Infection Control Exam Preparation Course Outline – 2017
Catherine A. Collier RDH, B.Ed, MS
The information in this handout has been selected by Catherine Collier, RDH, B.Ed, and MS. and is intended only to provide insight into information that may appear on the Infection Control Exam. Course participants are responsible for researching additional course information reflected this handout. The author, Catherine Collier, DOES NOT grant permission to copy or use this course information for teaching purposes at any level other than course participation directly affiliated with either Professional Learning Services or Catherine Collier.
Participants are required to print out and bring this handout to their scheduled course. All content will be addresses on the day of the program.
The Infection Control Exam Blueprint
Ø 10% Patient and Dental Healthcare Worker Education
Ø 20% Standard/Universal Precautions and the Prevention of Disease Transmission
Ø 10% Maintaining Aseptic Conditions
Ø 15% Instrument Processing
Ø 15% Aseptic Procedures
Ø 30% Occupational Safety
Agencies Involved:
The following agencies constitute who selects and enforces the regulations regarding Occupational Health and Safety for dental healthcare workers.
Occupational Health and Safety Administration - OSHA
OSHA compliance is mandatory for all healthcare institutions. OSHA is the law regulator and authority. Its main concerned with the health and safety of the employee
The Center for Disease Control – CDC is a federal agency that investigates, identifies, reports, tracks and tries to prevent and control diseases. The CDC is a nationally recognized agency regarding issues concerning public health, workplace hazards, infectious diseases, environmental health threats. It is a part of the Department of Health and Human Services. CDC establishes the guidelines and recommendations for infection control policies and procedures
Environmental Protection Agency - EPA is a federal agency that works to control and abate pollution in air, water, solid waste, pesticides, disinfectants, radiation and toxic substances. All surface disinfectants used in the healthcare industry should be approved by the EPA.
Food and Drug Administration – FDA is an agency of the Department of Health and Human Service that is responsible for ensuring the safety and effectiveness of food, drugs, cosmetics and medical devices.
National Institute for Occupational Safety and Health - NIOSH - It is the only institute responsible for conducting research and making recommendations for the prevention of work related disease and injury
The owner of the dental practice is responsible to provide training
Training should be conducted:
Ø Annually for all employees
Ø For new employees prior to initial assignment
Ø When a new product or new equipment is introduced into your practice
Office training can be conducted in various ways
Ø Appoint a safety coordinator in your practice to train
Ø Hire a person who is extremely familiar with the guidelines of OSHA and CDC ETC.
Ø Attend a presentation or have an in office presentation and walk through assessment of equipment and supplies
Office Record Keeping For Employees
Ø Employee medical or accident reports records are kept for full, part time or former employees
Ø A medical record is any record that holds the health status of an employee
Ø Record is completed by a doctor or healthcare provider
Ø Employees have the rights to access their record
Ø Employees are entitled to a copy of their medical records
Employee records also include, but are not limited to:
Ø CE credits – valid for 3 years
Ø Certification courses
Ø License
Ø Malpractice Insurance
Ø Any certification the employee carries
Ø Records of required immunization or decline
Ø Results of medical testing, medical opinions and treatment
All records are kept for a period of 30 years or the lifetime of the practice
Employers should inform outside services of office policies. Temps, interns or outside services are required to comply with all office policies regarding OSHA, Infection Control and HIPAA compliance
Documentation and Policies
Dental Records should be:
Ø Legible to someone other than the writer
Ø Written in black or blue ink
Ø Do not skip lines, erase or white out info or changes
Ø All entries should be dated
Ø Sign all documents with full name and credentials
Ø Document patient acceptance and refuse of treatment
Ø Document any and all emergency situations that may occur for patient or employee
Ø Document treatment received or refusal of post exposure or accident for patients or employees
Remember.. If you don’t write it down .. You never did it
How to handle an office inspection:
Ø Ask inspector to present credentials
Ø The following process should occur with an inspector:
Ø Opening conference
Ø Walk through assessment of the facility – Office Investigation
Ø Closing conference reviewing the office findings
Ø Results of inspection / Practice owners have the right to appeals findings
Ø How to file for work related injuries
Occupational Exposure Control Plan - OSHA CFR 1910.1030
Employers are required by OSHA to have a written Exposure Control Plan. An Exposure Control Plan (EPA) protects workers from exposures to blood and other body fluids.
ECP reduces exposure incident costs and serves as a document to answer questions related to bloodborne pathogen
Exposure Control Plan should include the following information:
Ø List the current names of high or low risk employees
Ø Must state their job classification and task descriptions
Ø Must state the methods of compliance
Ø Employees should receive training according to their job position and potential risk exposure
Ø Employee Tasks and Work Restrictions
Ø Employers should provide a comprehensive written policies manual regarding employees work restrictions
Ø Work restrictions/exclusions are limitations in professional duties as determined by policies set within the dental practice setting
Ø Restrictions/exclusions may be imposed on dental workers whose health status poses a high risk of infection to patients, coworkers, or themselves
Ø Every dental practice should have a written work restriction and exclusion policy which includes who may implement restrictions and exclusions
Work related injuries are considered accidents or injuries that occur in the workplace during the days and times employees are assigned to be there. They are injuries that require the employee to seek medical attention outside the office.
Employers must establish a log for each facility
OSHA Log 300 will assist the employer and employee with how to properly recognize and file a work related accident.
Log 300 - Classifies work-related injuries and illness
Log 301 - The complete injury and illness Report
Log 300A - This is a Summary Report that should be posted in the office from Feb.1st to April 30th.
Hazard Communication Program - CFR 1910.1020
Occupational Safety and Health Administration (OSHA) guideline requiring dental offices to develop and implement a program to instruct all employees who might be exposed to hazardous materials in the safe handling and disposal of those materials.
These materials include but are not limited to:
Ø Amalgam
Ø Composites
Ø Glass Ionomers
Ø Disinfectants
Ø Bleach
Ø Phenols/ alcohols
Ø Impression materials
Ø Developer/ Fixer
Ø Injectable/ OTC
Safety Data Sheet (SDS) should contain the following information:
Ø Information provided by manufacturers of potentially hazards related to the product
Ø Product identification
Ø Chemical content
Ø Hazardous ingredients
Ø Physical data, fire and explosion information
Ø Reactivity data
Ø Health hazard data
Ø Emergency and first aid procedures, spill or leak procedures
Ø Labeling and storage information.
The New Hazard Communication Standard was previously known as "Employee's Right to Know,”
Ø Globally Harmonized System of Classification and Labeling (GHS).
Ø Allows employees to understand the risks associated with and protections needed when working with hazardous chemicals or drugs.
Ø Required updates to chemical labels including the use of pictograms and signal words.
Ø Material Safety Data Sheets will be updated and be referred to as Safety Data Sheets.
The user of the chemical product assumes liability for any misuse of products
Follow manufacturer’sdirections for:
Ø Proper mixing
Ø Use/handling
Ø Storage and disposal
Ø Proper selection of personal protective equipment
Ø Effective ventilation
Ø First Aid protocol
Use of Secondary Container Labels Information
Dental Unit Waterlines and Suction Lines
No more than 500 Colony Forming Units of bacteria /ml of water. Water lines can contain high amounts of rod- shaped, gram-negative bacteria known as Legionella pneumophilia. These bacteria are considered to be the cause of Legionnaires’ disease.
To minimize bacterial growth in the waterline purge the lines for 2 minutes at the beginning of the day, 30 seconds in between patients, and at the end of the day. In addition, use a tablet system for bottled water supplies or filtration system attached to in coming city water lines to control bacteria growth in water lines.
Bacterial growth in the dental unit waterline is encouraged due to:
Ø Size of tubing
Ø Surface material
Ø Speed of flow rate
Ø Intermittent flow rate
Available methods for treating the dental unit waterline:
Ø Utilize Isolated Water Supply - Isolates the dental unit water from the municipal water supply. Water supply is filled and maintained by office staff
Ø Utilize Chemical or Physical Treatments of the water supply
Ø Flushing the waterlines for 20-30 seconds clears the waterlines of free-floating microorganisms
Ø Utilize sterile water supply
Pros and Cons of having an isolated water supply
Ø Isolate the dental unit from the municipal water supply
Ø Allow the practice to control the quality of water in the unit
Ø Provide a way to introduce chemical agents to waterlines and permit the use of water of known microbiologic quality
Ø Cannot reliably improve the quality of dental unit water without additional chemical or mechanical treatment against the biofilm
Ø Improperly maintained systems could deliver water of worse quality than from a municipal source.
Pros and Cons of Chemical treatment of waterline
Ø May be time-consuming and technique-sensitive
Ø Treatment involves purging the waterlines, adding a chemical to the water reservoir
Ø Require strict compliance with the recommended treatment regimen
Ø May be incompatible with dental equipment (the proper treatment protocol depends on the type and components of the dental unit)
Ø Continuous-release chemicals may be incompatible with various dental materials (for example, dental
Adhesives)
Pros and Cons of utilizing physical treatments
Ø Produces water that meets or exceeds drinking water standards
Ø May include anti - retraction features
Ø Are not labor intensive when placing and replacing
Ø May require periodic chemical treatment of the post-filter segment of the waterlines to control biofilm
Ø May be expensive, as each waterline requires a separate filter that must be maintained daily or weekly, depending on the brand
Ø Point of entry filters are a considerable investment and must be professionally installed
Pros and Cons of flushing the waterlines
Ø Helps to remove contaminants that may have been retracted during patient treatment
Ø Clears away free-floating organisms in the water, temporarily reducing the number of microbes in treatment water
Ø Flushing is not recommended as a control method for dental water quality
Ø Has only temporary effects (Biofilm bacteria continually break free and re-contaminate dental unit water during the course of clinical treatment)
Ø When used alone, has little effect on waterline contamination
Ø Does not prevent or eliminate biofilm
Pros and Cons of utilizing sterile water delivery systems
Autoclavable, self-contained water systems with disposable or autoclavable tubing
Ø Bypass the dental unit's water line
Ø Deliver sterile water to the patient
Ø Used for oral surgery and implantology handpieces, ultrasonic scalers and retrofit devices for restorative handpieces
Ø Have autoclavable components which require sterilization between uses
Suction unit lines should be cleaned in between patients and at the end of the day according to the product manufacturer.
Nitrous Oxide
Dental healthcare workers are exposed to N2O while administering the anesthetic gas to patients.
Implementing scavenging systems that vent unused and exhaled gas will keep N2O away from the work area.
Even with scavenging systems in place there is 12 times the NIOSH recommended limit in hospital operating rooms and 40 times the NIOSH recommended limit in dental operating rooms.
Properly operating scavenging systems have been shown to reduce N2O concentrations by more than 70%. CDC reports clearly demonstrate that simply using a system is not sufficient. The system should be continuously monitored and maintained to effectively reduce exposure to N2O.
Offices should monitor anesthetic equipment when installed and every 3 months thereafter
Monitor air in the worker's personal breathing zone and the environment (room air)
Eliminate or replace:
Ø Loose-fitting connections
Ø Loosely assembled or deformed slip joints and threaded connections
Ø Defective or worn seals, gaskets, breathing bags and hoses
Control waste N2O with a well-designed scavenging system that includes the following:
Ø Securely fitting masks
Ø Sufficient flow rates (i.e., 45 liters per minute) for the exhaust system
Ø Properly vented vacuum pumps
Ø Room ventilation effectively removes waste N2O.
If concentrations of N2O are above 25 ppm, take the following steps:
Ø Increase the airflow into the room
Ø Use supplemental local ventilation to capture N2O at the source
Ø Institute an education program that describes N2O hazards and defines prevention measures.
Symptoms of Nitrous Oxide exposure include difficulty breathing, headache, drowsiness
Radiation Exposure Controls
Ø Provide film badges
Ø Keep records of the test results
Ø Provide lead aprons, goggles, gloves as needed
Ø Dispose of lead aprons according to the EPA regulations
Radiation warning signs should be posted in facilities with x-ray units. The facility should survey the types of radiations used in the facility
Infection Control Practices and Policies
The goal of infection control is to break the chain of transmission and stop the spread of disease.
Infection Occurs when there is a place for an organism to live
Ø Mode of Transmission - a way to transfer the organism to the host