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Developing a workable infection control policy for the dental laboratory
SECTION
EDITOR
oping a workable
infection
control
policy
for the dental
Pius M. Kimondollo, MS, MDT, CDTa Division of Allied Health and Public Services,Southern Illinois University, Carbondale, Ill. An enforced infection control policy in a laboratory will reduce occupational exposure to blood-borne pathogens and other infectious diseases and protect the dental laboratory personnel from exposure to infective disease. An outline of a workable laboratory infection control policy based on “Occupational Exposure to Bloodborne Pathogens” requirements is presented. (J PROSTHETDENT 1992;68:
974-S.)
D
ental health care personnel (DHCP) are aware of such transmissible diseases as hepatitis B, herpes simplex II, cytomegalovirus, mononucleosis, influenza, and other infectious diseases that have existed for many years. However, a renewed awareness has been brought about by the recognition of the most recent devastating disease, acquired immunodeficiency syndrome (AIDS). It is reinforced by the outcry from the general public, who are concerned about potentially devastating consequences that may occur if established guidelines for infection control are not followed by the DHCP. The public has the right to expect the DHCP to do everything possible to prevent the spread of transmissible diseases. In response to public and government concerns, the DHCP are adopting strict infection control policies, practicing appropriate procedures, and utilizing proper and effective disinfecting chemicals. As members of the DHCP, dental laboratory personnel (DLP), both owners and employees, have the moral and legal responsibility to prevent the spread of transmissible diseases to coworkers, other DHCP, patients, and/or their significant others via the dental laboratory. The DLP are in an ideal position to ensure that all items brought from the dental office to the laboratory are decontaminated before they are distributed and subjected to treatment. Likewise, after laboratory work has been completed, all items to be sent to the dental office and subsequently placed in the patient’s mouths should be disinfected before delivery. To succeed in controlling cross contamination of infectious diseases such as AIDS, hepatitis B, herpes II, and others, dental laboratories should develop and have in place a workable infection control policy that supports the practice of universal precautions by all DLP to reduce the spread of these diseases and to disseminate information regarding the diseases, mode of
transmission, and infection control measures. Essentially, the practice of universal precautions by all laboratory personnel requires that all human blood and certain human body fluids be treated as if known to be infectious for human immunodeficiency virus, hepatitis B virus, herpes II, or other blood-borne pathogens. For dental laboratory personnel, this means that all items received in the laboratory from the dental office should be treated as if known to be contaminated with infective diseases prevalent in dentistry. Likewise? all items that have been worked on in the laboratory should be disinfected before they are delivered to the dental office and subsequently placed in the patient’s mouth. Using universal precautions when doing dental laboratory procedures is in compliance with the “Occupational Exposure to Bloodborne Pathogens” requirement. This requirement is designed to protect DHCP from exposure to blood and other potentially infectious materia1s.l Compliance is the law, and violators face a possible fine of up to $10,000 per occurrence regardless of whether it is serious or nonserious. 3 A workable laboratory infection control policy will reduce occupational exposure to bloodborne pathogens and meet OSHA compliance requirements. Laboratory infection control policy statements should be precise, concise, and written in a language that is easy to understand. It must state what the employers’ obligations are, as well as the employees’ responsibilities to control infection in the dental laboratory. All laboratory personnel must be informed of the laboratory infection control policy and then required to sign an informed consent document (Fig. 1). It is recommended that each DHCP keep a copy of the laboratory infection control policy document. In addition, a copy of the laboratory policy document should be posted in a conspicuous place in the laboratory where notices for employees are customarily posted. SAMPLE
aAdjunct AssistantProfessorand Researcher,Dental Laboratory. 10/l/40961 974
DOCUMENT
This article will provide an outline of a laboratory infection control policy that was developed for the PIA Dental Laboratory, and will subsequently be referred to as PDL. DECEMBER
1992
VOLUME
68
NUMBER
6
WORKABLE
INFECTION
CONTROL
POLICY
The PDL depicted here is fictitious and is intended for communication purposes only. Dental laboratory owners and/or managers may use the PDL infection control policy as a model for developing a policy that fulfills their needs based on laboratory size. However, it is important that any developed laboratory infection control policy be in compliance with the “Occupational Exposure to Bloodborne Pathogens” requirement. The sample PDL infection control policy contains eight topics with subheadings.
I. Practice
of universal
precautions
All laboratory personnel procedures requiring contact with blood, items received from the dental office, or other potentially infectious materials will be performed with universal precautions. All items received from a dental office, such as jaw registrations, intraoral devises, impressions, repairs, crowns or dentures that have been tried in the mouth, and everything they have touched, shall be treated as if they are infected with hepatitis B virus (HBV), the human immunodeficiency virus (HIV), or other infectious diseases. All dental laboratory personnel are required to practice universal precautions.
II. Personal equipment
protective
materials
and
A. Employer responsibilities The PDL will provide all laboratory personnel who have the potential for occupational exposure with personal protective materials and equipment. Such protective materials and equipment will include gloves (disposable and/or puncture-resistant utility gloves), facemasks, protective eye wear, laboratory coats, and disinfecting materials and supplies such as handscrubs, cleaners, and disinfectants. These supplies, materials, and equipment will be provided to each individual in the laboratory based on the type of exposure expected. 3. Employee responsibilities 1. Disposable gloves. Disposable gloves shall be worn by all laboratory personnel whose hands have the potential for direct skin contact with blood or other potentially infectious materials and when handling items brought in the laboratory from the dental office. It also includes items that have been worked on in the dental laboratory and are ready to be delivered to the dental office, as well as surfaces soiled with blood or other potentially infectious materials. Laboratory procedures that require use of disposable gloves include pouring impressions, packing items to be delivered to the dental office, and unpacking items received in the dental laboratory from the dental office. It should be noted that glove wearing should not be regarded as a substitute for hand washing. Hands must be washed with antimicrobial solution before gloving and after removing gloves. 2. Utility gloves. Puncture-resistant utility gloves, such as neoprene or polynitrile gloves, shall be worn by all laboratory personnel when cleaning and disinfecting equipment and surfaces. After completing the task, the utility THE
JOURNAL
OF PROSTHETIC
DENTISTRY
gloves must be washed clean and disinfected before they are stored away. Utility gloves may be reused if the integrity has not been compromised and the glove is not cracked, peeling, torn, punctured, and does not exhibit other signs of deterioration. Laboratory procedures that require the use of utility gloves include cleaning and disinfecting items and surfaces such as sinks, pumice pans, case pans, bench tops, ultrasonic cleaners, facebow transfers, articulators, mixing bowls, mixing spatulas, bristle brushes, rag wheels, lathes, handpieces, vibrators, quick polymerization pots, model trimmers, containers for immersion disinfectants, grinding burs and stones, retrieving immersed prosthetics or appliance from disinfection solution, and disposing of potentially contaminated trash. 3. Face masks. Face masks and protective eye wear shall be worn by all laboratory personnel when performing procedures from which they may expect splashes, spray, spatter, droplets, or aerosols of contaminated liquid and there is potential for eye, nose, or mouth contamination. Laboratory procedures that require use of face masks and eye protective wear include pouring impression, using a vibrator, grinding with model trimmer, grinding with lathe or handpiece, and polishing with pumice on rotating bristle brushes and rag wheels. Frequent change of face masks is required, because moisture promotes the growth of bacterial microorganisms. 4. Laboratory coats. Laboratory coats shall be worn by all personnel when working in the laboratory. Such laboratory procedures may include polishing, trimming casts, handling and packaging potentially infectious waste, grinding, pouring impressions; unpacking items received in the laboratory from the dental office and items completed in the dental laboratory and ready to be delivered to the dental office; cleaning and disinfecting items that have been contaminated; cleaning and disinfecting surfaces such as sinks, pumice pans, case pans, ultrasonic cleaners, quick polymerization pots, cast trimmers, lathes, handpieces, and work bench tops.
III.
Vaccination
for hepatitis
B virus
A. Employer responsibilities The PDL shall make available hepatitis B virus vaccination to all laboratory personnel who experience occupational exposure on the average of one or more times per month unless he or she has a previous vaccination or an antibody test revealing immunity. All laboratory personnel who have an occupational exposure incident will be provided with counseling, post-exposure evaluation, and follow-up. A laboratory employee who initially refuses vaccination for hepatitis B virus and later changes his or her mind will be vaccinated at the expense of the PDL. B. Employee responsibilities 1. Laboratory personnel who receive the hepatitis B vaccine will do so at their own risk. 2. The PDL strongly recommends that all of its personnel be vaccinated against hepatitis B virus. However, lab975
KIMONDOLLO
PIA DENTALLAHCRATORY INFECTEN CONTROLPOLICY -A-NESS STATEMENTThe Occupational Safety and Health Administration (OSHA) Regulations requires that dental laboratory personnel (DLJ?) be made aware of the Laboratory Infection Control Policy at workplace (Rule 29 CFR 1910.1030 which became effective on March 6, 1992). The PIA Dental Laboratory (PDL) Infection Control Policy is in compliance with the New OSHA Regulations. After reading the "PDL Infection Control Policy" and other relevant infection control guidelines as provided to you by the Laboratory Safety Supervisor (I.%) during employees information and training session, please complete and return this form to your ES or laboratory owner/manager. Hy signing Bela, you acknrxledge that you are aware and have in you possession a copy of the PDL Infection Control Policy and the procedures applicable to the New OSHARegulations. The PDL/LSS will provide additional information and training as appropriate. employee Name (Please Print) Qloyee
Signature
Social Security
Date
Number Fig.
1. Infection
control
oratory personnel may wish not to be vaccinated. Employees declining vaccination will be required to sign a refusal document, which will be placed in the personnel file. Before an individual laboratory employee signs the refusal document, he or she will be provided the appropriate training regarding hepatitis B, hepatitis B vaccination, the efficacy, safety, methods of administration, and benefits of vaccination, and that the vaccine and vaccination are provided free of charge to him or her. The content of the “Refusal Document” or “Declination Statement” must contain the information in Fig. 2.
IV. Environmental and disinfection
and surface
cleaning
A. Employer responsibilities The PDL will develop and implement a written schedule for cleaning and disinfecting laboratory surfaces and maintaining a sanitary working environment. The written schedule will outline work sites to be cleaned and procedures to be done. Cleaning and disinfecting materials and equipment required to do any cleaning and disinfecting task will be provided by the laboratory to the employee doing the task. The cleaning and disinfecting schedule will
976
policy
awareness
statement.
be posted at a conspicuous place where notices to employees are customarily posted. B. Employee responsibilities 1. Laboratory personnel shall immediately clean and decontaminate all surfaces and items that potentially have been contaminated during packing and/or unpacking procedures; for example, decontamination procedures shall be performed after unpacking items received in the laboratory from the dental office and/or after packing items to be delivered to the dental office. 2. Laboratory personnel shall use cleaning and disinfecting procedures when: a. Surfaces such as sinks and bench tops are obviously contaminated. b. Reusable items such as puncture-resistant utility gloves, protective eye wear, case pans, pumice pans, quick polymerization pots, and ultrasonic units are contaminated. c. Equipment and containers such as packing boxes and trash containers have been contaminated. d. Potentially infectious materials have been spilled. This task shall be performed immediately after the incident has occurred.
DECEMBER
1992
VOLUME
66
NUMBER
6
WORKABLE
INFECTION
CONTROL
POLICY
DECLINATIONSTATEMENT "'I understand that due to my occupational elrposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opxxtunity to be Ho&ever, I vaccinated with hepatitis B vaccine, at no charge to myself. decline hepatitis B vaccination at this time. I understand that by declining this vaccine I continue to be at risk of acquiring hepatitis , a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatjtis B vaccine, I can receive the vaccination series at no charge to ma." Employee Signature Social Security
Date
Number Fig. 2. Declination statement.
e. Laboratory procedures that contaminate surfaces have been completed. f. Laboratory lathes and handpieces have been contaminated during grinding and/or polishing potentially contaminated dental prostheses and appliances. g. It is the end of the work day.
V. Biohazard A, Employer
labels
and symbols
responsibilities
The PDL will make available warning labels with a “Biohazard” symbol to identify infectious waste or other potentially infectious or harmful materials, such as trash containers, trash bags, and containers for sharp materials. B. Employee
responsibilities
Laboratory personnel must be aware of the items that require labels.
VI.
Clinics
Employer
and in-service
training
program
responsibilities
The PDL shall encourage all its employees to attend a clinic, course, or lecture at the time of initial employment and annually thereafter. These are usually available at professional meetings on the subject. However, if the laboratory conducts in-service training, all laboratory personnel will be required to participate in such training. The PDL will maintain a record of employees receiving training on infection control. The record will include names of employees attending the clinic or in-service training session(s), dates when the clinic or in-service training session(s) were conducted, individual clinician(s) conducting the clinic or in-service training session(s), and
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
the course content of the clinic or in-service training session(s). The clinic or in-service training session(s)should provide the participants with part or all of the following information and all of the following material must be presented at least once a year: 1. An explanation of the contents of the “Occupational Exposure to Bloodborne Pathogens” standard 2. An explanation of the dangers and symptoms of bloodborne diseases 3. An explanation of the modes of transmission of bloodborne pathogens 4. An outline of the PDL’s infection control program 5. A guideline for determining the tasks and procedures that may involve occupational exposure to bloodborne pathogens and other potentially infectious materials in the dental laboratory 6. An explanation of the practices that will prevent or reduce exposure to bloodborne pathogens and other infectious diseases, including appropriate engineering controls, workpractices, and personal protective equipment Information on the types, proper use of, location, removal, and handling of decontamination and/or disposal of personal protective equipment An explanation of the basis for the selection of personal protective materials and equipment Information on the hepatitis B vaccine, including its efficacy, safety, and the benefits of being vaccinated (The purpose of this information is to encourage all laboratory personnel to be vaccinated as part of the dental laboratory’s effort to lower the incidence of disease transmitted by occupational exposure.)
977
KIMONDOLLO
VII. General practices
laboratory
infection
control
All PDL personnel shall: 1. Wash their hands immediately after, or as soon as possible after, removal of gloves or other personal protective equipment and after hand contact with blood or other potentially infectious materials and items. 2. Remove immediately all personal protective equipment such as gloves, masks, eye wear, and laboratory coats on leaving the work area or as soon as possible if contaminated and place in a designated container for washing or disposal. 3. Not eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in prohibited areas in the dental laboratory or work areas where there is a potential for occupational exposure. 4. Perform all procedures involving blood or other potentially infectious materials in such a manner as to minimize splashing, spraying, and aerosolization of these substances. 5. Make slurry water from fresh set stone that has not been poured against an impression. 6. Clean and disinfect polishing rag wheels and bristle brushes, utilizing universal precautions. 7. Mix polishing pumice with a liquid disinfectant chemical. 8. Clean and disinfect grinding burs and stones with a disinfectant chemical. 9. Utilize disposable or utility gloves to retrieve items immersed in a disinfectant solution. 10. Not place ceramic brushes in the mouth when contouring or building up a ceramic crown. 11. Not use saliva to polish a wax pattern. 12. Replace expired disinfecting chemicals according to the manufacturer’s instructions 13. Change contaminated pumice after each use for polishing used prostheses. The pumice pan shall be cleaned and disinfected after each use. 14. Clean and disinfect grinding lathes and handpieces, following the manufacturer’s instructions.
978
VIII. Employer
Review
of infection
control
policy
responsibilities
The PDL will review the infection control policy every year and update it as necessary. In addition, periodic updates will be made whenever significant changes occur in laboratory tasks and/or procedures. CONCLUSION It is hoped that the foregoing outline of a workable laboratory infection control policy will be useful to laboratory owners, managers, and other individuals, such as laboratory safety supervisors, who are charged with the responsibility of developing and implementing an effective infection control policy. An infection control policy in the laboratory is an effort to reduce occupational exposure to bloodborne pathogens and protect its personnel from being infected. In addition, having a laboratory infection control policy complies with the ADA recommendations, CDC guidelines, and current OSHA requirements for prevention of the transmission of infectious diseases in a dental health setting. REFERENCES 1. Center for Disease Control. Update: Universal procedures for prevention of transmission of HIV, HBV, and other bloodborne pathogens in health care setting. MMWR, 1988;37:377. 2. Occupational Safety and Health Administration. Enforcement of procedures for occupational exposure to HBV and HIV. Washington, DC: OSHA Instruction CPL2-2-44B 1990. 3. Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens. U.S. Department of Labor. Washington, DC: Government Printing Office, 1992.
Reprint requests tot PIUS M. KIMONDOLLO, MS DIVISION OF ALLIED HEALTH AND PUBLIC SERVICES SOUTHERN ILLINOIS UNIVERSITY CARBONDALE, IL 62901
DECEMBER
1992
VOLUME
68
NUMBER
6
EDITOR
oping a workable
infection
control
policy
for the dental
Pius M. Kimondollo, MS, MDT, CDTa Division of Allied Health and Public Services,Southern Illinois University, Carbondale, Ill. An enforced infection control policy in a laboratory will reduce occupational exposure to blood-borne pathogens and other infectious diseases and protect the dental laboratory personnel from exposure to infective disease. An outline of a workable laboratory infection control policy based on “Occupational Exposure to Bloodborne Pathogens” requirements is presented. (J PROSTHETDENT 1992;68:
974-S.)
D
ental health care personnel (DHCP) are aware of such transmissible diseases as hepatitis B, herpes simplex II, cytomegalovirus, mononucleosis, influenza, and other infectious diseases that have existed for many years. However, a renewed awareness has been brought about by the recognition of the most recent devastating disease, acquired immunodeficiency syndrome (AIDS). It is reinforced by the outcry from the general public, who are concerned about potentially devastating consequences that may occur if established guidelines for infection control are not followed by the DHCP. The public has the right to expect the DHCP to do everything possible to prevent the spread of transmissible diseases. In response to public and government concerns, the DHCP are adopting strict infection control policies, practicing appropriate procedures, and utilizing proper and effective disinfecting chemicals. As members of the DHCP, dental laboratory personnel (DLP), both owners and employees, have the moral and legal responsibility to prevent the spread of transmissible diseases to coworkers, other DHCP, patients, and/or their significant others via the dental laboratory. The DLP are in an ideal position to ensure that all items brought from the dental office to the laboratory are decontaminated before they are distributed and subjected to treatment. Likewise, after laboratory work has been completed, all items to be sent to the dental office and subsequently placed in the patient’s mouths should be disinfected before delivery. To succeed in controlling cross contamination of infectious diseases such as AIDS, hepatitis B, herpes II, and others, dental laboratories should develop and have in place a workable infection control policy that supports the practice of universal precautions by all DLP to reduce the spread of these diseases and to disseminate information regarding the diseases, mode of
transmission, and infection control measures. Essentially, the practice of universal precautions by all laboratory personnel requires that all human blood and certain human body fluids be treated as if known to be infectious for human immunodeficiency virus, hepatitis B virus, herpes II, or other blood-borne pathogens. For dental laboratory personnel, this means that all items received in the laboratory from the dental office should be treated as if known to be contaminated with infective diseases prevalent in dentistry. Likewise? all items that have been worked on in the laboratory should be disinfected before they are delivered to the dental office and subsequently placed in the patient’s mouth. Using universal precautions when doing dental laboratory procedures is in compliance with the “Occupational Exposure to Bloodborne Pathogens” requirement. This requirement is designed to protect DHCP from exposure to blood and other potentially infectious materia1s.l Compliance is the law, and violators face a possible fine of up to $10,000 per occurrence regardless of whether it is serious or nonserious. 3 A workable laboratory infection control policy will reduce occupational exposure to bloodborne pathogens and meet OSHA compliance requirements. Laboratory infection control policy statements should be precise, concise, and written in a language that is easy to understand. It must state what the employers’ obligations are, as well as the employees’ responsibilities to control infection in the dental laboratory. All laboratory personnel must be informed of the laboratory infection control policy and then required to sign an informed consent document (Fig. 1). It is recommended that each DHCP keep a copy of the laboratory infection control policy document. In addition, a copy of the laboratory policy document should be posted in a conspicuous place in the laboratory where notices for employees are customarily posted. SAMPLE
aAdjunct AssistantProfessorand Researcher,Dental Laboratory. 10/l/40961 974
DOCUMENT
This article will provide an outline of a laboratory infection control policy that was developed for the PIA Dental Laboratory, and will subsequently be referred to as PDL. DECEMBER
1992
VOLUME
68
NUMBER
6
WORKABLE
INFECTION
CONTROL
POLICY
The PDL depicted here is fictitious and is intended for communication purposes only. Dental laboratory owners and/or managers may use the PDL infection control policy as a model for developing a policy that fulfills their needs based on laboratory size. However, it is important that any developed laboratory infection control policy be in compliance with the “Occupational Exposure to Bloodborne Pathogens” requirement. The sample PDL infection control policy contains eight topics with subheadings.
I. Practice
of universal
precautions
All laboratory personnel procedures requiring contact with blood, items received from the dental office, or other potentially infectious materials will be performed with universal precautions. All items received from a dental office, such as jaw registrations, intraoral devises, impressions, repairs, crowns or dentures that have been tried in the mouth, and everything they have touched, shall be treated as if they are infected with hepatitis B virus (HBV), the human immunodeficiency virus (HIV), or other infectious diseases. All dental laboratory personnel are required to practice universal precautions.
II. Personal equipment
protective
materials
and
A. Employer responsibilities The PDL will provide all laboratory personnel who have the potential for occupational exposure with personal protective materials and equipment. Such protective materials and equipment will include gloves (disposable and/or puncture-resistant utility gloves), facemasks, protective eye wear, laboratory coats, and disinfecting materials and supplies such as handscrubs, cleaners, and disinfectants. These supplies, materials, and equipment will be provided to each individual in the laboratory based on the type of exposure expected. 3. Employee responsibilities 1. Disposable gloves. Disposable gloves shall be worn by all laboratory personnel whose hands have the potential for direct skin contact with blood or other potentially infectious materials and when handling items brought in the laboratory from the dental office. It also includes items that have been worked on in the dental laboratory and are ready to be delivered to the dental office, as well as surfaces soiled with blood or other potentially infectious materials. Laboratory procedures that require use of disposable gloves include pouring impressions, packing items to be delivered to the dental office, and unpacking items received in the dental laboratory from the dental office. It should be noted that glove wearing should not be regarded as a substitute for hand washing. Hands must be washed with antimicrobial solution before gloving and after removing gloves. 2. Utility gloves. Puncture-resistant utility gloves, such as neoprene or polynitrile gloves, shall be worn by all laboratory personnel when cleaning and disinfecting equipment and surfaces. After completing the task, the utility THE
JOURNAL
OF PROSTHETIC
DENTISTRY
gloves must be washed clean and disinfected before they are stored away. Utility gloves may be reused if the integrity has not been compromised and the glove is not cracked, peeling, torn, punctured, and does not exhibit other signs of deterioration. Laboratory procedures that require the use of utility gloves include cleaning and disinfecting items and surfaces such as sinks, pumice pans, case pans, bench tops, ultrasonic cleaners, facebow transfers, articulators, mixing bowls, mixing spatulas, bristle brushes, rag wheels, lathes, handpieces, vibrators, quick polymerization pots, model trimmers, containers for immersion disinfectants, grinding burs and stones, retrieving immersed prosthetics or appliance from disinfection solution, and disposing of potentially contaminated trash. 3. Face masks. Face masks and protective eye wear shall be worn by all laboratory personnel when performing procedures from which they may expect splashes, spray, spatter, droplets, or aerosols of contaminated liquid and there is potential for eye, nose, or mouth contamination. Laboratory procedures that require use of face masks and eye protective wear include pouring impression, using a vibrator, grinding with model trimmer, grinding with lathe or handpiece, and polishing with pumice on rotating bristle brushes and rag wheels. Frequent change of face masks is required, because moisture promotes the growth of bacterial microorganisms. 4. Laboratory coats. Laboratory coats shall be worn by all personnel when working in the laboratory. Such laboratory procedures may include polishing, trimming casts, handling and packaging potentially infectious waste, grinding, pouring impressions; unpacking items received in the laboratory from the dental office and items completed in the dental laboratory and ready to be delivered to the dental office; cleaning and disinfecting items that have been contaminated; cleaning and disinfecting surfaces such as sinks, pumice pans, case pans, ultrasonic cleaners, quick polymerization pots, cast trimmers, lathes, handpieces, and work bench tops.
III.
Vaccination
for hepatitis
B virus
A. Employer responsibilities The PDL shall make available hepatitis B virus vaccination to all laboratory personnel who experience occupational exposure on the average of one or more times per month unless he or she has a previous vaccination or an antibody test revealing immunity. All laboratory personnel who have an occupational exposure incident will be provided with counseling, post-exposure evaluation, and follow-up. A laboratory employee who initially refuses vaccination for hepatitis B virus and later changes his or her mind will be vaccinated at the expense of the PDL. B. Employee responsibilities 1. Laboratory personnel who receive the hepatitis B vaccine will do so at their own risk. 2. The PDL strongly recommends that all of its personnel be vaccinated against hepatitis B virus. However, lab975
KIMONDOLLO
PIA DENTALLAHCRATORY INFECTEN CONTROLPOLICY -A-NESS STATEMENTThe Occupational Safety and Health Administration (OSHA) Regulations requires that dental laboratory personnel (DLJ?) be made aware of the Laboratory Infection Control Policy at workplace (Rule 29 CFR 1910.1030 which became effective on March 6, 1992). The PIA Dental Laboratory (PDL) Infection Control Policy is in compliance with the New OSHA Regulations. After reading the "PDL Infection Control Policy" and other relevant infection control guidelines as provided to you by the Laboratory Safety Supervisor (I.%) during employees information and training session, please complete and return this form to your ES or laboratory owner/manager. Hy signing Bela, you acknrxledge that you are aware and have in you possession a copy of the PDL Infection Control Policy and the procedures applicable to the New OSHARegulations. The PDL/LSS will provide additional information and training as appropriate. employee Name (Please Print) Qloyee
Signature
Social Security
Date
Number Fig.
1. Infection
control
oratory personnel may wish not to be vaccinated. Employees declining vaccination will be required to sign a refusal document, which will be placed in the personnel file. Before an individual laboratory employee signs the refusal document, he or she will be provided the appropriate training regarding hepatitis B, hepatitis B vaccination, the efficacy, safety, methods of administration, and benefits of vaccination, and that the vaccine and vaccination are provided free of charge to him or her. The content of the “Refusal Document” or “Declination Statement” must contain the information in Fig. 2.
IV. Environmental and disinfection
and surface
cleaning
A. Employer responsibilities The PDL will develop and implement a written schedule for cleaning and disinfecting laboratory surfaces and maintaining a sanitary working environment. The written schedule will outline work sites to be cleaned and procedures to be done. Cleaning and disinfecting materials and equipment required to do any cleaning and disinfecting task will be provided by the laboratory to the employee doing the task. The cleaning and disinfecting schedule will
976
policy
awareness
statement.
be posted at a conspicuous place where notices to employees are customarily posted. B. Employee responsibilities 1. Laboratory personnel shall immediately clean and decontaminate all surfaces and items that potentially have been contaminated during packing and/or unpacking procedures; for example, decontamination procedures shall be performed after unpacking items received in the laboratory from the dental office and/or after packing items to be delivered to the dental office. 2. Laboratory personnel shall use cleaning and disinfecting procedures when: a. Surfaces such as sinks and bench tops are obviously contaminated. b. Reusable items such as puncture-resistant utility gloves, protective eye wear, case pans, pumice pans, quick polymerization pots, and ultrasonic units are contaminated. c. Equipment and containers such as packing boxes and trash containers have been contaminated. d. Potentially infectious materials have been spilled. This task shall be performed immediately after the incident has occurred.
DECEMBER
1992
VOLUME
66
NUMBER
6
WORKABLE
INFECTION
CONTROL
POLICY
DECLINATIONSTATEMENT "'I understand that due to my occupational elrposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opxxtunity to be Ho&ever, I vaccinated with hepatitis B vaccine, at no charge to myself. decline hepatitis B vaccination at this time. I understand that by declining this vaccine I continue to be at risk of acquiring hepatitis , a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatjtis B vaccine, I can receive the vaccination series at no charge to ma." Employee Signature Social Security
Date
Number Fig. 2. Declination statement.
e. Laboratory procedures that contaminate surfaces have been completed. f. Laboratory lathes and handpieces have been contaminated during grinding and/or polishing potentially contaminated dental prostheses and appliances. g. It is the end of the work day.
V. Biohazard A, Employer
labels
and symbols
responsibilities
The PDL will make available warning labels with a “Biohazard” symbol to identify infectious waste or other potentially infectious or harmful materials, such as trash containers, trash bags, and containers for sharp materials. B. Employee
responsibilities
Laboratory personnel must be aware of the items that require labels.
VI.
Clinics
Employer
and in-service
training
program
responsibilities
The PDL shall encourage all its employees to attend a clinic, course, or lecture at the time of initial employment and annually thereafter. These are usually available at professional meetings on the subject. However, if the laboratory conducts in-service training, all laboratory personnel will be required to participate in such training. The PDL will maintain a record of employees receiving training on infection control. The record will include names of employees attending the clinic or in-service training session(s), dates when the clinic or in-service training session(s) were conducted, individual clinician(s) conducting the clinic or in-service training session(s), and
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
the course content of the clinic or in-service training session(s). The clinic or in-service training session(s)should provide the participants with part or all of the following information and all of the following material must be presented at least once a year: 1. An explanation of the contents of the “Occupational Exposure to Bloodborne Pathogens” standard 2. An explanation of the dangers and symptoms of bloodborne diseases 3. An explanation of the modes of transmission of bloodborne pathogens 4. An outline of the PDL’s infection control program 5. A guideline for determining the tasks and procedures that may involve occupational exposure to bloodborne pathogens and other potentially infectious materials in the dental laboratory 6. An explanation of the practices that will prevent or reduce exposure to bloodborne pathogens and other infectious diseases, including appropriate engineering controls, workpractices, and personal protective equipment Information on the types, proper use of, location, removal, and handling of decontamination and/or disposal of personal protective equipment An explanation of the basis for the selection of personal protective materials and equipment Information on the hepatitis B vaccine, including its efficacy, safety, and the benefits of being vaccinated (The purpose of this information is to encourage all laboratory personnel to be vaccinated as part of the dental laboratory’s effort to lower the incidence of disease transmitted by occupational exposure.)
977
KIMONDOLLO
VII. General practices
laboratory
infection
control
All PDL personnel shall: 1. Wash their hands immediately after, or as soon as possible after, removal of gloves or other personal protective equipment and after hand contact with blood or other potentially infectious materials and items. 2. Remove immediately all personal protective equipment such as gloves, masks, eye wear, and laboratory coats on leaving the work area or as soon as possible if contaminated and place in a designated container for washing or disposal. 3. Not eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in prohibited areas in the dental laboratory or work areas where there is a potential for occupational exposure. 4. Perform all procedures involving blood or other potentially infectious materials in such a manner as to minimize splashing, spraying, and aerosolization of these substances. 5. Make slurry water from fresh set stone that has not been poured against an impression. 6. Clean and disinfect polishing rag wheels and bristle brushes, utilizing universal precautions. 7. Mix polishing pumice with a liquid disinfectant chemical. 8. Clean and disinfect grinding burs and stones with a disinfectant chemical. 9. Utilize disposable or utility gloves to retrieve items immersed in a disinfectant solution. 10. Not place ceramic brushes in the mouth when contouring or building up a ceramic crown. 11. Not use saliva to polish a wax pattern. 12. Replace expired disinfecting chemicals according to the manufacturer’s instructions 13. Change contaminated pumice after each use for polishing used prostheses. The pumice pan shall be cleaned and disinfected after each use. 14. Clean and disinfect grinding lathes and handpieces, following the manufacturer’s instructions.
978
VIII. Employer
Review
of infection
control
policy
responsibilities
The PDL will review the infection control policy every year and update it as necessary. In addition, periodic updates will be made whenever significant changes occur in laboratory tasks and/or procedures. CONCLUSION It is hoped that the foregoing outline of a workable laboratory infection control policy will be useful to laboratory owners, managers, and other individuals, such as laboratory safety supervisors, who are charged with the responsibility of developing and implementing an effective infection control policy. An infection control policy in the laboratory is an effort to reduce occupational exposure to bloodborne pathogens and protect its personnel from being infected. In addition, having a laboratory infection control policy complies with the ADA recommendations, CDC guidelines, and current OSHA requirements for prevention of the transmission of infectious diseases in a dental health setting. REFERENCES 1. Center for Disease Control. Update: Universal procedures for prevention of transmission of HIV, HBV, and other bloodborne pathogens in health care setting. MMWR, 1988;37:377. 2. Occupational Safety and Health Administration. Enforcement of procedures for occupational exposure to HBV and HIV. Washington, DC: OSHA Instruction CPL2-2-44B 1990. 3. Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens. U.S. Department of Labor. Washington, DC: Government Printing Office, 1992.
Reprint requests tot PIUS M. KIMONDOLLO, MS DIVISION OF ALLIED HEALTH AND PUBLIC SERVICES SOUTHERN ILLINOIS UNIVERSITY CARBONDALE, IL 62901
DECEMBER
1992
VOLUME
68
NUMBER
6