Basic Expectations for Infection Control

The 8 Basic Expectations for Infection Control

Infection Control 101

This article is a summary of “Training: Basic Expectations for Safe Care” by the CDC — a training series that covers the basic principles of infection prevention and control that form the basis for CDC recommendations for dental health care settings. Almost all of the content here is summarized or quoted directly via their official COVID-19 Interim Guide and all credit goes to the CDC’s Division of Oral Health and/or the original authors.

We like things uncomplicated here at Done Desk. So today, let’s talk about the 8 Basic Expectations for Infection Control. We’ll be covering an insider’s look into the 20 training PDFs released by the CDC which you can find here. All supporting documents are available on the DOH website.

We’re hoping to get you an overview in plain, uncomplicated language. Please remember that, although every effort has been made to ensure the accuracy of this information, Done Desk is not responsible for any errors and omissions, or anyone’s interpretations, applications, and changes of the regulations described.

This material is an information source, but it is not currently a course for professional credit.

Looking for professional credits? Done Desk & Practice Secure offers a fast-paced, interactive, and information-packed session that covers the basics of OSHA and HIPAA regulations that apply to medical offices. Learn more here.

The 8 Basic Expectations for Infection Control we'll be covering today are:

• Hand hygiene.

• Using personal protective equipment (PPE).

• Respiratory hygiene/cough etiquette.

• Sharps safety.

• Safe injection practices.

• Sterilization and disinfection of instruments

and devices.

• Cleaning and disinfecting environmental surfaces.

• Dental Unit Water Quality.

Let’s dive in!

Introduction - Basic Expectations for Infection Control

This series gives you an overview of the basic principles of infection prevention and control for dental healthcare practices. It can be used to educate and train infection prevention coordinators, educators, consultants, and other dental healthcare personnel (DHCP.)

During dental treatments, patients and dental healthcare personnel can be exposed to a variety of pathogens or disease-causing organisms. To help prevent transmission of infectious organisms, following recommended infection prevention procedures is not only highly recommended — but ofter required practices.

1. Hand Hygiene

Why is hand hygiene so important? First, hands are the most common mode of pathogen transmission. Hand hygiene can reduce the spread of antimicrobial resistance in health care settings and the likelihood of healthcare-associated infections.

For things like examinations and nonsurgical procedures, use alcohol-based hand rub or either plain or antimicrobial soap and water. If hands are really dirty, opt for antimicrobial soap and water over alcohol-based hand rub.

Surgical hand hygiene can be performed by using either an antimicrobial soap OR an alcohol-based hand rub with persistent activity. When an antimicrobial soap is used, the hands and forearms should be scrubbed for the length of time recommended by the product’s manufacturer. When an alcohol-based hand rub with persistent activity is used, follow the manufacturer’s instructions on the amount of product to use. Prewash hands and forearms with a non-antimicrobial soap and allow them to dry completely. After applying the alcohol-based product as recommended, allow hands and forearms to dry thoroughly before putting on sterile gloves.

2. Personal Protective Equipment

Personal protective equipment (PPE) is a major component of standard precautions for DHCP. Rotary dental and surgical instruments, such as handpieces, ultrasonic scalers, and air-water syringes create a visible spray that contains primarily large-particle droplets of water, saliva, blood, and microorganisms. 

  • A surgical mask that covers both the nose and mouth and protective eyewear with solid side shields or a face shield should be worn by DHCP during procedures. A mask should be changed between patients or if it becomes wet during one patient’s treatment.
  • DHCP should wear long-sleeved disposable or reusable gowns or lab coats that cover skin and personal clothing. DHCP should change protective clothing when it becomes visibly soiled or as soon as feasible if penetrated by blood or other potentially infectious fluids
  •  Gloves should always be worn when contact with blood, saliva, and mucous membranes is possible. A new pair of gloves should be used for each patient
  • Hand hygiene should be performed immediately before putting on and after the removal of gloves.

In addition to wearing PPE, you should also use safe work practices. Avoid contaminating yourself by keeping your hands away from your face and not touching or adjusting PPE. Also, change your gloves if they become torn, and perform hand hygiene before putting on a new pair of gloves. Avoid spreading contamination by limiting surfaces and items touched with contaminated gloves. All protective clothing should be removed before leaving the work area—such as patient care, instrument processing, and dental laboratory areas. 

3. Respiratory Hygiene and Cough Etiquette

The following measures to contain respiratory secretions are recommended for all individuals with

signs and symptoms of a respiratory infection:

  • Cover your mouth and nose with a tissue when coughing or sneezing,
  • Use the nearest waste receptacle to dispose of the tissue after use
  • Perform hand hygiene after having contact with respiratory secretions and contaminated objects or materials.

Dental office staff can also offer masks to coughing patients and other symptomatic people when they enter the dental setting and encourage people with symptoms to sit as far away from others as possible.

The following supplies should be provided:

  • Tissues and no-touch waste receptacles for disposing of used tissues
  • Dispensers of alcohol-based hand rub and hand washing materials (when a sink is available).

Masks may be used to contain respiratory secretions for coughing patients

4. Sharps Safety

The recommended work practices that help ensure safety can be simplified into three quick points:

• Be prepared.

• Be aware.

• Dispose with care.

Before beginning a procedure that involves the use of a needle or other sharps device, DHCP should:

  • Ensure that equipment necessary for performing a procedure is available within arm’s reach and organized so that the procedure can be performed safely.
  • Assess the work environment before starting and make sure there is adequate lighting and workspace for the procedure.
  • Ensure that the sharps object being used is always pointed away from the user.
  • Identify the location of the sharps disposal container.
  • If moveable, place it as close to the point of use as appropriate for immediate sharps disposal. If sharps are reusable, determine in advance where to place sharps for safe handling after use.

During a procedure that involves the use of needles and other sharps devices you should:

  • Maintain visual contact with the procedure site and location of sharps.
  • Be aware of other DHCP in the immediate environment.
  • Take steps to control the location of sharps to avoid injury to yourself and other staff.
  • Do not pass needles unsheathed.
  • Consider alerting others when passing sharps and consider a neutral zone for placing and
  • retrieving sharps.
  • If using an engineered sharps injury prevention device, activate the safety feature as the procedure is being completed.
  • Listen and watch for audible or visual cues that the feature is locked in place.

During cleanup following a procedure, DHCP should:

  • Be accountable for sharps used. Visually inspect procedure trays or other surfaces containing waste materials for exposed sharps used during a procedure before handling them.
  • Look for sharps that may have been inadvertently left on the tray after the procedure.
  • Transport reusable sharps in a closed container.
  • Secure the container to prevent spilling contents.

5. Safe Injection Practices

The CDC recommends the following safe injection practices:

  • Prepare injections using an aseptic technique in a clean area free from contamination or contact with blood, body fluids, or contaminated equipment.
  • Disinfect the rubber septum on a medication vial with alcohol before piercing.
  • Do not use needles and syringes for more than one patient.
  • Medication containers, such as single and multidose vials, ampoules, and bags, are entered with a new needle and new syringe, even when obtaining additional doses for the same patient.
  • Use single-dose vials for injectable medications when possible.
  • Do not use single-dose or single-use medication vials, ampoules, and bags or bottles of intravenous solution for more than one patient.
  • Do not combine or pool leftover contents of single-dose vials for later use.

6. Sterilization and Disinfection

Patient-care items—such as dental instruments, devices, and equipment—are categorized as critical, semicritical, or noncritical.

  • Critical items, such as surgical instruments and periodontal scalers, are those that penetrate soft tissue or contacts bone, enters into, or contacts the vascular or other normally sterile tissue. They have the greatest risk of transmitting infection and should always be sterilized using heat.

  • Semicritical items (such as mouth mirrors, amalgam condensers, and reusable dental impression trays) are those that come into contact with mucous membranes or non-intact skin (such as exposed skin that is chapped, abraded, or has dermatitis). These items have a lower risk of transmission.

  • Noncritical patient-care items—such as radiograph head or cone, facebow, or blood pressure cuff—are those that only contact intact skin. These items pose the least risk of transmission of infection.

Cleaning is the basic first step in all decontamination processes to remove debris and organic contamination from instruments. If blood, saliva, and other contamination is not removed, these materials can shield microorganisms and compromise the disinfection or sterilization process. Automated cleaning equipment (such as ultrasonic cleaners and washer-disinfectors) should be used to remove debris to improve cleaning effectiveness and decrease worker exposure to blood. The majority of patient-care items in dentistry are heat-tolerant and therefore should be heat sterilized. 

After cleaning, instruments should be inspected, wrapped, packaged, or placed into container systems before heat sterilization. Instruments should be thoroughly dry before they are packaged, wrapped, or otherwise contained. DHCP should follow the manufacturer’s instructions for the packaging of patient-care items. 

  • Use a chemical indicator inside each wrapped package to verify that the sterilizing agent (such as steam) has penetrated the package and reached the instruments inside.
  • The ability of a sterilizer to reach conditions necessary to achieve sterilization should be monitored using a combination of mechanical, chemical, and biological indicators.

7. Environmental Infection Prevention and Control

In the dental operatory, environmental surfaces — for example, a surface or equipment that does not contact patients directly — can become contaminated through touch, splash, or droplets generated during patient care. Certain surfaces, especially ones touched frequently—such as light handles, unit switches, and drawer knobs—can serve as reservoirs of microbial contamination.

There are two categories of environmental surfaces:

Clinical contact surfaces have a high potential for direct contamination from patient materials either by direct spray or spatter generated during dental procedures or by contact with gloved hands of DHCP.

Housekeeping surfaces do not come into contact with patients or devices used in dental procedures. Therefore, they have a limited risk of disease transmission and can be decontaminated with less rigorous methods than those used on dental patient-care items and clinical contact surfaces.

Clinical contact surfaces should be barrier protected or cleaned and disinfected

between patients. Surface barriers are particularly useful for surfaces that are hard to clean, such as switches on dental chairs.

Housekeeping surfaces, carry less risk of disease transmission than clinical contact

surfaces and can be cleaned with soap and water or cleaned and disinfected if visibly contaminated with

blood. Reusable mops and cloths should be cleaned after use and allowed to dry before reuse.

8. Dental Unit Water Quality

Studies have demonstrated that dental unit waterlines— narrow-bore plastic tubing that carries water to the highspeed handpiece, air or water syringe, and ultrasonic scaler—can become colonized with microorganisms, including bacteria, fungi, and protozoa. Once formed, a biofilm serves as a reservoir that may dramatically increase the number of free-floating microorganisms in water used for dental treatment.

Although most organisms isolated from water systems are harmless, some have been known to cause serious disease. Using water of uncertain microbiological quality is inconsistent with infection prevention and control principles. Removal or inactivation of dental waterline biofilms requires the use of chemical germicides.

The CDC recommends that water used for routine dental treatment meet regulatory standards for drinking water, which is fewer than 500 CFU/mL of heterotrophic water bacteria. DHCP should consult with the dental unit manufacturer for appropriate methods and equipment to maintain the recommended quality of dental water and follow recommendations for monitoring water quality provided by the manufacturer of the unit or waterline treatment product.

Commercial devices and procedures designed to improve the quality of water used in dental treatment are widely available. Examples of effective water treatment methods include:

  • Independent reservoirs.
  • Chemical treatment.
  • Filtration.
  • Combinations of technologies.
  • Sterile water delivery.

DHCP should always consult with the dental unit manufacturer for appropriate methods to maintain the recommended dental unit water quality.

Alright! Those are the 8 Basic Expectations for Infection Control. Always better safe — than sorry. Done Desk can help you predict where risks may arise and actively work with you to select insurance programs that will take care of your practice should anything happen. Knowing you are compliant means running your business worry-free!

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