be developed based on the community TB risk assessment and reviewed annually. The policies should include appropriate screening for latent or active TB disease in dental care pro- viders, education about the risk for TB transmission, and provisions for detection and management of patients who have suspected or confirmed TB disease. The CDC recommends that all dental care providers be screened for TB upon hire, using either a tuberculin skin test or blood test [10]. The California Department of Public Health recommends an initial skin or blood test; positive reactions or results should be followed up by chest x-ray. Annual testing thereafter is recommended for dental personnel, although local and/or employer policies and methods of testing (e.g., questionnaire or skin or blood test) may differ [32]. Patients with symptoms of TB should be identified by screen- ing; dental treatment should be deferred until active TB has been ruled out or the patient is no longer infectious follow- ing treatment. The potentially active TB patient should be promptly referred to an appropriate medical setting for evalu- ation of possible infectiousness and should be kept in the dental care setting only long enough to arrange for referral. Standard Precautions are not sufficient to prevent transmis- sion of active TB [24]. A diagnosis of active respiratory TB should be considered for
A person with latent TB (positive skin test and no symptoms) can be treated in a dental office using standard infection control precautions [26]. This person has no symptoms and cannot transmit TB to others as there are no spores in his or her sputum. The American Dental Association recommends that all patients be asked about any history of TB or exposure to TB, including signs and symptoms and medical conditions that increase their risk for TB disease. The Health History Form, developed by the U.S. Department of Health and Human Services, can be used to ask these questions. If a patient with suspected or confirmed infectious TB disease requires urgent dental care, that care should be provided in a setting that meets the requirements for California ATD stan- dards and airborne infection isolation. Respiratory protection (with a fitted N95 disposable respirator) should be used while performing procedures on such patients. Standard surgical masks are not designed to protect against TB transmission [4; 26]. VACCINATION Due to increased risk of occupational exposure, the CDC strongly recommends that all healthcare workers, including dental care providers, receive immunizations as a preventive measure. While these are the recommendations from the CDC, state and local legislation and workplace regulations may or may not require these immunizations. Hepatitis B Cal/OSHA guidelines require that healthcare workers who perform tasks that may involve exposure to blood or bodily fluids must have hepatitis B vaccination made available to them within 10 working days of initial assignment. The employee must also be given free information about the efficacy, safety, and benefits of vaccination [30]. The hepatitis B vaccine is given in a series of three injections at 0, 1, and 6 months. If one of the injections is missed, the series does not need to be restarted. The CDC recommends if the series is interrupted, the second or third dose should be administered as soon as possible; the second and third doses should be separated by an interval of at least eight weeks [24]. No booster is necessary. Follow-up serologic testing two months after vaccination (to ensure efficacy) is recommended. The provision of employer-supplied hepatitis B vaccination may be delayed until after probable exposure for employees whose sole exposure risk is the provision of first aid.
any patient with the following symptoms: • Coughing for more than three weeks • Loss of appetite • Unexplained weight loss • Night sweats
46
EliteLearning.com/Dental
Powered by FlippingBook