The checklist in this and next month's article is based upon the requirements of the OSHA bloodborne pathogens standards and recommendations from the CDC.
The following checklist is based upon the requirements of the OSHA bloodborne pathogens standards and upon recommendations from the Center for Disease Control and Prevention.
Training, vaccination and documentation of procedures
- Training about hepatitis B vaccination is provided to new employees.
- The hepatitis B vaccination series is offered to new employees after they have received hepatitis B training, but within 10 days of employment at no cost to employees.
- Vaccination refusal by employees is documented.
- Hepatitis B vaccination of employees is performed under the supervision of a licensed physician or other licensed health-care professional, according to the current recommendations of the United States Public Health Service.
- The employer has a written statement from the health-care professional who evaluated an employee for hepatitis B vaccination stating whether the vaccination was indicated for the employee and if the employee received the vaccination.
- Annual update training on the cause and prevention of bloodborne diseases and on other office infection control procedures is provided to office staff.
- Training records are kept.
- A written exposure control plan has been prepared for the facility, is made available to employees, and is updated at least annually.
- An exposure determination has been prepared.
- Universal precautions are observed.
- Engineering controls are examined and maintained or replaced on a regular basis.
- A copy of the OSHA bloodborne pathogens standard is made available to employees.
Post-exposure evaluation and follow-up
- A confidential post-exposure medical evaluation and follow-up including prophylaxis is made available to all exposed employees.
- The post-exposure evaluation and follow-up is made available at no cost, at a reasonable time and place, under the supervision of a licensed physician or other licensed healthcare professional, according to the current recommendations of the United States Public Health Service.
- The employer has a written statement from the health-care professional that evaluated an employee after an exposure stating that the employee has been informed of the results of the evaluation and that the employee has been told of any medical conditions resulting from exposure to blood or saliva which require further evaluation or treatment.
Handwashing and use of personal protective equipment (PPE)
- Handwashing facilities are readily accessible to employees.
- Handwashing by employees after removing gloves or other personal protective equipment is ensured.
- Washing of hands or other skin after exposure to blood or saliva is ensured.
- Appropriate PPE in the proper sizes (e.g., gloves, masks, protective eyewear, protective clothing, and ventilation devices) is provided to employees.
- Alternatives are provided to employees who have reactions to gloves that are normally provided.
- The employer is responsible for and assures that PPE is cleaned, laundered, maintained, replaced, and disposed of at no cost to the employee.
- If a garment is penetrated by blood or saliva, the garment is removed immediately or as soon as possible.
- All PPE is removed before leaving the work area and placed in an appropriately designated area or container for storage, washing, decontamination, or disposal.
- Gloves are worn by employees when there is a chance for direct or indirect hand contact with blood or saliva.
- Gloves are replaced as soon as feasible after torn or punctured.
- Disposable gloves are not washed or decontaminated for reuse.
- The integrity of utility gloves that are decontaminated for reuse is not compromised.
- Utility gloves are observed for cracks, tears, punctures, and peeling and are discarded when these defects are detected.
- Masks, protective eyewear with solid side shields or face shields are worn by employees when there is a chance for spraying, splashing, spattering, or generation of droplets of blood or saliva and eye, nose, or mouth contamination may occur.
- Protective clothing (e.g., gowns, clinic jackets, aprons, lab coats, other outer garments) are worn by employees when there is a chance for spraying, splashing, spattering ,or generation of droplets of blood or saliva
- The use of appropriate PPE by employees is ensured.
Sharps safety and managing regulated waste
- Biohazard labels are affixed to containers of regulated waste, refrigerators, freezers, or other sites containing blood, saliva, or other potentially infectious materials. (Red bags or red containers may be substituted for labels.)
- Contaminated needles are not bent, cut, broken, or unsafely recapped before disposal.
- Sharps containers used in the office are puncture resistant, labeled or color-coded, leakproof on the sides and bottom, closable, easily accessible, located where sharps are used or may be found, not be allowed to overflow, and maintained in an upright position during use and closed before being transported.
- Nonsharp regulated waste is placed in containers that are leakproof, closable, labeled or color-coded and closed before being transported.
- If contaminated on the outside, sharps or other waste containers are placed in a secondary container that is closable, leakproof, color-coded or labeled, designed to contain the waste and prevent leakage, and secured before being transported.
- Regulated waste is disposed of according to local regulations.
- Specimens of blood, saliva or tissue are placed in containers that prevent leakage during collection, handling, processing, storage, transport, or shipping.
- The specimen containers are labeled or color-coded, closed prior to being transported, shipped or stored, and placed in second containers (if contaminated on the outside) that prevents leakage and is labeled or color-coded.
- If the specimen could puncture the primary container, the primary container is placed in a secondary container that is puncture-resistant.
Next month's article will include checklists for instrument cleaning and sterilization, surface asepsis, more record keeping, and reducing the spread of contamination.
Chris Miller, PhD, is professor of oral microbiology and executive associate dean at the Indiana University School of Dentistry.