Marie T. Fluent, DDS
As I concluded reading the Centers for Disease Control and Prevention's (CDC) Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care for the first time, I found myself thinking a more alluring title might have been "An Infection Control Primer for the Time-Constrained Dental Team."
ALSO BY DR. MARIE FLUENT |Instrument cleaning: Why, who, and how?
"Primers" were used in schools to convey elementary principles regarding a given subject in a well-organized and condensed version. And, CliffsNotes (or SparkNotes for younger students) were, and still are, used to complement and enhance our understanding of a larger literary piece. To take full advantage of such tools or resources, it is critical to appreciate that they:
• Are not meant as a substitute for the original work
• Provide an abridged version of a much longer work
• Are meant to be a study aid to facilitate students rapidly learning key points
• Provide a particular and fresh point of view
• Encourage readers to take an active role in their education
• May serve as an introduction, refresher, or a quick and handy reference on the topic of interest
It seems to me the CDC Summary fits this description quite nicely.
The Summary is not meant as a substitute for the original document. The introductory pages of Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care1 describe this document as a "summary guide" of Guidelines for Infection Control in Dental Health-Care Settings-2003. The document reflects existing evidence-based guidelines produced by the CDC using elements of Standard Precautions. It is not all-encompassing, nor is it intended to be a replacement for the 2003 Guidelines. Readers are encouraged to consult the full Guidelines for additional background, rationale, and scientific evidence behind each recommendation.
The Summary provides an abridged version of a much longer work. The contents of this document include basic expectations for safe dental care as it summarizes the CDC Guidelines for Infection Control in Dental Health-Care Settings-2003.2 In 43 pages, the Summary reaffirms that Standard Precautions are the foundation for infection prevention and focuses upon two separate, but complementary, elements critical to effective infection prevention. First, major content areas are addressed to include the six fundamental elements needed to prevent transmission of infectious agents in dental settings, key CDC recommendations, and the current CDC recommendations. Second, a pragmatic real-world implementation tool is included in the summary, consisting of a two-part assessment checklist to evaluate office infection prevention practices. Links to source documents, relevant recommendations published by the CDC since 2003, and selected references and additional resources by topic area are also included.
The Summary may be used as a study aid to facilitate students rapidly learning the key points. This manuscript may be used to learn fundamental CDC recommendations for elements needed to prevent transmission of infectious agents in dental settings. Highlighted text boxes that contain key CDC recommendations in each topic area are incorporated within the document. Topics addressed include education and training, dental health-care personnel safety, program evaluation, hand hygiene, personal protective equipment, respiratory hygiene/cough etiquette, sharps safety, safe injection practices, sterilization and disinfection of patient-care devices, environmental infection control, and dental unit water quality. These key points are emphasized in text boxes such that the reader can easily recognize and learn the basic requirements in each of these areas.
ADDITIONAL READING |Importance of instrument cleaning and cleaning monitors
The Summary provides a particular and fresh point of view. The Summary is written in "plain language." It is in a concise, consolidated, and well-organized format and is easier to read than Guidelines for Infection Control in Dental Health-Care Settings-2003. CDC continually publishes updated guidelines and recommendations for health and safety, and the Summary contains some new and fresh recommendations. Some key topics pertinent to dental health-care settings and new recommendations provided in this document include:
1. Administrative measures: Develop and maintain written infection prevention policies and procedures to be reassessed at least annually and assign at least one trained individual the responsibility of coordinating the program.
2. Infection prevention education and training: Maintain training records according to state and federal requirements.
3. Respiratory hygiene/cough etiquette: Dental personnel should be educated about the signs and symptoms of respiratory illnesses, and make every attempt to minimize transmission of respiratory pathogens via airborne routes in the dental setting.
4. Safe injection practices: The concept of safe injection practices is illustrated in the "One and Only Campaign": Use one needle, one syringe, only one time.
5. Sterilization and disinfection of patient-care items and devices: Have manufacturer instructions for reprocessing reusable dental instruments readily available, ideally in or near the reprocessing area. Label sterilized items with the sterilizer used, cycle or load number, and date of sterilization.
The Summary encourages readers to take a more active role in their education. The two-part checklists included as a companion to the Summary allow readers to take a more active role in their infection prevention education and training and provide an assurance of quality control. The first checklist focuses upon policies and practices of a dental facility and serves as a tool to enhance understanding of underlying principles, recommended practices, and their implementation. As DHCP use this checklist, they may assess whether their facility has appropriate infection prevention policies and practices in place, appropriate training for team members, and adequate supplies to provide safe care in a safe working environment.
The second checklist involves direct observation of personnel and patient-care practices. DHCP may participate in assessment of their hand hygiene, use of personal protective equipment, respiratory hygiene/cough etiquette, sharps safety, safe injection practices, sterilization and disinfection of patient-care items, environmental infection control, and dental unit water quality. This checklist provides a review of practices for basic expectations for safe dental care, aids in standardizing infection control protocol, and enhancing compliance with existing CDC Guidelines.
Both checklists may serve to initiate discussion among team members and facilitate improvement and compliance of infection prevention policies and protocol. As infection prevention practices are systematically assessed, feedback may be provided to DHCP regarding performance. Positive responses help ensure that minimum expectations are met for the delivery of safe dental care. Negative responses, however, assist in highlighting areas where protocol is weak and necessitates further attention, education, and training, and a correction of the practice.
The Summary may serve as an introduction or a refresher. This document may be useful and beneficial for both the dental health-care personnel in-training and the infection prevention aficionado. With the Summary, new dental health-care personnel may be introduced to basic information about infection control in dental health-care settings. Experienced DHCP may strengthen their current knowledge of infection prevention and review elements of standard precautions as they pertain to dental care. All dental personnel may ensure their setting has appropriate infection prevention policies and practices in place including appropriate training, education, and supplies. And, the checklists may help assess compliance of all dental personnel with regard to expected infection prevention practices.
For more information
CDC reference documents are listed for further reference, review, and study. The final section of the Summary, Appendix C, provides additional references and resources by topic area. This list is a tremendous resource to any dental personnel who wish to further study infection prevention in the dental setting. The Organization for Safety, Asepsis and Prevention (OSAP) website provides an overview of the Summary and a review of its use. Links to webinars, online training, toolkits, and live lectures regarding the Summary are provided.3
As CliffsNotes are considered a study aid and a tool to help understand literature, the document Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care is a companion to help comprehend basic infection prevention expectations for safe care in dental settings as recommended in Guidelines for Infection Control in Dental Health-Care Settings-2003. This document will help dental personnel learn and reinforce basic infection prevention principles and recommendations, self-assess infection control policies and protocol in their dental facility, and provide resources and references that are readily available. With this Summary, dental personnel may take an active role in their infection prevention education and training. The ultimate goal of this document is to ensure compliance with basic infection control policies and protocol recommended by CDC and to ensure a safe dental visit for all who enter the dental facility.
1. Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health; March 2016. http://www.cdc.gov/oralhealth/infectioncontrol/guidelines/. Published March 2016. Updated March 28, 2016. Accessed April 5, 2016.
2. Kohn WG, Collins AS, Cleveland JL, et al. Guidelines for Infection Control in Dental Health-Care Settings-2003. MMWR Recomm Rep. 2003;52(RR-17):1-61. Available at: http://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf.
3. New CDC Summary and Checklist. Organization for Safety, Asepsis and Prevention website. http://www.osap.org/page/NewCDCSummary. Accessed April 5, 2016. Updated April 11, 2016.
Marie T. Fluent, DDS, is a graduate of the University of Michigan School of Dentistry and has enjoyed 25 years of clinical practice. She is an educational consultant for the Organization for Safety, Asepsis and Prevention (OSAP) and has written peer-reviewed articles and lectures on infection control in the dental setting.