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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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