Infection Control in the Dental Office: Compliance Revisited
Follow this handy checklist to see if your practice is in compliance
One may look at the most recent breach of infection control within the Tulsa, Oklahoma oral surgery office with sadness. This office may have exposed as many as 7000 patients to HIV, hepatitis B, and hepatitis C in a 6-year period. Inspections by the Oklahoma Board of Dentistry reported numerous violations of infection control protocols, including unsanitary and unsafe conditions, improper dispensing of medications, and illegal administration of intravenous sedation by dental assistants. This news story has created media hype, raised state and national dental board awareness, and increased patient concerns throughout the country. How could this happen? How could an office seemingly ignore existing CDC guidelines and OSHA regulations and drift so drastically toward non-compliance and negligence?
Unfortunately, it often requires an incident of this magnitude to return the importance of infection control to the top of our priority list. Most dental teams are diligent and compliant, and follow proper infection protocols within their dental practices. However, this incident serves as a dramatic reminder that although infection transmission rarely occurs in the dental setting, the consequences of its occurrence may be severe, highly publicized, and possibly lethal.
It may be easy to let infection control compliance slip when other more pressing tasks and concerns fill the day. In addition to adhering to clinical duties, clinicians must attend to the business of dentistry, market their practices, stay current in their fields, and manage their staffs. The list seams endless, and infection control compliance may feel like one more chore to which they must attend. Unlike other tasks, infection control is not glamorous or revenue producing and the fruits from these efforts are not immediately evident. Thus, infection control may slip far down the priority list.
It might be difficult for a dental team to ask the tough questions of itself. Is the dental team adequately educated with regard to infection control regulations? Does the office have a collaborative atmosphere in which infection control is a team-based responsibility? Is everyone on the staff attentive, diligent, and striving for compliance? With the overwhelming national media attention regarding this most recent incident, patients are suddenly more infection-control conscious and observant. They have been educated to look for general cleanliness of the dental office, a neat and de-cluttered instrument processing area, and clinical personnel members washing hands and donning gloves. Clinicians and dental team members know that successful implementation of infection control protocol is much more involved and complicated than what a patient may observe.
OSHA mandates that dental offices review their infection control policies annually. However, now may be an opportune time to reevaluate the infection control policies within the dental practices. A self-audit check list serves as a useful aid to quickly evaluate infection control protocol and ensure dental offices are practicing with high standards. While this list is not intended to be all-inclusive or guarantee that dental offices are OSHA compliant, it should serve as a useful tool to highlight areas in which infection control protocol may be weak and necessitate further attention.
It is in the best interest of every dental practice to make sure that employee safety training is up-to-date at least annually. This brief review of infection control policies and protocol may allow a clinical staff an opportunity to clarify and address infection control weaknesses within a practice. We should be proud of the care we provide to our patients and have confidence that we do so in a safe manner.
Self-Audit Check List (click here to download a printable PDF of the checklist)
Dental Infection-Control Program Administration
Y N Are “standard precautions” followed for all patients?
Y N Is there a written infection-control program?
Y N Does the office have an infection-control and OSHA coordinator assigned?
Y N Have all personnel received training regarding infectious agents?
Y N Does the office routinely evaluate the office infection-control program?
Preventing Transmission of Bloodborne Pathogens
Y N Is the HBV vaccination offered and are records kept?
Y N Are sharps containers and needle-recapping devices available?
Y N Is there a “needle stick” protocol and postexposure program?
Y N Do clinic personnel perform hand hygiene before and after treating patients?
Y N Are alcohol hand rubs available?
Y N Are products available for hand hygiene manufactured for healthcare providers?
Y N Are appropriate hand lotions available to prevent skin disorders?
Contact Dermatitis and Latex Sensitivity
Y N Are latex-free items available for patients and clinic personnel?
Y N Are clinic personnel members made aware of latex sensitivity and consequences?
Personal Protective Equipment
Y N Do clinic personnel wear appropriate eye protection?
Y N Do clinic personnel change masks between patients?
Y N Do clinic personnel wear protective clothing and change when necessary?
Y N Is protective clothing removed before leaving office?
Y N Are gloves appropriate to treatment, available in sizes required?
Y N Are gloves changed between patients?
Sterilization and Disinfection of Patient-Care Items
Y N Is there a central instrument processing area available for the office?
Y N Are the manufacturer’s guidelines followed for sterilizer maintenance?
Y N Has clinical personnel received training on how to use the equipment?
Y N Is visible blood and debris removed from instruments prior to sterilization?
Y N If hand scrubbing is performed, is a long-handled brush utilized and are utility gloves worn?
Y N If instrument cleaning via ultrasonic is performed, are proper enzymatic cleaners used?
Y N Are heavy-duty utility gloves provided for instrument cleaning?
Y N Are instruments wrapped appropriately before sterilization?
Y N Is sterilization equipment properly monitored and are records maintained?
Y N Are all wrapped instrument packages inspected to ensure they are intact?
Y N Are all implantable devices sterilized before use?
Environmental Infection Control
Y N Are clinical contact surfaces disinfected or barrier-protected for each patient?
Y N Are surface barriers changed between patients?
Y N Are appropriate products utilized for cleaning and disinfecting clinical contact areas?
Y N Do clinic personnel use PPE when cleaning environmental surfaces?
Y N Are housekeeping surfaces cleaned routinely?
Dental Unit Waterlines
Y N Does the dental unit water meet EPA regulatory standards for drinking water?
Y N Have the manufacturers’ recommended guidelines been followed?
Y N Is the water flushed (handpieces, ultrasonic scalers, and air/water syringes) for 20 to 30 seconds after each patient?
Y N Are handpieces lubricated, cleaned, and sterilized between patients?
Y N Are single-dose medications and devices used for one patient only
and disposed appropriately?
Oral Surgical Procedures
Y N Do clinical personnel wear sterile surgeon’s gloves and use
Y N Is sterile water (or saline) used for invasive procedures?
Y N Are biopsy specimens placed in a sturdy leak-proof container with
Y N Are extracted teeth disposed as a regulated medical waste or
returned to the patient?
Y N Are clinical personnel using PPE when handling items received in
Y N Are impressions disinfected prior to being transported to the
laboratory and communicated as such?
Dr. Fluent has received honorarium from Hu-Friedy.
About the Author
Marie T. Fluent, DDS
The Dental Advisor
Ann Arbor, Michigan
Adjunct Clinical Instructor
Dental Assisting Program
Washtenaw Community College
Ann Arbor, Michigan