infection control osha compliance for dental personnel l.
Skip this Video
Loading SlideShow in 5 Seconds..
Infection Control/OSHA Compliance for Dental Personnel PowerPoint Presentation
Download Presentation
Infection Control/OSHA Compliance for Dental Personnel

Loading in 2 Seconds...

play fullscreen
1 / 130

Infection Control/OSHA Compliance for Dental Personnel - PowerPoint PPT Presentation

  • Uploaded on

Infection Control/OSHA Compliance for Dental Personnel. Katherine West,BSN,MSEd,CIC Infection Control Consultant. Objectives. Review laws & regulations pertaining to dental practice Review bloodborne pathogens & TB Define Exposure Describe the process for post exposure medical management

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

Infection Control/OSHA Compliance for Dental Personnel

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
infection control osha compliance for dental personnel

Infection Control/OSHA Compliance for Dental Personnel

Katherine West,BSN,MSEd,CIC

Infection Control Consultant

  • Review laws & regulations pertaining to dental practice
  • Review bloodborne pathogens & TB
  • Define Exposure
  • Describe the process for post exposure medical management
  • List infection control practices for daily dental practice
laws regulations4
Laws - Regulations
  • OSHA Bloodborne Pathogens
  • OSHA – CDC TB Guidelines 2005
  • CDC Guidelines for dental practice - 2003
  • Needlestick Safety & Prevention Act
  • State laws
    • HIV
    • Medical Waste
osha bloodborne pathogens

OSHA Bloodborne Pathogens



2001 (update)

updated standard
Updated Standard
  • Federal Standard
    • 1/18/2001
      • Needle Safe Devices
      • Sharps Injury Log
      • CPL 2-2.69 (Compliance Directive)
exposure control plan
Exposure determination


Hepatitis B Vaccine Program/ TB skin testing

Personal Protective Equipment

Engineering controls

Post-exposure Management

Medical Waste Management

Compliance monitoring


Exposure Control Plan
hc cdc definition
HCCDC Definition
  • Health-care personnel - employee, student, contractor, attending clinician, public-safety worker, or volunteer whose activities involve contact with blood/OPIM
infection control concepts
Infection Control Concepts
  • Universal Precautions
  • Body Substance Isolation
  • Standard Precautions**
exposure control plan10
Exposure Control Plan
  • Readily accessible at the worksite
  • Copy in 15 days if requested
plan review process
Plan -Review Process
  • Annually (at least every 12 months)
  • And, Whenever -
    • new procedures
    • employee positions (at risk)
    • new tasks
    • document consideration/implementation of effective engineering controls

Comp Dir. ,1999, 2001 OSHA

training clarification
Training Clarification
  • New hire training
  • Annual update training
annual training
Annual Training
  • Refresher training must cover topics listed in the standard to the extent needed and must emphasize new information or procedures

OSHA, 1910.1030

qualified instructor
“Qualified Instructor”
  • Work experience in subject matter area
  • Degree in subject matter area
  • Certificate of additional specialized training
cdc guidelines
CDC Guidelines
  • The law of the land
  • OSHA enforcing many of them
work restriction guidelines
Work Restriction - Guidelines
  • CDC published 1997
  • Don’t come to work sick
    • Risk to co-workers
    • Risk to patients/clients
needle safe dental
Needle Safe - Dental
  • Self-sheathing anesthetic needles
  • Dental units designed to shield burs
  • Blunt suture needles
  • Engineered butterfly needles

CDC. 2003

  • Deposit into sharps container
  • Container at site of use
  • Full at 3/4 mark
exposures 2008
Exposures – 2008
  • 20 contaminated sharps injuries reported
medical waste regulations
Medical Waste Regulations
  • State laws prevail
    • Ohio (OAC) 33745-27 and 3745-37
      • Does not include patient care waste
      • Does include sharps/glass
  • Copy in Exposure Control Plan
    • Include in training
post exposure management
Post Exposure Management
  • Must be done outside the dental practice
    • confidentiality

CDC, 2003 , OSHA

patient consent to testing
Patient Consent to Testing
  • State law controls
    • Informed consent/deemed consent
  • OSHA bloodborne pathogens protocol
ohio testing law
Ohio Testing Law
  • Consent with exception
    • Healthcare worker exposure
patient consent
Patient Consent
  • Have consent signed when patient comes in as a new patient
osha rapid hiv testing
OSHA – Rapid HIV Testing
  • OSHA states that “an employers failure to use rapid HIV testing when testing is required by paragraph (f)(3)(ii)(A) would usually be considered a violation of that provision”

OSHA Letter, July 21, 2006

rapid hiv tests

Rapid HIV Tests

Blood - Rapid HIV Test - currently available





CDC January 2007

testing issues post exposure
Testing Issues - Post Exposure
  • If source patient is negative with rapid testing = no further testing of health-care worker
  • Use of rapid testing will prevent staff from being placed on toxic drugs for even a short period of time
  • CDC, May , 1998, CDC June 29, 2001, September 2005
declination form
Declination Form
  • Decline to follow medical advice for exposure follow up treatment
osha enforcement
OSHA Enforcement
  • CDC post exposure guidelines
  • TB Guidelines
  • Vaccinations/immunizations
  • Work restriction guidelines
  • Hand Hygiene guidelines
formula for infection
Formula For Infection




Mode of




i incubation period
IIncubation Period
  • Time following exposure until the onset of signs/symptoms
  • Time one can transmit the disease to others
hepatitis b transmission
Hepatitis B - Transmission
  • Blood
  • Sexual Transmission
  • Indirect - contaminated objects
hepatitis b
Hepatitis B
  • Measurable Risk Data –
    • Needlestick injury
      • 6% - 30% in the non-vaccinated healthcare worker who does not report an exposure
hepatitis b infection
Hepatitis B Infection
  • 50% - 60% of infected persons have no outward signs or symptoms of the disease
hepatitis b long term effects
Hepatitis B Long Term Effects
  • Chronic Carriers - 10%
    • Chronic Active Hepatitis - 3% - 5%
    • Cirrhosis
    • Liver Cancer
hepatitis b prevention
Hepatitis B - Prevention
  • Vaccines -
      • Heptavax HB
      • Recombivax HB
      • Engerix - B
hepatitis b vaccines
Hepatitis B Vaccines
  • Safe Effective Recombinant - NO human factors
  • Allergy Issues - Yeast & Thimersol
hepatitis b vaccine
Hepatitis B Vaccine
  • CDC - 1992
      • Vaccine is safe for women who are pregnant, thinking of becoming pregnant or who are breast feeding
hepatitis b vaccine series
Hepatitis B Vaccine Series
  • OSHA-
      • To be administered within 10 days of assignment to a risk position
      • Administered after education and training
hepatitis b vaccine44
Hepatitis B Vaccine
  • Informed Denial
  • Informed Consent
titer blood test
Titer – Blood test
  • Required- employer pay
  • 1-2 months after completion of vaccine series
  • Once positive titer on file- no need to titer even post exposure
hepatitis b vaccine46
Hepatitis B Vaccine
  • Offers protection via “immunologic memory”
  • There is NO formal requirement or recommendation for a booster
      • CDC, 1992,1997, 2001, 2006
universal vaccination
Universal Vaccination
  • Healthcare workers- 1982
  • All newborns – 1990
  • All high school/college students – 2000
  • All persons - 2006
hbv infection rate us
HBV Infection Rate- US
  • 0.4%

CDC, September, 2008

hepatitis c transmission
Hepatitis C - Transmission
  • Blood
    • IV drug use*
    • Mother to infant
    • Intranasal cocaine use
  • Sexual Contact
    • High-risk sexual practices

NIH/CDC, 2008

cdc tattoos body art
CDC- Tattoos & Body Art
  • CDC has published info on website
hepatitis c cases
Hepatitis C Cases

Incident rate continues to decline

  • Rate in US- 1.3%
  • September, 2008
hepatitis c occupational risk
Hepatitis C - Occupational Risk
  • Primary risk related to needlestick injury- 1.5%
  • One reported case of transmission via splash into the eye (1997)
  • One transmission via non-intact skin (1999)
        • CDC, July 28,2000, & June 29,2001, March 21, 2008
hepatitis c testing
Hepatitis C - Testing
  • Antibody testing had a high rate for false-positives
  • Now, other more accurate testing is available
axsym anti hcv
  • New rapid test for HCV
  • Takes 23 mins.
  • More accurate than other antibody tests
  • Performed on the source !
confirmatory test
Confirmatory Test
  • RIBA - recombinant immunoblot assay
  • required after a positive EIA

CDC, 1999, 2001

Reminder -
  • If you are exposed to a hepatitis C positive patient, you should have a blood test in 4- 6 weeks
  • HCV-RNA (blood test)
    • $65.00
hepatitis c early treatment
Hepatitis C – Early Treatment
  • Studies – Germany & France
    • HCV-RNA positive begin treatment
    • 24 weeks – clear viral load
modes of transmission
Modes of Transmission
  • Primary
    • Sexual
    • Blood
    • Mother to Infant
modes of transmission61
Modes of Transmission
  • Secondary
    • Contaminated blood products
    • Occupational exposure
infected healthcare workers occupational infection hiv
Infected Healthcare Workers- Occupational Infection-HIV
  • 1978 - December 2006
    • 57* documented cases
      • 0 in dental personnel
      • 49 were sharps related exposures

HIC, Jan., 2007(CDC)

hiv virus survival
HIV Virus- Survival
  • HIV is unable to reproduce itself outside the living host, except under laboratoryconditions ,therefore it does not spread or maintain its infectiousness outside the host

CDC, 1980

  • Availability of the quick test on the source patient in an exposure may prevent the unnecessary administration of chemoprophylaxis in the health care worker

CDC, May 1998, June 2001, Sept. 2005

rapid testing
Rapid Testing
  • Sensitivity - 99.9% (false negatives)
  • Specificity - 99.6% (false positives)
  • No false positives
risk data hiv
Sharps injury

Mucous membrane

Non-intact skin



one in prospective studies (1999)

Risk Data - HIV

Sept., 2005

viral load testing

Viral Load Testing

Key to risk - dose related

non progressors
  • HIV positive for 16-20+ years
  • Never ill
  • Immune system intact
  • No virus in blood
gene issues hiv
Gene Issues - HIV
  • Mutation of the second receptor CCR5 and are resistant to HIV infection
cocktail mixture
Cocktail Mixture
  • AZT, (ZDV)
  • 3TC and
  • Protease inhibitor
aids cocktail
AIDS Cocktail
  • Combination of 2, 3 or 4 drugs
  • Stops HIV from producing new virus in some patients
hiv aids74
  • Now a chronic disease for many infected persons
fla dentist case
Fla. Dentist Case
  • No testing by genetic sequencing showed support for a link between virus strains

Annals of Internal Medicine, Dec. 1994

syphilis cases
Syphilis Cases
  • Continue to rise in the U.S.
  • Post exposure follow up if source is HIV positive or Hepatitis C positive
  • Low risk
highest states for cases 2007
Highest States for cases - 2007
  • District of Columbia
  • California
  • Maryland
  • Georgia
  • Texas
cdc plan
CDC - Plan
  • Update plan to eliminate syphilis by 2015
guidelines for preventing the transmission of mycobacterium tuberculosis in health care settings

Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings

December 30, 2005

risk assessment
Risk Assessment
  • Based on new formula
  • Three listings
    • Low risk
    • Medium risk
    • Potential for on-going transmission
tb hipaa
  • HIPAA permits disclosure of TB information
testing recommendations
Low Risk

On hire

2 step with TST or QFTB-Gold( blood test)

Post exposure testing

Medium Risk

On hire

2 step or QFTB-Gold

Annual Testing

Post exposure testing

Testing Recommendations
define exposure

Define Exposure

Bloodborne Pathogens

defining exposure bloodborne pathogens
Defining Exposure - Bloodborne Pathogens
  • A contaminated Needlestick Injury
  • Blood/OPIM in contact with the surface of the eye, inner surface of the nose or mouth
defining exposure bloodborne pathogens85
Defining Exposure- Bloodborne Pathogens
  • Blood/OPIM in contact with an open area of the skin
  • Cuts with sharp objects covered with blood/OPIM
  • Human bites (bloody)
define other potentially infectious materials opim

Synovial fluid

Pleural fluid

Amniotic fluid

Peritoneal fluid

Any body fluid containing gross visible blood

Define - Other Potentially Infectious Materials -OPIM
non risk body fluids hiv hbv hcv






Nasal Secretions


Non -Risk Body Fluids, HIV, HBV,HCV
  • CDC, May 15, 1998, June 29, 2001, Sept. 2005
tuberculosis transmission
Tuberculosis - Transmission
  • Inhalation of droplets from an infectious patient
  • Contact time
  • Ventilation present
  • Your health status
osha tb dental
OSHA & TB- Dental
  • dental offices = low risk
    • Do not perform “cough inducing” procedures

OSHA Review October, 2008

routine immunizations
Routine Immunizations
  • HBV Vaccine
  • MMR
  • Tdap
  • Chickenpox Vaccine
  • Flu Vaccine

CDC, 1997, OSHA,1999,2005

Tdap -
  • All health care workers
    • 1X dose
hands cdc osha
Hands - CDC/OSHA
  • Non intact skin - cover with a dressing
  • If too large to cover, restrict from risk task activities


Major protective measure

cdc new requirements
CDC New Requirements
  • No antibacterials for routine handwashing
  • No artificial nails or extensions
  • Use alcohol based foams or gels

CDC, October 25, 2002

definition of terms

destroying or hindering the growth of bacteria


preventing or destroying the development of microbes

kills viruses

Definition of Terms
cleaning solutions
Cleaning Solutions
  • Check label claims
    • EPA registered
    • Bleach & water
      • 1:100
surface cleaning
Surface Cleaning
  • Tuberculocidal level cleaners are not required for routine surface cleaning
new skin prep recommendation
New Skin Prep Recommendation
  • Chlorohexidine

“ CHG reduces skin microflora more effectively and better

residual activity than povidone-iodine after a single application”

APIC 2005

  • When in contact with:
    • patient mucous membranes
    • contaminated surfaces
    • Patient open wounds
  • Mask & Eyewear
  • Face shield
  • If a pullover style is worn -
    • if large amount of contamination, the employee is to be trained how to remove without contact to the face
  • Remains under employer “control”
  • Washer/dryer in office
    • No special water temp (120-160)
    • No additive needed
  • Contract
shoe safety
Shoe Safety
  • Not permitted in work areas where there is danger of foot injuries due to falling, rolling, or piercing objects
  • In closed dispensers
  • Wash before refilling
  • Use only at the end of the workday

CDC, 2003

surface cleaning108
Surface Cleaning
  • Wipe down
  • Cover ?
mrsa dental operatory surfaces
MRSA – Dental Operatory Surfaces
  • Study – MRSA transmission via dental surfaces
    • MRSA on air-water syringe
    • MRSA on reclining chair
    • 8 out of pts. Out of 140 infected or colonized

British Dental Journal, 2006

remember to clean your workplace
Remember to Clean Your Workplace
  • Nothing beats plain old cleaning

No data to support risk

  • No data to support risk to immunocompromised patients
  • Water 500 colony forming units of bacteria per milliliter of water (CDC)
biological indicators
Biological Indicators
  • Use “at least” weekly
  • Always use a control as test indicator
    • Quarantine until results are know
extracted teeth
Extracted Teeth
  • Can be given to the patient!
post exposure medical management
Post Exposure Medical Management
  • Detailed procedures to follow
    • Who to call
    • First Aid
    • Treatment facility
post exposure treatment
Post Exposure Treatment
  • The employer must provide post-exposure medical care


post exposure treatment116
Post Exposure Treatment
  • Must be done outside the practice
    • CDC, 2003
  • Selection of care provider
  • Letters of Agreement
post exposure care
Post Exposure Care
  • The word “immediate”
    • an exact time is not given because the time limit varies with each disease
    • HIV follow up is now worded “hours but not days”

OSHA 1999

exposed employee
Exposed Employee
  • Right to refuse care
  • Must sign declination form
  • Must have a system for protecting employee identity and test results
  • Exposed employee has become a patient !
letter of written opinion
Letter of Written Opinion
  • Issued by the treating within 15 days of the exposure event




medical records
Medical Records
  • Refers to OSHA 1910.1020 -Medical Records Standard
  • Medical Records are to be kept confidential
  • Disclosure is permitted only when required by this standard or other Federal, State or local law

Comp. Dir., pg.64

compliance monitoring126
Compliance Monitoring
  • OSHA required
  • Who has responsibility
    • employee have a role for their safety
osha most common bbp citations 2007
Failure to have an Exposure Control Plan

Failure to update Exposure Control Plan annually

Failure to offer new hire training

Failure to use engineering/work practice controls

Failure to offer HBV vaccine within 10 days of hire

Failure to have a sharps injury log

Failure to discard sharps into sharps containers ASAP

Failure to have employee input to selection of needle safe devices

Failure to reflect review of technology in the ECP

Failure to offer annual training

OSHA Most Common BBP Citations-2007

OSHA Jan. 2008

most common osha citations
Most Common OSHA Citations
  • Failure to have an Exposure Control Plan
  • Failure to conduct new hire training
  • Failure to conduct annual training
  • Failure to use needle safe devices

OSHA, 2007

questions answers

Questions & Answers

(703) 365 – 8388