Chris Miller, PHD
The regulations that influence dentistry`s infection control policies come from the Occupational Safety and Health Administration and from local groups such as a state board of dentistry, state board of dental examiners, or a state or county department of health. Agencies or groups that make recommendations about infection control include the Centers for Disease Control and Prevention (CDC), the American Dental Association, and the Office of Sterilization and Asepsis Procedures (OSAP) Research Foundation.
All of the above make an effort to keep you informed, supplying interested dental practitioners with as much information as you desire.
Author of the Bloodborne Pathogens Standard
OSHA originally published the Bloodborne Pathogens Standard in the Federal Register. This standard indicates that each dental office needs to have a copy of this standard in the office. The copy should be available to the employees, as well as the evaluating physicians who provide the hepatitis B vaccinations and post-exposure medical evaluations for the employees.
The Federal Register is published almost every workday by the federal government and its information includes all government transactions. Law libraries, some state and county libraries, and some dental and medical schools subscribe to the Federal Register.
A copy of the Bloodborne Pathogens Standard can be obtained from the U.S. Government Printing Office (GPO Order No. 069-001-0040-8) for about $2. Call (202) 783-3238 to order. More information about the standard can be obtained by contacting your regional OSHA office (or, in some instances, your state OSHA office; see related article).
A very useful description of the standard appears in the OSHA publication, "Controlling Occupational Exposure to Bloodborne Pathogens in Dentistry." Contact the OSHA Publications Office at (202) 523-9667 for a single free copy. Or write to them at 200 Constitution Ave., NW, Room N-3101, Washing-ton, DC 20210 and enclose a self-addressed label. The publication number is No. 3129, 1992.
Other OSHA publications that may be of value include:
- "Chemical Hazards in the Workplace," OSHA No. 3084.
- "How to Prepare for Workplace Emergencies," OSHA No. 3000.
- "Occupational Exposure to Bloodborne Pathogens," OSHA No. 3127.
- "Personal Protective Equipment," OSHA No. 3077.
- "Employee Workplace Rights," OSHA No. 3021.
By the way, the proper bibliographical citation for the Bloodborne Pathogens Standard is: Department of Labor, OSHA: Occupational Exposure to Bloodborne Pathogens; Final Rule, Federal Register [29 CFR- Title 29 Code of Federal Regulations - Part 1910.1030] vol 56 {No. 235}: 64175-64182, December 6, 1991.
The leading authority on infectious diseases
While the CDC does not have the authority to make regulations like OSHA, it is the foremost recommending body related to infectious diseases and their prevention. They publish their infection control recommendations and other information in their own weekly publication, Morbidity and Mortality Weekly Reports (MMWR).
The most recent dental infection control recommendations appeared as, "CDC: Infection Control Practices for Dentistry" [MMWR 42 (No. RR-8) May 28, 1993]. MMWR can be found in most dental and medical school libraries, as well as state libraries.
The CDC Oral Health Program also has an excellent voice information service for infection control in dentistry; call (404) 332-4552. The topics discussed include:
- Needlestick (and other sharps) emergencies.
- Barrier precautions (gloves, masks, eyewear, and gowns).
- Sterilization and disinfection practices, including CDC`s recommendations about chemical germicides and infectious waste.
- Bloodborne disease transmission in the dental office.
- Management of occupational exposures to HIV and hepatitis B virus in health care workers.
- Needlestick precautions, including recapping techniques.
Information for obtaining educational materials from CDC and a faxed copy of any topic presented by the voice information service is also provided. Callers are given the option of talking with a CDC dental officer.
In 1993, the CDC, in joint efforts with other federal agencies, developed the Dental Infection Control File, which contains a booklet and other educational information. This can be purchased for $25 plus $3 for shipping and handling (order #PB-94113990) from National Technical Information Services, 2585 Port Royal Road, Springfield, VA 22161; or call (703) 487-4650.
The CDC also publishes recommendations concerning tuberculosis in health care facilities such as dental offices. A document of interest would be, "CDC: Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities" [MMWR 43 (No. RR-13) October 28, 1994].
Additional information on this or other infection control issues can be obtained by calling the Oral Health Program at (707) 488-3031.
Other sources
The current infection control recommendations from the ADA were recently published in the May 1996 Journal of the American Dental Association. The ADA Council on Scientific Affairs and Council on Dental Practice`s recommendations were titled, "Infection Control Recommenda-tions for the Dental Office and the Dental Laboratory."
Other publications from the ADA include their "Regulatory Compliance Manual" and videotapes about infection control procedures; call (312) 440-2500.
The OSAP Research Foundation also provides various educational materials on infection control; call (800) 298-6727.
Chris Miller is director of Infection Control Research and Services and professor of oral biology at Indiana University.
Contacting OSHA
Unless a state administers its own occupational safety and health regulations, readers can contact regional OSHA offices for more information about the Bloodborne Pathogens Standard (or any other workplace safety and health issue). OSHA is divided into following regions:
- Region I: Workers in Massachusetts, Maine, New Hampshire, and Rhode Island can contact OSHA at (617) 565-7164.
- Region II: Workers in New Jersey can contact OSHA at (212) 337-2378.
- Region III: Workers in the District of Columbia, Delaware, Pennsylvania, and West Virginia can contact OSHA at (215) 596-1201.
- Region IV: Workers in Alabama, Florida, Georgia, and Mississippi can contact OSHA at (404) 347-3573.
- Region V: Workers in Illinois, Ohio, and Wisconsin can contact OSHA at (312) 353-2220.
- Region VI: Workers in Arkansas, Louisiana, Oklahoma, and Texas can contact OSHA at (214) 767-4731.
- Region VII: Workers in Kansas, Missouri, and Nebraska can contact OSHA at (816) 426-5861.
- Region VIII: Workers in Colorado, Montana, North Dakota, and South Dakota can contact OSHA at (303) 844-3061.
- Region X: Workers in Idaho can contact OSHA at (201) 553-5930.
Workers employed in states that administer their own OSHA programs can contact the following phone numbers for more information: Alaska, (907) 465-2700; Arizona, (602) 542-5795; California, (415) 703-4590; Connecticut, (203) 566-5123; Hawaii, (808) 548-3150; Indiana, (317) 232-2665; Iowa, (515) 281-3447; Kentucky, (502) 333-4179; Maryland, (301) 333-4179; Michigan, (517) 373-9600; Minnesota, (612) 296-2342; Nevada, (702) 687-3032; New Mexico, (505) 827-2850; New York, (518) 457-2741; North Carolina, (919) 733-7166; Oregon, (503) 378-3272; South Carolina, (803) 734-9594; Tennessee, (615) 741-2582; Utah, (801) 530-6900; Vermont, (802) 828-2765; Virginia, (804) 786-2376; Washington, (206) 753-6307; Wyoming, (307) 777-7786.
