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Following CDC2

Summary of Infection Prevention Practices in Dental Settings:
Basic Expectations for Safe Care

FUNDAMENTAL ELEMENTS | ADMIN MEASURES | PERSONNEL SAFETY | EDUCATION AND TRAINING PROGRAM EVALUATION STANDARD PRECAUTIONS 2003 GUIDANCE  

 

OVERVIEW                 

CDC’s Summary of Infection Prevention Practices in Dental Settings:  Basic Expectations for Safe Care, released in 2016, is a summary of basic infection prevention recommendations for safe dental care. The 2016 CDC publication is a plain language summary of the Guidelines for Infection Control in Dental Health-Care Settings – 2003 and other CDC recommendations published after 2003 that are relevant to dental healthcare settings. The Summary also includes a two-part checklist to assess compliance with the CDC recommendations.

The 2016 Summary is not a replacement for CDC’s Guidelines for Infection Control in Dental Health-Care Settings–2003. Although the guidelines were published over a decade ago, the basic principles of infection control have not changed, and the CDC guidelines from 2003 continue to represent the standard of care for dental infection control. 

 

Relevant CDC Recommendations Since 2003                    

Since the release of the Guidelines for Infection Control in Dental Health-Care Settings–2003 CDC has developed additional recommendations that impact dental health care.  The additional recommendations are listed in Appendix B of the 2016 Summary {link}.   Several of these already exist as, or are closely aligned with the 2003 CDC dental infection control recommendations, but were later designated as formal elements of standard precautions. Inclusion of these in Appendix B underscores this significant elevation of importance.

To easily identify each new recommendation, OSAP has highlighted them in the sections below.



Fundamental Elements Needed To Prevent Transmission Of Infectious Agents In Dental Settings          

The 2016 Summary covers 5 fundamental elements that all dental settings need for infection prevention:

  1. Administrative Measures
  2. Dental Healthcare Personnel Safety
  3. Infection Prevention Education and Training
  4. Program Evaluation
  5. Standard Precautions

These elements are not more important than, and do not replace CDC’s Guidelines for Infection Control in Dental Health-Care Settings–2003.  The fundamental elements are presented in the 2016 Summary to highlight the basic expectations for safe care, present key recommendations and to provide new information released by CDC since publication of the 2003 Guidelines. 


1. Administrative Measures                 


Infection prevention must be a priority in your dental setting.  This includes having an infection prevention coordinator and an infection prevention program that is tailored for your dental setting and reassessed at least once a year.  


Key CDC Administrative Recommendations For Dental Settings:

  • Develop and maintain infection prevention and occupational health programs.
  • Provide supplies necessary for adherence to Standard Precautions (e.g., hand hygiene products, safer devices to reduce percutaneous injuries, personal protective equipment).
  • Designate at least one individual trained in infection prevention to coordinate the program.
  • Develop and maintain written infection prevention policies and procedures appropriate for the services provided by the facility and based upon evidence-based guidelines, regulations, or standards.
  • Establish a system for early detection and management of potentially infectious persons at initial points of patient encounter

Additional Recommendation: Although not designated as a key recommendation, the following is a relevant recommendation published by CDC since 2003, found in Appendix B of the 2016 Summary.  

  • Re-assess Infection prevention policies and procedures at least annually or according to state or federal requirements.  

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2. Infection Prevention Education and Training                

Providing education and training is a critical step for ensuring that dental health care personnel (DHCP) understand and follow infection prevention policies and procedures.

Key CDC Recommendations For Education And Training In Dental Settings:

  • Provide job- or task-specific infection prevention education and training to all DHCP.
    • This includes those employed by outside agencies and available by contract or on a volunteer basis to the facility.
  • Provide training on principles of both DHCP safety and patient safety.
  • Provide training during orientation and at regular intervals (e.g., annually).
  • Maintain training records according to state and federal requirements.

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3. Dental Health Care Personnel Safety                     


Your infection prevention program should address staff safety and comply with OSHA’s bloodborne pathogens standard. In addition, it should include occupational health needs such as vaccinations, exposure management, post-exposure protocols, and work restrictions for personnel who are ill. 

 

Key CDC Recommendations for Dental Health Care Personnel Safety:

  • Current CDC recommendations for immunizations, evaluation and follow-up are available. There is a written policy regarding immunizing DHCP, including a list of all required and recommended immunizations for DHCP [e.g., Hepatitis B, MMR (Measels, Mumps, Rubella), Varicella (Chickenpox), Tdap (Tetanus, Diphtheria, Pertussis)].
  • All DHCP are screened for tuberculosis (TB) upon hire regardless of the risk classification of the setting.
  • Referral arrangements are in place to qualified health care professionals (e.g., occupational health program of a hospital, educational institutions, health care facilities that offer personnel health services) to ensure prompt and appropriate provision of preventive services, occupationally- related medical services, and postexposure management with medical follow-up
  • Facility has well-defined policies concerning contact of personnel with patients when personnel have potentially transmissible conditions. 


4. Program Evaluation                


Evaluation provides opportunities to identify problems or areas that can be improved through training, corrective action or further evaluation. The 2016 Summary includes a new 2-part checklist for evaluation of administrative polices and practices and personnel compliance. See Appendix A. Link to PDF of Appendix

 

Key CDC Recommendation For Program Evaluation In Dental Settings:

  • Establish routine evaluation of the infection prevention program, including evaluation of DHCP adherence to infection prevention practices.

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5. Standard Precautions                 


HAND HYGIENE  | PPE
 | COUGH ETIQUETTE | SHARPS SAFETY | SAFE INJECTIONS | STERILIZATION |
SURFACES | 
DUWL
 


Standard Precautions are the minimum infection prevention practices that apply to all patient care. They are designed to protect DHCP and also to prevent DHCP from spreading infections among patients. Standard Precautions are used whenever and wherever health care is delivered, regardless of the patient’s infection status. Education and training on Standard Precautions are critical for understanding the importance of these practices, making appropriate decisions and complying with recommended practices.

Hand Hygiene:             

Hand cleaning is the most important way to prevent the spread of infections. Your infection control program should include education and training that covers hand hygiene for routine care and oral surgery.


Key CDC Recommendations For Hand Hygiene In Dental Settings:

  • Perform hand hygiene:
    • When hands are visibly soiled.
    • After barehanded touching of instruments, equipment, materials, and other objects likely to be contaminated by blood, saliva, or respiratory secretions.
    • Before and after treating each patient.
    • Before putting on gloves and again immediately after removing gloves.
  • Use soap and water when hands are visibly soiled (e.g., blood, body fluids); otherwise, an alcohol-based hand rub may be used.


Personal Protective Equipment (PPE)
:        

PPE protects DHCP by covering skin and personal clothing that may become contaminated by blood, saliva or other potentially infectious materials (OPIM).  All DCHP should be trained to select and put on the appropriate PPE for each task and to effectively remove PPE in a way that reduces contamination of skin or clothing. 

Key CDC Recommendations For PPE In Dental Settings:

  • Provide sufficient and appropriate PPE and ensure it is accessible to DHCP.
  • Educate all DHCP on proper selection and use of PPE.
  • Wear gloves whenever there is potential for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment.
    • Do not wear the same pair of gloves for the care of more than one patient.
    • Do not wash gloves; gloves cannot be reused.
    • Perform hand hygiene immediately after removing gloves.
  • Wear protective clothing that covers skin and personal clothing during procedures or activities where contact with blood, saliva or OPIM is anticipated.
  • Wear mouth, nose and eye protection during procedures that are likely to generate splashes or spattering of blood or other body fluids.
  • Remove PPE before leaving the work area. 

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Respiratory Hygiene and Cough Etiquette
:          

Respiratory Hygiene and Cough Etiquette strategies target anyone who may have undiagnosed respiratory infections, including patients, people accompanying patients, and also DHCP.  These measures limit the spread of respiratory pathogens by droplet or airborne routes, such as cough, congestion, runny nose, or increased production of respiratory secretions. In 2007 CDC added respiratory hygiene and cough etiquette as formal elements of Standard Precautions. Because this important change occurred after publication of the current CDC guidelines for dental infection control, respiratory hygiene and cough etiquette are included in the list of relevant recommendations published by CDC after 2003, found in Appendix B of the 2016 Summary.  



Key CDC Recommendations For Respiratory Hygiene And Cough Etiquette In Dental Settings:

  • Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and continuing throughout the visit.
  • Post signs at entrances with instructions to patients with symptoms of respiratory infection to:
    • Cover their mouths/noses when coughing or sneezing.
    • Use and dispose of tissues.
    • Perform hand hygiene after hands have been in contact with respiratory secretions.
  • Provide tissues and no-touch receptacles for disposal of tissues.
  • Provide resources for performing hand hygiene in or near waiting areas.
  • Offer masks to coughing patients and other symptomatic persons when they enter the dental setting.
  • Provide space and encourage persons with symptoms of respiratory infections to sit as far away from others as possible. If available, facilities may wish to place these patients in a separate area while waiting for care.
  • Educate DHCP on the importance of infection prevention measures to contain respiratory secretions to prevent the spread of respiratory pathogens when examining and caring for patients with signs and symptoms of a respiratory infection.


Sharps Safety
:                 

Your infection control program should include policies and procedures addressing sharps safety to prevent exposure to blood and other potentially infectious material.  This includes training of DHCP to understand the risk of injury and use precautions when sharps are present.

Key CDC Recommendations For Sharps Safety In Dental Settings:

  • Consider sharp items (e.g., needles, scalers, burs, lab knives, and wires) that are contaminated with patient blood and saliva as potentially infective and establish engineering controls and work practices to prevent injuries.
  • Do not recap used needles by using both hands or any other technique that involves directing the point of a needle toward any part of the body.
  • Use either a one-handed scoop technique or a mechanical device designed for holding the needle cap when recapping needles (e.g. between multiple injections and before removing from a non-disposable aspirating syringe).
  • Place used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers located as close as feasible to the area where the items are used.


Safe Injection Practices
:              

Safe injection practices are used to administer injections in the safest possible manner. These practices are intended to prevent transmission of infection between patients, or between DHCP and patients when preparing and administering parenteral (e.g., intravenous or intramuscular injection) medications. When CDC published the 2003 infection control guidelines, these safe practices were included with recommendations for following aseptic techniques when administering parenteral medications. In 2007 CDC added safe injection practices as a formal element of Standard Precautions. Because this change occurred after publication of the current dental infection control guidelines, safe injection practices are included as relevant recommendations published by CDC, found in Appendix B of the 2016 Summary.  

Key CDC Recommendations For Safe Injection Practices In Dental Settings:

  • Prepare injections using aseptic technique in a clean area.
  • Disinfect the rubber septum on a medication vial with alcohol before piercing.
  • Do not use needles or syringes* for more than one patient (this includes manufactured prefilled syringes and other devices such as insulin pens).
  • Medication containers (single and multi-dose vials, ampules and bags) are entered with a new needle and syringe, even when obtaining additional doses for the same patient. 
  • Use single-dose vials for parenteral medications when possible.
  • Do not use single-dose (single-use) medication vials, ampules, and bags or bottles of intravenous solution for more than one patient.
  • Do not combine the leftover contents of single-use vials for later use.
  • The following apply if multidose vials are used:
    • Dedicate multidose vials to a single patient whenever possible.
    • If multidose vials will be used for more than one patient, they should be restricted to a centralized medication area and should not enter the immediate patient treatment area (e.g., dental operatory) to prevent inadvertent contamination.
    • Date multidose vials when first opened and discard within 28 days, unless the manufacturer specifies a shorter or longer date for that opened vial.
  • Do not use fluid infusion or administration sets (e.g., IV bags, tubings, and connections) for more than one patient.

*Two relevant recommendations in Appendix A are very similar to key recommendations above, but differ in text. The recommendations, as found in Appendix A:

  • Do not reuse needles or syringes to enter a medication vial or solution, even when obtaining additional doses for the same patient.
  • If multidose vials will be used for more than one patient, they should be kept in a centralized medication area and should not enter the immediate patient treatment area to prevent inadvertent contamination


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Sterilization and Disinfection of Patient-Care Items and Devices
:                 

Cleaning, disinfection and sterilization of equipment should be done by DHCP who are properly trained in all steps of reprocessing using appropriate PPE. Make sure that manufacturer’s instructions for reprocessing are readily available and DHCP understand that cleaning is always the first step before disinfection or sterilization.

 

Key CDC Recommendations For Sterilization And Disinfection Of Patient-Care Devices For Dental Settings:

  • Clean and reprocess (disinfect or sterilize) reusable dental equipment appropriately before use on another patient.
  • Clean and reprocess reusable dental equipment according to manufacturer instructions. If the manufacturer does not provide such instructions, the device may not be suitable for multi-patient use.
  • Have manufacturer instructions for reprocessing reusable dental instruments/equipment readily available, ideally in or near the reprocessing area.
  • Assign responsibilities for reprocessing of dental equipment to DHCP with appropriate training.
  • Wear appropriate PPE when handling and reprocessing contaminated patient equipment. 
  • Use mechanical, chemical, and biological monitors according to manufacturer instructions to ensure the effectiveness of the sterilization process; maintain sterilization records in accordance with state and local regulations. 

Additional Recommendations: Although the following items are not included as key recommendations, they are included in Appendix B as relevant recommendations for sterilization and disinfection released by CDC since 2003:

  • Label sterilized items with the sterilizer used, the cycle or load number, the date of sterilization, and, if applicable, the expiration date.
  • Ensure routine maintenance for sterilization equipment is performed according to manufacturer instructions and maintenance records are available.

 

Environmental Infection Prevention:                     

Your infection prevention plan should include policies and procedures for routine cleaning and disinfection of environmental surfaces.   

 

Key CDC Recommendations For Environmental Infection Prevention And Control In Dental Settings:

  • Establish policies and procedures for routine cleaning and disinfection of environmental surfaces in dental health care settings.
    • Use surface barriers to protect clinical contact surfaces, particularly those that are difficult to clean (e.g., switches on dental chairs, computer equipment) and change surface barriers between patients.
    • Clean and disinfect clinical contact surfaces that are not barrier-protected with an EPA-registered hospital disinfectant after each patient. Use an intermediate-level disinfectant (i.e., tuberculocidal claim) if visibly contaminated with blood.
  • Select EPA-registered disinfectants or detergents/disinfectants with label claims for use in health care settings. 
  • Follow manufacturer recommendations for use of cleaners and EPA-registered disinfectants (e.g., amount, dilution, contact time, safe use, and disposal).  

Dental Unit Water Quality:              

Ensure that water used for dental treatment meets drinking water standards. Commercial products and devices are available that can improve the quality of water used in dental treatment. 

 

Key CDC Recommendations For Dental Unit Water Quality In Dental Settings:

  • Use water that meets EPA regulatory standards for drinking water (i.e., ≤ 500 CFU/mL of heterotrophic water bacteria) for routine dental treatment output water.
  • Consult with the dental unit manufacturer for appropriate methods and equipment to maintain the quality of dental water.
  • Follow recommendations for monitoring water quality provided by the manufacturer of the unit or waterline treatment product.
  • Use sterile saline or sterile water as a coolant/irrigant when performing surgical procedures.

Additional background information, rationale and evidence can be found in the Summary of Infection Prevention Practices in Dental Settings:  Basic Expectations for Safe Care (link to pdf) and the Guidelines for Infection Control in Dental Health-Care Settings–2003

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Following the CDC Guidelines              

OVERVIEW  | PERSONNEL HEALTH | BBP | HAND HYGIENE | PPE | LATEX ALLERGY |
INSTRUMENT PROCESSING | SURFACES | DUWL SPECIAL CONSIDERATIONS | 
CHECKLISTS  

The CDC issued Standard Precautions for infection control in 1996, and in 2003 published its “Guidelines for Infection Control in Dental Health-Care Settings – 2003.”                   

Standard Precautions apply to all patient care involving contact with all body fluids (except sweat), mucous membranes and open wounds in skin. They include: hand hygiene; use of personal protective equipment (PPE); respiratory hygiene and cough etiquette; safe injection practices; and, safe handling of potentially contaminated equipment or surfaces. They apply to all patients (not just those suspected/known to be high-risk or with signs/symptoms of disease).  

Guidelines for Infection Control in Dental Health-Care Settings – 2003 reviews the scientific evidence for dental infection control issues and provides evidence-based recommendations. 

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Overview of 9 Key Elements of the CDC Guidelines for Infection Control in Dental Health-Care Settings – 2003                     

Key elements of the CDC guidelines are outlined below.

Detailed information on all of these can be found in the following resources:

Additional resources with more information on specific topics are included in each section below.        

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(1) Personnel Health Elements of an Infection-Control Program
                     

A written health program should be developed for dental healthcare workers. Personnel health elements covered in this program (with policies, procedures and guidelines) include: 

  • Education and training
  • On initial employment; when new tasks require additional training; when changes in recommendations/OSHA mandates requires this; AND, at least annually
  • Medical conditions, work-related illness, and associated work restrictions
  • Contact dermatitis and latex hypersensitivity
  • Immunizations
  • Exposure prevention, and postexposure management, including having referral arrangements from the outset (as opposed to in an emergency situation after an incident has occurred)
  • Maintenance of records, data management, and confidentiality.

More information on the above can be found at: Guide to Compliance with OSHA Standards for Medical & Dental Offices. Available at: https://www.osha.gov/Publications/osha3187.pdf 

Immunizations Recommended for Healthcare Personnel are as follows:

  • Hepatitis B vaccination – if no documented evidence of a complete hepB vaccine series, OR lack of an up-to-date blood test showing immunity to hepatitis B. Vaccination requires a 3-dose series (dose #1, #2 after 1 month, #3 approximately 5 months after #2). An anti-HBs serologic test is required  1–2 months after dose #3 to ascertain immunity has been acquired
  • Influenza – 1 dose annually
  • Measles and mumps – if born in 1957 or later and have not had the MMR vaccine, or lack an up-to-date blood test showing immunity: 2 doses of MMR at least 28 days apart
  • Rubella – if born in 1957 or later and have not had the MMR vaccine, or lack of an up-to-date blood test showing immunity, then 1 dose of MMR

1)  For measles, mumps and rubella, ACIP vaccine recommendations should be consulted for healthcare workers born before 1957

  • Varicella (chickenpox) – if have not had chickenpox, or the vaccine, or lack of an up-to-date blood test showing immunity, then 2 doses of varicella vaccine, 4 weeks apart
  • Tetanus, diphtheria, and pertussis (whooping cough) – a single dose of Tdap if not previously received AND Td booster after that every 10 years. A dose of Tdap during each pregnancy
  • Meningococcal – 1 dose ONLY if routinely exposed to isolates of N. meningitis.

The above information is from Recommended Vaccines for Healthcare Workers on the CDC website. More detailed information on these can be found in the following resources:

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(2) Preventing Transmission of Bloodborne Pathogens                   

The CDC recommendations include immunization recommendations against Hepatitis B (HBV) (see above), testing post-immunization, education on the risks of HBV, counseling, and general recommendations related to standard precautions and OSHA’s Bloodborne Pathogens Standard. In addition, engineering and work controls to reduce the risk of sharps injuries are addressed, as well as postexposure management and prophylaxis. In accordance with OSHA requirements, all personnel with occupational risk for bloodborne pathogens MUST be offered Hepatitis B vaccination at no charge prior to performing tasks with potential exposure. If they decline, they must sign a Hepatitis B declination form which must be kept in the personnel records.

More detailed information on these topics can be found in the following resources:

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(3) Hand Hygiene                 

Hand hygiene must be performed: Before donning and after removing gloves; when changing out gloves during a procedure; before and after ungloved skin contact with patients; and, following ungloved skin contact with potentially contaminated inanimate surfaces. The specific method depends on the type of procedure, presence/absence of visible contamination, and other factors. 

More detailed information on the CDC guidelines for hand hygiene can be found in:

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(4) Personal Protective Equipment (PPE)       
                   

PPE protects skin, and mucous membranes of the eyes, nose and mouth, from exposure to blood or other potentially infectious material (OPIM) via direct/indirect contact, splashes, spatter (splatter) and bacterial aerosols. PPE is required during patient care, instrument processing and operatory clean-up. Appropriate gloves, surgical facemasks, protective eyewear and protective clothing are also mandated by OSHA when there is occupational risk of exposure to bloodborne pathogens. During influenza epidemics and for certain diseases (e.g., TB), NIOSH respirators should be used instead of surgical facemasks, as part of transmission-based/isolation precautions.

More detailed information on the CDC guidelines on PPE can be found at:

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(5) Contact Dermatitis and Latex Hypersensitivity                    

Latex hypersensitivity reactions, and irritant and allergic contact dermatitis, can be associated with frequent hand hygiene and glove use. Using products containing emollients, and hand lotion, helps to prevent irritation (not allergic reactions). Latex Type I hypersensitivity occurs rapidly, can include itching, runny nose, asthma, difficulty breathing, and is potentially life-threatening. Non-latex gloves must be available for personnel and patients, and emergency treatment kits containing latex-free products must always be available.

More detailed information on these conditions can be found at:

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(6) Sterilization and Disinfection of Patient-Care Items (Instrument Processing)                  

Instrument Processing is required for all reusable instruments and devices. Appropriate PPE must be worn (see above). A designated central processing area is recommended. The stages involved include 1) Transportation; 2) Sorting (critical, semi-critical and noncritical instruments per Spaulding’s classification; 3) Cleaning (optional pre-soak) – preferably automated cleaning, which is more effective and safer; 4) Preparation and Packaging; 5) Sterilization; and, 6) Storage. Only semi-critical instruments may be sterilized unwrapped and provided they will be used immediately. Semi-critical heat-sensitive reusable instruments (except handpieces) may be processed after the cleaning stage by using an FDA-cleared, high-level sterilant/disinfectants in accordance with the instructions for use. Handpieces must be cleaned and heat-sterilized; the manufacturer’s instructions must be followed. Sterilization monitoring consists of mechanical, chemical and biological (spore test) indicators – these are to be used in accordance with the CDC recommendations.

More detailed information on instrument processing can be found in:

  • Miller, CH. Instrument Processing. In Infection Control and Management of Hazardous Materials for the Dental Team. 5th ed., St. Louis, 2014, Elsevier, pp. 142.
  • Rutala WA, Weber DJ. Choosing a sterilization wrap for surgical packs. Infect Cont Today. 2000;4:64-70.

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(7) Environmental Infection Control                        

Environmental surfaces consist of housekeeping surfaces and clinical contact surfaces. The requirements for clinical contact surfaces are more stringent as there is greater risk of contact with these by personnel, patients and instruments/devices. Requirements for clinical contact surfaces include use of an EPA-registered intermediate-level or low-level disinfectant – an intermediate-level is required if the surface is visibly contaminated with blood. The surfaces must be cleaned prior to disinfection – if the disinfectant contains a cleaning agent (i.e., is a cleaner/disinfectant) then the same product may be used for cleaning and disinfecting. If not, a separate cleaner must be used, then the disinfectant. Appropriate PPE must be worn during cleaning and disinfecting of surfaces. Clinical contact surfaces can be treated with barrier protection replaced for each patient, and is especially useful for difficult-to-clean surfaces.

More detailed information on Environmental Infection Control, and on the recommendations for Regulated Medical Waste can be found in the following:  

  • Kurita H, Kurashina K, Honda T. Nosocomial transmission of methicillin-resistant Staphylococcus aureus via the surfaces of the dental operatory. Br Dent J. 2006; 201:297-300.


(8) Dental Unit Waterlines, Biofilm, and Water Quality  
                  

Water from dental unit waterline (DUW) water must meet the standards for drinking water (<500 CFU/mL of heterotrophic water bacteria) for routine dental treatment output water. For routine, nonsurgical care, DUW should be treated and maintained using a product intended for this use. Antiretraction valves/devices in the dental unit must also be maintained in accordance with the unit’s manufacturer’s recommendations. During a boil-water advisory, water from the DUW and public water supply may not be used for patient care, rinsing or hand hygiene.  

More detailed information on DUW can be found in the following resources: 

  • Ricci ML, Fontana S, Pinci F et al. Pneumonia associated with a dental unit waterline. The Lancet. 2012;18;379:684.

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(9) Special Considerations                       

The CDC Guidelines also contain information and recommendations on other issues under ‘Special Considerations’. Each of these topics is listed below.

  • Dental Handpieces and Other Devices Attached to Air and Waterlines
  • Dental Radiology
  • Aseptic Technique for Parenteral Medications
  • Single-Use (Disposable) Devices
  • Preprocedural Mouth Rinses
  • Oral Surgical Procedures
  • Handling of Biopsy Specimens
  • Handling of Extracted Teeth
  • Dental Laboratory
  • Laser/Electrosurgery Plumes/Surgical Smoke
  • Mycobacterium tuberculosis
  • Creutzfeldt-Jakob Disease (CJD) and Other Prion Diseases
  • Program Evaluation

More information on these topics can be found in:

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Checklists                      

Checklists should be used for repeatable, recurring processes and for auditing purposes. They are especially helpful for complex procedures. Using checklists reminds individuals of critical steps to complete each time, helps ensure that each step is performed, provides a record that the proper procedure and all steps are completed, and serves and documentation to investigate adverse events should these occur. State Boards also use audit checklists for compliance with the procedures involved in infection control and prevention, and may be available online from your State Board.

Checklists are available in the following resources:

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Additional Tool Kit Resources


The information above is a resource prepared by the Organization for Safety, Asepsis and Prevention (OSAP) with the assistance and expertise of its members. OSAP is a nonprofit, independent organization providing information and education on infection control and prevention and patient and provider safety to dental care settings worldwide. This resource is an overview with links to more detailed information. Additional relevant information is available on CDC, OSHA, EPA, OSAP and other websites. Content provided is current at time of publication. OSAP assumes no liability for actions taken based on information herein.

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