California Infection Control Regulations for Dental Professionals.

Infection control regulations that affect dental professionals come from several regulatory agencies and are increasingly complex. Staying up to date on changes and the overlapping requirements can challenge a busy dental practice. This article reviews the current regulations in California and suggests methods for ensuring every dental office is in compliance.

Preliminary Evidence Supports Modification of Retraction Technique to Prevent Needlestick Injuries.

A modified retraction technique was introduced into the DDS degree preclinical anesthesia course in 2011 with the goal of reducing needlestick exposure incidents. In numerous studies of dental exposures, injuries from dental anesthetic needles account for the highest proportion of all exposures. The purpose of this study was to assess the preliminary impact of a modified retraction technique on the incidence of blood and body fluids (BBF) exposure incidents associated with needles during injection. Data from evaluations of students from 2014 and 2015 were obtained and tracked to determine whether the modified retraction technique was "excellent," "clinically acceptable," or "clinically unacceptable." Data were collected to determine if the patient perceived the modified retraction technique as "comfortable" or "correctable when addressed" to help improve student technique for future injections. Likewise, data from the blood-borne exposure database where all information related to BBF exposures is recorded were reviewed and the information separated by year and class. This study presents preliminary data only and because of the small sample size does not lend itself to validation by statistical analysis. However, the technique effectively removes the operator's hand from the field during injection, reducing the risk of accidental intraoral needlestick to the nondominant hand of the operator.

Sterilization for Large Volunteer Temporary Clinics.

Large portable clinics staffed by volunteers present many unique challenges, including establishing appropriate instrument processing services. This article explores many of the specific steps an organization can take to ensure a safe care environment for patients and a safe working environment for volunteers.

Core Practices for Infection Prevention and Control in Oral Healthcare.

Infection prevention and control (IPC) is an essential part of every encounter with patients in a healthcare setting, including oral healthcare. To ensure best practices are being followed, dental healthcare personnel (DHCP) should be familiar with several guidelines from the Centers for Disease Control and Prevention, including the Core Infection Prevention and Control Practices. The core practices represent the foundation upon which all other IPC protocols are built. This article is intended to increase DHCP awareness of these core practices and other guidelines so they can more effectively critically evaluate their facilities to manage IPC beyond standard precautions and ensure a safe environment in which to work and provide patient care.

Preventing percutaneous injuries among dental health care personnel.

BACKGROUND: The Occupational Safety and Health Administration and the Centers for Disease Control and Prevention (CDC) recommend that health care personnel (HCP) adopt safer work practices and consider using medical devices with safety features. This article describes the circumstances of percutaneous injuries among a sample of hospital-based dental HCP and estimates the preventability of a subset of these injuries: needlesticks. METHODS: The authors analyzed percutaneous injuries reported by dental HCP in the CDC's National Surveillance System for Health Care Workers (NaSH) from December 1995 through August 2004 to describe the circumstances. RESULTS: Of 360 percutaneous injuries, 36 percent were reported by dentists, 34 percent by oral surgeons, 22 percent by dental assistants, and 4 percent each by hygienists and students. Almost 25 percent involved anesthetic syringe needles. Of 87 needlestick injuries, 53 percent occurred after needle use and during activities in which a safety feature could have been activated (such as during passing and handling) or a safer work practice used. CONCLUSIONS: NaSH data show that needlestick injuries still occur and that a majority occur at a point in the workflow at which safety syringes--in addition to safe work practices and recapping systems--could contribute to injury prevention. CLINICAL IMPLICATIONS: All dental practices should have a comprehensive written program for preventing needlestick injuries that describes procedures for identifying, screening and, when appropriate, adopting safety devices; mechanisms for reporting and providing medical follow-up for percutaneous injuries; and a system for training staff members in safe work practices and the proper use of safety devices.

Student occupational exposure incidence: perception versus reality.

Reports of clinical injuries made to a dental school Office of Occupational Health and Safety at the time of their occurrence were compared to self-reports on a survey for dental students in five classes at various times over their educational careers. The majority of injuries were from needlesticks and mishaps with hand instruments. Underreporting at the time of injury was approximately one-third in the first clinical year and one-half in the final clinical year of the three-year program. Students reported a greater perceived likelihood of injury later in their education than at the beginning but a decreased fear of such injuries. Female students reported more needlesticks and a greater fear of injury than did male students. It is hypothesized that a personal interpretation of the meaning of clinical injuries influences reporting behavior.

Comprehensive training for hazard communication.

Long before the Bloodborne Pathogens Standard caught the attention of the dental profession, the Occupational Safety and Health Administration required all employers to collect information about hazardous chemicals in the workplace and provide information and training to employees regarding the materials. The Hazard Communication Standard requires employers to establish written programs, collect specific information regarding workplace chemicals, and conduct a formal training program for employees.

The use of a process challenge device in dental office gravity displacement tabletop sterilizers.

There is evidence that dental office sterilizers often fail to pass the challenge of a biological indicator test. The use of a class 5 integrating indicator in each load could reduce the risk of instruments being released when all parameters for sterilization have not been met.

Quality assurance and risk management: a survey of dental schools and recommendations for integrated program management.

Quality assurance (QA) and risk management (RM) programs are intended to improve patient care, meet accreditation standards, and ensure compliance with liability insurance policies. The purpose of this project was to obtain and disseminate information on whether dental schools integrate QA and RM and what mechanisms have been most effective in measuring accomplishments in these programs. All sixty-five U.S. and Canadian dental schools were sent a twenty-nine-item survey, and forty-six (71 percent) schools responded. The main findings are as follows: 66 percent had a written QA program combined with a QA committee; 95 percent received administrative support; there was wide variation in the makeup of the QA committee; many institutions reported significant changes resulting from the QA program; and over half of the respondents merged QA and RM in some fashion. To develop or maintain an effective QA/RM program, the authors propose the following: obtain active support from the dean; develop goals and mission/vision statements; include trained personnel on the committee; establish wide levels of involvement in the QA program; develop QA measurements to ensure compliance with institutionally developed standards of patient care; and establish continuous cycles of improvement.

Current concepts in hand hygiene.

Recent Centers for Disease Control and Prevention guidelines provide new concepts in hand hygiene. A major cornerstone of infection control, hand contamination has often been cited as the culprit in hospital-associated infections. New products and new science provide the basis for the next generation of recommendations for controlling the transmission of infectious organisms on the hands of health care providers.

OSHA bloodborne pathogens rule--revisions and clarifications.

Recent revisions to the Occupational Safety and Health Administration's Bloodborne Pathogens Rule have clarified requirements for record keeping and engineered sharps injury protection devices. It is important for dental workers, and especially dentists who are employers, to be aware of the changes in the regulatory language and be prepared to modify existing programs to meet these new demands. This article provides an overview of the 2001 Bloodborne Pathogens Rule with an emphasis on the impact on dental offices.