Charles John Palenik, MS, PhD
Infection surveillance, control, and prevention has been integrated into many programs. However, only limited information exists concerning the exact materials and administrative elements needed to ensure a successful infection control program. What critical functions need to be undertaken? How will responsibilities be assigned? And how shall we judge success?
In 1998, the Society for Healthcare Epidemiology of America (SHEA) established three principal goals for infection control and prevention programs:
• Protect the patient;
• Protect healthcare workers, visitors, and others in the healthcare environment;
• Accomplish the previous two goals in a cost-effective manner, whenever possible.
For patients, the ultimate value of infection control programs is measured by avoidance of or decreases in morbidity associated with health care. Primary to this goal is routine use of sterile instruments chairside. Use of sterile anesthetic materials is also essential. Some items are single use and disposable. Use of potable water during routine treatment and sterile water for surgical procedures also helps to protect the patient. Practices need to identify engineering and work-practice controls that increase patient safety. There are many examples of effective safety and health programs. While there have been reports of clustered outbreaks among patients where infection controls were lacking, such episodes are very rare today in dental practices.
Dental practice workers must also be protected. Successful employee infection control programs contain personnel health elements. These include employee education and training; an immunization program (especially concerning hepatitis B); a written and rehearsed postexposure program; a written policy on workplace injuries, illnesses, and work restrictions; and employee medical records. Proper hand hygiene protects everyone, as does the use of personal protective equipment such as masks, gloves, protective eyewear, face shields, and clothing. Selection and proper use of safer sharps is also protective.
Regular exposure to patient body fluids during dental treatment has associated elements of risk. However, the chances of acquiring infection occupationally can be markedly decreased through a successful employee safety and health program.
Infection control measures should be both effective and efficient. Cross infections have legal ramifications and can impact the practice's position in the local community. Programs that prevent the spread of disease to patients from practitioners, other patients, and the environment provide important cost savings to the practice. Similarly, maintenance of employee health and well being, avoidance of disease-related absences, and prevention of claims of unsafe working conditions are important safety and health goals.
Both processes and products can prevent the spread of disease. All must be carefully examined and applied. There also are nonmonetary outcomes. Examples include patient and practitioner satisfaction, ethical and legal issues, and reputation enhancement within the community.
The success of an infection control program can be defined by its effectiveness in achieving its goals. The goals of the program are designed to limit or prevent disease transmission during dental treatment. Each dental practice needs to develop specific objectives and outcomes to determine if its infection control goals have been achieved. These include:
• Measuring the effectiveness of procedures, policies or programs to protect dental patients;
• Measuring the effectiveness of procedures, policies or programs to protect dental practitioners; and,
• Determining the cost-effectiveness of these activities.
OSAP (www.osap.org) is the leading source for infection control and human safety and health information in dentistry. Several tenets of OSAP's current strategic plan apply directly to the infection control goals identified by SHEA. These include: 1) Increasing access to information for dental patients; 2) Increasing information and education in infection control and health and safety in dental healthcare settings worldwide; 3) Supporting development of products, devices, and services founded on the best available scientific and evidence-based information, and 4) Actively participating in the development of standards and guidelines.
Dr. Charles John Palenik is an assistant director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik has authored numerous articles, book chapters, and monographs. He is the co-author of the popular Infection Control and Management of Hazardous Materials for the Dental Team. He serves on the Executive Board of OSAP, dentistry's resource for infection control and safety.Questions about this article or any infection-control issue may be directed to [email protected].
