OSHA STANDARDS CITED These are the 20 most frequent OSHA Standard violations: 1. 1910.1200 E1 Written Hazard Communication Program 2. 1910.100 H Employee Training on the Hazard Communication Program 3. 1910.1200 Labeling of Containers in Hazard Communication Program 4. 1910-1200 G1 Obtain or Develop MSDS 5. 5 A 1 General Duty Clause (mostly bloodborne pathogen program elements) 6. 1910.141 A4 Use and Maintenance of Waste Disposal Containers 7. 1904.2A Maintaining the Log and Summary of Occupational Injuries and Illnesses 8. 1910.145 F8 Use of Biohazard Tags to Identify the Actual or Potential Of a Biohazard 9. 1019.1200 G8 Maintaining Readily Accessible Copies of MSDS 10. 1903.2 A1 OSHA Poster Must Be Posted 11. 1910.132 A Personal Protective Equipment Must Be Provided and Used 12. 1910.151 C Availability of Medical Personnel for Advise and Consultation on Matters on Plant Health 13. 1910.20 G1 Employees Informed on the Availability of Medical and Exposure Records 14. 1910.1200 H2 Training of Specific Hazardous Chemicals Employees Likely to Encounter 15. 1910.20 G2 Making Copies of This Section Readily Available to Employees on Request 16. 1910.133 A1 Providing Protective Eye and Face Equipment 17. 1910.38 A1 Written Emergency Action Plan 18. 1910.101 B Handling, Storage and Utilization of Compressed Gases 19. 1910.145 E4 Bio-Hazard Warning Signs Were Not Provided to Signify The Actual or Potential Presence of a Bio-Hazard 20. 1910.145 F5 Danger Tags Were Not Used in Major Hazard Situations Where an Immediate Hazard Presents a Threat of Death Or Serious Injury

COMMON CDC VIOLATIONS OBSERVED IN DENTAL OFFICES 

 

Improper Management and Disposal of Biohazardous Waste Materials 

Improper Biological Monitoring of Sterilizer 

Improper Disposal of Sharp Implements 

Improper Hand Hygiene 

Lack of Appropriate Personal Protective Equipment 

Lack of Written Exposure Control Plan 

Lack of Written Protocol for Instrument Processing and Sterilization 

Lack of Verification of Office Staff Vaccination for Hepatitis B Vaccine  

Inability to Verify Sterilization of Dental Instruments  

Improper Storage of Dental Instruments 

Improper Flushing of Dental Water Lines 

Repeated Use of Single Use Disposables 

Cross Contamination in the Operatory, Sterilization Area and/or  Dental Laboratory 

Improper Operatory Disinfection 

Failure to Properly Sterilize Dental Handpieces  

Improper Instrument Debridement 

Failure to Disinfect Impressions 

Failure to Use Sterile Gloves While Providing Surgical Services 

Failure to Use Heavy Utility Gloves While Handling Contaminated Instruments in 

Sterilization Area 

Failure to Separate Sterile from Non‐Sterile Areas in Sterilization Area 

Co‐mingling of Dental Materials and Food in Refrigerator 

Failure to Maintain Updated Material Safety Data Sheets 

ASSESSMENT OF INFECTION CONTROL PROTOCOLS IN DENTAL PRACTICES FOR PATIENT SAFETY

By Mary Govoni CDA, RDA, RDH, MBA

Learn more about NEW courses and other opportunities at FRIENDSOFHU-FRIEDY.COM

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• Instruments should be cleaned and inspected for cleanliness prior to sterilization

• Heat sterilize all reusable items and instruments that are heat tolerant using FDA cleared medical devices for sterilization

• Use high level disinfection/chemical sterilization on reusable items that are heat sensitive (“cold sterilization”)

• Package/wrap all instruments and/or cassettes prior to sterilization in wrapping compatible with the type of sterilization process used and that have received FDA clearance

• Use a chemical indicator in each instrument pack or cassette, or use sterilization pouches with internal and external indicators

• Monitor all heat sterilizers weekly with a biological monitor (spore test)

• Packages should be labeled with the date and, if multiple sterilizers are used within the facility, the sterilizer used should also be noted

• Keep contaminated items separated from clean/sterile items in the instrument processing area

• Use impervious barriers where appropriate to protect equipment and surfaces from contamination

• Replace equipment barriers after each patient

• Use intermediate level (tuberculocidal) disinfectants to clean and decontaminate surfaces in treatment areas

• Use personal protective equipment – gloves, safety glasses, face masks and gowns/lab coats when treating patients and reprocessing instruments

• Follow principles of aseptic technique during patient treatment, instrument processing and radiographic procedures

• Wash hands prior to donning gloves for treatment and immediately after removing gloves after treatment. If hands are not visibly soiled, an alcohol-based hand rub can also be used

• Change face masks between each patient or sooner if it becomes wet during treatment

• Wear a new pair of gloves for every patient; change gloves immediately if they become torn or punctured during a procedure

• Use sterile gloves for surgical procedures

• Segregate and dispose of contaminated sharps and waste according to state and federal guidelines

• Follow CDC prescribed protocol for follow-up after an exposure incident

• Vaccinate doctors, assistants and hygienists for Hepatitis B

• Maintain waterlines in dental units to provide water quality at 500 cfu/ml or less for treatment

• Use sterile water or sterile saline for surgical procedures

• Use single-dose medication vials whenever possible

• Prepare all medications in a clean area and use only sterile needles in multiple use medication vials

• Follow “standard precautions” (i.e. treating every patient) as if they are potentially infectious

• Screen patients for possible tuberculosis (TB) infections and provide only emergency treatment for patients who are known to have active TB or who are suspected of having TB because of symptoms that they exhibit

• Maintain a written infection control/exposure control for the practice – update annually

• Participate in or conduct annual OSHA-required infection control training updates

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INSTRUMENT MANAGEMENT

Mary Govoni, CDA, RDA, RDH, MBA Mary Govoni brings over 40 years of experience in dentistry. She is a Certified Dental Assistant, a Registered Dental Assistant (MI) and a Registered Dental Hygienist, with experience in general and specialty practices both clinically and as an administrator. Mary is a former dental assisting educator and was a partner in a successful dental staffing service.

For the past 20 years, Mary has focused on speaking and consulting with dental teams on infection prevention, OSHA compliance, ergonomics, chairside efficiency and team communication and development. Recently Mary has added HIPAA compliance and employment law compliance to her areas of expertise. Mary has published numerous articles in professional journals. She is a life member and Past President of the American Dental Assistants Association, and serves on the ADAA Editorial Board as well as the Corporate Council for Dimensions of Dental Hygiene. Mary is also a consultant to the American Dental Association on Dental Practice (ADA) and a featured speaker on the Continuing Education and Lifelong Learning Seminar Series.

The following is a list of CDC recommended infection control protocols that every dental practice should follow to help keep their patients safe from disease transmission during dental treatment.

How effective are your practice protocols?

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INFECTION PREVENTION

Proactive Approach – The patient has not asked questions, but team members bring up the subject of infection prevention and patient safety:

You may have heard some news recently about the lack of proper infection control procedures (issues) in dental offices in different areas of the country. We want you to know that we are very concerned about your safety here at ________________ Dental Practice. We want to assure you that we follow all of the infection control guidelines from the Centers for Disease Control and Prevention, as well as state and federal rules. Do you have any questions about this? Would you like to see the area where we sterilize our instruments? Please let us know if you ever have any questions or concerns about your safety here in our practice.

Reactive Approach – The patient has questions/concerns that they have voiced on the phone prior to their appointment:

I understand your concern. There has been a great deal of publicity lately about a few dental practices whose sterilization and infection control procedures did not meet the standards set by the Centers for Disease Control and Prevention. I can assure you that our doctor(s) and all of the employees do follow the standards set by the CDC, and we will be happy to show you our instrument sterilization procedures when you come in for your appointment, as well as answer any additional questions that you might have.

Reactive Approach – The patient has questions/concerns that they have voiced at the time of their appointment:

I understand your concern. There has been a great deal of publicity lately about a few dental practices where their sterilization and infection control procedures did not meet the standards set by the Centers for Disease Control and Prevention. I can assure you that our doctor(s) and all of the employees do follow the standards set by the CDC. Would you like to see the area where we sterilize our instruments? Are there any other concerns that you have about your safety during your treatment?

CONVERSATION SCRIPTS FOR DENTAL TEAMS

| Response to Infection Control Breaches

Visit us online at Hu-Friedy.com©2013 Hu-Friedy Mfg. Co., LLC. All rights reserved. M7312/0513

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Telephone Message for Voice Mail or Message on Hold:

You may have heard the recent news about the lack of proper infection control steps (procedures) in dental practices. We want to assure you that we follow all infection control guidelines from the Centers for Disease Control and Prevention. If you wish to discuss any of our protocols with us, please let us know.

Message for Social Media:

The entire team at _________________ wants to reassure all of our patients that your safety during dental treatment is our #1 concern. We follow all of the infection control guidelines from the Centers for Disease Control and Prevention, including weekly monitoring of our sterilizers.

Posting on Website:

Show photos of sterilization area, packaged instruments and sterilizer (but make sure the sterilization area is clean and uncluttered).

At _________________ your safety is our #1 concern. All of the instruments used during patient treatment are cleaned and sterilized, according to the guidelines from the Centers for Disease Control and Prevention (CDC). All of the instruments used for patient treatment are wrapped or packaged with internal monitors for each set of instruments, to indicate that each set has been properly processed. The instruments are placed in sealed packages to protect the sterility of the instruments until they are opened at the time your treatment begins. Our sterilizer(s) are tested for effectiveness on a weekly basis, according to CDC guidelines.

If you ever have any questions regarding the safety protocols we follow to protect you, please let us know. We are happy to discuss these issues with you and to show you how we sterilize our instruments.

I n f e c t i o n C o n t r o lIN PRACTICEDentistr y’s Newsletter for Infection Control and Safet y

The Office Safety Coordinator (OSC) is a person identified to coordinate various office activities that help protect patients and office staff from harmful situations and help ensure compliance with related regulations and recommendations. You may be assigned to the position of OSC if the office decides to revamp its safety program, or if there is a related staff change, or if a new office is being set up. This position (often held by a dental assistant or office manager) is challenging and very important in regard to the safety of everyone in the office and relates to compliance with regulations and key recommendations. The duties may involve infection control, management of hazardous materials, fire prevention, radiation and electrical safety, and management of non-medical emergencies and office evacuation procedures.

General Duties of the OSCThe main categories of the OSC’s duties are given here with details presented on page 3 “Putting It All Together” and page 4 “Communicate and Educate”.

■ Obtain/prepare/update required safety documents, plans and records■ Obtain/prepare other beneficial safety documents■ Ensure proper and timely training of new, regular, janitorial, and temporary staff■ Help establish a culture of safety in the office■ Ensure proper availability, functioning and maintenance of infection control, haz-com and other safety supplies, equipment and procedures

After reading this article, the reader should be able to:

► define the position of a dental Office Safety Coordinator.► describe the types of training/knowledge beneficial to an Office Safety Coordinator.► describe ways to disseminate information to the rest of the office staff.► list the duties of an Office Safety Coordinator.

Continued on page 2

1. Topic Overview Learning Objectives

2. Topic Overview (continued)

3. Putting It All Together

4. Communicate and Educate Around the World What are Your “Bright Ideas”?

5. What’s Wrong With This Picture? Did You Know? Sponsors

6. Roadmap to OSAP Links to Resources Glossary

7. Continuing Education

8. Bright Ideas

Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org 1

So you just became the Office Safety Coordinator —What do you do now?

Learning Objectives

Contents

Special Series on CircumstancesOur series of topics for this year is designed to help you with infection control and safety by addressing some different circumstances that can occur in the office. The first issue is “So you just became the Office Safety Coordinator—What do you do now?” This will be followed by “When Stuff Happens”, “Exceptional Patients”, “Bringing the Outside In”, “High Tech Infection Control” and “Frequently Asked Questions”.

Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org

SPECIAL SERIES ON CircumstancesI n f e c t i o n C o n t r o lIN PRACTICE

Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org

TrainingThe OSC is frequently one who has the most training and/or experience with safety procedures. However, extra training may be needed or be beneficial at the time of appointment to the position. Helpful knowledge includes:

■ an understanding of basic microbiology and general dental procedures.■ modes of infectious diseases spread in the office.■ infection control and other safety procedures.■ familiarity with OSHA’s (Occupa- tional Safety and Health Admin- istration) Bloodborne Pathogens and Hazard Communication Standards,1,2 the CDC’s infection control recommendations for dentistry, 3 and other rules related to fire prevention and emergency evacuations4. ■ communication and computer skills.■ organizational skills.

The OSC and OSAPThe OSC should be a member of OSAP which is the premier edu-cational resource for dental office safety. See the “Roadmap to OSAP” on p.6 for further information. The OSC can turn to OSAP for:

■ current safety information, regulations and recommendations. ■ educational materials (e.g., textbooks, workbooks, video tapes, posters, guidelines, charts, Web links, newsletters, on-line forum).■ information on suppliers and manufacturers of infection control and safety supplies and equipment. ■ interaction with other OSCs and with infection control and safety experts. ■ live infection control presentations and product displays at the annual symposium (June 11-14, 2009, Dallas).■ much more.

Dr. Miller is Professor Emeritus of Microbiol-ogy, Executive Associate Dean Emeritus and As-sociate Dean Emeritus for Academic Affairs and for Graduate Education at Indiana University School of Dentistry. He

is past Chair and a Founding Member of OSAP.

Infection Control In Practice is a resource prepared for clinicians by the Organization for Safety & Asepsis Proce-dures (OSAP) with the assistance and expertise of its members. OSAP is a nonprofit, independent organization providing information and education on infection control and occupational health and safety to dental care settings worldwide. Infection Control In Practice is published six times per year and is a trademark belonging to OSAP. OSAP assumes no liability for actions taken based on information herein.

Contents of the issue copyright © 2009 by OSAP. All rights reserved under international and Pan-American copy-right conventions. Printed in USA. Reproduction in whole or part is forbidden without prior written permission. Back issues are available for a small fee. Send requests for permissions, purchases of back issues and address changes to OSAP, P.O. Box 6297, Annapolis, MD 21401 or office@osap.org.

Editorial Staff Denise Sabol RDH MEdManaging Editor

Alison HirdLayout Editor

Therese Long MBA CAEExecutive Director

Editorial Review Board Jennifer Cleveland DDS MPHCenters for Disease Control & Prevention

Eve Cuny RDA MSArthur A. Dugoni Pacific School of Dentistry

Leann Keefer RDH MSMDENTSPLY Professional Relations & Educational Services

Editorial Consultants Enrique Acosta-Gio DDS PhDNational University MEXICO

Gerald Condon BDSc MDScDental Council AUSTRALIA

Jonathan Lawoyin DDS MMScCollege of Med. Ibadan Nigeria AFRICA

Nita Mazurat MSc DDSUniversity of Manitoba CANADA

Isabela Almeida Pordeus MS PhDUniversity Federal de Minas Gerais BRAZIL

Laksham Samaranayake BDS DDSUniversity of Hong Kong CHINA

Fritz Stauffer MDBernhard Gottlieb University Austria EUROPE

Mikael Zimmerman DDS PhDKarolinska Institutet StockholmSWEDEN

2

So you just became the Office Safety Coordinator —What do you do now?

Editor-In-ChiefChris H. Miller PhD

continued from front cover

Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org

SPECIAL SERIES ON CircumstancesI n f e c t i o n C o n t r o lIN PRACTICE

Examples of the Office Safety Coordinator Duties.

1. Obtain/prepare/update OSHA- required safety documents, plans and records.

Obtain a copy of OSHA’s Bloodborne Pathogens1 and Haz-Com2 standards and OSHA’s “Job Safety and Health, It’s the Law” poster5. Prepare and update the OSHA- required written Exposure Control Plan, Hazard Communication Program, Material Safety Data Sheets, list of hazardous chemi-cals, Emergency Action Plan.Maintain records on OSHA train-ing, spore-testing, regulated waste disposal; equipment maintenance.Ensure staff medical records are being kept.Maintain sterilization records for the length of time required in your jurisdiction.Ensure X-ray equipment certifica-tions are up to date.Ensure all those taking X-rays are properly qualified/certified.

2. Obtain/prepare other beneficial documents.

Obtain a copy of CDC’s infection control guidelines for dentistry. Pre-pare a TB infection control plan.Ensure the maintenance of employ-ee health records recommended by the CDC.Develop CDC-recommended evaluations of the office’s infection control procedures.Prepare a list of emergency contacts to help manage staff injuries, sterilizer failures, sup-plies/instrument/utility problems or repairs.

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3. Ensure proper and timely training of new, regular, janitorial, and temporary staff.

Ensure cleaning crews and temps have received the proper blood-borne pathogens and hazardous chemicals training.Make sure temporary office help know where infection control sup-plies and important safety materials are located (e.g., MSDSs, eyewash stations).Ensure training records are updated.

4. Help establish and maintain a “culture of safety” in the office6.

Monitor/evaluate safety procedures and compliance with regulations. Promote individual accountability for the safety of all in the office.Maintain a bulletin board for notices, posters, signs and other reminders to enhance office safety awareness and change the post-ings regularly. Manage/describe any evaluations of safety devices performed and place information in the OSHA Exposure Control Plan.Reinforce procedures for post-ex-posure medical evaluations and review of exposure incidents.Post signs in the sterilization area to prevent the intermingling of ster-ile and contaminated packages. Replace sharps containers when they are ¾ full and prepare regu-lated waste containers for disposal or pick-up by the medical waste hauler. Ensure proper handling of contaminated laundry.Ensure the decontamination of items received from the dental lab. Ensure proper labeling of hazardous waste containers and hazardous chemicals.Ensure proper maintenance of smoke alarms and fire extinguish-ers and periodically monitor the integrity of all electric cords.

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Ensure a mechanism for soliciting ideas from the staff for safety im-provement and for reporting safety problems.Hold emergency fire/evacuation drills.Make sure exit signs/lights are posted.Ensure no hazardous chemicals are being stored in office refrigera-tors, and post appropriate signs.

5. Ensure proper availability, functioning and maintenance of infection control, haz-com and other safety supplies, equipment and procedures.

Evaluate, select and maintain the stock of supplies and equipment needed to maintain office safety.Ensure routine maintenance/clean-ing (as described by the manufac-turer) on sterilizers, sonic cleaners, washers/disinfectors.Ensure proper functioning of eyewash stations and (if present) safety showers.Check reusable heavy utility gloves and heat resistant gloves for cracks, tears and worn places. Replace empty soap dispensers (wash reusable dispensers before refilling).Sterilize, or disinfect or at least clean equipment to be shipped for repair and ensure proper labeling of any contaminated parts.

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Putting It All Together

Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org

SPECIAL SERIES ON CircumstancesI n f e c t i o n C o n t r o lIN PRACTICE

Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org

How do you develop a “culture of safety”? Communication is important in any business, and in a dental office the OSC plays a key role in disseminating information to the boss, the rest of the staff and sometimes to patients. One of the very important roles of the OSC is to keep the others in the office informed about changes in procedures, regulations and recommendations, products, equipment, safety techniques and new hazardous chemicals in the office. While this is commonly done in staff meetings, sometimes things come up that require immediate notification such as a detected sterilization failure or a “boil water” notice from the depart-ment of health. It’s also very important for all in the office to be continuously

mindful of office safety. While it’s good that infection control procedures become routine, the downside is the risk of developing complacency. For ex-ample one might say, “I don’t see why we have to keep placing these chemical indicators in every package day after day.” Well, it’s true that sterilization failures don’t occur very frequently, but when they do, it’s very important to detect them as quickly as possible, and chemical indicators can help with this. So, visual and verbal forms of communication about safety help fight complacency, and not only include the careful handling of sharps and hazard-ous chemicals, but also include remind-ers in other areas as described above to develop a “culture of safety” in the office. See “Bright Ideas” on page 8.

Sometimes the simplest changes

to daily routine can make a big difference! What changes or ideas

have you implemented in your office or clinic to make it easier to comply with infection

control and safety procedures?

Do you have a bright idea about infection control/safety you’d like to share with us?

Email it to office@osap.org and be sure to include your contact information,

a 10-word description of your title and role, and a jpeg photo

(if you choose). or,

fax your “bright idea” to OSAP at

1- 410-571-0028.

What are your “Bright Ideas”?

Forty cases of human avian influenza (H5N1) have occurred in Indonesia, Egypt, Bangladesh, Pakistan, Vietnam and China. The 49 cases of yellow fever reported from Guinea, Cote d’Ivoire, Central African Republic, Liberia, Paraguay and Brazil have prompted large scale vaccination programs. Rift Valley fever that emerged in Africa in the late 1980s has been reported this year in Mada-gascar and Sudan. In July a case of Marburg hemorrhagic fever was reported in a resident of The Nether-lands who had just visited Uganda. The Marburg virus is a relative of the Ebola virus both of which are quite deadly. Also in 2008 a newly described are-navirus was identified as the cause of 4 infections (with 3 deaths) in Zambia and South Africa. Arenaviruses are gener-ally associated with rodent-transmitted disease causing hemorrhagic fevers. This new virus, along with other known arenaviruses like Lassa and Machupo viruses, has also been associated with person-to-person spread and nosoco-mial infections.

4

Communicate and Educate

Around the World We hear a lot about the common cold, strep throat, the flu, TB, and malaria, but there are numerous other more rare infectious diseases still oc-curring around the world. The following summarizes the epidemiology of some of these diseases that were reported to the World Health Organization during the first 9 months of 2008. There have been thousands of cases of dengue and dengue hemorrhagic fever in Brazil. In Iraq, Guinea and Guinea-Bissau 507 cases of cholera were reported. Hand, foot and mouth disease, first recognized in 1970, oc-curred in about 3,000 people in China.

Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org

SPECIAL SERIES ON CircumstancesI n f e c t i o n C o n t r o lIN PRACTICE

OSHA

What are your “Bright Ideas”?

Take this photo chal-lenge and see if you can readily identify the breach in aseptic procedure and safety in this photo. Chal-lenge your knowledge first before checking your answers below!

5

OSAP thanks the following companies that help to underwrite each issue of this special series of Infection Control In Practice in 2009.

A-dec ► a-dec.com Enriching the lives of dental professionals by providing simple and creative solutions.

Air Techniques ► airtechniques.com A leading manufacturer of utility and imaging products for the dental market since 1962.

Biotrol ► biotrol.comE-mail sciencegeeks@biotrol.com for infection control answers. Infection control down to a science.

Crosstex ► crosstex.com A leading global manufacturer of infection control and single-use disposable products for the healthcare industry.

DentalEZ Group ► dentalez.com DentalEZ’s six brands provide a full line of products for the operatory.

Dentsply ► dentsply.comDelivering solutions ‘For Better Dentistry’ which benefit practitioners and patients globally.

DUX ► duxdental.com Trustworthy innovation for superior infection control products, staff safety and patient comfort.

Henry Schein ► henryscheindental.com We’re here for you! Supplies, equipment, services and technology for dental practices.

Hu-Friedy ► hu-friedy.com Hu-Friedy helps dental professionals perform at their best by providing superior products, knowledge and support.

Medicom ► medicom.com Medicom, proud leaders in disposable infection control products since 1988.

Midmark ► midmark.comMidmark Corporation, A provider of innovative solutions that work for you.

Miele ► miele.com Developed specifically to clean dental instruments and accessories and to reduce the risk of infection by providing high-level disinfection.

North Bay/Bioscience ► nbbs.comProviding sterilizer monitoring solutions and infection control products since 1991. Experience. Quality. Customer care.

Palmero Health Care ► palmerohealth.com DisCide Ultra Disinfectant Spray & Wipes • DisCide XRA Hand Sanitizing Wipes • TelAseptic Wipes • Citrisol Wipes.

Patterson Dental ► pattersondental.com Dental’s most trusted partner for service, supplies, equipment and technology.

PDI, The healthcare division of Nice-Pak ► pdipdi.com Live a healthier life with clinically proven products that safely clean, disinfect and control disease infection.

SciCan ► scican.com SciCan Inc., the final word in all dental instrument reprocessing. Septodont ► septodontusa.com Septodont, providing better dentistry through pain control, restoratives and infection control products.

SmartPractice ► smartpractice.com Smarter Practices. Healthier Patients. Premium quality gloves and dental supplies with everyday low prices.

SPSmedical Supply Company ► spsmedical.comSterilization monitoring (spore tests), chemical indicators/integrators and packaging products (wrap and pouches).

Sultan Healthcare ► sultanhealthcare.com Products to complete the cycle of infection control.

TotalCare ► kerrtotalcare.com Offering high-quality infection prevention products to protect staff and patients in the dental operatory.

What’s Wrong With This Picture?

Did You Know?

“Thanks” to our SPONSORS

ANSWERS: 1) Patient is not wearing safety glasses.

2) Dental assistant is not wearing safety glasses with side shield.

3) Dentist and dental assistant are not wearing face masks and their forearms are not covered.

4) Dental assistant is wearing jewelry that is exposed.

Did you know that OSHA advises each work site handling hazardous chemicals to designate a person (such as the OSC) to help manage the Hazard Communication Program? Appendix E of the Hazard Communication Standard (HCS)7 states: “In order to have a successful program, it will be nec-essary to assign responsibility for both the initial and ongoing activities that have to be undertaken to comply with the rule”. Also, the Directive that OSHA inspectors use to determine compliance with the HCS8 states that citations be given if there is nodesignation of person(s) responsible for:

► ensuring the labeling of containers of hazardous chemicals;► ensuring the labeling of containers used to ship hazardous chemicals;► obtaining/maintaining Material Safety Data Sheets (MSDS);► conducting the required HCS training.

This alone provides a pretty strong incentive for each office to have an OSC.

Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org

SPECIAL SERIES ON CircumstancesI n f e c t i o n C o n t r o lIN PRACTICE

Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org

If you have received this newsletter from a friend or associate, you can access other helpful resources and timely information on infection control and safety by becoming a member of the OSAP community.

Member resources include: ► Infection Control Educator’s Kit ► Surface disinfectants chart ► OSAP Q&A ► NEW online CDC Guidelines course ► Monthly news summary and weekly news flash ► Links to FDA patient safety news, traveler’s guide to safe dental care, and much more!

1. OSHA. Bloodborne pathogens standard. Accessed January 2009 at: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table= STANDARDS&p_id=10051.

2. OSHA. Hazard communication. Accessed January 2009 at: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table= STANDARDS&p_id=10099.

3. CDC. Guidelines for infection control in dental health-care settings – 2003. Accessed January 2009 at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm.

4. OSHA. Evacuation plans and procedures. Accessed January 2009 at: http://www.osha.gov/SLTC/etools/evacuation/eap.html.

5. OSHA. New OSHA workplace poster Job Safety and Health: It’s the Law (in English). Accessed January 2009 at: http://www.osha.gov/Publications/poster.html.

6. Institute for Healthcare Improvement. Patient safety: general. Accessed January 2009 at: http://www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/.

7. OSHA. Guidelines for Employer Compliance (Advisory) - 1910.1200 App E. Accessed January 2009 at: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table= STANDARDS&p_id=10104.

8. OSHA. CPL 02-02-038 - CPL 2-2.38D - Inspection Procedures for the Hazard Communication Standard. Accessed January 2009 at: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table= DIRECTIVES&p_id=1551#inspection.

Culture of Safety: An atmosphere of mutual trust in which all staff members can talk freely about safety problems and how to solve them, without fear of blame or punishment.

Exposure Control Plan: A written plan required by the Occupational Safety and Health Administration that describes how exposure to bloodborne disease agents will be controlled in a given work site.

Nosocomial: Nosocomial infections are harmful infections resulting from treatment in a hospital or other health-care unit, but secondary to the patient’s original condition.

PPE: Personal protective equipment is a collective phrase for gloves, masks, eyewear, protective clothing and any other personal barriers that may be ap-propriate.

WHO: The World Health Organization is a specialized agency of the United Na-tions that acts as a coordinating author-ity on international public health. It was established in 1948 and is headquartered in Geneva, Switzerland.

Member registration is easy. Online at www.osap.org or by phone: 1-800-298-OSAP (6727) within the U.S. or 1-410-571-0003 outside the U.S.

Current membership levels: ► Individual member (within the U.S.) $110 ► Individual member (outside the U.S.) $160► Web-only member (anywhere) $100 ► Student member $25 ► Corporate memberships are welcome; please contact OSAP for more information.

6

Links to Resources Glossary

Roadmap to OSAP

Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org Infection Control In Practice • Volume 8, No. 1 March 2009 • www.OSAP.org

SPECIAL SERIES ON CircumstancesI n f e c t i o n C o n t r o lIN PRACTICE

If you wish to obtain one (1) hour of continuing education (CE) credit, complete the following test by selecting the best answer and fax or mail it to the OSAP Central Office for grading. Please include a check or credit card to cover the handling charges. Pending satisfactory results (at least seven out of ten), you will be issued a letter for one (1) CE credit hour. OSAP is recognized by the American Dental Association as a CERP Provider. For more information, call OSAP at 800-298-6727 (410-571-0003).

For each item, pick the best answer.

1. A culture of safety is: a. a special bacterial strain (Gopolis milleri) that destroys bloodborne pathogens when added to contaminated blood spills. b. the use of disinfectants to decontaminate full sharps containers before disposal. c. the incubation of spore tests for 3 hours at 37oC then for 24 hours at 56oC. d. an atmosphere of mutual trust in which all staff members can talk freely about safety problems and how to solve them, without fear of blame or punishment.

2. Duties of an Office Safety Coordinator relate to all of the following except: a. infection control. b. patient scheduling. c. hazardous chemicals. d. fire prevention.

3. The 2009 annual OSAP symposium will be held June 11-14 in what city? a. San Francisco b. Boston c. Indianapolis d. Dallas

4. Which of the following can cause an OSHA inspector to give a citation when determining compliance with the Hazard Communications Standard? a. Not designating a person responsible for obtaining MSDSs b. Not having a written Exposure Control Plan c. Not having sterilizer spore-testing records for the previous 6 months d. Not having employee medical records 5. The OSHA-required Exposure Control Plan describes how to: a. limit staff exposure to X-rays. b. protect employees from exposure to hazardous chemicals. c. keep patients from being exposed to potentially infectious microbes. d. control exposure of employees to bloodborne disease agents.

6. When was hand, foot and mouth disease first recognized? a. 1952 b. 1970 c. 1991 d. 2008

7. Which of the following was not listed as helpful knowledge for an Office Safety Coordinator? a. Communication and computer skills b. Organizational skills c. Basic chemistry course d. Modes of infectious disease spread in the office

8. The item from OSHA titled “Job Safety and Health, It’s the Law” is a: a. poster. b. DVD. c. video tape. d. workbook.

9. Nosocomial infections: a. are viral infections of the nose. b. result from treatment in a hospital or other healthcare unit, but are secondary to the patient’s original condition. c. are fungal infections transmitted to office staff by dental unit water. d. no longer occur.

10. When the soap dispenser needs more liquid hand soap, what should be done before refilling the dispenser? a. pour out any remaining liquid b. dip it in warm water to help loosen the pump mechanism c. thoroughly wash the inside d. nothing – just fill it up with fresh soap

Please Mail or Fax Completed test with the appropriate payment to receive one (1) hour of continuing-education credit.

Your Name: ______________________________________________ OSAP Member Name: _______________________________________________

Address: ____________________________________________________________________________________________________________________

Fees: ○ OSAP MEMBER, $15 ○ NON-MEMBER, $20 Payment Options: ○VISA ○ MASTERCARD ○CHECK ENCLOSED

Name on Card: _____________________________________________ Card Number: ____________________________________________________ _Expiration Date: ____________________________________________ Signature: _________________________________________________________

MAIL TO: OSAP CE • P.O. Box 6297 • Annapolis, MD 21401 • USA FAX TO: 1.410.571.0028

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Continuing Education CE Unit 01/09

Sterilization Room, Laboratory, Laundry Room:

Contaminated (sterilization room)Sterile (sterilization room)Disinfected (sterilization room, lab)Clean (sterilization room, laundry room, lab)Not clean (sterilization room or laundry)Hot (sterilization room, lab)Do Not Touch (sterilization room) Ready (sterilization room, lab)Not Ready (sterilization room)Change on: __Date (sterilization room)Prepared on: __Date (sterilization room)Expiration Date: __Date (sterilization room)Ready to Ship (lab prep room)

Staff Rooms:

For Food Only (refrigerator)Think First (bulletin board)Look Before Reaching (bulletin board)Get Your Flu Shot (bulletin board)Report Exposures (bulletin board)Handle Sharps Safely (bulletin board)Be Careful (bulletin board)Suggestions (meeting room)Remove Gloves (daylight loader, darkroom)Remove PPE (lunch room, staff restroom)Wash Hands Before Leaving (staff restrooms) No PPE (lunch room, staff restroom)

Patient Areas:

Wash Hands Before Leaving (all restrooms) Decontaminate Hands (reception room)Alcohol Hand Rub (reception room)Cover When Coughing (reception room)Facial Tissue (reception room)

When Stuff HappensIn the next issue...

Please forward this issue of ICIP to other dental professionals involved in infection control and safety.

I n f e c t i o n C o n t r o lIN PRACTICED e n t i s t r y ’ s N e w s l e t t e r f o r I n f e c t i o n C o n t r o l a n d S a f e t y

SPECIAL SERIES ON CircumstancesI n f e c t i o n C o n t r o lIN PRACTICE

FIRST-CLASS MAILU.S. POSTAGE

PAIDWoodbridge, VAPERMIT NO. 70

Bright IdeasThe following safety-related signs and where they may be placed may be helpful to establish a “culture of safety” in the office. We’re sure you can think of more examples.

HandleSharps Safely!

REPORT EXPOSURES

THINK FIRST!