Infection Control/OSHA Compliance for Dental Personnel

1. Infection Control/OSHA Compliance for Dental Personnel Katherine West,BSN,MSEd,CIC Infection Control Consultant

2. Objectives • 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

3. Laws & Regulations

4. 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

5. OSHA Bloodborne Pathogens 1910.1030 1991 2001 (update)

6. Updated Standard • Federal Standard • 1/18/2001 • Needle Safe Devices • Sharps Injury Log • CPL 2-2.69 (Compliance Directive)

7. Exposure determination Education/Training Hepatitis B Vaccine Program/ TB skin testing Personal Protective Equipment Engineering controls Post-exposure Management Medical Waste Management Compliance monitoring Recordkeeping Exposure Control Plan

8. HCCDC Definition • Health-care personnel - employee, student, contractor, attending clinician, public-safety worker, or volunteer whose activities involve contact with blood/OPIM

9. Infection Control Concepts • Universal Precautions • Body Substance Isolation • Standard Precautions**

10. Exposure Control Plan • Readily accessible at the worksite • Copy in 15 days if requested

11. 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

12. Training Clarification • New hire training • Annual update training

13. 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

14. “Qualified Instructor” • Work experience in subject matter area • Degree in subject matter area • Certificate of additional specialized training

15. CDC Guidelines • The law of the land • OSHA enforcing many of them

16. Work Restriction - Guidelines • CDC published 1997 • Don’t come to work sick • Risk to co-workers • Risk to patients/clients

17. Needlestick Safety and Prevention Act, P.L. 106-430

18. Needle Safe - Dental • Self-sheathing anesthetic needles • Dental units designed to shield burs • Blunt suture needles • Engineered butterfly needles CDC. 2003

19. Sharps • Deposit into sharps container • Container at site of use • Full at 3/4 mark

20. Exposures – 2008 • 20 contaminated sharps injuries reported

21. 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

22. Post Exposure Management • Must be done outside the dental practice • confidentiality CDC, 2003 , OSHA

23. Patient Consent to Testing • State law controls • Informed consent/deemed consent • OSHA bloodborne pathogens protocol

24. Ohio Testing Law • Consent with exception • Healthcare worker exposure

25. Patient Consent • Have consent signed when patient comes in as a new patient

26. 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

27. Rapid HIV Tests Blood - Rapid HIV Test - currently available OraQuick Uni-Gold Multispot Clearview CDC January 2007

28. 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

29. Declination Form • Decline to follow medical advice for exposure follow up treatment

30. OSHA Enforcement • CDC post exposure guidelines • TB Guidelines • Vaccinations/immunizations • Work restriction guidelines • Hand Hygiene guidelines

31. Understanding Risk

32. Formula For Infection Dose Organism Virulence Mode of Entry Host Resistance

33. IIncubation Period • Time following exposure until the onset of signs/symptoms • Time one can transmit the disease to others

34. Exposure Does NOTMean Infection

35. Disease Review

36. Hepatitis B - Transmission • Blood • Sexual Transmission • Indirect - contaminated objects

37. Hepatitis B • Measurable Risk Data – • Needlestick injury • 6% - 30% in the non-vaccinated healthcare worker who does not report an exposure

38. Hepatitis B Infection • 50% - 60% of infected persons have no outward signs or symptoms of the disease

39. Hepatitis B Long Term Effects • Chronic Carriers - 10% • Chronic Active Hepatitis - 3% - 5% • Cirrhosis • Liver Cancer

40. Hepatitis B - Prevention • Vaccines - • Heptavax HB • Recombivax HB • Engerix - B

41. Hepatitis B Vaccines • Safe Effective Recombinant - NO human factors • Allergy Issues - Yeast & Thimersol

42. Hepatitis B Vaccine • CDC - 1992 • Vaccine is safe for women who are pregnant, thinking of becoming pregnant or who are breast feeding

43. Hepatitis B Vaccine Series • OSHA- • To be administered within 10 days of assignment to a risk position • Administered after education and training

44. Hepatitis B Vaccine • Informed Denial • Informed Consent

45. 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

46. Hepatitis B Vaccine • Offers protection via “immunologic memory” • There is NO formal requirement or recommendation for a booster • CDC, 1992,1997, 2001, 2006

47. Universal Vaccination • Healthcare workers- 1982 • All newborns – 1990 • All high school/college students – 2000 • All persons - 2006

48. HBV Infection Rate- US • 0.4% CDC, September, 2008

49. Hepatitis C Viral Infection

50. Hepatitis C - Transmission • Blood • IV drug use* • Mother to infant • Intranasal cocaine use • Sexual Contact • High-risk sexual practices NIH/CDC, 2008