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The primary goals of an infection prevention program are to prevent health care-associated infections in patients and prevent exposures in personnel, thus ensuring safe practice.1 To achieve these goals, health care settings — including dental clinics — must have an operational infection prevention program consistent with current U.S. Centers for Disease Control and Prevention (CDC) guidance, Occupational Safety and Health Administration (OSHA) regulations, and relevant state and local standards. The site-specific program requires management and oversight. This is the primary responsibility of the infection prevention coordinator, also referred to as the infection control coordinator.1,2 While the roles and responsibilities may vary from one setting to another, depending on the size of the dental practice or institution, ultimately, the infection prevention coordinator is responsible for the safe delivery of care.
The role of the dental infection prevention coordinator has been supported by the CDC since 2003. The CDC’s Guidelines for Infection Control in Dental Health-Care Settings — 2003 state, “An infection-control coordinator (e.g., dentist or other dental health care personnel) knowledgeable or willing to be trained should be assigned responsibility for coordinating the program. The effectiveness of the infection control program should be evaluated on a day-to-day basis and over time to ensure that policies, procedures, and practices are useful, efficient, and successful. Although the infection control coordinator remains responsible for overall management of the program, creating and maintaining a safe work environment ultimately requires the commitment and accountability of all dental health care personnel.”1
Cleveland et al3 reviewed reports of transmissions of bloodborne pathogens associated with dental health care settings between 2003 and 2015. The authors concluded bloodborne disease transmission in dental settings since 2003 was rare. The researchers noted that oral health professionals’ lack of adherence to the CDC guidelines most likely caused the cases of disease transmission. They suggested this conclusion be used to motivate oral health professionals to ensure they have broad knowledge of infection prevention protocols, and that strategies — such as checklists and printed policies — should be used to improve adherence.3
In 2016, the CDC introduced its Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care, which summarized current infection prevention recommendations and included a two-part checklist to evaluate compliance with CDC recommendations.2 In this document, the CDC further reinforces support for the infection prevention coordinator, citing the need for this position to be a priority in all dental settings. The summary suggests the employee with the most expertise in infection prevention should be designated as the program coordinator. This role would be in charge of creating written infection prevention policies and procedures based on high-level sources.2 Table 1 summarizes CDC guidance for administrative measures, including the support for the infection prevention coordinator.
In 2017, the Organization for Safety, Asepsis and Prevention (OSAP) developed a sample job description, which is intended to facilitate discussion about the role and responsibilities of the infection prevention coordinator. Although site-specific responsibilities may vary from one practice to another, some of the general responsibilities include:
- Developing site-specific policies and standard operating procedures consistent with CDC guidelines, OSHA regulations, state and local regulations, and relevant standards
- Reviewing existing policies and standard operating procedures to identify gaps and outdated information
- Acting as a resource for dental team personnel
- Maintaining relevant documentation, including records, permits and licenses
- Providing infection prevention education and training for new and existing personnel
- Monitoring compliance with written policies and procedures through observations, checklists and other evaluation methods
Implementing sound policies and procedures is essential to an effective infection prevention program. The CDC summary recommends tailoring these policies and procedures to the characteristics of each dental setting, and reviewing protocols regularly (at a bare minimum of once per year). It is important to realize the type of oral health services provided, as well as patient populations utilizing the clinic, will affect policies and procedures.2
Written policies and procedures should be implemented in daily practice. The team member designated as the infection prevention coordinator is responsible for all equipment and supplies; this includes ordering hand hygiene products and personal protective equipment, as well as safety devices to reduce the risk of needle sticks. This individual is also in charge of communicating all information and concerns regarding infection prevention efforts.2
Education and training should be provided to all personnel when new tasks or procedures are introduced and, at a minimum, annually.2 In its Bloodborne Pathogens Standards, OSHA addresses training and the need for a qualified individual to conduct the training. Standard 910.1030(g)(2)(viii) states, “The person conducting the training shall be knowledgeable in the subject matter covered by the elements contained in the training program as it relates to the workplace the training will address.”4 The infection prevention coordinator may be responsible for providing education and training to ensure personnel understand and follow the site-specific infection prevention policies and procedures. Associated responsibilities include documentation of the training and maintaining training records.4
MONITORING AND EVALUATION
Another responsibility of the infection prevention coordinator is monitoring and evaluating the site-specific infection control and safety program. According to the CDC guidelines, this affords the ability to improve the efficacy of the practice’s standards and asepsis protocols.1
A variety of tools and checklists is available to assist monitoring and evaluation. The CDC encourages the use of its Infection Prevention Checklist for Dental Settings to periodically evaluate policies, procedures and practices, and to assess compliance with recommended guidelines.2 The CDC provides resources for evaluating and managing asepsis breaches identified in health care settings — including those involving lapses related to reprocessing of medical devices.5,6 To assist site-specific evaluation, the CDC created the CDC DentalCheck mobile app to help infection prevention coordinators monitor and evaluate clinics to ensure they meet minimum requirements.7 Team members will also find additional monitoring and evaluation checklists on OSAP’s website (osap.org).8
To ensure a successful infection prevention program, the coordinator must have support from management and administration. This includes adequate time and access to resources to effectively complete the responsibilities of the infection prevention coordinator. Key resource categories include:
- Relevant guidelines, regulations and standards
- Professional journals, such as the Journal of Dental Infection Control and Safety (available at osapjdics.scholasticahq.com)
- Continuing professional education in infection prevention efforts
- Professional membership in organizations such as OSAP to access resources and network with other infection prevention coordinators
EDUCATION IS KEY
A strong educational foundation is key to the infection prevention coordinator’s success. The CDC notes this individual must be well-versed in infection prevention protocols and be willing to continually update his or her knowledge of the subject.1 At the time of publication of the CDC’s Guidelines for Infection Control in Dental Health-Care Settings — 2003, nationally accepted and standardized core curriculum elements for dental infection prevention education did not exist. (While the Commission on Dental Accreditation had broad guidelines, they did not offer curriculum elements specific to dentists, dental hygienists and dental assistants.)
In 2014, seven national dental organizations formed an Infection Control Consortium in which CDC’s Division of Oral Health participated. The consortium’s charge was to “provide a framework for infection control education of oral health care professionals responsible for performing and/or overseeing infection control procedures in oral health care settings.”7 Table 2 lists the participating organizations.
The Infection Control Consortium used the CDC’s Guidelines for Infection Control in Dental Health-Care Settings — 2003 and OSHA’s Bloodborne Pathogens Standard (29CRF 1910.1030) as the foundation for its work. In 2016, the consortium published Master Curriculum Elements, which serve as a practical resource for oral health professionals, as well as educators, consultants and state regulatory agencies, in promoting patient and provider safety.9,10
Building on the work of the Infection Control Consortium, OSAP, the Dental Assisting National Board (DANB), and the Dental Auxiliary Learning and Education Foundation (DALE Foundation) collaborated to develop a multiyear infection prevention education and certification initiative to support the education of the infection prevention coordinator.11 A standardized educational program on infection prevention has since been created — the OSAP-DALE Foundation Dental Infection Prevention and Control Certificate Program. The partnership has resulted in the development of what is described as a “comprehensive, baseline educational program intended for everyone on the dental team, plus educators, consultants, dental sales representatives, and state dental board investigators and inspectors.”12 In addition, in late 2020 two certification programs will be launched: (1) OSAP-DANB Certified in Dental Infection Prevention and Control; and (2) OSAP-DANB Dental Industry Specialist in Infection Prevention and Control certification.
Developed specifically for dentistry, these professional certifications will demonstrate the bearer’s competence in dental infection control. Collaboratively, these initiatives are designed to enhance patient and provider safety.
Patient and dental team safety — along with preventing the transmission of infectious diseases — are the core goals of any infection prevention program. A knowledgeable infection prevention coordinator plays a vital role in ensuring the clinic’s site-specific program remains compliant and effective.
- To ensure safe care, dental clinics must have an infection prevention program consistent with U.S. Centers for Disease Control and Prevention guidance, Occupational Safety and Health Administration regulations, and relevant state and local standards.
- Although responsibilities may vary depending on the size of the practice or institution, all dental clinics should designate an infection prevention coordinator who is responsible for the safe delivery of care.
- Checklists and printed policies can improve compliance with written infection prevention protocols.
- The infection prevention coordinator is responsible for all related equipment and supplies.
- In addition, infection prevention coordinators should continuously monitor and evaluate the office’s infection control and safety program.
- Ultimately, while the infection prevention coordinator is responsible for managing asepsis protocols, maintaining a safe work environment requires the commitment and accountability of all team members.
- Kohn WG, Collins AS, Cleveland JL, et al. U.S. Centers for Disease Control and Prevention. Guidelines for infection control in dental health-care settings — 2003. MMWR Recomm Rep. 2003;52(RR-17):1–61.
- U.S. Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. Available at: https://www.cdc.gov/oralhealth/infectioncontrol/summary-infection-prevention-practices/index.html. Accessed January 14, 2020.
- Cleveland JL, Gray SK, Harte JA, Robison VA, Moorman AC, Gooch BF. Transmission of blood-borne pathogens in U.S. dental health care settings: 2016 update. J Am Dent Assoc. 2016;147:721–738.
- Occupational exposure to bloodborne pathogens; needlesticks and other sharps injuries; final rule. Occupational Safety and Health Administration (OSHA), Department of Labor. Final rule; request for comment on the information collection (paperwork) requirements. Fed Regist. 2001;66:5318–5325.
- U.S. Centers for Disease Control and Prevention. Steps for Evaluating an Infection Control Breach. Available at: https://www.cdc.gov/hai/outbreaks/steps_for_eval_ic_breach.html. Accessed January 14, 2020.
- U.S. Centers for Disease Control and Prevention. Introduction to the Patient Notification Toolkit. Available at: https://www.cdc.gov/injectionsafety/pntoolkit. Accessed January 14, 2020.
- U.S. Centers for Disease Control and Prevention. CDC DentalCheck Mobile App. Available at: cdc.gov/oralhealth/infectioncontrol/dentalcheck.html. Accessed January 14, 2020.
- Organization for Safety, Asepsis and Prevention. CDC Checklist in Action. Available at: osap.org/page/CDC_Checklist_Toolkit. Accessed January 14, 2020.
- Organization for Safety, Asepsis and Prevention. Infection Control Consortium Supports Education to Advance Patient and Provider Safety. Available at: https://www.osap.org/news/news.asp?id=425276. Accessed January 14, 2020.
- Infection Control Consortium. Master Curriculum Elements. Available at: https://dentalinfectioncontrol.org/site-files/wp-content/uploads/2018/11/ICC_MasterCurriculum_Elements_052518.pdf. Accessed January 14, 2020.
- Durley C, Garrett JH, Long T. Advancing patient safety through a new education and credentialing initiative in dentistry. Available at: https://osapjdics.scholasticahq.com/article/5077-advancing-patient-safety-through-a-new-education-and-credentialing-initiative-in-dentistry. Accessed January 14, 2020.
- Organization for Safety, Asepsis and Prevention, Dental Assisting National Board Inc, and Dental Auxiliary Learning and Education Foundation Dental Infection Control Education and Certification. Available at: dentalinfectioncontrol.org. Accessed January 14, 2020.
The author has no commercial conflicts of interest to disclose.
From Decisions in Dentistry. February 2020;6(2):23–25.