Taking Safety Seriously

1. Perform hand hygiene— 

    a. When hands are visibly soiled. 

    b. After barehanded touching of instruments, equipment, materials, and other objects likely to be contaminated by blood, saliva, or respiratory secretions. 

    c. Before and after treating each patient. 

   d. Before putting on gloves and again immediately after removing gloves. 

2. Use soap and water when hands are visibly soiled (e.g., blood, body fluids); otherwise, an alcohol-based hand rub may be used.

1. Provide sufficient and appropriate PPE and ensure it is accessible to DHCP. 

2. Educate all DHCP on proper selection and use of PPE. 

3. Wear gloves whenever there is potential for contact with blood, body fluids, mucous membranes, non-intact skin or contaminated equipment. 

a. Do not wear the same pair of gloves for the care of more than one patient. 

b. Do not wash gloves. Gloves cannot be reused. 

c. Perform hand hygiene immediately after removing gloves. 

4. Wear protective clothing that covers skin and personal clothing during procedures or activities where contact with blood, saliva, or OPIM is anticipated. 

5. Wear mouth, nose, and eye protection during procedures that are likely to generate splashes or spattering of blood or other body fluids. 

6. Remove PPE before leaving the work area.

1. Implement measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and continuing throughout the visit. a. Post signs at entrances with instructions to patients with symptoms of respiratory infection to— i. Cover their mouths/noses when coughing or sneezing. ii. Use and dispose of tissues. iii. Perform hand hygiene after hands have been in contact with respiratory secretions. b. Provide tissues and no-touch receptacles for disposal of tissues. c. Provide resources for performing hand hygiene in or near waiting areas. d. Offer masks to coughing patients and other symptomatic persons when they enter the dental setting. e. Provide space and encourage persons with symptoms of respiratory infections to sit as far away from others as possible. If available, facilities may wish to place these patients in a separate area while waiting for care. 

2. Educate DHCP on the importance of infection prevention measures to contain respiratory secretions to prevent the spread of respiratory pathogens when examining and caring for patients with signs and symptoms of a respiratory infection.

1. Consider sharp items (e.g., needles, scalers, burs, lab knives, and wires) that are contaminated with patient blood and saliva as potentially infective and establish engineering controls and work practices to prevent injuries. 

2. Do not recap used needles by using both hands or any other technique that involves directing the point of a needle toward any part of the body. 

3. Use either a one-handed scoop technique or a mechanical device designed for holding the needle cap when recapping needles (e.g., between multiple injections and before removing from a non-disposable aspirating syringe). 

4. Place used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers located as close as possible to the area where the items are used.

1. Prepare injections using aseptic technique in a clean area. 

2. Disinfect the rubber septum on a medication vial with alcohol before piercing. 

3. Do not use needles or syringes* for more than one patient (this includes manufactured prefilled syringes and other devices such as insulin pens). 

4. Medication containers (single and multidose vials, ampules, and bags) are entered with a new needle and new syringe, even when obtaining additional doses for the same patient. 

5. Use single-dose vials for parenteral medications when possible. 

6. Do not use single-dose (single-use) medication vials, ampules, and bags or bottles of intravenous solution for more than one patient. 

7. Do not combine the leftover contents of single-use vials for later use. 

8. The following apply if multidose vials are used— a. Dedicate multidose vials to a single patient whenever possible. b. If multidose vials will be used for more than one patient, they should be restricted to a centralized medication area and should not enter the immediate patient treatment area (e.g., dental operatory) to prevent inadvertent contamination. c. If a multidose vial enters the immediate patient treatment area, it should be dedicated for single-patient use and discarded immediately after use. d. Date multidose vials when first opened and discard within 28 days, unless the manufacturer specifies a shorter or longer date for that opened vial. 

9. Do not use fluid infusion or administration sets (e.g., IV bags, tubing, con)

1. Clean and reprocess (disinfect or sterilize) reusable dental equipment appropriately before use on another patient. 

2. Clean and reprocess reusable dental equipment according to manufacturer instructions. If the manufacturer does not provide such instructions, the device may not be suitable for multi-patient use.    a. Have manufacturer instructions for reprocessing reusable dental instruments/equipment readily available, ideally in or near the reprocessing area. 

3. Assign responsibilities for reprocessing of dental equipment to DHCP with appropriate training. 

4. Wear appropriate PPE when handling and reprocessing contaminated patient equipment. 5. Use mechanical, chemical, and biological monitors according to manufacturer instructions to ensure the effectiveness of the sterilization process. Maintain sterilization records in accordance with state and local regulations.

1. Establish policies and procedures for routine cleaning and disinfection of environmental surfaces in dental health care settings. a. Use surface barriers to protect clinical contact surfaces, particularly those that are difficult to clean (e.g., switches on dental chairs, computer equipment) and change surface barriers between patients. b. Clean and disinfect clinical contact surfaces that are not barrier-protected with an EPA-registered hospital disinfectant after each patient. Use an intermediate-level disinfectant (i.e., tuberculocidal claim) if visibly contaminated with blood. 

2. Select EPA-registered disinfectants or detergents/disinfectants with label claims for use in health care settings. 

3. Follow manufacturer instructions for use of cleaners and EPA-registered disinfectants (e.g., amount, dilution, contact time, safe use, disposal).

1. Use water that meets EPA regulatory standards for drinking water (i.e., ≤ 500 CFU/mL of heterotrophic water bacteria) for routine dental treatment output water. 

2. Consult with the dental unit manufacturer for appropriate methods and equipment to maintain the quality of dental water. 

3. Follow recommendations for monitoring water quality provided by the manufacturer of the unit or waterline treatment product. 

4. Use sterile saline or sterile water as a coolant/irrigant when performing surgical procedures.

Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; October 2016.