Infection Control Protocol and Regulation Review

1. Infection Control Protocol and Regulation Review

2. Committee on Dental Auxiliaries (COMDA) • The Committee on Dental Auxiliaries (COMDA) examines and licenses California dental auxiliaries and advises the Dental Board of California on auxiliary issues.  • COMDA1428 Howe Avenue, #58Sacramento, CA 95825 (916) 263-2595 Fax (916)263-2709 • http://www.comda.ca.gov

3. Committee on Dental Auxiliaries • Infection Control - Regulation section 1005 details the minimum standards for infection that all dental health professions must follow.  This regulation can be found in the publication of laws and regulation referred to above. • http://www.dbc.ca.gov/lawsregs/regulations/ch1_article1.htm#1005

4. COMDA -BUSINESS AND PROFESSIONS CODE • SECTION 1680. Unprofessional conduct by a person licensed under this chapter is defined as, but is not limited to, any one of the following • Unsanitary or unsafe office conditions, as determined by the customary practice and standards of the dental profession. • Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines of the board, thereby risking transmission of blood-borne infectious diseases from dentist or dental auxiliary to patient, from patient to patient, and from patient to dentist or dental auxiliary.

5. COMDA -BUSINESS AND PROFESSIONS CODE • SECTION 1670. Any licentiate may have his license revoked or suspended or be reprimanded or be placed on probation by the board for unprofessional conduct • http://www.leginfo.ca.gov/cgi-bin/displaycode?section=bpc&group=01001-02000&file=1670-1686

6. COMDA -BUSINESS AND PROFESSIONS CODE • Section 1680 B&P General Unprofessional Conduct • Maximum Penalty: Revocation of license or Statement of Issues denying admission into • examination. • Minimum Penalty: Revocation stayed, five years probation, 50 hours of non-dental community • services, continuing education course in dental ethics, 100 hours of • community service for each year of probation.

7. Fines Related to Infection Control Regulations • a small fine is $7,000, and the highest fine for a single violation is $70,000 • Fines can include a minimum of $5,000 per violation, with penalties of up to for each willful violation or repeat offense

8. Universal/Standard Precautions • Universal Precautions: Treat all human blood and body fluids including saliva as infectious • Standard Precautions: Expanded version of Universal Precautions • Follow both before, during and after patient treatment

9. Universal/Standard PrecautionsHand Hygiene • Short fingernails without artificial nails, nailpolish or rings • Open sores or weeping dermatitis must not have direct patient contact or touch contaminated instruments/eqpt.

10. Universal/Standard PrecautionsHandwashing Gloves and handwashing Liquid soap versus bar soap Which faucet types are better? Antimicrobial soap versus non antimicrobial soap Soap containers

11. Universal/Standard Precautions Hand Washing

12. Universal/Standard PrecautionsAlcohol Based Hand Rubs • Gel, foam or rinse • More effective than plain soap and antimicrobial soap • 60-95% concentration most effective • Less damaging to skin • “dose sensitive” • When not to use…

13. Training Facility Policies Review of medical hx • No treatment for • Active TB • Active herpes • Infectious conditions (case-by-case)

14. Universal/Standard PrecautionsProtocol Prior to Patient Treatment • Review medical hx • Use disposable barriers • Fill water supply • Flush waterlines • Place disposable items • Set-up unit • Maintain sterility

15. Universal/Standard PrecautionsProtocol During Patient Treatment Practice universal/ standard precautions Wear PPE – when appropriate • Acceptable attire • When to wear

16. Universal/Standard PrecautionsProtocol During Patient Treatment Protective mask • Protect nose and mouth • Don’t fit face perfectly need to chose mask that fits face • Change between patients or when wet • Dome type vs. flat type • A visor is not a mask

17. Universal/Standard PrecautionsProtocol During Patient Treatment Exam glove protocol • When to change • Wash or re-use? • Jewelry? • When to remove

18. Universal/Standard PrecautionsProtocol During Patient Treatment Overgloves • Lightweight, inexpensive, clear plastic • Used to prevent contamination of clean objects

19. Universal/Standard PrecautionsProtocol During Patient Treatment Protective eyewear • Protect eyes from aerosols, flying debris, spatter or caustic chemicals • Need front and side protection • Clean with soap & water or disinfect (Rinse prior to wearing) • Patients should wear also • Tinted eyewear with use of curing light

20. Universal/Standard PrecautionsProtocol During Patient Treatment • Fluid resistant • Long sleeves & high neckline • Cuff tucked inside glove • Knee level for high risk procedures • No buttons, trims or zippers

21. Universal/Standard PrecautionsProtocol During Patient Treatment • Type is based on degree of anticipated exposure • Low exposure vs. high exposure

22. Universal/Standard PrecautionsProtocol During Patient Treatment • Do not wear outside of office • Changed daily or if soiled • If soiled or saturated – change • Don’t wear in staff lounge, eating or drinking • Contaminated laundry should be in leakproof bags with biohazard label if they are to be washed

23. PPE – Order • Protective clothing • Mask • Eyewear – then wash hands • Gloves – over cuff of clothing • When removing – do opposite

24. Universal/Standard PrecautionsProtocol During Patient Treatment Disposables and instrument handling • Disposables 1x use only • Dropped items • Reaching into drawers or retrieving non-contaminated items

25. Universal/Standard PrecautionsProtocol During Patient Treatment Handling materials or equipment • Follow manufacturer’s instructions • Exposure to chemicals • Cure light precautions

26. Universal/Standard PrecautionsProtocol During Patient Treatment • Avoid cross contamination • Touch only patient’s mouth, tray set-up and equipment that will be disinfected • Do not touch mask, protective clothing, hair or eyewear after putting on gloves • Do not go into drawers or touch anything that can’t be disinfected

27. Universal/Standard PrecautionsProtocol During Patient Treatment Opening drawers and cabinets • Sterile cotton pliers • Overgloves • Paper towel or gauze

28. Universal/Standard PrecautionsProtocol After Patient Treatment • Dismiss patient • Remove gloves, wash hands and make chart entry • Dispose of regulated waste • Use utility gloves – prepare instrument cassette • Place metal tips from syringes into sharps container • Clean and disinfect instrument tray

29. Universal/Standard PrecautionsProtocol After Patient Treatment Utility gloves • Not used for direct patient care • Used for disinfecting treatment room and handling contaminated instruments • Wash, disinfect and sterilize (if necessary) • Puncture resistant but not puncture proof

30. Operatory Disinfection and Clean-Up • Breakdown unit • Disinfect unit • Flush water lines • Disinfect cure light • prepare handpiece for sterilization (if used) • Place equipment into “at rest” position or prep. for next patient

31. Sterilization Protocol • Contaminated vs. uncontaminated area • PPE for sterilization area • Process contaminated instruments • Dishwasher/disinfector • Wrap and tape • Autoclave (follow protocol used in Dent 51)

32. Trash and PPE Management • Remove PPE and discard appropriately • Regular (unregulated waste) • Sharps disposal