California revises infection control regulations. What about your state?

By Leslie Canham, CDA, RDA

California dental practices have new infection control regulations effective Aug. 20, 2011. These updated regulations must be put into place by all California dental practices. The Dental Board of California does not contact dental licensees to inform them of the new regulations; instead dental licensees are expected to check the Dental Board website to keep informed of any changes.

Each state’s dental board can determine its own regulations for infection control, or simply defer to the U.S. Centers for Disease Control and Prevention 2003 Guidelines for Infection Control in Dental Healthcare settings and the 2008 Guidelines for Disinfection and Sterilization in Healthcare Facilities.

Here are highlights of the some of the mandatory changes for California infection control compliance.

Utility gloves are now required when working with hazardous chemicals and when processing contaminated instruments. Utility gloves are chemical-resistant/puncture-resistant gloves that can be purchased through your dental supplier. Household dishwashing gloves are not adequate for dental office use. Some companies manufacture gloves that are heat resistant and can be autoclaved. Utility gloves can also be decontaminated by washing them with soap and water during wear, or by using disinfectant spray or wipes. While some people balk at wearing utility gloves, the chance of coming in direct contact with blood, body fluids, or chemicals is greatly reduced.

Instrument pouches, packages, or wraps must be labeled with the date of sterilization, and the sterilizer used if there is more than one sterilizer in the dental practice. Instrument pouches, packages, or wraps do not expire. Sterile packages/wraps are considered sterile unless an event, such as packages getting opened, wet, or damaged, causes the barrier of the package to be breached. The reason for dating the packages is to easily identify when instruments were sterilized in the event of a sterilization failure. In this case, instruments dated after the last successful sterilization cycle would be considered not sterile and would need to be collected for resterilization. The proper procedure would be to reclean, dry, and rewrap the instruments in new sterilization packaging, or wrap and resterilize in a working sterilizer.

Instruments, items, and devices processed by high-level disinfection (cold sterile) must be packaged or wrapped and dated upon completion of the disinfection process. This keeps instruments clean and dust-free but not sterile. Items processed with liquid chemical sterilant can be disinfected or sterilized by following the manufacturer’s instructions for the length of time items must be submerged to achieve the desired result.

Hand washing with soap and water must be performed at the start and end of each workday. To achieve effective hand washing, wet hands and apply plain or antimicrobial soap. The next step is to vigorously rub hands together to create a lather covering all the surfaces of the palms, tops of the hands, between the fingers, base of the fingers and thumbs, backs of the fingers, wrists, and fingernails. The hands should then be rinsed thoroughly to remove all lather. Washing and rinsing should be performed with cool water because hot water can dry the skin. Remember not to touch the faucet with freshly washed hands; instead use a paper towel to turn off the water. Alcohol-based hand rubs may still be used between glove changes as long as hands are not visibly soiled or contaminated.

After each patient treatment, face shields and protective eyewear should be cleaned, disinfected, or disposed. Protective eyewear and face shields can become contaminated by aerosols generated during patient care, and by the gloved hands of dental workers. Protective eyewear and face shields should be cleaned with soap and water when visibly soiled, and disinfected between patients. Protective eyewear provided to the patient should also be cleaned and disinfected after each use.

California requires dentists to post a copy of the Minimum Standards for Infection Control in a visible location in each dental office. Does your office have the regulations for infection control posted or accessible? What about infection control and exposure incident protocols? Even if your state doesn’t require you to post the regulations, it is important that each clinical team member be acquainted with your practice’s protocols, procedures, and systems for infection control.

How do your state dental board’s requirements for infection control compare to California? If you would like a complementary poster of the NEW California Infection Control regulations, send an email to [email protected].

Author bio
Leslie Canham is a dental speaker and consultant specializing in infection control and OSHA compliance. She has more than 36 years of experience in dentistry. Canham is the founder of Leslie Canham Seminars, providing in-office training, mock inspections, consulting, and online seminars and webinars to help the dental team navigate state and federal regulations. Reach Canham at (888) 853-7543 or Leslie Canham.