A periodic review of the "standard" infection-control procedures performed in the office sometimes identifies problems in techniques or use of products and may even reflect deficiencies in training.
Chris Miller, PhD
Periodic reviews of office procedures will assure that infection control is compliant with regulations and is protective of patients and the office staff. If you haven`t reviewed your procedures lately, start with a review of the current infection-control regulations and recommendations. These include federal and state regulations as well as professional recommendations, such as the OSHA Bloodborne Pathogens Standard, CDC recommendations, and ADA recommendations.
Training and recordkeeping
The OSHA bloodborne pathogens standard requires initial training on the general nature and prevention of bloodborne diseases, as well as on the components of the standard itself. Updated training on at least an annual basis also is required when changes in procedures or personal protective equipment have occurred. Make sure the necessary training and updates have been provided, and that new employees received the training on hepatitis B vaccination prior to being offered the vaccination series.
Check that documents and records are in order. These include the written OSHA Exposure Control Plan that must have been updated within the last year; records on bloodborne pathogens training (to include the date and content of training, qualifications of trainer, names of staff members trained); employee medical records relating to hepatitis B vaccination and post-exposure medical evaluations; occupational injury (exposure incident) report for practices with 11 or more employees; a written schedule and description of procedures for disinfection of office sites that may become contaminated with patients` blood or saliva; and spore-testing results and waste disposal manifests, if required by your state. Check to make sure all employees know where the copy of the bloodborne pathogens standard and the OSHA Exposure Control Plan are kept. Review the mechanisms for hepatitis B vaccination of new employees and re-confirm that a health-care facility is available to perform the required medical evaluation of those staff members that may receive an exposure to blood or saliva.
Procedures
A periodic review of the "standard" infection-control procedures sometimes identifies problems in techniques or use of products and may even reflect deficiencies in training. For example, check to see:
Y If instruments are being cleaned and packaged properly before sterilization and stored properly after sterilization.
Y If the sterilizers are being loaded, operated, and maintained correctly.
Y If spore tests are being performed faithfully and results recorded properly.
Y If surfaces are being cleaned before being disinfected.
Y If plastic surface barriers are being installed and replaced in a proper fashion.
Y If sharps and other waste items are being handled and disposed of in a safe manner.
There are several things to check in regard to personal protective barriers. Check to make sure all full- and part-time employees know where protective barriers are stored and that alternative barriers are available for those staff members needing such items. Confirm that gloves, masks, protective eyeglasses, and protective clothing are being used when needed as well as donned and removed in the proper sequence. Also, confirm that hands are being properly washed at appropriate times, and that there is a mechanism in place for assuring that barriers are properly maintained, cleaned, and replaced when necessary. Assure that procedures or products used to maintain low microbial counts in dental unit treatment water are being performed or used correctly and routinely.
Make sure employees are not taking contaminated protective clothing home to launder and are not wearing this clothing out of the office. Confirm that no staff members are eating, drinking, or applying cosmetics in areas where blood or saliva contamination may be found (the operatory). Also, make sure that all disposable items are being disposed of after use on a single patient and that any specimens containing blood or saliva being sent away for analysis are in leak-proof containers and are properly labeled. Also, check to see that equipment being sent out for repair (such as a high-speed handpiece) is properly sterilized prior to shipment.
A review of other office safety programs also should be conducted. These would include the OSHA hazard communication program for the office and fire or other emergency evacuation plans.
Chris Miller, PhD, is professor of oral microbiology and executive associate dean at the Indiana University School of Dentistry.
