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Infection Control for Dental Professionals: The California Requirement

Course #58583 - $15 • 2 Hours/Credits

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  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
  1. The California Division of Occupational Safety and Health (Cal/OSHA) adopted the nation's first aerosol transmissible disease (ATD) standard in

    OSHA AND CAL/OSHA REGULATIONS

    In 2009, Cal/OSHA adopted the nation's first aerosol transmissible disease (ATD) standard, which remains in effect today. The standard is designed to protect healthcare workers from diseases spread by an airborne or droplet route. The ATD standard requires healthcare employers to develop exposure control procedures and train employees to follow those procedures [4,5]. Basic exposure precautions, such as source screening, infection control, hand hygiene, and cleaning and decontamination procedures, are a fundamental part of the standard. Employees must be included in the periodic review and assessment of these procedures.

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  2. California dental offices must comply with the ATD standard if they

    OSHA AND CAL/OSHA REGULATIONS

    California dental offices whose patients have suspected or confirmed illnesses that require Airborne or Droplet Precautions, such as tuberculosis (TB) or other respiratory illnesses, must comply with the ATD standards [4]. Key points include:

    • Dental employees must be trained to screen patients for ATDs.

    • The screening process must be described in a written office procedure.

    • Screening must be consistently implemented.

    • Elective dental treatment should be deferred until the patient is non-infectious for TB or other diseases requiring Airborne or Droplet Precautions.

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  3. Of the following, which generally poses the greatest risk for airborne infection?

    MODES OF TRANSMISSION

    Aerosols, droplets (produced by the respiratory tract), and splatter contaminated with blood and bacteria are produced during many dental procedures [8]. Devices such as dental handpieces, ultrasonic and sonic scalers, air polishers, air-water syringes, and air abrasion units produce visible aerosol clouds and possible airborne contamination. Splatter generated by dental procedures such as drilling is a primary risk for transmission of bloodborne pathogens. In general, because of their smaller size, aerosols pose the greatest risk for airborne infection.

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  4. The average risk for infection after a needlestick or cut exposure to hepatitis C virus-infected blood is approximately

    BLOODBORNE PATHOGENS

    Hepatitis C is transmitted primarily through percutaneous exposure to infected blood. The average risk for infection after a needlestick or cut exposure to hepatitis C virus-infected blood is approximately 1.8% [17]. The risk following a blood exposure to the eye, nose, or mouth is unknown but is believed to be very small; however, hepatitis C virus infection from blood splashes to the eye has been reported [17]. There also has been a report of hepatitis C virus transmission that may have resulted from exposure to nonintact skin, but there is no known risk from exposure to intact skin [8]. Documented transmission of hepatitis C or hepatitis B virus has resulted from using the same syringe or vial to administer medication to more than one patient, even if the needle was changed.

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  5. Standard Precautions apply to contact with all of the following, EXCEPT:

    PREVENTION STRATEGIES

    The gradual acceptance of various infection prevention standards has changed the way we work in the provision of dental care. The use of Standard Precautions reduces the risk of infection to staff and patients and ensures that the right precautions are used with both known and unknown carriers of diseases due to bloodborne pathogens. Standard Precautions apply to contact with:

    • Blood

    • All bodily fluids, secretions, and excretions (except sweat), regardless of whether they contain blood

    • Intact or nonintact skin

    • Mucous membranes

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  6. The OSHA Bloodborne Pathogens Standard mandates the wearing of masks, eye protection, and face shields

    PREVENTION STRATEGIES

    Procedures that generate splashes or sprays of blood, bodily fluids, secretions, excretions, or chemical agents require either a face shield (disposable or reusable) or mask and goggles. The wearing of masks, eye protection, and face shields in specified circumstances (when blood or other potentially infectious material exposures are likely to occur) is mandated by the OSHA Bloodborne Pathogens Standard. Sterile barriers for invasive procedures and masks or respirators for the prevention of droplet contamination are also required.

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  7. Studies have shown that which of the following types of gloves have the highest failure rates?

    PREVENTION STRATEGIES

    Studies have repeatedly shown that vinyl gloves have higher failure rates than latex or nitrile gloves. For this reason, either latex or nitrile gloves are preferable for clinical procedures that require manual dexterity or those involving more than brief patient contact. Heavier, reusable utility gloves should be used for non-patient-care activities, such as handling or cleaning contaminated equipment or surfaces, handling chemicals, or disinfecting contaminated tools [28,30].

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  8. Which of the following is NOT a regulated waste found in dental practice settings?

    ENVIRONMENTAL CONTROL MEASURES

    Regulated medical waste accounts for only 9% to 15% of total waste in hospitals and 1% to 2% of total waste in dental offices [6]. Examples of regulated waste found in dental practice settings are solid waste soaked or saturated with blood or saliva (e.g., gauze saturated with blood after surgery), extracted teeth, surgically removed hard and soft tissues, and contaminated sharp items such as needles, scalpel blades, and wires [6].

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  9. Devices connected to the dental water system that enter the patient's mouth should be flushed for how long after each patient?

    ENVIRONMENTAL CONTROL MEASURES

    Patient material, such as oral micro-organisms, blood, and saliva, can enter the dental water system during treatment. Devices connected to the dental water system that enter the patient's mouth should be flushed to discharge water and air for a minimum of 20 to 30 seconds after each patient to remove patient material that might have entered the turbine, air, or waterlines.

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  10. Postexposure prophylaxis, or the provision of medications after a substantial exposure in order to reduce the likelihood of infection, is available for

    PROTECTING DENTAL HEALTHCARE WORKERS

    Postexposure prophylaxis (PEP) involves the provision of medications to someone who has had a substantial exposure, usually to blood, in order to reduce the likelihood of infection. PEP is available for HIV and hepatitis B virus. Although there is no PEP recommended for hepatitis C virus, limited data indicate that antiviral therapy might be beneficial when started early in the course of infection [38]. For employees who have not received the hepatitis B vaccine series, the vaccine (and in some circumstances hepatitis B immunoglobulin) should be offered as soon as possible (within seven days) after the exposure incident. The effectiveness of hepatitis B immunoglobulin administered more than seven days after exposure is unknown. PEP has been the standard of care for healthcare providers with substantial occupational exposures since 1996 and must be provided in accordance with the recommendations of the U.S. Public Health Service [38].

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  • Back to Course Home
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.