Something did change: New CDC documents streamline dental infection control

By NOEL BRANDON KELSCH, RDHAP

Last month, I conducted an interview with the Dr. Michele Junger from the Centers for Disease Control and Prevention (CDC) about the new documents that the agency published for infection control in dentistry (search RDHmag.com for "Junger"). I received a phone call from a hygienist who was upset. She had read the CDC documents and said nothing has changed.

She is just about right. Nothing has changed in what we are being asked to do to keep the patient, clinician, and community safe. The big change is the method of evaluation and self-care. These documents make doing what is right so much easier, as well as give more information on compliance and a compliance program for your office.

The checklist in "Infection Prevention Checklist of Dental Settings: Basic Expectations for Safe Care" is a document we should all be using. It gives you all of the recommendations from the CDC in one place and allows you to evaluate your own program. Many states have adopted CDC recommendations as law. This is a simple way to see if you are in compliance.

The second document is titled, "Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care." All of us need to stop and look at this great summary of all the current recommendations. The hygienist was right that "nothing is new" as this document is based primarily on the "2003 Guidelines for Infection Control in Dental Health-Care Settings."

The 2003 guidelines, along with the "2008 guidelines for Disinfection and sterilization," should be in every office, and all staff members should be trained in the concepts. These documents contain necessary infection prevention expectations for safe care in dental settings, making that process so much easier.

The summary in the second document also gives us some really great resources for training on:

Infection prevention program administrative measures

• Infection prevention education and training
• Respiratory hygiene and cough etiquette
• Updated safe injection practices
• % Administrative measures for instrument processing

Handpieces, an example

One great example of how to use this document would be the dental handpiece. Dental handpieces are required to be autoclaved. You are putting the patient at risk if you do not do this. It is included in the instructions for use (IFU) for an FDA approved product for both high-speed and low-speed handpieces. We are all required to know, follow, and comply with IFUs for FDA-approved medical devices.

Last year, when I did a survey on handpiece sterilization with hygienists, it was revealed that only 23% were sterilizing their slow-speed handpieces between patients in the United States. Thus, 77% are putting the patient at risk. Barrier protection and surface disinfection do not take the place of heat sterilization. Having enough handpieces to sterilize between patients is the cost of doing business.

On page 14 of the summary, it states, "Dental handpieces and associated attachments, including low-speed motors and reusable prophylaxis angles, should always be heat sterilized between patients and not high-level or surface disinfected. Although these devices are considered semicritical, studies have shown that their internal surfaces can become contaminated with patient materials during use. If these devices are not properly cleaned and heat sterilized, the next patient may be exposed to potentially infectious materials."

Page 17 of the check list states, "Dental handpieces (including the low-speed motor) and other devices not permanently attached to air and waterlines are cleaned and heat-sterilized according to manufacturer instructions." Having the reason along with the checklist makes compliance more streamlined.

So how are we suppose to incorporate those changes? Who is in charge of making this happen? This document really gives you the solutions we have all needed.

An infection prevention coordinator (the sixth page of the summary) is the key here. They will be there to make sure that protocols and procedures to be followed. Their duties include:

• Develop and maintain infection prevention and occupational health programs
• Provide supplies necessary for adherence to standard precautions (hand hygiene products, safer devices to reduce percutaneous injuries, personal protective equipment, etc.)
• Assign at least one individual trained in infection prevention responsibility for coordinating the program
• Develop and maintain written infection prevention policies and procedures appropriate for the services provided by the facility and based on evidence-based guidelines, regulations, or standards
• Facility has system for early detection and management of potentially infectious persons at initial points of patient encounter

My friend is right. There are not a lot of changes in the new documents. But the format and the concepts are presented in a manner that makes compliance a simple process. This document is full of great information and reminders on keeping everyone safe. RDH

NOEL BRANDON KELSCH, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists' Association.