Ecu school of Dental Medicine Infection Control Manual Table of Contents Page



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Appendix A Definitions and Abbreviations used in the ECU Bloodborne Pathogen Exposure Control Plan
Blood--human blood, human blood components, and products made from human blood.

Bloodborne Pathogens—refers to pathogenic microorganisms that are present in human blood or other potentially infectious materials (OPIM). These pathogens include, but are not limited to, hepatitis B virus (HBV), and human immunodeficiency virus (HIV). Pathogenic micro organisms can also cause diseases such as hepatitis C (HCV), malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, Creutzfeldt-Jakob disease, adult T-cell leukemia/Lymphoma (caused by HTLV-I), HTLV-I associated myelopathy, diseases associated with HTLV-II, and viral hemorrhagic fever.

Clinical Laboratory--a workplace where diagnostic or other screening procedures are performed on blood or other potentially infectious materials.

Contaminated--the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.

Contaminated Laundry--laundry that has been soiled with blood or other potentially infectious materials or may contain sharps. (At ECU all laundry is handled as though contaminated and is placed in leak proof clear bags.)

Contaminated Sharps--any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires.

Decontamination--the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

Engineering Controls--controls that isolate or remove the bloodborne pathogens hazards from the workplace. (E.g. controls relating to sharps disposal containers and safer medical devices, such as sharps with engineered sharps injury protection and needless systems.)

Exposure Incident--a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee, student or resident’s duties.

Hand Washing Facilities--a facility providing an adequate supply of running potable water, soap and single use towels or hot air drying machines.

HBV--hepatitis B virus

HCV—hepatitis C virus

HIV--human immunodeficiency virus

Needleless System—a device that does not use needles for the 1) collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established, 2) the administration of medication or fluids, or 3) any other procedure involving the potential for occupational exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps.

Note: The SoDM dental providers will place the anesthetic needle into a needle cuff to secure the needle and syringe during dental treatment. If a dental needle is to be recapped (for use later in the procedure) a single-handed scoop technique will be used.

Occupational Exposure—reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties.

Other Potentially Infectious Materials (“OPIM”)

Saliva, mucous, and any body fluid that is visibly contaminated with blood and all body fluids in situations where it is difficult or impossible to differentiate between body fluids.



Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and

HIV-containing cell or tissue cultures, organ cultures, and HIV or HBV containing culture medium or other solutions; and blood organs or other tissues from experimental animals infected with HIV or HBV.

Parenteral--piercing mucous membranes or the skin barrier through such events as needle sticks, human bites, cuts, and abrasions.

Personal Protective Equipment--specialized clothing or equipment worn by faculty, employee, student or resident for protection against a hazard. General work clothes (e.g. uniforms, scrubs, pants, shirt, or blouses) are not intended to function as protection against a hazard and are not considered personal protective equipment.

Regulated Waste--liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other infectious materials.

Standardization Committee—an ECU committee in which products used at ECU are evaluated. A subgroup of this committee (Needle Safety Subcommittee) will solicit input from non-managerial employees in direct patient care (who are potentially exposed to injuries from contaminated sharps) to identify, evaluate, and select effective safety devices and will document the results. Members of Nursing Leadership will appoint one or more staff-level representatives from each division and to evaluate devices.

Sharps with engineered sharps injury protection— a non-needle “sharp” or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in feature or mechanism that effectively reduces the risk of an exposure incident.

Source Individual--any individual whose blood or other potentially infectious materials may be a source of occupational exposure to the employee. Examples include, but not limited to, hospital and clinic patients, clients in institutions for the developmentally disabled; clients of drug and alcohol treatment facilities, residents of hospices and nursing homes; human remains; and individuals who donate or sell blood or blood components.

Sterilization--the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores.

Standard (Universal) Precautions—is an approach to infection control. All blood and all fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens. Wherein it involves the use of personal protective equipment to prevent any contact with human blood and other potential infectious materials.

Work Practice Controls--controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g. prohibiting recapping of needles by a two-handed technique
Abbreviations:

ADA: American Dental Association

ADA: American with Disabilities Act

CDC: Centers for Disease Control and Prevention

CSLC: Community Service Learning Center

DHCP: Dental Health Care Personnel

ECU SoDM: East Carolina University School of Dental Medicine

EPA: U.S. Environmental Protection Agency

FDA U.S. Food and Drug Administration

HAI: Health-Care-Associated Infection

HBV: Hepatitis B Virus

HCV: Hepatitis C Virus

HIV: Human Immunodeficiency Virus

ICO: Infection Control Officer:

ICRF: Infection Control Review Function

MSDS: Material Safety Data Sheet

OPIM: Other Potentially Infectious Material

OSHA: Occupational Safety and Health Administration

PPE: Personal Protective Equipment

PH: Prospective Health

PHS: Public Health Service

TB: Tuberculosis


Important Resources

CDC Guidelines for Infection Control in Dental Health Care Settings http://www.cdc.gov/oralhealth/infectioncontrol/index.htm


Current OSHA Regulatory Documents: US Department of Labor, Occupational Safety and Health Administration: 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; needle sticks and other sharps injuries; final rule. Federal Register 2001;66:5317–25. Available at

www.osha.gov/SLTC/dentistry/index.html or http://www.oshamanual.com/dental_OSHA.htm


ECU Office of Prospective Health: http://www.ecu.edu/cs-dhs/prospectivehealth/index.cfm (Biologic Safety and Waste Management, Employee Health, Infection Control)
ECU School of Dental Medicine Office of Clinical Affairs (252 737-7008)
MSDS search: http://www.msdssearch.com/DBLinksN.htm
Appendix B Common Dental Procedures and Required Personal Protective Equipment
Employees and students will follow the dress code policy and the following requirements:

Scrubs will be worn for all dental procedures

Long hair will be tied back

Jewelry will be removed (dangling earrings, necklaces, watches, bracelets, rings, etc.)

Disposable Headwear will be used during surgical procedures
Oral examinations: disposable gown, gloves, mask, face shields or eye glasses with side

shields
X-rays: disposable gown, gloves, mask


Impressions: disposable gown, gloves, mask, face shields or eye glasses with side

shields
Cleaning of Teeth: disposable gown, gloves, masks, face shields or eye glasses with side shields


Fillings: disposable gown, gloves, masks, face shields or eye glasses with side shields
Extractions: disposable gown, gloves, masks, face shields or eye glasses with side

shields
Root Canals: disposable gown, gloves, masks, face shields or eye glasses with side shields


Crown & bridge: disposable gown, gloves, mask, face shields or eye glasses

partials/dentures with side shields


Periodontal therapy: disposable gown, gloves, masks, face shields or eyeglasses with side

surgery and cleaning shields


Emergency procedures: disposable gown, gloves, mask, face shields or eye glasses with side

shields
Oral Surgery: disposable gown, gloves, mask, face shields or eye glasses with side

extractions and surgery shields

Note: Don PPE after completing the medical history and after washing hands. Place barrier film on keyboard, dental unit controls, dental unit instruments, and dental chair controls prior to dental treatment, following asepsis protocol.



Appendix C ECU School of Dental Medicine

Blood borne Pathogen Post Exposure Protocol

Quick Guide

(Rev March 2014)


  • Stop dental treatment, Do NOT discharge patient;

  • Remove the contaminated instrument/sharps that caused exposure

from the dental instrument field;

  • Remove contaminated PPE & WASH HANDS;

  • Administer First Aid-see below;

  • Notify Supervisor/Supervising Clinical Faculty;

(Vidant Employees follow Vidant’s protocol)

  • Exposed Person Calls ECU Office of Prospective Health to notify of possible exposure, obtains Mandatory Risk Assessment & further instructions:

  • (252) 744-2070

  • Monday-Friday, 8:00-4:30 PM, office closes at 4:30 PM

  • After 4:30 PM? Trained faculty or staff will administer the HIV OraQuick saliva test on the source patient.

    • If the test result is positive, go with the source patient to after hours medical provider/ER for source patient testing-rapid HIV, Hepatitis B and C.

    • If the result is negative, the source patient and exposed person go to the medical provider for routine testing the next business day.

  • Supervisor/Supervising Clinical Faculty completes SoDM Event Report & submits to Clinical Affairs Office within 24 business hours;

  • Maintain patient confidentiality.

Remember…

  1. EVERY Source Patient is a risk, which is why we adhere to Universal Precautions.

  2. It’s not just blood exposure; it is also mucous, sputum-spray, splatter in your eyes, mouth, nose, or broken skin.


I think I may have had an exposure, what now?

  1. DO NOT DISCHARGE YOUR PATIENT; stop dental treatment immediately.

  2. Remove the contaminated instrument/sharps from the dental instrument field to prevent recontamination.

  3. First aid first! Wash hands.

    1. Skin-wash vigorously with soap and water up to 15 minutes

    2. Eyes/mouth-use eye wash station and rinse up to 15 minutes

  4. Clinic Staff notifies their supervisor/Resident or Student notifies supervising clinic faculty.

  5. Supervisor/Supervising Clinic Faculty explains to the source patient there may have been an exposure to blood or body fluid. Asks the patient to please wait for further instructions. (Vidant employees follow your protocol.)

  6. Exposed person calls the Office of Prospective Health (252) 744-2070 ASAP to notify the office of a potential exposure. (The office closes at 4:30 pm, testing must be completed before then.)

After 4:30 PM? Exposed person and Source Patient go to established Medical Partner/ER for evaluation/possible testing. Exposed person calls the Office of Prospective Health the following business day.

  1. The Office of Prospective Health will determine if you had an exposure and if testing is required.

    1. Advised this is an exposure? North Carolina law requires Source Patient testing.

Exposed party will be tested at time of exposure (baseline) 6 weeks, 3 months and at 6 months.

    1. Advised this is Not an Exposure? Resume patient treatment if your skin is not bleeding.

  1. Supervisor/Supervising Clinical Faculty completes SoDM Event Report and submits to Office of Clinical Affairs within 24 business hours. Do NOT copy the SoDM Event form.

  2. Do not enter the incident in the patient’s record.

  3. Do not enter test results in the patient’s record, unless the source patient discloses test results at the next appointment when updating the medical history.

Note:

Blood borne Pathogen Quick Guide and SoDM Event reports are located in the following places:



  1. In the Infection Control Manual in every dispensary and/or on the designated clipboard

  2. On the SoDM website- Internal Documents

  3. In the Office of Clinical Affairs

  4. Outside the Office of Clinical Affairs in the hanging file.

Form 910.4.3



ECU School of Dental Medicine Event Report Rev. Nov 2013
Directions: Administer First Aid (when indicated). Notify Supervisor.

Is this is a possible Blood borne Pathogen Exposure (BBP)?

Vidant employees follow Vidant’s protocol.

  • Do NOT discharge source patient

  • Injured Person Calls ECU Office of Prospective Health for

Mandatory Risk Assessment

252-744-2070 (M-Fri 8-4:30 PM) Office closes at 4:30 PM

Do NOT place this form in the patient’s record

Submit this form to Office of Clinical Affairs within 24-hours of event. Attach a 2nd page if needed Phone: 252 737-7008 or Fax 252 737-7198
Reported by _________________________________ Title ______________________ Phone __________________
Date of Event ____/____/____ Time _____ Location (be specific) ________________________________
Dental Provider Name (Do not enter name if provider is the injured party) ___________________________________
Dental Provider Status (Check one) Faculty Resident Student

Supervising Clinical Faculty Name ___________________ Phone __________________
Staff Supervisor ___________________________________ Phone __________________
Witness(es) _______________________________________ Phone __________________
Injured Patient* Name ______________________ axiUm number ________ Date of Birth ___/___/___

*If injured party is NOT a patient, only check injured party’s status Faculty Resident Student Staff Visitor
Family member notified: yes no Family Member Name & Phone # ____________________________________
Nature of Injury & how it happened be specific:

(E.g., 1-inch laceration right index finger while placing a contaminated 23-gauge needle in sharps container)

_________________________________________________________________________________


Document the Interventions Provided Below (Leave Blank if N/A)

Prospective Health Risk Assessment for possible BBP Exposure Yes No N/A

First Aid (specify) ___________________________________ ☐ BLS ☐ EMS arrival time: ________

Temp ______ Pulse _____ Respiration _____ BP ____ /____ Pulse Oximetry _______ %

Blood Glucose _________ Repeat Glucose ___________

Oxygen __ liters/minute Nasal Cannula Face Mask

Person Repositioned, Trendelenburg
Medications Administered (list medication(s)/route/dose/time) __________________________________________________________________________________________________

__________________________________________________________________________________________________

Status

Treated on site, no further intervention required

Transported to medical facility via ☐EMSFamily

Refused medical assessment (excludes possible BBP exposure) or refuses medical transport or treatment,

Completed Refusal of Assessment &Treatment Form
Disposition

Employee, Resident, or Student: Returned to work ☐Sent for BBP Evaluation

Patient: Continued Appointment Stopped Appointment, discharged Sent for BBP Evaluation
Form #910.4.6

ECU School of Dental Medicine

Refusal of Emergency Medical Assessment, Treatment or Medical Transportation after

Serious Illness or Injury

The following applies to me (or my child or my legal ward). Please check all that apply:


_I am refusing medical assessment.

_I am refusing medical treatment.

_I am refusing medical transportation to an emergency room.

_I have received medical assessment and treatment, but decline medical transportation.



_The injured is not a patient of record at ECU SoDM.
I understand that the ECU School of Dental Medicine (“ECU SoDM”) students, residents, faculty and staff and 9-1-1 personnel are not physicians and may not be qualified or authorized to make a diagnosis, and that emergency care or first aid provided is not a substitute for that of a physician. I recognize that I may have a serious injury or illness which could get worse without medical attention even though I (or the patient for whom I am legally responsible) may feel fine at the present time.
I understand that I may change my mind and call 9-1-1 if treatment or assistance is needed later. I also understand that treatment is available at an emergency room 24-hours a day or from my physician.
If I insist on being transported to a destination other than that recommended by the 9-1-1 personnel, I understand that I have been informed that there may be a significant delay in receiving care at the emergency room, that the emergency room may lack the staff, equipment, beds or resources to care for me promptly, and/or that I might not be able to be admitted to that hospital.
I acknowledge this advice has been explained to me by ECU SoDM affiliates and/or 9-1-1 personnel and that I have read this form completely and understand its provisions. I agree, on my own behalf (and for the patient for whom I am legally responsible) to release, indemnify and hold harmless all ECU SoDM affiliates, officers or other agents, from any and all claims, actions, causes of action, damages, or legal liabilities of any kind arising out of my decision, or from any act or omission of the ECU SoDM affiliates and 9-1-1 providers.
__ Patient has refused to complete this form.
Date _______ Time ______
Patient’s or Legal Guardian’s Signature _________________________________ Date _________
Dental Student Signature ____________________________________________ Date _________
Dental Resident Signature ___________________________________________ Date _________
Dental Faculty Signature ___________________________________________ Date ________
Witness’ Signature _________________________________________________ Date ________

September 2012


Form # 910.4.3.11


ECU School Instructions for Use of OraQuick Rapid HIV Test
This test is for after hours use only, or when the Office of Prospective Health or identified medical partner (CSLCs) is closed.
If the result is positive, the source patient and exposed party will go to the Emergency Room for testing and follow up.
If the result is negative, the source patient and exposed party goes to the Office of Prospective Health or identified medical partner the next business day for testing.
Step 1 – Gather: OraQuick test, source patient information sheet, instructions for use, and have a watch or clock visible. Tell source patient about exposure and requirement to test. Give source patient the information sheet.


  • Test kit must include vial, Flat Pad, vial holder, and absorbent packet.

  • Ensure the source patient has not had any food, water, or chewing gum in their oral cavity within the last 15 minutes; wait to administer test for 15 minutes if necessary.

  • Delay administering the test for 30 minutes if the source patient used any oral care products just prior to testing (toothpaste, mouth rinse).

Step 2 – Testing:




  • Have the source patient remove the device from its pouch. DO NOT touch the Flat Pad. Check to make sure that an Absorbent Packet is included with the Device. If no Absorbent Packet is present, discard the device and obtain a new pouch for testing.




  • Carefully open the vial and place upright in the holder.







  • Direct the source patient to place the Flat Pad above the teeth against the outer gum and gently swab completely around the outer gums, both upper and lower, one time around. (Both sides of the Flat Pad may be used.)




  • While wearing gloves, insert the Flat Pad all the way into the vial, touching the bottom of the vial. The result window on the Flat Pad should be facing toward you.




  • Start timing the test. Do not remove the test from the vial while the test is running. Pink/purplish fluid will appear and travel up to the result window. Read the results after 20 minutes but not more than 40 minutes in a fully lighted area.

Step 3 – Results:




  • Negative: A test is non-reactive (negative) if a reddish- purple line appears next to the triangle labeled “C”, and NO line appears next to the triangle labeled “T”. A non-reactive test result means that HIV-a and HIV-2 antibodies were not detected in the specimen..




  • Preliminary Positive: A test is reactive (positive) if a reddish purple line appears next to both the triangles labeled “C” and “T”. One of the lines may appear darker than the other. A reactive test means that HIV-1 and/or HIV-2 antibodies have been detected in the specimen.



  • Invalid: A test is invalid if no lines appears next to the triangle labeled “C”, a red background appears in the result window after 20 minutes making it difficult to read, or if any of the lines are outside of the “C” and “T” areas.


* Dispose of test in wastebasket.
Step 4 – Event Report:


  • Complete SoDM event report, and submit to the Office of Clinical Affairs.

Step 5-Reorder:




  • OraQuick from SoDM Central Supply (Ross Hall) or Henry Schein (CLSCs)

May 2014


July 9, 2014
Dear ECU School of Dental Medicine “After Clinic Hours” Health Partner:

An ECU employee, resident, dental student or clinic patient may have been exposed to a source patient’s blood or other potentially infectious materials. We are requesting and authorizing you to perform the following blood tests and prescribe post-exposure prophylaxis, (based on current CDC guidelines) if post-exposure medications are indicated.


If your geographic location does not offer a 24-hour pharmacy, please provide a

3-day quantity and a prescription for 10 days, with 2 renewals


Source patient testing

  • Rapid HIV, HIV Viral Load if source patient is HIV positive

  • Hepatitis B Surface Antibody

  • Hepatitis B Core Antibody

  • Hepatitis B Surface Antigen

  • Hepatitis C Antibody

The exposed party will be baseline tested at our primary health partner the next business day.


Please fax lab results and any treatment records with your contact information to:

Dr. Paul Barry, MD, MPH, Director

ECU Office of Prospective Health

Phone: (252) 744-2070 Fax (252) 744-2417


NOTE: DO NOT BILL THE SOURCE PATIENT

ECU School of Dental Medicine is the guarantor.

Invoices with a claim statement should be sent to:

ECU School of Dental Medicine Office of Clinical Affairs

1851 MacGregor Downs Rd, Mail Stop 701

Greenville, NC 27834-4354

Phone: (252) 737-7008

Fax: (252) 737-7198
ECU School of Dental Medicine Accounts Payable Phone: (252) 737-7088.
Sincerely,

Dr. Robert R. Foreman

Associate Dean, Clinical Affairs

Director of Clinics













Appendix D Hand (contact) Dermatitis
All cases of hand dermatitis should be evaluated for treatment and follow-up. If open sores or weeping dermatitis exists, refrain from direct patient contact and handling of dental instruments and equipment until the condition is resolved.









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