Is Your Office Up to Speed? by Andrea Cook

Most of my clients say they'd be happiest if they could focus on just moving teeth, because practice management is one of the most challenging and frustrating parts of their job. Management of sterilization, OSHA and instrument reprocessing are some of the least favorite areas of the orthodontic office.

The most current recommendations for infection control and instrument reprocessing come from the Centers for Disease Control and Prevention's Guidelines for Infection Control in Dental Health-Care Settings, 2003. Understanding the CDC guidelines is the first step toward developing and implementing systems that will help your team gain compliance, but many offices struggle to make sense of them.

In March 2016, the CDC released an update to its 2003 guidelines. The additional recommendations are more administrative in nature, rather than changes to any existing protocols. The new document, Summary of Infection Prevention Practices in Dental Settings Basic Expectations for Safe Care and Companion Checklist,1 summarizes existing recommendations to make them easier to understand and use in dental settings, including orthodontic practices. The summary focuses on standard precautions and the foundation for preventing transmission of infectious agents during patient care; it is intended to supplement the existing CDC recommendations, not replace them.

The resource includes tools to help team members follow infection prevention guidelines:

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

The following is a list of CDC recommendations 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.
• Reassess infection-prevention policies and procedures 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, such as hand-hygiene products, safer devices to reduce injuries, and personal protective equipment.
• Ensure the facility has a system for early detection and management of potentially infectious persons at initial points of patient encounter.

Respiratory hygiene and cough etiquette

• Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and continuing throughout the visit.
• Post signs at office entrances, with instructions to patients with symptoms of respiratory infection to:
  • Cover their mouths/noses when coughing or sneezing.
  • Use and dispose of tissues.
  • Perform hand hygiene after hands have been in contact with respiratory secretions.
• Provide tissues and no-touch receptacles for their disposal.
• Provide resources for performing hand hygiene in or near the waiting area.
• Offer masks to coughing patients and other symptomatic persons when they enter the dental setting.
• Provide space and encourage people with symptoms of respiratory infections to sit as far away from others as possible. If available, facilities may wish to place these patients in a separate area while waiting for care.
• Educate dental health care professionals on the importance of infection-prevention measures to contain respiratory secretions and help prevent the spread of respiratory pathogens when examining and caring for patients with signs and symptoms of a respiratory infection.

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 and 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 CDC Summary is the importance of having an individual in every dental practice assigned to be the infection-prevention coordinator. This person will be responsible for developing written infection-prevention policies for the practice, communicating with all team members to address infection-prevention issues, and ensuring that the practice has the necessary equipment and supplies.

• 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 personal protective equipment.
• Monitor the sterilization process.
• Evaluate safety devices.
• Monitor dental unit water quality

Training your team on infection-prevention guidelines and protocols should be documented, and each team member should have a signed copy in his or her personnel file. This will help protect the doctor and practice in case of an accident in the office. (If a team member becomes injured and hasn't trained, it leaves the doctor open for responsibility.) Training must be done at hiring, annually, and when processes, products or tasks change. There may be additional state regulations that must be met.

The CDC has developed an infection prevention checklist that offices can use to determine their level of compliance, available on its website. Once the checklist is completed, areas for improvement or change will be clear, and a plan of action can be put in place.

References
1. http://www.cdc.gov/oralhealth/infectioncontrol/guidelines

Download your free copy of the new CDC Summary
To download the Centers for Disease Control and Prevention's Summary, go to cdc.gov/oralhealth and click "Infection Prevention & Control," then look for the guidelines and recommendations section.