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In a dental care center, everyone should work together to minimize the risk of possible infection transmission. However, without an Infection Control Coordinator (ICC) to implement systems and examine their effectiveness, many protective processes are possible. The ICC should take responsibility for the team’s training in regards to the handling of personal protective equipment (PPE) and the correct procedures for sterilization. During this pandemic, focussing extra attention to the safety of personnel and customers is essential. The ICC must ensure that patients with COVID-19 symptoms stay home, and healthy individuals feel at ease when they visit the facility.
Training
The Occupational Safety and Health Administration (OSHA) requires employers to provide a safe workplace.[1] In dentistry, hazards such as bloodborne pathogens, pharmaceuticals, and other chemical agents are common.[2] Dental Health Care Professionals (DHCPs) should receive ongoing, regular training to minimize injury or infection transmission risk. When a new member joins the team, their initial induction should be conducted as soon as possible and cover topics such as handling infectious agents, processing instruments and the importance of following the practice’s standard operating procedures (SOPs). Hand hygiene procedures should be such an integral part of the practice that they become second-nature, and clear communication of the correct information concerning the use of Personal Protective Equipment (PPE) is crucial.
For single-use items such as paper gowns, gloves, single-use face shields, and surgical masks, the ICC should provide instruction on how to use them properly to minimize the risk of contamination. The correct methods for disposing of these items is just as important. For reusable equipment, the team should be aware of the proper decontamination techniques.
Sterilization
A Dental Economics magazine survey found that nearly half of respondents did not know if their team had gone through training on instrument processing. If DHCPs do not follow the right procedures, mistakes will almost certainly occur, and reprocessed instruments labeled as safe may not be adequately processed.
This same survey also revealed that just under three-quarters of respondents were aware that there should be a document log to record the instrument processing details. The lack of documentation is another argument for introducing a coordinator to ensure the team follows the right procedures and keeps appropriate records.
The training should cover the sterilizer’s correct use and make sure that all indicators comply with the manufacturer’s standards. The ICC must verify the thorough performance of sterilization with sufficient monitoring, and the correct documentation of the results in the log. When monitoring the sterilization process, the use of the correct biological indicators is essential. Since there are numerous types, with some intended for specific cycles, and others for specific sterilizers, it is vital to check the employment of the correct procedures. It will also be important that the biological indicator is chosen based on the needs of the office.
Extra COVID-19 Measures
The Center for Disease Control and Prevention (CDC) has given additional advice concerning the spread of the Sars-Cov 2. Dental offices are a unique environment requiring specific infection control attention.[3] The role of the ICC is to inform the team about these new regulations and advisories to ensure everybody is confident and capable when it comes to their implementation. The CDC advises the prioritization of patients needing the most urgent dental services, but at the same time, minimize harm from delaying care to other customers where possible. However, because the pandemic continues to evolve, dental professionals are starting to perform some non-emergency treatments too. It is the responsibility of the ICC to inform the team about the CDC pandemic framework, disseminate any recommendations and set out a specific decision-making process for the facility.[4]
It is essential to clearly communicate rules regarding staying at home if team members are ill. This also applies to patients and is for everyone’s safety. Personnel should also be aware of the correct steps to take if a patient with COVID-19 symptoms[5] visits the facility.[6] Updated SOPs and pandemic training form an integral part of protecting everyone from the Coronavirus and many other potential pathogens.
It is necessary to put in place a patient screening system to assess clients before entering the facility. This triage-type telephone screening also helps determine who needs service prioritization. Upon arrival, measure the patient’s temperature to check for fever and follow any other CDC recommendations.
As described above, hand hygiene should be second-nature to dental professionals. During the pandemic, the importance of sanitizing your hands has received increased emphasis over. All employees must always wash hands before putting on gloves and immediately after removal. Practical handwashing instructions should be provided for patients as well. Alcohol-based sanitizers with 60– 95% alcohol, tissues, and no-touch receptacles for disposal, should be found at facility entrances, waiting rooms, and patient check-ins.
The ICC should ensure that visual alerts are put in place to inform patients of respiratory hygiene and cough etiquette. They should also monitor the installation of physical barriers to ensure social distancing and that the chairs in the waiting room are at least six feet apart.
The ICC should also consider if immunization is appropriate for employees. When the team is immunized, it reduces the risk of spreading infections within the team, and to clients.[7] The CDC states that immunizations are an essential part of prevention and infection-control programs for DHCPs. The Advisory Committee on Immunization Practices (ACIP) has implemented specific guidelines for healthcare professionals.[8]
When a vaccine for the Coronavirus becomes available, the ICC should thoroughly investigate its efficacy and any other relevant information, including how to obtain it, the costs involved, side effects, safety etc.
The role of an Infection Control Coordinator in dental healthcare is essential to reduce the risk of infection transmission in personnel and patients. The ICC must ensure that all team members have the appropriate training and are well aware of the correct usage techniques of protective equipment and reprocessing dental instruments. During this pandemic, there should be extra attention paid in the workplace to ensure safety and minimize the risk of contamination, with everyone playing their part in protecting against COVID-19, all under the ICC’s watchful eye.
[1] "Safety and Health Topics | Healthcare - Standards ... - OSHA." https://www.osha.gov/SLTC/healthcarefacilities/standards.html. Accessed 28 Jul. 2020.
[2] "Safety and Health Topics | Dentistry | Occupational Safety and ...." https://www.osha.gov/SLTC/dentistry/. Accessed 28 Jul. 2020.
[3] "Guidance for Dental Settings | CDC." https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html. Accessed 28 Jul. 2020.
[4] "Non-COVID-19 Care Framework | CDC." https://www.cdc.gov/coronavirus/2019-ncov/hcp/framework-non-COVID-care.html. Accessed 28 Jul. 2020.
[5] "Symptoms of Coronavirus | CDC." 13 May. 2020, https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. Accessed 28 Jul. 2020.
[6] "Guidance for Dental Settings | CDC." https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html. Accessed 29 Jul. 2020.
[7] "Guidelines for Infection Control in Dental Health-Care ... - CDC." 19 Dec. 2003, https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm. Accessed 28 Jul. 2020.
[8] "Immunization of Health-Care Workers ... - CDC." 26 Dec. 1997, https://www.cdc.gov/mmwr/preview/mmwrhtml/00050577.htm. Accessed 29 Jul. 2020.