Dr. Michele Junger describes the agency's resources
By NOEL BRANDON KELSCH, RDHAP
Infection control is never static. The practices that I learned early in my career have changed. I now wear gloves before I enter the patient's oral cavity and would never consider doing otherwise. I learned the science, and I changed my practice.
Making decisions in infection control in the dental setting means that each of us has to stay updated. We have to be aware of the findings in science-based information and know the current rules, regulations, laws, and recommendations. Recommendations come from the Centers for Disease Control and Prevention (CDC) and are based on the science behind each and every concept. It is our responsibility to be aware of any new findings from the CDC and to adapt our practice to those findings.
This is a banner year for the CDC in infection control for the dental setting. A new guidance document is coming out that can make our decision-making process much easier. I interviewed Dr. Michele Junger, the CDC dental officer, and discovered the many tools that are available for your practice.
Kelsch: What is the mission of the CDC?
Junger: The CDC's mission is to protect America from health, safety, and security threats, both foreign and in the U.S. The Division of Oral Health's (DOH) mission is to improve the oral health of the nation and reduce inequalities in oral health. You can learn more about CDC and DOH at our websites (cdc.gov).
Kelsch: How are guidelines developed and what do they mean?
Junger: The 2003 guidelines remind us: The Guidelines for Infection Control in Dental Health-care Settings - 2003 were developed by CDC staff members in collaboration with other authorities on infection control. Draft documents were reviewed by other federal agencies and professional organizations from the fields of dental health care, public health, and hospital epidemiology and infection control. A Federal Register notice elicited public comments that were considered in the decision-making process. Existing guidelines and published research pertinent to dental infection-control principles and practices were reviewed. Wherever possible, recommendations are based on data from well-designed scientific studies. However, only a limited number of studies have characterized risk factors and the effectiveness of prevention measures for infections associated with dental health-care practices.
Some infection-control practices routinely used by health-care practitioners cannot be rigorously examined for ethical or logistical reasons. In the absence of scientific evidence for such practices, certain recommendations are based on strong theoretical rationale, suggestive evidence, or opinions of respected authorities based on clinical experience, descriptive studies, or committee reports. In addition, some recommendations are derived from federal regulations. No recommendations are offered for practices for which insufficient scientific evidence or lack of consensus supporting their effectiveness exists.
Kelsch: What resources and tools are available at the CDC?
Junger: The CDC develops a broad range of guidelines that are intended to improve the effectiveness and impact of public health interventions and inform key audiences, most often clinicians, public health practitioners, and the public. CDC also develops fact sheets, scientific statements, toolkits, and resources to support state health departments.
Some of the guidelines that may be applicable to dental providers in their daily practice are: Guidelines for Infection Control in Dental Health-care Settings (2003); Guideline for Disinfection and Sterilization in Healthcare Facilities (2008); 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings; Guidelines for Environmental Infection Control in Health-Care facilities (2003); immunization; hand hygiene; resources for investigation outbreaks; patient notification tool kit; resources for sharps safety; One and Only Campaign; and healthcare-associated infections. Information about all of the guidelines can be found at cdc.gov.
Kelsch: What are the responsibilities of health-care providers in staying up to date, and what are some resources for staying up to date?
Junger: The CDC is not a regulatory agency. CDC’s 2003 Guidelines for Infection Control in Dental Health-care Settings provide overall guidance on infection prevention practices for dental health-care personnel and represent the minimum standard of practice recommended for safe care in all dental settings. Some practices, however, are mandated by federal, state, or local regulations. Dental practitioners should review their state dental practice acts for licensure requirements.
Kelsch: Can you please share some details about the updated guidelines?
Junger: The Guidelines for Infection Control in Dental Health-care Settings (2003) are still current. We have repackaged them for easier understanding to assist in compliance and have included a checklist for evaluating administrative policies and clinical practices. This summary and checklist are on our website.
The decisions we make in infection control need to be based on up-to-date findings, recommendations, rules, and regulations. Utilizing the CDC guidelines will help to make those decisions so much easier.
The Guidelines for Infection Control in Dental Health-care Settings - 2003 are still current. CDC will not be releasing new guidelines for infection control in dental settings. However, CDC has developed a document entitled Summary of Infection Prevention Practices for Dental Settings: Basic Expectations for Safe Care. This document summarizes existing recommendations to make them easier to understand and use in all dental settings. The Summary focuses on standard precautions as the foundation for preventing transmission of infectious agents during patient care. The Summary is intended to supplement existing CDC recommendations, not replace them.
The Summary also includes the following tools and resources to help dental health care providers follow infection prevention guidelines:
- Links to references and additional resources
- Two checklists to evaluate how well dental staff are following the guidelines.
- The first checklist focuses on administrative policies and dental setting practices that should be included in infection prevention and control programs
- The second checklist is an observational assessment that can be used to evaluate compliance with the CDC’s recommendations during patient care
Kelsch: How long did it take to update them?
Junger: CDC staff stay abreast of the infection prevention and control literature so that our agency’s recommendations are evidenced-based and supported by the best available science.
Kelsch: Who is involved in the update?
Junger: In addition to experts in the Division of Oral Health, we engaged CDC subject matter experts from the Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, and the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.
Kelsch: What do you think is the biggest area of focus and concern?
Junger: In this new Summary publication, we reinforce the importance of standard precautions as the key to preventing transmission of infectious agents in dental settings. In addition, we emphasize the importance of having an individual in every dental practice assigned to be the infection prevention coordinator. That individual would be responsible for developing written infection prevention policies based on evidence-based guidance, regulations, and standards.
The infection prevention coordinator also would ensure that the practice has needed equipment and supplies required for adherence to standard precaution practices and communicate with all staff members to address infection prevention issues. RDH
NOEL BRANDON KELSCH, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists' Association.