Use a checklist to help assure infection control: part 2

Bloodborne pathogens be controlled if you follow the proper procedures. A proven checklist of procedures can help reduce or eliminate unnecessary exposures.

Bloodborne pathogens be controlled if you follow the proper procedures. A proven checklist of procedures can help reduce or eliminate unnecessary exposures.

The following is a continuation of a checklist based on the requirements of the OSHA bloodborne pathogens standards and recommendations from the Centers for Disease Control and Prevention.

Instrument cleaning and sterilization

  • Instruments, high-speed handpieces, low-speed handpiece components, reusable prophy angles, ultrasonic scaler tips, and reusable air/water syringe tips used in a patient's mouth are cleaned, packaged, and sterilized (by autoclaving, dry heat, or chemical vapor) between uses.
  • Proper functioning of sterilization cycles is verified at least weekly by use of biological indicators (i.e., spore tests).
  • A chemical indicator is placed in each multiple instrument pack or in the center of a load of unwrapped instruments to be processed through a sterilizer.
  • Heat-sensitive reusable items are sterilized in a liquid chemical germicide.

Surface asepsis

  • Environmental surfaces that have been contaminated with patient materials are cleaned and then disinfected with a chemical germicide registered with the EPA as a hospital disinfectant and labeled for tuberculocidal activity.
  • As an alternative to surface cleaning and disinfection between patients, surface barriers (protective coverings) are used to prevent contamination of surfaces, and the barriers are replaced between patients.

Reducing contamination

  • Single-use disposable items (prophy angles, cups and brushes, evacuator tips, air/water syringe tips, and saliva ejector tips) are used for one patient only and then discarded.
  • No one is permitted to eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in areas where occupational exposure from blood or saliva may occur.
  • Food and drinks are not stored in refrigerators, freezers, shelves, cabinets, countertops, or benchtops where blood or saliva may be present.
  • Procedures are used to minimize spraying, splashing, spattering, and generation of droplets of blood or saliva.
  • Reusable contaminated sharps are not stored or processed in a manner that requires employees to reach by hand into the containers where these sharps have been placed.
  • Equipment that may be contaminated with blood or saliva is examined prior to servicing or shipping, and decontaminated as necessary (unless this is not possible).
  • Those portions of equipment to be serviced that cannot be decontaminated are clearly labeled, and this information is clearly conveyed to those who will be handling or servicing the equipment.
  • Biopsy specimens are placed in a sturdy, labeled or color-coded container with a secure lid to prevent leakage during transport.
  • If the outside of a specimen container is contaminated, it is placed in a secondary container, which prevents leakage and is labeled or color-coded.
  • Laboratory materials used in the mouth are cleaned and disinfected before being manipulated in the laboratory.
  • Laboratory materials manipulated in the laboratory are cleaned and disinfected before being placed in the mouth.

Laundering

  • Contaminated laundry is handled as little as possible and is not sorted where it was used.
  • Contaminated laundry is placed and transported in bags that are labeled with a biohazard symbol or are color-coded.
  • Wet laundry is placed in leakproof bags or containers that prevent leakage.
  • Employees who have contact with contaminated laundry wear gloves and other appropriate protective clothing.
  • Contaminated laundry shipped off-site to a facility that does not use protective clothing to handle all laundry is placed in bags or containers labeled with a biohazard symbol or are color-coded.

Recordkeeping

  • Appropriate and confidential medical records are kept on employees that include name, Social Security number, hepatitis B vaccination status, records relative to the ability of the employee to receive the hepatitis B vaccination, written opinions from health-care workers who evaluated the employee for hepatitis B vaccination or after exposures, description of exposed employee's duties, documentation of the route of exposures, results of exposure-related source individual's blood testing.
  • Medical records are kept for at least the duration of employment plus 30 years.
  • Records for bloodborne diseases training are kept for three years, including dates of training, contents or a summary of the training, name and job titles of people trained, name and qualifications of the trainer.

Needlestick prevention

  • The written exposure control plan for the office required by OSHA has been updated to include the new requirements aimed at needlestick prevention which became effective on April 18, 2001.

Complete listings of the rules in the OSHA Bloodborne Pathogens Standard and the recommendations from CDC for infection control in dentistry are found in the report by the United States Department of Labor, Occupational Safety and Health Administration: "Occupational exposure to bloodborne pathogens;" Final rule (29 CFR Part 1910.1030). Federal Register, December 6, 1991; 56(No. 235): regulatory text 64175-64182.

You may also read the report from the CDC: "Recommended infection control practices for dentistry" 1993. Morbidity & Mortality Weekly Reports May 28, 1993; 41(No.RR-8):1-12. If you're a member of the Organization for Safety and Asepsis Procedures, call 1-800-298-OSAP for a copy of these documents. If you're not a member, call the same phone number for information on how to join this dental infection control organization.

Chris Miller, PhD, is professor of oral microbiology and executive associate dean at the Indiana University School of Dentistry.

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