Subject: Infection Control
Effective Date: March 1992
Review Dates: January 2002, September 2008, January 2016
To provide policy regarding infection control which is designed to minimize biohazard risks to patients, students, residents, staff, and faculty who are associated with dental care and dental research at the University of Washington School of Dentistry.
All patient care, laboratory procedures and equipment management in the School of Dentistry is to be carried out in an environment and with techniques consistent with guidelines set forth by the US Public Health Service Centers for Disease Control (CDC), the Occupational Safety and Health Administration (OSHA), the Washington Industrial Safety and Health Act (WISHA), as well as state and local regulatory boards.
It is the policy of the University of Washington School of Dentistry that all students, faculty, and staff care for patients within their level of competence without regard to infectious disease status when it is appropriate to do so. Specific strategies for treatment of individuals with an infectious disease should be discussed with the supervising faculty member prior to treatment. (Refer to Treating Patients with Highly Infectious Diseases policy.)
Affiliated clinics are expected to comply with federal, state, and local regulations relating to infection control when university students are participating in their clinic or laboratory programs.
The infection control policy along with the companion manual entitled, Blood Borne Pathogens Manual, (herein referred to as “ BBP Manual”) are designed to establish guidelines and procedures to prevent transmission of Hepatitis B or HIV. All dental health care providers (HCP) are responsible for obtaining a copy of the manual which is available on the School’s website at : https://dental.washington.edu/health-and-safety/ .
It is ultimately the responsibility of the individual providing care, whether it be student, resident, faculty, or staff, to insure that appropriate care is rendered in a safe environment, with appropriately processed and handled instruments and materials to minimize chances of contamination and subsequent disease transmission. This applies not only to clinical procedures, but also those procedures performed in the laboratory. The laboratory phase of care should also be done on appropriately processed appliances and impressions, and with aseptic technique. It is the responsibility of faculty and staff associated with patient care to monitor compliance with standards for care outlined in this policy and in the manual. Staff in sterilization facilities and dispensaries are likewise charged with the obligation to insure strict compliance with protocols for the prevention of cross contamination. Individuals who are found to be in violation of these standards are subject to sanctions as outlined in the personnel and professional conduct policies of the University of Washington.
I. Medical History and “Universal Precautions” (Body Substance Isolation)
It is not possible to determine the infectious disease status of individuals through a review of the medical history alone. Patients may be unaware of their condition or the mechanism of disease transmission. Others may choose not to reveal a known condition to health care workers.
Furthermore, the infectious disease status of patients may change with time, and assumptions made about disease status may not be valid in perpetuity.
Proper review of the health history is imperative to insure that patients receive appropriate care for their condition, but since all conditions may not be disclosed with this review, it is essential that all body fluids from all patients be considered infectious and all patients be treated with the same high standard of infection control practice, employing “UNIVERSAL PRECAUTIONS” for all care, as defined by the Center for Disease Control (CDC).
II. Personal Hygiene and Appearance
All individuals with patient contact will adhere to high standards of personal hygiene, and will dress in a clean, professional manner appropriate to the care provided as outlined in the BBP Manual.
III. Use of Personal Protective Equipment
All students, faculty, and staff shall use appropriate personal protective equipment (PPE), as well as mechanical protective devices or procedures to minimize skin contact with potentially infectious materials. These precautions will be maintained during the treatment of patients and in laboratory procedures with any items contaminated with blood, saliva, or gingival fluids. See chapter three of the manual for details on the use of personal protective equipment.
IV. Personal Protection: Training, Immunization, and Infected Worker Protocols
All faculty, staff, and students who work in or in support of clinics and/or laboratories shall receive training on blood-borne disease risk, epidemiology, and transmission in the dental setting. They will be immunized in accordance with University of Washington Health Science Center policy (see appendix A of the BBP Manual) as a condition of employment, or acceptance into clinical dental education programs.
As described previously within this policy, it is expected that all dental patient care within the University of Washington will be provided with appropriate barrier protection as defined in chapter three of the manual. It is further expected that students, staff, and faculty will correctly report any body fluid contacts occurring during patient care.
Protocols are in place for counseling and testing of source patients and recipients in the event of accidental, potentially inoculating events. Health care providers who have infectious diseases shall not perform certain invasive procedures in order to reduce the risk of disease transmission to patients. (See Fitness to Practice policy.)
V. Management of Dental Environment
Surfaces of fixtures or non-sterilizable equipment and materials which are potentially contaminated by blood or other body fluids during the course of dental care shall be covered with disposable barriers or cleaned and disinfected after use to minimize potential for disease transmission between patients. (See BBP Manual for clinical asepsis protocols.)
VI. Aseptic Clinical Techniques
Dental health care workers will employ techniques during the care of patients which will assure that diseases are not transmitted between patients or between providers and patients by reason of contamination of materials or supplies as outlined in the BBP Manual.
VII. Instrument Sterilization
All reusable heat stable instruments, sonic and ultrasonic scalers as well as prophy angles that come into contact with the patient’s blood, saliva, teeth, or mucous membranes must be cleaned and heat or gas sterilized (steam, dry heat, unsaturated chemical vapor, ethylene oxide are acceptable methods of sterilization) before use on another patient.
Dental handpieces are to be processed in compliance with the Centers for Disease Control guidelines which state, “Equipment and devices that touch intact mucous membranes but do not penetrate the patient’s body surfaces should be sterilized when possible or undergo high level disinfection if they cannot be sterilized before being used for each patient.” (July 12, 1991 CDC) and with Washington Administrative Code (WAC 246-816-701 to WAC 246-816-730) which states that dental handpieces must be heat sterilized before use for each patient.
Only sterilizers that are routinely spore-tested and demonstrate repeated ability to kill spores are to be used for sterilization of instruments. Sterilizers must be spore-tested weekly and monitored with chemical indicators on every load. Records of these tests are to be maintained by the School of Dentistry’s sterilization staff.
All items to be sterilized must be properly cleaned (preferably in an ultrasonic cleaner) and must be packaged before sterilization in covered cassettes/ trays, Nyclave bags, paper/plastic pouches, or sterilization wrap.
Those items which will be destroyed by a heat sterilization method, but can be submerged in a solution, must be cleaned, dried and sterilized in an EPA-registered, ADA-accepted glutaraldehyde solution using a submersion time and product concentration that achieves sterilization following the manufacturer’s label directions (6-10 hours).
VIII. Waste Management
Waste generated during the course of dental care will be disposed of in a fashion consistent with University, local, and State regulations. The waste categories that are regulated include:
- Items referred to as “sharps” which are discarded: Used and unused needles, anesthetic cartridges, scalpel blades, sutures, instruments or broken glass
- Human materials and foreign bodies removed during surgery
- Blood contaminated material
See chapter five of the manual for waste management procedures.
IX. Laboratory Asepsis
All materials and appliances from the clinics destined for laboratory work shall be disinfected prior to leaving the clinic. In addition, all appliances and materials coming from the laboratory phase of care will be disinfected and rinsed prior to try-in and insertion. All laboratory aspects of dental care will be carried out in a manner which will minimize the potential for disease transmission by contact with appliances or materials contaminated by human body fluids. This policy also extends to preclinical instructional use of human material such as teeth. Any procedures done on extracted human teeth must be done on disinfected or sterilized teeth, and must include the use of personal protective equipment (PPE) for the operator.
X. Equipment Monitoring
Equipment involved in infection control procedures will be monitored on a regular basis to insure efficiency of function as described in the BBP manual.
Confidential medical information may be accessed only in accordance with University of Washington Health Sciences policy and Washington State and Federal Law. Exchange of confidential medical information is authorized when such information is necessary for the training and teaching of health care providers and students, and is specifically related to the care of the patient. See chapter five of the manual for confidentiality procedures.
XII. Products, Devices and Equipment Review
Products, devices and equipment used for infection control (e.g., personal protection, dental environment management or instrument asepsis/ sterilization) shall be reviewed and approved by the Health and Safety Committee prior to incorporation into the clinics of the School of Dentistry.
XIII. Affiliated Clinic Programs
A condition of an affiliation agreement shall be that the clinic must meet the requirements defined in federal, state, and local laws relating to infection control when university students are functioning at the affiliated site.
Course directors are responsible for the verification of compliance and shall communicate that to the Associate Dean for Clinical Services upon request. Conversely, students from an outside institution must function under compliance with federal, state, and local regulations related to infection control and University policy.
Dean of UW SOD:
Joel Berg, Dean of the UW School of Dentistry
February 2, 2016