Personnel health elements of an infection-control program
The CDC's gold standard for personnel in an effective infection-control program
By Charles John Palenik, MS, PhD, MBA, and Ginny Jorgensen, CDA, EFDA, EFODA, AAS
On December 19, 2003, the Centers for Disease Control and Prevention issued its set of new infection control recommendations in "Guidelines for Infection Control in Dental Health-Care Settings — 2003." The guidelines are available in print (MMWR 2003;52(RR-17):1-68) or electronically at www.cdc.gov/mmwr/preview /mmwrhtml/rr5217a1.htm.¹ The last comprehensive CDC recommendations were written in 1993.²
General recommendations
It is imperative that each dental practice develop a written health program for all its dental healthcare practitioners, or DHCP. It should contain policies, procedures, guidelines, and methods for handling noncompliance (due process). Also present should be the practice's education and training programs as well as schemes for DHCP immunization, exposure prevention, and postexposure management. The health program must have written policies and practices concerning DHCP health conditions, contact dermatitis, and latex allergies, as well as descriptions of how DHCP records would be maintained in a confidential manner.¹
In order to better provide protection, treatment, and instruction for DHCP, practices must establish formal arrangements with qualified healthcare professionals or facilities, or both. This will better assure prompt and appropriate preventive care for occupationally related medical services, including postexposure management with follow-up activities.¹
Success of a personnel health program can be greatly enhanced by the appointment of a dental-practice infection-control coordinator (compliance officer). Such coordinators who are properly trained and empowered can lead a practice toward meeting the demands of each element of a personnel health program, however, ultimate responsibility for the safety and health of DHCP remains with the employer-dentist.¹
Elements
There are five basic elements involved with a personnel health program in infection control (click here to download a .pdf of Table 1). Each element plays an important part in the protection of DHCP. To create a healthy and safe working environment, each element must be addressed.
Education and training is essential for the success of any infection-control program. The sharing of information in a proper manner is the responsibility of the employer. DHCP must understand and then practice what is required.
Employers must inform all DHCP of their occupational risks and which diseases can be prevented by immunization. Currently, employers must pay only for vaccination against hepatitis B. Serologic testing for proper seroconversion is important. DHCP must also be current as to their immune protection against influenza and tetanus. There are other important diseases to consider; but most are prevented today through childhood vaccination schemes.
Occupational exposures are part of practicing dentistry. They can occur in spite of preventive efforts. When dental practices establish written comprehensive postexposure protocols they must include medical follow-up considerations. A tuberculosis skin test after a probable or proven exposure to a case of active tuberculosis is an example of a postexposure protocol.
DHCP can become ill after exposures occupationally and outside the practice. There is concern for some infections that might be transmitted to dental patients. A list of suggested work restrictions for DHCP is found in Table 1 of the new guidelines. However, handling of such cases must involve qualified health care professionals as to correctly diagnosis, interpretation of laboratory results, and case management. This is a difficult proposition because DCHP are naturally hesitant to share details concerning their personal health. Nevertheless, patients and other DHCP deserve protection. Ideally, a written policy would support the reporting of any and all diseases without prejudice.
Examples of medical records include immunization histories and activities and outcomes associated with postexposure management of occupational exposures. Each practice must establish a mechanism through which medical records of DHCP can be maintained in a confidential manner.
References
- Centers for Disease Control and Prevention. "Guidelines for Infection Control in Dental Health-Care Settings — 2003." MMWR 2003;52(RR-17):1-68.
- Centers for Disease Control and Prevention. "Recommended infection control practices for dentistry." MMWR 1993;42(RR-08):1-16.
Dr. Charles J. Palenik is director of Infection Control Research at Indiana University School of Dentistry in Indianapolis, Ind. He may be reached by e-mailing [email protected]. Ginny Jorgensen is the Clinical Procedures instructor at Portland Community College, Dental Assisting Program, Portland, Ore. She may be reached at (503) 977-4036 or by e-mail at [email protected].