ADA Statement on Infection Control in Dental Settings
Chicago – In light of recent news reports concerning a Tulsa, Okla.-based oral surgeon, the American Dental Association (ADA) understands that there may be heightened interest in infection control procedures. Regulations for dental office inspections are determined on a state by state basis by the state dental board.
The ADA has long recommended that all practicing dentists, dental team members and dental laboratories use standard precautions as described in the Centers for Disease Control and Prevention’s (CDC) Infection Control in Dental Health Care Settings guidelines. Studies show that following proper infection control procedures greatly reduces risk to patients to the point of an extremely remote possibility.
Infection control procedures are designed to protect patients and health care workers by preventing the spread of diseases like hepatitis and HIV. Examples of infection control in the dental office include the use of masks, gloves, surface disinfectants and sterilizing reusable dental devices. In addition, dental health care providers are expected to follow procedures as required by the Occupational Safety and Health Administration.
Before you enter the examining room, all surfaces, such as the dental chair, dental light, instrument tray, drawer handles and countertops, have been cleaned and decontaminated. Some offices may cover this equipment with protective covers, which are replaced after each patient.
Non-disposable items like the dental instruments are cleaned and sterilized between patients. Disposable items like needles or gauze are placed in special bags or containers for monitored, proper disposal. Infection control precautions also require all dental staff involved in patient care to use appropriate protective garb such as gloves, masks, gowns and eyewear. After each patient, disposable wear like the gloves and masks are discarded. Before seeing the next patient, the members of the treatment team scrub their hands and put on a new pair of gloves.
Patients who have questions about infection control in the dental setting should talk with their dentists, who will be glad to explain or demonstrate their procedures. More information on infection control in dental offices is available online at www.ADA.org
From OSAP:
Infection Control Breach
Annapolis — The news that broke on March 28 of an Oklahoma oral surgeon that treated patients under unsanitary and unsafe conditions is as shocking to dental healthcare professionals as it is to the patients for whom we provide oral healthcare. While none of us outside of that practice and the officials investigating the reported violations can know all of the details, the Associated Press reports and other news agencies suggest that there is at least one suspected case of HCV transmission to a patient. The press reports that the dentist used instruments that were rusted and pitted, rendering them unsuitable for proper sterilization. He also is suspected of using single vials of medications on multiple patients and allowing unlicensed individuals to perform procedures that would require licensure, such as administration of intravenous medications. The office had no written infection control protocol. The Organization for Safety, Asepsis and Prevention (OSAP) would like to provide practitioners with information that may be helpful in reassuring patients who become fearful of receiving dental care due to the widespread reporting of this case. It is important to focus on why patients should feel safe in our clinics and offices. Some talking points may include:
- Inform patients that the practice uses evidence-based infection control precautions as recommended by the Centers for Disease Control and Prevention. The latest recommendations and other resources can be downloaded from the CDC at http://www.cdc.gov/oralhealth/infectioncontrol/index.htm.
- Explain that dental anesthetics are provided using sterile single-use needles and cartridges of anesthetic and that these items are properly discarded after each patient.
- If IV medications are used, those medications are either from single-dose vials or that multi-dose vials are accessed only once with a single needle and syringe and that additional medications, even for a single patient, are drawn with a new syringe and needle.
- An explanation of the sterilization process, including thorough cleaning, examination and then sterilization of instruments.
- Reassurance that instruments are maintained in sterile pouches or wrap until they are needed for patient care. It may be particularly useful to only open pouches once patients have arrived, so they may see for themselves that the instruments are properly packaged.
- Discussion of processes used for sterility assurance, including chemical indicators on and/or in packs of instruments and the regular monitoring of the sterilization process though the use of a biological indicator (spore test).
- Reassure the patient that all procedures requiring licensure or certification are provided only by professionals licensed to provide those services. More information may be found through the American Dental Association (www.ada.org).
Finally, this case serves as a reminder to ensure all professionals understand the guidelines and regulations related to infection control practices in dentistry. Every dental healthcare professional should periodically review infection control procedures and have those procedures in writing. Communication between team members is also essential to ensuring everyone understands their role in the infection control processes. At least annual review of written protocols should include all team members, and the scientific literature as well as other resources such as the CDC, OSAP and ADA should be reviewed for changes in recommendations.
OSAP has a broad array of instructional content and educational resources available to dental clinicians at www.OSAP.org. The organization will continue to monitor the situation and post new information and resources as they become available.