Infection control and prevention

Jan. 1, 2004
In 1946, the Communicable Disease Center, or CDC, opened in the old Office of Malaria Control in War Areas in downtown Atlanta.

Charles John Palenik, MS, PhD

In 1946, the Communicable Disease Center, or CDC, opened in the old Office of Malaria Control in War Areas in downtown Atlanta. Part of the United States Public Health Service, the CDC's mission was to work with state and local health officials in the fight against malaria still prevalent in southern states, typhus, and other communicable diseases. In 1947, the CDC moved to its present location on Clifton Road.

In 1970, the Communicable Disease Center was renamed the Center for Disease Control to better reflect a broader mission in prevention. In 1980, the agency was renamed the Centers for Disease Control to explain a change in organizational structure. In time, the CDC would include 12 centers, institutes, and offices.

Finally in 1992, the Centers for Disease Control added "Prevention" to its name. The initials, CDC, were retained. The change was made to describe the ever-increasing role the agency had come to play — a role that came to include not only a strong domestic response, but also a much greater international presence, especially regarding emerging infectious diseases.

For many years, the terms "dental infection control," "infection control in dentistry," and "dental asepsis" have been used to describe procedures designed to minimize the chances of cross-transmission. Perhaps the addition of "prevention" is now warranted. The CDC recently issued its Guideline for Infection Control In Dental Health-Care Settings. It consolidated recommendations for the prevention and control of infectious diseases and the management of personnel safety and health issues related to infection control in dental settings.

Infection control and prevention connotes a broader scope, a more encompassing approach. The ultimate outcome or goal of these efforts is the prevention of bloodborne pathogens, such as hepatitis B and C as well as HIV. "Prevention" describes many of the processes currently being performed in dental practices. This includes sterilization of patient-care items, vaccination schemes, and personal protective equipment (PPE).

Processing instruments is a collection of procedures that prepares contaminated instruments for reuse. Processing must be performed in such a manner that the instruments will not transfer disease agents — from a previous patient, a member of the dental team, or from the environment — to the next patient. The goal is to routinely provide sterile instruments. Items that penetrate soft tissue, contact bone, enter into or contact the bloodstream, or other normally sterile tissues pose the highest risk for transmitting infection and should be sterilized by heat. Sterilization is an essential preventive element of any infection-control program. It is a prime example of infection prevention.

Another mode of prevention is the proper application, when possible, of vaccines. Immunizations especially important for dental personnel include hepatitis B, influenza, and tetanus. Unfortunately, immunologic protection against two other bloodborne pathogens, hepatitis C and HIV, is not currently available.

A third mode of prevention is PPE. This is specialized clothing or equipment worn for protection against a hazard. General work clothes, such as uniforms, pants, shirts, or blouses are not usually intended to function as protection against a hazard and should not be considered to be PPE. Proper examples include gloves, masks, protective eyewear, and gowns.

PPE cannot prevent all forms of occupational risk, such as needlesticks. Greater disease prevention can be realized with the application of engineering and work practice controls. Engineering controls isolate or remove hazards such as bloodborne pathogens from the workplace. Examples are sharps disposal containers, self-sheathing needles, and safer medical devices such as sharps with engineered sharps injury protection, and needleless systems. Work control practices are incorporated into the everyday work routine. They reduce the likelihood of exposure by altering the manner in which a task is performed. An example would be the prohibition of needle recapping using a two-handed technique.

OSAP is the leading source for infection control and prevention and human safety and health information in dentistry. OSAP is currently supported in its efforts by a cooperative agreement with the CDC. This relationship allows OSAP to conduct more and larger training programs as well as new or improved written and electronic resources. The agreement allows OSAP to release a reprise of a classic training video, "If Saliva Were Red." The video highlights common prevention and safety flaws, the cross-contamination dental workers would see if saliva were red, and how controlling contamination with proper engineering controls, work practices, and personal protective equipment reduces the risk of exposure. Further information is available on the OSAP Web site — www.osap.org.

Questions about this article or any infection-control issue may be directed to [email protected].

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