Infection Control Guidelines for Dental & Medical Offices
Healthcare-associated infections (HAIs) comprise a major threat to patients at healthcare facilities across the United States. According to the Centers for Disease Control (CDC), HAIs affect between five and 10 percent of hospitalized patients in the US each year, resulting in 99,000 deaths and sparking an estimated $20 billion in healthcare costs.
Thus, infection control is a top priority for dental and medical offices across the country. Leading trade associations like the American Dental Association, along with the CDC, stand at the forefront of professional education, setting high standards for infection prevention practices in dental clinic, medical office, and surgical center settings.
Infection control guidelines center on several key areas, including personnel training and education and HAI surveillance and reporting. Today, we’ll talk about actual precautions for infection control expected to be taken during daily clinical practice in patient settings, with regard to hand hygiene, personal protective equipment (PPE), safe injections, medical devices, and respiratory hygiene/cough etiquette. While there are many published guides for clinicians from the CDC and ADA, we’ll use the CDC’s comprehensive Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care.
Infection control in medical and dental offices starts with devout hand hygiene practices. It’s important to know which situations demand handwashing/sterilization in the clinical setting.
- Before any contact with the patient.
- Before performing an aseptic task, such as insertion of an IV or preparing an injection.
- After contact with the patient or objects in the immediate vicinity of the patient.
- After contact with blood, body fluids or contaminated surfaces.
- When moving from a contaminated-body site to a clean-body site during patient care.
- After removal of personal protective equipment.
Personal Protective Equipment
Personal protective equipment is a term that comprises an array of medical equipment meant to protect the health and safety of health care professionals as they go about their work. There are specific guidelines governing use of PPE with regard to prevention of infection in dental and medical offices.
- Facilities should assure that sufficient and appropriate PPE is available and readily accessible to HCP. Educate all HCP on proper selection and use of PPE.
- PPE, other than respirators, should be removed and discarded prior to leaving the patient’s room or care area.
- If a respirator is used, it should be removed and discarded (or reprocessed if reusable) after leaving the patient room or care area and closing the door.
- Hand hygiene should be performed immediately after removal of PPE.
- Wear gloves for potential contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment.
- Do not wear the same pair of gloves for the care of more than one patient.
- Do not wash gloves for the purpose of reuse.
- Wear a gown to protect skin and clothing during procedures or activities where contact with blood or body fluids is anticipated.
- Do not wear the same gown for the care of more than one patient.
- Wear mouth, nose and eye protection during procedures that are likely to generate splashes or sprays of blood or other body fluids.
Many HAIs occur from failure to follow proper infection control protocol with regard to injections. Both physicians and dentists use injections for a variety of purposes, including anesthesia and pain management. The following guidelines help clinicians to prevent HAIs with regard to injections.
- Use aseptic technique when preparing and administering medications.
- Cleanse the access diaphragms of medication vials with alcohol before inserting a device into the vial.
- Never administer medications from the same syringe to multiple patients, even if the needle is changed or the injection is administered through an intervening length of intravenous tubing.
- Do not reuse a syringe to enter a medication vial or container.
- Do not administer medications from single-dose or single-use vials, ampoules, or bags or bottles of intravenous solution to more than one patient.
- Do not use fluid infusion or administration sets (e.g., intravenous tubing) for more than one patient.
- Dedicate multidose vials to a single patient whenever possible. If multidose vials will be used for more than one patient, they should be restricted to a centralized medication area and should not enter the immediate patient treatment area (e.g., operating room, patient room/cubicle).
- Dispose of used sharps at the point of use in a sharps container that is closable, puncture-resistant, and leak-proof.
- Wear a facemask (e.g., surgical mask) when placing a catheter or injecting material into the epidural or subdural space (e.g., during myelogram, epidural or spinal anesthesia).
A source of many HAIs is the clinical re-use of medical devices. There are multiple guidelines for the use and reuse of medical devices in medical and dental clinics.
- Facilities should ensure that reusable medical devices (e.g., blood glucose meters and other point-of-care devices, surgical instruments, endoscopes) are cleaned and reprocessed appropriately prior to use on another patient.
- Reusable medical devices must be cleaned and re-processed (disinfection or sterilization) and maintained according to the manufacturer’s instructions. If the manufacturer does not provide such instructions, the device may not be suitable for multi-patient use.
- Assign responsibilities for reprocessing of medical devices to HCP with appropriate training.
- Maintain copies of the manufacturer’s instructions for reprocessing of devices in use at the facility; post instructions at locations where reprocessing is performed.
- Hands-on training on proper selection and use of PPE and recommended steps for reprocessing assigned devices should be provided upon hire (prior to being allowed to reprocess devices), annually, and when new devices are introduced or policies/procedures change.
- HCP should be required to demonstrate competency with reprocessing procedures (i.e., correct technique is observed by trainer) following each training.
- Assure HCP have access to and wear appropriate PPE when handling and reprocessing contaminated medical devices.
Respiratory Hygiene/Cough Etiquette
Respiratory hygiene and cough etiquette, with regard to HAIs, covers a range of concerns, from patient information to use of PPEs, and hand hygiene.
- Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and continuing throughout the duration of the visit.
- Post signs at entrances with instructions to patients with symptoms of respiratory infection to inform HCP of symptoms of a respiratory infection when they first register for care, cover their mouths/noses when coughing or sneezing, and use and dispose of tissues.
- Perform hand hygiene after hands have been in contact with respiratory secretions.
- Provide tissues and no-touch receptacles for disposal of tissues.
- Provide resources for performing hand hygiene in or near waiting areas.
- Offer masks to coughing patients and other symptomatic persons upon entry to the facility, at a minimum, during periods of increased respiratory infection activity in the community.
- Provide space and encourage persons with symptoms of respiratory infections to sit as far away from others as possible. If available, facilities may wish to place these patients in a separate area while waiting for care.
- Educate HCP on the importance of infection prevention measures to contain respiratory secretions to prevent the spread of respiratory pathogens.
At Richmond, we are committed to providing HCP education for proper reprocessing (sterilization and disinfection) of our products used to treat patients in dental and medical clinics worldwide. For example, we provide a guide for autoclaving, gas sterilization, and chemical sterilization of all applicable Richmond Dental and Medical dispensers.
In addition, Richmond’s sterile products receive the required dosage of gamma irradiation within the precision and accuracy of the dosimetry system employed. The sterilization facility operates a Quality Management System that complies with the requirements of ISO 13485: 2003 & EN ISO 13485: 2012 for the following scope: The provision of ethylene oxide and radiation sterilization services in accordance with EN ISO11135-1:2007 & EN ISO11137-1:2006 +A1 2013 chemistry, microbiology and consulting services for the sterilization industry.