Infection Control Manual

Section XIII: Education Protocol on Infection Control

1. DUTIES OF EACH DEPARTMENTAL INFECTION CONTROL REPRESENTATIVE

   1. Similar to the practice in UNC hospitals, each dental office is currently required to designate a person, dentist or auxiliary, to have major on-site responsibility for exposure/infection control.

   2. ASSIGNMENT. Each Chair and/or Clinical Service director will designate an OSHA/Infection Control (OSHA/IC) representative for each clinical facility. The representative should be an auxiliary supervisor, assistant, hygienist, or dentist most able to annually review OSHA and State infection control requirements for that department or service, orient new personnel, and assure that records are kept and reported. Two persons may serve as a team to educate and orient persons in their clinic and department.

   3. DUTIES. The departmental OSHA/IC representative must annually update the faculty and staff of the department regarding changes in IC regulations and other IC issues which may be necessary to review.

      The representative shall assist the department chair in monitoring and reinforcing infection control practices in the clinical setting.

      Before a new employee begins clinical work, the departmental OSHA/IC representative must assure that the new employee has been educated on IC matters as noted in section B below, that HB immunization and tuberculin testing have been addressed, and that the employee signs the OSHA form to document training at orientation.

   4. TRAINING. Each departmental OSHA/IC representative must attend an OSHA/IC update session each year presented by an OSHA/IC Coordinator for the School or by the Chair of the Infection Control Committee. Attending a program presented by the Hospital or Biological Safety Office for the Campus may also be helpful, however such a program cannot address IC concerns specific to the dental school.

   5. COMMUNICATION. The OSHA/IC representatives should maintain communication with the Director of Clinics, the Chair of the Infection Control Committee, and the Coordinator for Infection Control.

   6. Departmental OSHA/IC representatives must assure that all employee records are filed in the department. This includes training records, HB immunization records, and tuberculin testing records. Copies of training records go to the Office of Biological Safety and to the Infection Control Committee Chair for recording and central filing.

2. EDUCATION FOR NEW EMPLOYEES WITH CLINICAL DUTIES

   1. When an employment position is created in the School of Dentistry, the recruiter (person filling out the Recruitment Requisition form) must identify whether the potential employee will be exposed to bloodborne pathogens, other infectious material, or hazardous chemicals as defined by OSHA. When such exposure is anticipated, the following items apply.

   2. The Personnel Department, upon notification of the new employee's start date by the UNC campus Office of Human Resources, will contact the School of Dentistry recruiter and inform him/her of the start date. The recruiter is then responsible for scheduling a meeting between the employee and the departmental OSHA/IC representative prior to patient contact or exposure to bloodborne pathogens.

   3. The departmental OSHA/IC representative will then provide a one hour orientation, to include the following:

      1. A review of the "Needlestick/Sharps Injury" protocol and the Blood or Body Fluids Exposure Incident Report in the Infection Control Manual.

      2. A review of procedures for handling an employee exposure.

      3. A review of clinical infection control procedures. The employee will receive a copy of the checklist of NC infection control regulations located at the end of this section. The employee will also answer the clinical orientation questions at the end of this section.

      4. Determine whether the person has had an approved OSHA Bloodborne Pathogen Training/DEHNR course or has graduated in the last year from a North Carolina dental program (including dental assisting and dental hygiene programs).

         1. If such experience is confirmed, further personalized training is not needed at this time. The new employee must read a copy of the UNC School of Dentistry's Bloodborne Pathogen Exposure Control Plan and view the video on TB. The departmental copy of the School of Dentistry's Infection Control Documents must be made available to the new employee.

         2. If such experience (part d. above) cannot be confirmed, the new employee must read a copy of the UNC School of Dentistry's Infection Control Documents (Parts I: Bloodborne Pathogens Exposure Control Plan and DEHNR; Part II: Epidemiology of Major Infections Transmissible in Dentistry; Part III: Infection Control Manual). The employee will then be tested on the material and must score an 80% correct to meet minimum standards. Employees scoring less than 80% will be asked to reread the material and then be retested until the minimum passing score has been achieved.

         3. If the new employee is from a foreign country or does not have previous knowledge of OSHA, then the new employee must view the OSHA videotape on the Bloodborne Pathogens Standard.

      5. Assure that the new employee has started or has made an appointment for their hepatitis B vaccine.

      6. Assure that the new employee has seen the tuberculosis (TB) video and made an appointment for their TB test.

      7. Assure that the new employee fills out and signs the OSHA training documentation form, which is then given to the Chair of the Infection Control Committee.

3. EDUCATION FOR NEW EMPLOYEES IN THE DENTAL RESEARCH CENTER (OR ANY NEW DRC LABORATORY PERSONNEL)

   1. New laboratory personnel in the Dental Research Center (DRC) may be research technicians, dental students, graduate students, research fellows, postdoctoral fellows, or visiting scholars. All of these new personnel are required to be trained by the Laboratory Safety Officer of each laboratory. The Laboratory Safety Officer is designated by (or may be) the principal investigator of that laboratory. The new personnel will be trained according to the Laboratory Safety Plan which is written and updated by the principal investigator and/or the Laboratory Safety Officer as mandated by OSHA. The Laboratory Safety Plan must cover infection control protocols for laboratory specimens such as blood and tissue samples which might harbor human pathogens.

   2. When new laboratory personnel have research duties involving oral examinations of human research subjects or potential exposure to the blood or body fluids of a human research subject in a clinical setting, then the Laboratory Safety Officer is required to arrange a meeting of the new personnel with an OSHA/IC representative for training as outlined in II above. The new personnel may be referred to the OSHA/IC representative of the department of the principal investigator or of the clinical area in which the new personnel will be conducting research on human subjects.

   3. The DRC will have two of its own OSHA/IC representatives who will verify that the training described above (C.1,2) takes place. The DRC OSHA/IC representatives will regularly obtain an updated list of DRC laboratory personnel and will ask those personnel about their risk of infectious exposure and their training in matters of infection control. The Laboratory Safety Officers and principal investigators will maintain the updated list of DRC personnel, and will receive a copy of this section (XIII) of the Manual of Infection Control from the DRC OSHA/IC representative.

Check List of NC Infection Control regulations that apply to the dental team, including the dentist.

Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses performed only in non exposure?prone areas.

Masks and glasses with side shields are worn during patient treatment and examinations.

Over-gowns are worn by all who work in the operatory; not worn or taken home for cleaning.

Whenever heavily soiled or at least each day, over-gowns are placed in a color coded hamper near the place of use.

Treatment gloves are worn for all oral contact procedures and chair-side assisting.

Treatment gloves are changed for each patient.

Charts, drawers, door knobs, light switches, phones etc. are not contaminated with used treatment gloves.

Soiled/used gloves are not worn to get instruments from drawers without using an additional clean barrier.

Hands washed when gloves changed unless multiple gloves are worn and stripped off one at a time.

Drapes on the unit are changed, suction/water tips are changed, and uncovered surfaces are disinfected after every patient.

A heavy glove is worn on each hand when gathering up and cleaning used instruments, and until the instruments are bagged for sterilization, such as in central sterilization and DFP.

A heavy glove is worn on each hand when cleaning suction traps.

Instruments are ultrasonically cleaned instead of scrubbed whenever possible.

Needles are only resheathed with one handed technique.

Needles are not bent except for canal irrigation.

Sharps are discarded where used (not in clean-up area).

Labeled sharps container: located at each operatory; discarded before over filling.

Unsheathed needles are not passed, or passed in a safe manner.

Hands not inserted down into containers to remove contaminated sharps.

Contaminated broken glass is picked up only with tongs; contaminated spills are cleaned up with disinfectant and paper towels while wearing utility gloves.

Sterilizers are monitored daily with indicator strips, and monitored weekly with biological indicator (spore test).

Sterilizer monitoring and problem-solving records are kept in a note book.

Handpieces are sterilized; water tips disposed of or autoclaved.

Radiographic films and equipment are handled aseptically.

Impressions are cleaned free of blood and debris, disinfected, and sent to lab in a biohazard labeled bag.

Infection Control Documents are kept in a brightly colored binder in a central location.

Questions to be answered by new staff, residents, and clinical faculty regarding the clinic in which they work:

1. Where is the note book located containing the OSHA EXPOSURE CONTROL PLAN?

2. Where is the NEEDLE/SHARPS EXPOSURE PLAN located?

3. Where are the following located?

   gowns....	(What gown is permitted in the clinic in order to present a uniform standard of protection and care to students and patients?) laundry hampers
   masks
   gloves

4. How or where can protective eyewear be obtained with side shields?

5. Where are needles and needle prop/shields obtained and discarded?

6. How are sterile instruments/handpieces obtained?

7. What procedures are used for repackaging and returning used instruments?

8. How is saliva/blood-contaminated trash discarded?

9. Where are materials located to clean up spills?

10. How do we protect charts?

11. How are radiographic films handled and how is the day-light loader used aseptically?

12. In areas where instruments are cleaned and re-sterilized:

    Where are materials for monitoring sterilization located?

    What sterilization records must be kept in a log book?

13. Where are we allowed to eat, drink, apply cosmetics, lip balm, and store food?

14. Where are first aid kits, oxygen tanks, and disposable resuscitation masks located?

15. Is it permissible to pass unsheathed needles between clinical personnel?

16. Are there any new regulations or concerns that need to be addressed or updated?

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