Chris Miller
Checklists often help review infection control procedures for the office. In the first column of this series last month, suggested reviews of recordkeeping, training, and hepatitis B vaccination procedures were outlined. In this issue, the checklists below address post-exposure medical evaluations, barrier protection, and general aseptic techniques.
Post-exposure medical evaluations
A post-exposure medical evaluation is an OSHA Bloodborne Pathogens rule requiring the establishment of a mechanism to give a medical evaluation to employees who are exposed to blood or saliva.
- The procedures for providing the post-exposure medical evaluation are included in the office`s written exposure control plan (see the column in the November issue).
- Procedures for evaluating the circumstances surrounding an exposure incident are described in the office`s written exposure control plan.
- The required procedures for the OSHA post-exposure medical evaluation are in place, which include:
- The exposed employee reports the exposure to the supervisor.
- The exposed employee is sent to the health care professional (HCP) (such as a physician) for a medical evaluation and appropriate testing regarding HIV disease and hepatitis status.
- The source individual (usually the patient involved in the employee injury) is sent (with consent) to the HCP for evaluation of HIV disease and hepatitis status. The patient`s personal physician may be chosen, but the results of the evaluation are to be given to the HCP evaluating the exposed employee.
- The HCP evaluating the exposed employee is given the following: 1) a copy of the OSHA Bloodborne Pathogens standard; 2) the incident report describing the conditions surrounding the exposure; 3) the employee`s job description as it relates to the exposure incident; 4) past employee information (written opinions from the HCP) regarding hepatitis B vaccination status of the employee and any information from previous exposure-related medical evaluations. Such records may have been kept by the HCP, if previously involved in hepatitis B vaccinations or other medical evaluations.
- The employer assures that test results of the source individual are transmitted to the HCP and that the HCP informs the exposed employee of these results while stressing confidentiality.
- The employer receives a written statement from the evaluating HCP within 15 days of the completion of the evaluation. The statement is limited to the following: 1) that the employee has been informed of the results of the evaluation; and 2) that the employee has been told about any medical conditions resulting from exposure to blood or saliva which require further evaluation or treatment. No other findings or diagnoses shall be included in this statement.
- A copy of the HCP`s statement is provided to the exposed employee and is kept in the confidential medical records maintained for that employee (see the November issue?s column).
- Provisions are made for the HCP to properly store the exposed employee?s blood for at least 90 days if the employee gives consent for drawing of the blood sample but not for testing. This allows for testing at a later date should the employee change his or her mind.
Barriers
- Appropriate gloves, face masks, protective eyewear, and protective clothing in the proper sizes are provided to employees for use when there is any potential for exposure to blood or saliva. This potential may occur during patient treatment at chairside, when cleaning up the unit for the next patient, when processing contaminated instruments in the sterilizing room, when working in the in-office laboratory, and when sorting laundry or during other duties.
- Alternative barriers are provided when needed (if an employee has a reaction to certain gloves, for example, alternative gloves are made available).
- Mechanisms ensure use of appropriate barriers.
- Disposable barriers are changed and discarded after every patient.
- Barriers are removed before leaving the work area (they should not be worn into the lunchroom, for example).
- The employer is responsible for cleaning, laundering, disposing, repairing, and replacing barriers when appropriate to ensure proper functioning of the barriers.
- Contaminated laundry is placed in leakproof bags identified with a biohazard symbol/color coding.
- Gloves, masks, eyewear, and protective clothing are put on and removed in the proper order to avoid unnecessary contamination (for example, put on protective clothing, mask, and then gloves ? this avoids contaminating the gloves before they are used with the patient).
Aseptic techniques
- Hands are washed before gloving, after removing gloves, after using the restroom, before eating, and at other times when they may become contaminated.
- Eating, drinking, smoking, applying cosmetics, contacts, or lip balm are not done in areas where blood and saliva may be present on environmental surfaces.
- Spattering of the patient?s contaminated oral fluids are kept to a minimum (for example, when high-volume evacuation [HVE], rubber dam, or preprocedural antimicrobial mouthrinse are used).
- Dental unit water is not used to irrigate surgical sites.
- Consideration is given to providing good quality water for patient treatment.
- Aseptic retrieval systems are in place for selecting materials from any bulk containers (sterile cotton pliers, for example, are provided with each patient setup).
- Disposable items are not reused on other patients even if they are cleaned.
- A one-way CPR airway or a bagging system is available for use by qualified people to avoid contact with a person?s oral fluids.
- Universal and standard precautions are performed in the office.
In summary, these checklists will help review procedures related to employee exposures, the use of protective barriers, and general aseptic techniques when organizing, maintaining, or revamping the office infection control program.
Chris Miller is director of Infection Control Research and Services and professor of oral biology at Indiana University.
