4 ways to improve your practice's infection control in 2019

While improvement goals can be started anytime, the new year just might be a good motivator to look at your practice and think about how infection prevention can be improved in 2019.

Make it a priority

The first piece of advice isn’t necessarily a solid, roll-up-your-sleeves-and-get-to-work recommendation. Rather, it helps to get in the mindset of infection prevention.

“A goal that all dental practices should consider setting for the year is to make infection prevention a priority,” says Mary Borg-Bartlett, president of SafeLink Consulting. “This begins with developing a system for establishing the infection prevention procedures specific to the practice. An excellent guideline is the 2003 Guidelines for Infection Control in Dental Health-Care Settings and the 2016 Summary of Infection Prevention Practices in Dental Settings that were both published by the Centers for Disease Control and Prevention (CDC).”

Further, someone at the practice should be designated to coordinate infection prevention activities.

“In the 2016 Summary, dental practices are encouraged to appoint someone as the Infection Prevention Coordinator (IPC),” Borg-Bartlett says. “The CDC includes an Infection Prevention Checklist in the 2016 Summary that can be used to conduct the assessment. The IPC must then be provided time each month to conduct the assessments, write up their findings, and present them to the dentist and other team members. This group can then determine what actions will be taken to ensure that the infection prevention procedures are being followed.”

Review your plans

Once the practice is in the right mindset - and has that infection prevention coordinator in place - the next step is to review your plans and make sure they are complete and up-to-date.

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“Be sure your practice knows how to manage occupational exposures to Bloodborne Pathogens (BBP) and have a clear and concise exposure control plan for your practice,” Joyce Moore, RDH, an infection control consultant and clinical instructor at Bristol Community College in Fall River, Mass. says. “First and foremost, make sure your Dental Health-Care Personnel (DHCP) - aka staff -have been offered the compensated Hepatitis B vaccine, have received appropriate BBP exposure training and that you have a referral arrangement with a qualified health-care provider prior to a possible BBP exposure. Then make sure you have a written site-specific plan that provides guidance if an exposure incident occurs. In 2017, NIH and OSAP did a study that showed that a significant number of dental practices did not have a plan. Make sure that staff know who their exposure is reported to and where the plan is kept so they have immediate access.”

Not sure where to get a plan? OSHA has resources to help develop one specifically for any practice. Specific information about Model Plans and Programs for the OSHA Bloodborne Pathogens and Hazard Communications Standards can be found at: www.osha.gov/Publications/osha3186.html

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“While some documentation may be the same for each practice, (i.e., a sharps injury log to be filled out), other parts may be tailored to the specific practice, (i.e., information (and possibly a map) for the qualified medical professional where a staff member will go for post-exposure testing,” Moore says.

The Organization for Safety, Asepsis and Prevention (OSAP) offers this advice on its website:

“OSHA requires that employers in private dental settings (and applicable public dental settings) MUST have a written exposure control plan,” it reads. “Your exposure control plan MUST be accessible for all employees and on request employees must be able to receive a copy of this. Its location must also be reviewed during training. The overall goal of the Exposure Control Plan is to identify potential occupational exposure to bloodborne pathogens and to describe the methods that are and will be used in the dental setting (i.e., the specific dental office) to prevent exposure.”

Exposure control plans must include:

• Determination of employee exposure (a list of who and which jobs have occupational exposure, and during which tasks and procedures)

• Safe work practices and methods of implementation and control (e.g., PPE, engineering and work practice controls, universal precautions)

• Hepatitis B vaccination

• Communication of hazards to employees and training

• Post- exposure evaluation and follow-up

• Recordkeeping (training records on BBP Standard, medical records, declination of Hep B vaccination, OSHA recordkeeping, sharps injury log)

• A list and description of procedures for evaluating exposure circumstances. 

Once the plan has been developed and is in place it must be reviewed and updated annually.

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Learn the rules

There are a lot of agencies telling practices how to do their jobs. If conflicts arise, penalties can be severe. The new year is a good time to know who expects what.

“Another goal for the year would be to investigate and understand all of the regulatory standards that apply to the practice,” Borg-Bartlett says. “This can include the State Board of Dentistry, OSHA, EPA, and FDA to name a few. For instance, in many states the State Board of Dentistry states that the dentist must comply with the CDC recommendations. If that’s the case in the state where the practice is located, then it’s even more important for the practice to fully understand the infection prevention procedures established by the CDC.”

Regulatory agencies, while looking out for the best interests of the public, don’t make it easy on practices. As such, it might be best to enlist outside help.

“Since it’s time consuming to learn about all of the regulations that apply to dentistry, it may be best to hire an outside expert to conduct an assessment,” Borg-Bartlett says. “When hiring a firm make certain that they are experienced in all of the regulatory requirements and not just the CDC requirements.”

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Check your PPE

A major line of defense against infection is personal protective equipment (PPE). The new year is a good time to check on what you have, what you need and your employees’ relationship with your supplies.

“Take a critical look at the personal protective equipment that your staff are using,” Moore says. “Are you providing, and are they using, the best PPE for the procedure that is being performed? Is their eyewear appropriate -ANSI rated, side shields (if using corrective lens), colored safety glasses for lasers and curing lights, etc.? Perform a mask assessment to make sure that you are using the mask with the right filtration level to prevent inhalation of aerosols. Make sure each employee has their own pair of utility gloves for operatory and instrument reprocessing.”

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Using PPE should be a no-brainer: After all, why wouldn’t staff want to keep themselves safe? Regrettably, the answer just isn’t that simple.

“Sometimes they are lazy, too hot, items don’t fit properly, etc,” Moore observes. “Employees will often wear PPE, but may not be aware of the specific criteria that are necessary (i.e. mask filtration levels, ANSI-rated safety eyewear, etc.)”

The best way to encourage the use of PPE is through leadership and positive reinforcement.

“Be a good example,” Moore advises. “Monitoring and when you catch employees doing the right thing, give kudos or possibly an incentive like gift cards, and always...education and training!”

It’s never too early - or too late - to hone the practice’s infection prevention initiatives. January 1, 2019 is just a day on the calendar, but serving as a reminder to improve the practice’s infection prevention measures is a good tool.