CDC Guidelines and Infection Prevention Protocols

By Andrea Cook

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Orthodontists find managing various aspects of their practice more challenging than treating patients. Sound familiar? Most of my clients tell me that if they could just move teeth, they would be so happy. Managing the practice is one of the areas they find most challenging and frustrating; management of sterilization, OSHA, and instrument reprocessing are some of the least favorite areas of the orthodontic office.

“Sterilization is a complex process requiring specialized equipment, adequate space, qualified dental health care professionals who are provided with ongoing training, and regular monitoring for quality assurance.” Centers for Disease Control and Prevention, 2003.

The most current recommendations for infection control and instrument reprocessing come from “Guidelines for Infection Control in Dental Health-Care Settings, 2003”. Many offices struggle with understanding the current guidelines. An understanding of the guidelines is the first step in developing and implementing systems and protocols that will help you and your team gain compliance.

 In March of 2016 the CDC released its update to the Guidelines for Infection Control in Dental Health-Care Settings, 2003. The additional recommendations are more administrative rather than changes to the infection control and sterilization protocols. The new document is Summary of Infection Prevention Practices in Dental Settings Basic Expectations for Safe Care and Companion Checklist. This document summarizes existing recommendations to make them much easier to understand and use in all dental settings including our orthodontic practices. The summary focuses on standard precautions and the foundation for preventing transmission of infectious agents during patient care. The summary is intended to supplement the existing CDC recommendations, not replace them.

The resource includes tools to help your team members follow infection prevention guidelines. These include:

  1. A summary of basic infection prevention principles and recommendations for dental settings
  2. A checklist to evaluate dental staff compliance with administrative and clinical practice infection prevention recommendations

Below is a list of recommendations published by CDC since 2003 that all offices must incorporate into their practices:

Administrative Measures

  • 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.
  • Infection prevention policies and procedures are reassessed at least annually or according to state or federal requirements.
  • Assign at least one individual trained in infection prevention responsibility for coordinating the program.
  • Provide supplies necessary for adherence to Standard Precautions including hand hygiene products, safer devices to reduce injuries, and personal protective equipment.
  • Facility has system for early detection and management of potentially infectious persons at initial points of patient encounter.

Respiratory Hygiene/Cough Etiquette

Infection Prevention Education and Training

  • Maintain training records according to state and federal requirements

Sterilization and Disinfection of Patient-Care Items and Devices

  • Have manufacturer instructions for reprocessing reusable dental instruments/equipment readily available, ideally in or near the reprocessing area.
  • 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.

One emphasis of the summary is the importance of having an individual in every dental practice assigned to be the infection prevention coordinator. That individual is responsible for developing written infection prevention policies for the practice based on the current standards. The infection prevention coordinator would also ensure that the practice has the needed equipment and supplies required for adherence to standard precaution practices and communicate with all team members to address infection prevention issues.

Infection prevention coordinator responsibilities in your practice would include:

  • Review existing policies and standard operating procedures
  • Identify gaps and outdated information
  • Develop written infection prevention policies and procedures
  • Act as a resource for the rest of the team or organization
  • Maintain related permits, licenses, and other documents
  • Provide training and education related to infection prevention
  • Monitor compliance through observations, checklists, and other methods
  • Evaluate current systems
    • Immunization of the team
    • Occupational exposure to infectious materials
    • Post-exposure management
    • Hand hygiene procedures
    • Use of PPE
    • Monitoring the sterilization process
    • Evaluation of safety devices
    • Dental unit water quality

Training your team on the guidelines and infection prevention protocols you have developed should be documented and each team member should have a signed copy in their personnel file. This will help protect the doctor and practice in case of an exposure or accident in the office. If a team member becomes injured and has not been trained it leaves the doctor open for responsibility. Training must be done at hiring, annually, and when processes, products, or tasks change. You may also have additional state regulations that must be met.

The CDC has also developed an infection prevention checklist that offices can use to determine their level of compliance. Use the link above to download the summary, and see the checklist. Once the checklist is completed areas for improvement or change will be clear and a plan of action can be put in place.

Andrea Cook works as a clinical consultant and trainer for premier orthodontic offices across the country. Since effectively training clinical team members is a critical portion to the advancement of clinical productivity and profitability, Andrea works with teams to increase efficiency, improve communication, and guide the office to a new level of excellence. Her years of experience include working in single, double, and multi-doctor practices. She has extensive experience as clinical coordinator for a multi-doctor practice seeing more than 120 patients per day.

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