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4/25/2019
1
Dental Compliance Review
OHSA, Infection Control, HIPAA
Disclaimer
• Karen Gregory RN is an employee of Total Medical Compliance.
• Karen Gregory is a Hu-FriedyKey Opinion Leader, a consultant for SciCan and serves on the OSAP Board of Directors.
Objectives
• Recognize specific employee safety measures required by the OSHA Bloodborne Pathogen Rule and the Hazard Communication Standard.
• Recall acceptable standards of care outlined in the CDC Dental Infection Control Guidelines.
• Discuss identification of breach situations and reporting process to impacted patients.
Safety Program
Images courtesy of agency websites
What’s Your WHY?
Infection Control Coordinator
Who’s on First?
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Bloodborne Pathogen Standard
HIV HEP B
HEP CPrevent
and Protect
Presence of Bloodborne Pathogen
Bloodborne Pathogen infects
healthy cells
Transmitted via exposure
Bloodborne Pathogens
Fast Facts
• May have flu-like symptoms or none at all
HIV - .23%
• May have fever, joint pain, nausea, vomiting, weakness• 50 - 100 times more infectious than HIV• Best protection is vaccination
Hepatitis B – 6 – 30%
• May have fever, joint pain, nausea, vomiting, weakness• Testing recommended for individuals born between 1945 –
1965
Hepatitis C - .1%
Hazard Assessment Certification
Hepatitis B Vaccine
• After training• Within 10 working days of assignment
• Documentation must be in medical file
Hep B Vaccine Titer
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Personal Protective Equipment Heavy Duty Utility Gloves
• Contaminated sharp items
• Sizable
• Puncture and chemical resistant
• Wash or surface disinfect
• Discard when cracked, peeling, torn, punctured
Work Practices Controls Engineering Controls
Cassettes
Safety AspiratingSyringe
Safety Scalpel
Blade Remover
RecappingDevice
Needlestick Safety and Prevention Act
• Use of engineering controls and safety devices
• Annual feedback on work practice controls
Surface Disinfection
Use PPE -Gloves and
possibly face protection
Utilize Two Step Method
EPA registered Hospital
Disinfectant
Don‘t forget handpiece
cradles, light switches, door
handles
Surface disinfectant
contact time?
Follow manufacturer’s instructions for
use
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Exposures
• Splash to eyes, nose or the mouth
• Splash to non-intact skin
• Stick with a needle or sharp instrument
800,000 Needlestick Injuries Occur Each Year in the US
In the Event of Exposure….
Clean Report Seek Care
Hazard Communication Chemical Hazard
GHS Manufacturer’s Labels
• Symbols - Pictograms • Signal Words • Hazard Statements• Precautionary Statements
Pictograms
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SDS – Finding Help!
Section 2 - Hazard(s) identification
Section 4 - First-aid measures
Section 6 - Accidental release measures and spill clean-up
Section 8 - Exposure controls and personal protection
When the OSHA Inspector Arrives
1. Opening Conference 2. Walk-through 3. Review documentation4. Closing Conference
Fee Structure
VIOLATION TYPE
PRIOR Maximum
AS OF 1/2018
AS OF 1/13/2018
Non-Serious* $7000 $12, 600 $12,934
Serious $7000 $12,600 $12,934
Willful or Repeated
$70,000 $126,000 $129,336
Fail to Abate on time
None stated None stated $12,934
Infection Control
To Wash or Not to Wash?
Instrument Processing
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EH Spaulding
•CRITICAL
•SEMI-CRITICAL
•NONCRITICAL
CDC Recommendations - Dental
• Clean and heat-sterilize critical instruments• Clean and heat sterilize semi- critical
instruments• Allow packages to dry in the sterilizer
Steps in the Process
• Cleaning
• Packaging
• Sterilization/disinfection
• Monitoring• Physical• Chemical• Biological
• Storage
Divide and Conquer
Cleaning - First Step Cleaning Chemicals
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Ultrasonic Handpice Cleaning
Slow-speed Handpieces
• Clean and heat-sterilize handpieces and motors that can be removed from the air and waterlines
Packaging
Preparation and Packaging
• Dry• Wrap all instruments• Hinged instruments
opened and unlocked• Place indicators
Types of Indicators
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What’s Wrong? Package Labeling
Steam Sterilizers
Photo courtesy of OSAP
What Do You See?
DRY and COOL Sterilization Monitoring
•Physical
•Chemical
•Biological
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Physical Biological Monitors
APIC Disinfection/Sterilization2005. WA Rutala
Positive Spore Test - Steam
PositivePositive
Storage of Sterile Items
• Event• Time• First in• First out
Manufacturer’s IFU
Three Years
One Year
Dental Unit Waterlines
• Georgia and California
• Mycobacterium abscessus
• Goal: Less than 500 CFU/mL
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Dental Unit Waterlines Single-Use (Disposable) Devices
•Use for one patient•No preservatives•Usually not heat-tolerant
•Difficulty cleaning•Examples:
•Syringes• Impression trays•Burs/endo files
A NEVER Event
Using unsterilized instruments on a
patient
Using unsterilized instruments on a
patient
Karen Gregory, RNDirector of Compliance and Education
www.totalmedicalcompliance.comKaren@totalmedicalcompliance.com888.862.6742
Thank you!
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