Infection control osha compliance for dental personnel
1 / 130

- PowerPoint PPT Presentation

  • Updated 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

PowerPoint Slideshow about '' - Gabriel

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 l.jpg

Infection Control/OSHA Compliance for Dental Personnel

Katherine West,BSN,MSEd,CIC

Infection Control Consultant

Objectives l.jpg

  • 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 l.jpg
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 l.jpg

OSHA Bloodborne Pathogens



2001 (update)

Updated standard l.jpg
Updated Standard

  • Federal Standard

    • 1/18/2001

      • Needle Safe Devices

      • Sharps Injury Log

      • CPL 2-2.69 (Compliance Directive)

Exposure control plan l.jpg

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 l.jpg
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 l.jpg
Infection Control Concepts

  • Universal Precautions

  • Body Substance Isolation

  • Standard Precautions**

Exposure control plan10 l.jpg
Exposure Control Plan

  • Readily accessible at the worksite

  • Copy in 15 days if requested

Plan review process l.jpg
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 l.jpg
Training Clarification

  • New hire training

  • Annual update training

Annual training l.jpg
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 l.jpg
“Qualified Instructor”

  • Work experience in subject matter area

  • Degree in subject matter area

  • Certificate of additional specialized training

Cdc guidelines l.jpg
CDC Guidelines

  • The law of the land

  • OSHA enforcing many of them

Work restriction guidelines l.jpg
Work Restriction - Guidelines

  • CDC published 1997

  • Don’t come to work sick

    • Risk to co-workers

    • Risk to patients/clients

Needle safe dental l.jpg
Needle Safe - Dental

  • Self-sheathing anesthetic needles

  • Dental units designed to shield burs

  • Blunt suture needles

  • Engineered butterfly needles

CDC. 2003

Sharps l.jpg

  • Deposit into sharps container

  • Container at site of use

  • Full at 3/4 mark

Exposures 2008 l.jpg
Exposures – 2008

  • 20 contaminated sharps injuries reported

Medical waste regulations l.jpg
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 l.jpg
Post Exposure Management

  • Must be done outside the dental practice

    • confidentiality

CDC, 2003 , OSHA

Patient consent to testing l.jpg
Patient Consent to Testing

  • State law controls

    • Informed consent/deemed consent

  • OSHA bloodborne pathogens protocol

Ohio testing law l.jpg
Ohio Testing Law

  • Consent with exception

    • Healthcare worker exposure

Patient consent l.jpg
Patient Consent

  • Have consent signed when patient comes in as a new patient

Osha rapid hiv testing l.jpg
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 l.jpg

Rapid HIV Tests

Blood - Rapid HIV Test - currently available





CDC January 2007

Testing issues post exposure l.jpg
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 l.jpg
Declination Form

  • Decline to follow medical advice for exposure follow up treatment

Osha enforcement l.jpg
OSHA Enforcement

  • CDC post exposure guidelines

  • TB Guidelines

  • Vaccinations/immunizations

  • Work restriction guidelines

  • Hand Hygiene guidelines

Formula for infection l.jpg
Formula For Infection




Mode of




I incubation period l.jpg
IIncubation Period

  • Time following exposure until the onset of signs/symptoms

  • Time one can transmit the disease to others

Exposure does not mean infection l.jpg

Exposure Does NOTMean Infection

Hepatitis b transmission l.jpg
Hepatitis B - Transmission

  • Blood

  • Sexual Transmission

  • Indirect - contaminated objects

Hepatitis b l.jpg
Hepatitis B

  • Measurable Risk Data –

    • Needlestick injury

      • 6% - 30% in the non-vaccinated healthcare worker who does not report an exposure

Hepatitis b infection l.jpg
Hepatitis B Infection

  • 50% - 60% of infected persons have no outward signs or symptoms of the disease

Hepatitis b long term effects l.jpg
Hepatitis B Long Term Effects

  • Chronic Carriers - 10%

    • Chronic Active Hepatitis - 3% - 5%

    • Cirrhosis

    • Liver Cancer

Hepatitis b prevention l.jpg
Hepatitis B - Prevention

  • Vaccines -

    • Heptavax HB

    • Recombivax HB

    • Engerix - B

Hepatitis b vaccines l.jpg
Hepatitis B Vaccines

  • Safe Effective Recombinant - NO human factors

  • Allergy Issues - Yeast & Thimersol

Hepatitis b vaccine l.jpg
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 l.jpg
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 l.jpg
Hepatitis B Vaccine

  • Informed Denial

  • Informed Consent

Titer blood test l.jpg
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 l.jpg
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 l.jpg
Universal Vaccination

  • Healthcare workers- 1982

  • All newborns – 1990

  • All high school/college students – 2000

  • All persons - 2006

Hbv infection rate us l.jpg
HBV Infection Rate- US

  • 0.4%

CDC, September, 2008

Hepatitis c transmission l.jpg
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 l.jpg
CDC- Tattoos & Body Art

  • CDC has published info on website


Hepatitis c cases l.jpg
Hepatitis C Cases

Incident rate continues to decline

  • Rate in US- 1.3%

  • September, 2008

Hepatitis c occupational risk l.jpg
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 l.jpg
Hepatitis C - Testing

  • Antibody testing had a high rate for false-positives

  • Now, other more accurate testing is available

Axsym anti hcv l.jpg

  • New rapid test for HCV

  • Takes 23 mins.

  • More accurate than other antibody tests

  • Performed on the source !

Confirmatory test l.jpg
Confirmatory Test

  • RIBA - recombinant immunoblot assay

  • required after a positive EIA

CDC, 1999, 2001

Reminder l.jpg
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 l.jpg
Hepatitis C – Early Treatment

  • Studies – Germany & France

    • HCV-RNA positive begin treatment

    • 24 weeks – clear viral load

Modes of transmission l.jpg
Modes of Transmission

  • Primary

    • Sexual

    • Blood

    • Mother to Infant

Modes of transmission61 l.jpg
Modes of Transmission

  • Secondary

    • Contaminated blood products

    • Occupational exposure

Infected healthcare workers occupational infection hiv l.jpg
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 l.jpg
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

Benefit l.jpg

  • 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 l.jpg
Rapid Testing

  • Sensitivity - 99.9% (false negatives)

  • Specificity - 99.6% (false positives)

  • No false positives

Risk data hiv l.jpg

Sharps injury

Mucous membrane

Non-intact skin



one in prospective studies (1999)

Risk Data - HIV

Sept., 2005

Viral load testing l.jpg

Viral Load Testing

Key to risk - dose related

Non progressors l.jpg

  • HIV positive for 16-20+ years

  • Never ill

  • Immune system intact

  • No virus in blood

Gene issues hiv l.jpg
Gene Issues - HIV

  • Mutation of the second receptor CCR5 and are resistant to HIV infection

Cocktail mixture l.jpg
Cocktail Mixture

  • AZT, (ZDV)

  • 3TC and

  • Protease inhibitor

Aids cocktail l.jpg
AIDS Cocktail

  • Combination of 2, 3 or 4 drugs

  • Stops HIV from producing new virus in some patients

Hiv aids74 l.jpg

  • Now a chronic disease for many infected persons

Fla dentist case l.jpg
Fla. Dentist Case

  • No testing by genetic sequencing showed support for a link between virus strains

Annals of Internal Medicine, Dec. 1994

Syphilis cases l.jpg
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 l.jpg
Highest States for cases - 2007

  • District of Columbia

  • California

  • Maryland

  • Georgia

  • Texas

Cdc plan l.jpg
CDC - Plan

  • Update plan to eliminate syphilis by 2015

Guidelines for preventing the transmission of mycobacterium tuberculosis in health care settings l.jpg

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

December 30, 2005

Risk assessment l.jpg
Risk Assessment tuberculosis in Health-Care Settings

  • Based on new formula

  • Three listings

    • Low risk

    • Medium risk

    • Potential for on-going transmission

Tb hipaa l.jpg
TB & HIPAA tuberculosis in Health-Care Settings

  • HIPAA permits disclosure of TB information

Testing recommendations l.jpg

Low Risk tuberculosis in Health-Care Settings

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 l.jpg

Define Exposure tuberculosis in Health-Care Settings

Bloodborne Pathogens

Defining exposure bloodborne pathogens l.jpg
Defining Exposure - Bloodborne Pathogens tuberculosis in Health-Care Settings

  • 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 l.jpg
Defining Exposure- Bloodborne Pathogens tuberculosis in Health-Care Settings

  • 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 l.jpg

CSF tuberculosis in Health-Care Settings

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 l.jpg

Tears tuberculosis in Health-Care Settings






Nasal Secretions


Non -Risk Body Fluids, HIV, HBV,HCV

  • CDC, May 15, 1998, June 29, 2001, Sept. 2005

Define exposure tb l.jpg

Define Exposure - TB tuberculosis in Health-Care Settings

Tuberculosis transmission l.jpg
Tuberculosis - Transmission tuberculosis in Health-Care Settings

  • Inhalation of droplets from an infectious patient

  • Contact time

  • Ventilation present

  • Your health status

Osha tb dental l.jpg
OSHA & TB- Dental tuberculosis in Health-Care Settings

  • dental offices = low risk

    • Do not perform “cough inducing” procedures

OSHA Review October, 2008

Safe work practices basic infection control l.jpg

Safe Work Practices/Basic tuberculosis in Health-Care SettingsInfection Control

Additional protection

Routine immunizations l.jpg
Routine Immunizations tuberculosis in Health-Care Settings

  • HBV Vaccine

  • MMR

  • Tdap

  • Chickenpox Vaccine

  • Flu Vaccine

CDC, 1997, OSHA,1999,2005

Slide93 l.jpg
Tdap - tuberculosis in Health-Care Settings

  • All health care workers

    • 1X dose

Hands cdc osha l.jpg
Hands - CDC/OSHA tuberculosis in Health-Care Settings

  • Non intact skin - cover with a dressing

  • If too large to cover, restrict from risk task activities

Handwashing l.jpg

Handwashing tuberculosis in Health-Care Settings

Major protective measure

Cdc new requirements l.jpg
CDC New Requirements tuberculosis in Health-Care Settings

  • No antibacterials for routine handwashing

  • No artificial nails or extensions

  • Use alcohol based foams or gels

CDC, October 25, 2002

Definition of terms l.jpg

Antibacterial tuberculosis in Health-Care Settings

destroying or hindering the growth of bacteria


preventing or destroying the development of microbes

kills viruses

Definition of Terms

Cleaning solutions l.jpg
Cleaning Solutions tuberculosis in Health-Care Settings

  • Check label claims

    • EPA registered

    • Bleach & water

      • 1:100

Surface cleaning l.jpg
Surface Cleaning tuberculosis in Health-Care Settings

  • Tuberculocidal level cleaners are not required for routine surface cleaning

New skin prep recommendation l.jpg
New Skin Prep Recommendation tuberculosis in Health-Care Settings

  • Chlorohexidine

    “ CHG reduces skin microflora more effectively and better

    residual activity than povidone-iodine after a single application”

APIC 2005

Gloves l.jpg
Gloves tuberculosis in Health-Care Settings

  • When in contact with:

    • patient mucous membranes

    • contaminated surfaces

    • Patient open wounds

Clarification l.jpg
Clarification tuberculosis in Health-Care Settings

  • Mask & Eyewear

  • Face shield

Scrubs l.jpg
Scrubs tuberculosis in Health-Care Settings

  • 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

Laundry l.jpg
Laundry tuberculosis in Health-Care Settings

  • Remains under employer “control”

  • Washer/dryer in office

    • No special water temp (120-160)

    • No additive needed

  • Contract

Shoe safety l.jpg
Shoe Safety tuberculosis in Health-Care Settings

  • Not permitted in work areas where there is danger of foot injuries due to falling, rolling, or piercing objects

Lotions l.jpg
Lotions tuberculosis in Health-Care Settings

  • In closed dispensers

  • Wash before refilling

  • Use only at the end of the workday

CDC, 2003

Clean dirty areas well defined l.jpg

Clean/Dirty Areas well defined tuberculosis in Health-Care Settings

Surface cleaning108 l.jpg
Surface Cleaning tuberculosis in Health-Care Settings

  • Wipe down

  • Cover ?

Mrsa dental operatory surfaces l.jpg
MRSA – Dental Operatory Surfaces tuberculosis in Health-Care Settings

  • 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 l.jpg
Remember to Clean Your Workplace tuberculosis in Health-Care Settings

  • Nothing beats plain old cleaning

Biofilm l.jpg
Biofilm tuberculosis in Health-Care Settings

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 l.jpg
Biological Indicators tuberculosis in Health-Care Settings

  • Use “at least” weekly

  • Always use a control as test indicator

    • Quarantine until results are know

Extracted teeth l.jpg
Extracted Teeth tuberculosis in Health-Care Settings

  • Can be given to the patient!

Post exposure medical management l.jpg
Post Exposure Medical Management tuberculosis in Health-Care Settings

  • Detailed procedures to follow

    • Who to call

    • First Aid

    • Treatment facility

Post exposure treatment l.jpg
Post Exposure Treatment tuberculosis in Health-Care Settings

  • The employer must provide post-exposure medical care


Post exposure treatment116 l.jpg
Post Exposure Treatment tuberculosis in Health-Care Settings

  • Must be done outside the practice

    • CDC, 2003

  • Selection of care provider

  • Letters of Agreement

Post exposure care l.jpg
Post Exposure Care tuberculosis in Health-Care Settings

  • 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 l.jpg
Exposed Employee tuberculosis in Health-Care Settings

  • Right to refuse care

  • Must sign declination form

Hipaa source patient testing l.jpg

HIPAA & Source Patient Testing tuberculosis in Health-Care Settings

Confidentiality l.jpg
Confidentiality tuberculosis in Health-Care Settings

  • Must have a system for protecting employee identity and test results

  • Exposed employee has become a patient !

Letter of written opinion l.jpg
Letter of Written Opinion tuberculosis in Health-Care Settings

  • Issued by the treating within 15 days of the exposure event

Recordkeeping l.jpg

Recordkeeping tuberculosis in Health-Care Settings



Medical records l.jpg
Medical Records tuberculosis in Health-Care Settings

  • 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

Procedure to access their records l.jpg

Procedure to access their records tuberculosis in Health-Care Settings

Compliance monitoring l.jpg

Compliance Monitoring tuberculosis in Health-Care Settings

Compliance monitoring126 l.jpg
Compliance Monitoring tuberculosis in Health-Care Settings

  • OSHA required

  • Who has responsibility

    • employee have a role for their safety

Disciplinary action policy l.jpg

Disciplinary Action Policy tuberculosis in Health-Care Settings

Osha most common bbp citations 2007 l.jpg

Failure to have an Exposure Control Plan tuberculosis in Health-Care Settings

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 l.jpg
Most Common OSHA Citations tuberculosis in Health-Care Settings

  • 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 l.jpg

Questions & Answers tuberculosis in Health-Care Settings

(703) 365 – 8388

[email protected]