Playing it safe with standard precautions

July 28, 2008
Standard precautions remind us that all patients must be handled as though they were infected with Hepatitis B, C, or Human Immunodeficiency Virus.

By Leslie Canham, CDA, RDA

With OSHA regulations, use of disinfectants, and advances in sterilization technology, we might relax a little too much when it comes to standard precautions.

Standard precautions remind us that all patients must be handled as though they were infected with Hepatitis B, C, or Human Immunodeficiency Virus. We cannot let our guard down simply because a patient looks healthy, is youthful, or seems to be aware of his or her health status.

Standard precautions are a set of combined precautions that include the major components of universal precautions (designed to reduce the risk of transmission of bloodborne pathogens) and body substance isolation (designed to reduce the risk of transmission of pathogens from moist body substances). Similar to universal precautions, standard precautions are used for care of patients regardless of their diagnosis or personal infectious status.

Dental patients and dental heath care workers can be exposed to pathogenic microorganisms, including cytomegalovirus, HBV, HCV, herpes simplex virus types 1 and 2, HIV, mycobacterium tuberculosis, staphylococci, streptococci, and other viruses and bacteria that colonize or infect the oral cavity and respiratory tract.

These organisms can be transmitted in dental settings through 1) direct contact with blood, oral fluids, or other patient materials, 2) indirect contact with contaminated objects such as instruments, equipment, or environmental surfaces, 3) contact of conjunctival, nasal or oral mucosa with droplets (such as spatter) containing microorganisms generated from an infected individual and propelled a short distance through coughing, sneezing or talking, and 4) inhalation of airborne microorganisms that can remain suspended in the air for long periods.

Infection through any of these routes requires that the following conditions be present:

* a pathogenic organism of sufficient virulence and in adequate numbers to cause disease

* a reservoir or source that allows the pathogen to survive and multiply (e.g., blood)

* a mode of transmission from the source to the host

* a portal of entry through which the pathogen can enter the host

* a susceptible host

These events provide the chain of infection. Infection-control strategies prevent disease transmission by interrupting one or more links in the chain. Effective infection control can interrupt the spread of epidemiologically important diseases from patient to dental health-care worker, from dental health-care worker to patient, and from patient to patient.

Infection control means interrupting the spread of disease agents by performing specific procedures. In addition to performing infection control procedures correctly, it is also important to perform the procedures with the same diligence after every patient.

Dental health-care workers cannot assume that patients are healthy and skip protecting themselves with personal protective attire, or dispense with appropriate disinfection or sterilization procedures.

The World Health Organization estimated that, in 2007, 33.2 million people were living with HIV and 2.5 million people were newly infected. This year 40,000 people will be infected with HIV in the United States.

Dental practitioners can expect to see more patients infected with HIV in need of oral care. In addition to the increased numbers of individuals known to be infected with HIV, there are also people who are infected and are unaware of their status.

In a case in October 2001, one patient infected another patient with Hepatitis B in an oral surgery office. The first patient, who was identified as having Hepatitis B, was seen for oral surgical procedures by the same oral surgeon two hours before the second patient (who became infected).

The exact route of this "patient-to-patient" disease transmission was not discovered. Instead it was thought to be the result of contact with contaminated clinical surfaces or devices. The information surrounding the Hepatitis B virus includes its ability to live on clinical contact surfaces for up to one week.

Today, we must be vigilant when it comes to standard precautions. It is imperative that OSHA regulations are followed and proper infection-control procedures are performed. Remember, do not make assumptions about the health status of any patient. Play it safe by using standard precautions every time.

References available upon request.

Leslie Canham is a dental speaker and consultant specializing in infection control and OSHA compliance. She has more than 36 years of experience in dentistry. Canham is the founder of Leslie Canham Seminars, providing in-office training, mock inspections, consulting, and online seminars and webinars to help the dental team navigate state and federal regulations. Reach Canham at Leslie Canham, or at (888) 853-7543.