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Heartland Dental Presents OSHA/HIPAA

Taking care of our Patients and Each Other

All Education

on 4 March 2015

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Transcript of Heartland Dental Presents OSHA/HIPAA

Preventing Transmission of Bloodborne Pathogens
enter for isease ontrol
In 2003, the Center for Disease Control
created the Guidelines for Infection
Control in Dental Health-Care Settings.

The same guidelines are still in use
at this time.

oals f SHA raining
Provide principles about infection control to apply in your day to day routine

Emphasize the importance of written policies, procedures, and maintaining continual records of full implementation

Emphasize the significance of each person on the team to ensure implementation

Average Risk of Bloodborne Virus Transmission after Needlestick
Heartland Dental OSHA/HIPAA
Why Is Infection Control Important ?
Both patients and dental health care personnel (DHCP) can be exposed to pathogens

Contact with blood, oral and respiratory secretions, and contaminated equipment occurs

Proper procedures can prevent transmission of infections among patients and DHCP

Modes of Transmission
Direct contact with blood or body fluids

Indirect contact with a contaminated
instrument or surface

Contact of mucosa of the eyes, nose, or
mouth with droplets or spatter

Inhalation of airborne microorganisms

At Heartland Dental, we strive to protect our employees and
our patients.

Having a system in place will make this responsibility seamless in your practice.

partners with the CDC to develop guidelines for health requirements
Standard Precautions
Apply to all patients

Integrate and expand Universal Precautions to include organisms spread by blood

Body fluids, secretions, and excretions except sweat, whether or not they contain blood
Non-intact (broken) skin
Mucous membranes

Elements of Standard Precautions
Personnel Health Elements
of an Infection Control Program
Education and training
Exposure prevention and post exposure
Medical condition management and
work-related illnesses and restrictions
Health record maintenance

Critical Instruments
Semi-critical Instruments
Noncritical Instruments
and Devices

Instrument Processing Area
Infection Control Program
Sterilization and Disinfection of Patient Care Items
Program Evaluation
Provide a Safe working environment
G o O T
Taking Care of Our Patients and Each Other

How do we
Documented Cases
Documented Possible
Dental Worker 0 6 *
Nurse 24 35
Lab Tech, clinical 16 17
Physician, nonsurgical 6 12
Lab Tech, nonclinical 3 –
Other 8 69
Total 57 139

* 3 dentists, 1 oral surgeon, 2 dental assistants

Characteristics of Percutaneous Injuries Among DHCP
Engineering Controls
Administrative Controls
Bloodborne viruses such as hepatitis B virus
(HBV), hepatitis C virus (HCV), and human
immunodeficiency virus (HIV)

Are transmissible in health care settings
Can produce chronic infection
Are often carried by persons
unaware of their infection

Reported frequency among general dentists has declined
Caused by burs, syringe needles, other sharps
Occur outside the patient’s mouth
Involve small amounts of blood
Among oral surgeons, occur more frequently during fracture reductions and procedures involving wire

Isolate or remove the hazard

Sharps container
Medical devices with injury
protection features
(e.g., self-sheathing needles)

Policies, procedures, and enforcement measures
Placement in the hierarchy varies by the problem
being addressed
Placed before engineering controls for airborne
precautions (e.g., TB)

Penetrate mucous membranes or contact bone, the bloodstream, or other normally sterile tissues (of the mouth)

Heat sterilize between uses or use sterile single-use,
disposable devices

Examples include surgical instruments, scalpel blades, periodontal scalers, and surgical dental burs

Contact mucous membranes but do not penetrate
soft tissue

Heat sterilize or high-level disinfect

Examples: Dental mouth mirrors, amalgam condensers,
and dental handpieces

Contact intact skin

Clean and disinfect using a low to
intermediate level disinfectant

Examples: X-ray heads, facebows,
pulse oximeter, blood pressure cuff

Use a designated processing area to control
quality and ensure safety
Divide processing area into work areas
Receiving, cleaning, and decontamination
Preparation and packaging

Committed to doing
the Right Thing
Susceptible Host





Chain of Infection

HBV 22.0%-31.0% clinical
hepatitis; 37%-62%
serological evidence
of HBV infection

HBsAg+ and HBeAg+ 1.0%-6.0% clinical
hepatitis; 23%-37%
HBV infection
serological evidence of

HCV 1.8% (0%-7% range)

HIV 0.3% (0.2%-0.5% range)
High Moderate Low/Not

Blood Semen Urine
Serum Vaginal Fluid Feces
Wound exudates Saliva Sweat
Breast Milk

Vaccinate all DHCP who are at risk of exposure to blood

Provide access to qualified health care professionals for administration and
follow-up testing

Test for anti-HBs 1 to 2 months after 3rd dose
Hepatitis B Vaccine
CDC Database as of December 2002

Engineering controls

Work practice controls

Administrative controls
Work Practice Controls
Change the manner of performing tasks
Examples include:
Using instruments instead of fingers to retract
or palpate tissue
One-handed needle recapping

Post-exposure Management Program
Clear policies and procedures
Education of dental health care personnel
Rapid access to
*Clinical care
* Post-exposure prophylaxis (PEP)
*Testing of source patients/HCP

Why is
Hand Hygiene
so important?

Hands are the most common
mode pathogen transmission

Reduce spread of antimicrobial

Prevent health care-associated

Hands Need to be Cleaned When
Prevention Strategies

Visibly dirty
After touching contaminated
objects with bare hands
Before and after patient
treatment (before glove
placement and after
glove removal)
Personal Protective
A major component of Standard Precautions
Protects the skin and mucous membranes
from exposure to infectious materials in
spray or splatter
Should be removed when leaving treatment areas
Wear a surgical mask and either eye protection
with solid side shields or a face shield to
protect mcous membranes of the eyes,
nose, and mouth

Change masks between patients

Clean reusable face protection between patients;
if visibly soiled, clean and disinfect
Protective Clothing
Wear gowns, lab coats, or uniforms that cover skin
and personal clothing likely to become soiled with blood, saliva, or infectious material

Change if visibly soiled

Remove all barriers before leaving the work area

Recommendations for Gloving
Remove gloves that
are torn, cut, or punctured

Do not wash, disinfect
or sterilize gloves for reuse

Automated Cleaning
Ultrasonic cleaner
Instrument washer
Preparation and Packaging
Critical and semi-critical items that will be stored should be wrapped or placed in containers before heat sterilization
Hinged instruments opened and unlocked
Place a chemical indicator inside the pack
Wear heavy-duty, puncture-resistant utility gloves

Heat-Based Sterilization

Steam under pressure
Gravity displacement
Dry heat
Unsaturated chemical vapor

Only for heat-sensitive critical and semi-critical devices
Powerful, toxic chemicals raise safety concerns
Heat tolerant or disposable alternatives are available

Liquid Chemical Sterilant/Disinfectants
Sterilization Monitoring
Types of Indicators
Mechanical (AUtoclave Log)
Measures time, temperature, pressure

Change in color when physical parameter
is reached.

Biological (spore tests)
Use biological spores to assess the
sterilization process directly
Storage of Sterile and Clean Items
and Supplies
Use date- or event-related shelf-life practices
Examine wrapped items carefully prior to use
When packaging of sterile items is damaged, re-clean, re-wrap, and re-sterilize
Store clean items in dry, closed, or covered containment

Environmental Infection Control

Environmental Surfaces

May become contaminated

Not directly involved in infectious
disease transmission

Do not require as stringent
decontamination procedures
Categories of
Clinical contact surfaces
High potential for direct
contamination from spray or
spatter or by contact with
DHCP’s gloved hand

Housekeeping surfaces
Do not come into contact with
patients or devices limited risk
of disease transmission

Clinical Contact Surfaces
Use barrier precautions (e.g., heavy-duty utility gloves, masks,
protective eyewear) when cleaning and disinfecting
environmental surfaces

Physical removal of microorganisms by cleaning is as
important as the disinfection process

Follow manufacturer’s instructions for proper use of EPA-
registered hospital disinfectants

environmental surfaces

Do not use sterilant/high-level disinfectants on
Dental Handpieces and other devices
attached to Air and Waterlines
Clean and heat sterilize intraoraldevices
that can be removed from air and waterlines

Follow manufacturer’s instructions for cleaning,
lubrication, and sterilization

Do not use liquid germicides or ethylene oxide

Saliva Ejectors

Previously suctioned fluids might be retracted into the patient’s mouth when a seal is created
Do not advise patients to close their lips tightly around the tip of the
saliva ejector

Medical Waste
Medical Waste: Not considered infectious,
thus can be discarded in regular trash

Regulated Medical Waste: Poses a potential risk
of infection during handling and disposal

General Cleaning Recommendations
Cleaning Clinical Contact Surfaces
Risk of transmitting infections greater than for housekeeping surfaces
Surface barriers can be used and changed between patients
Clean then disinfect using an EPA-registered low- (HIV/HBV claim) to intermediate-level (tuberculocidal claim) hospital disinfectant

Cleaning Housekeeping Surfaces
Routinely clean with soap and water or an
EPA-registered detergent/hospital disinfectant
Clean mops and cloths and allow to dry thoroughly before re-using
Prepare fresh cleaning and disinfecting solutions daily and per manufacturer recommendations

Regulated Medical Waste Management

Properly labeled containment to prevent injuries and leakage
Medical wastes are “treated” in accordance with state and local EPA regulations
Processes for regulated waste include autoclaving and incineration

Components of Devices Permanently
Attached to Air and Waterlines
Do not enter patient’s mouth but may become contaminated
Use barriers and change between uses
Clean and intermediate-level disinfect the surface of devices if visibly contaminated

Dental Radiology
Wear gloves and other appropriate personal protective equipment as necessary
Heat sterilize heat-tolerant radiographic accessories
Transport and handle exposed radiographs so that they will not become contaminated
Avoid contamination of developing equipment

Single-Use (Disposable) Devices
Intended for use on one patient during a single procedure
Usually not heat-tolerant
Cannot be reliably cleaned
Examples: Syringe needles, prophylaxis cups, and plastic orthodontic brackets

Extracted Teeth
Considered regulated medical waste
Do not incinerate extracted teeth containing amalgam
Clean and disinfect before sending to lab for shade comparison

Can be given back to patient

Handling Extracted Teeth
in Educational Settings

Remove visible blood and debris
Maintain hydration
Autoclave (teeth with no amalgam)
Use Standard Precautions
and Tools
exposures to bloodborne pathogens

Periodic observational assessments

Checklists to document procedures

Routine review of occupational
Laser/Electrosurgery Plumes and Surgical Smoke
Destruction of tissue creates smoke that may contain harmful by-products

Infectious materials (HSV, HPV) may contact mucous membranes of nose

No evidence of HIV/HBV transmission

Need further studies
Dental Laboratory

Dental prostheses, appliances, and items used in their making are potential sources of contamination

Handle in a manner that protects patients and DHCP from exposure to microorganisms
Dental Laboratory

Clean and disinfect prostheses and impressions
Wear appropriate PPE until disinfection has been completed
Clean and heat sterilize heat-tolerant items used in the mouth
Communicate specific information about disinfection procedures

Spread by droplet nuclei
Immune system usually prevents spread
Bacteria can remain alive in the lungs for many years (latent TB infection)
Transmission of Mycobacterium tuberculosis
Risk of TB Transmission in Dentistry
Risk in dental settings is low
Only one documented case
of transmission
Tuberculin skin test conversions among DHP are rare
Preventing Transmission of TB
in Dental Settings
Assess patients for history of TB
Defer elective dental treatment
If patient must be treated
DHCP should wear face mask
Separate patient from
others/ mask/tissue
Refer to facility with proper TB infection control precautions

Use of gloves, masks, eye protection,
lab coats, and utility gloves (PPE)

*Patient care equipment

*Environmental surfaces

*Injury prevention

Think Safety First

Must document breaches to HIPAA Guidelines

Remove opportunities for patients to view names of other patients

Ensure destruction of discarded paper with patient personal information

Practice computer information privacy

Utilize privacy notice on correspondence through faxes and email
HIPAA Guidelines
Document breaches to HIPAA Guidelines
IE: printed schedules, discarded insurance claims, printed and discarded reports with patient information including balances, or medical alerts

Diary Log to be kept at each office in business area
*Must document on log when breach occurs (IE:
lost schedules, items not shredded, etc).
Remove Opportunities for Patients to
View Names of Other Patients

In operatories or any areas other than
the business area (with no patient access)

*Patient names will be removed from the
"View" on the patient schedule
Ensure Destruction
of Discarded Paper with Patients Personal Information
Any papers that have patient information on it must be shredded before being discarded.

If errors are made, papers lost, etc., this is the type of "breach' that is documented on the Diary Log
Practice Computer Information Privacy
When leaving computers idle,
either in operatories, consultations
rooms, etc.-use safe practice of
'locking' your computer
Press the Windows Key ( ) and the
'L' on your keyboard to lock the computer

Press Ctrl + Alt+ Delete to log back in
Utilize Privacy Notice on Correspondence through
Faxes and Email
IT has already implemented the privacy notice on email correspondences to all email addresses outside Heartland Dental

Barracuda encryption is an additional tool required for sending out attachments containing patient information out-side of Heartland Dental.

On the HD Intranet: Departments/ IT / Email Encryption with HD Mail
Departments/ IT / Email Encryption with Microsoft Outlook

Contact your CA if you are unfamiliar with using Barracuda email
Full transcript