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Looking inside the 2003 CDC dental infection control guidelines.

On Dec. 19, 2003, the Centers for Disease Control and Prevention published updated infection control guidelines for dentistry. The guidelines provide comprehensive information on all aspects of dental infection control. The recommendations are designed to prevent or reduce the potential for disease transmission from patient to dental health care personnel, from dental health care personnel to patient, and from patient to patient. Most recommendations will be familiar and are already practiced routinely. This article highlights major updates and additions in the CDC guidelines and provides additional information to assist readers in applying the latest guidelines. Almost a year ago, the CDC and Prevention published updated dental infection control guidelines in a supplement to the Morbidity and Mortality Weekly Report. The Guidelines for Infection Control in Dental Health Care Settings--2003 represent a collaborative effort between leading experts in infection control from other federal agencies, public health, and hospital epidemiology and infection control. Unlike regulatory agencies such as the Occupational Safety and Health Administration, the U.S. Food and Drug Administration, or the U.S. Environmental Protection Agency, the CDC cannot mandate certain practices; it can only recommend. However, the CDC is recognized as the nation's disease prevention agency and develops a broad range of guidelines intended to improve health care and to inform clinicians and the public. As a result, many dental licensing boards adopt CDC's recommendations, or variations of them, as the infection control standard for dental practice in their states. In contrast to the 1986 and 1993 CDC dental infection control recommendations, the 2003 CDC publication includes more background information and the scientific rationale for the recommendations. Also, readers will notice that each recommendation has a rank assigned to it categorizing the recommendation on the basis of existing scientific data, theoretical rationale, and applicability (Table 1). Most recommendations will be familiar and already are practiced routinely. As with previous CDC recommendations, the guidelines are designed to prevent or reduce the potential for disease transmission from patient to dental health care personnel; from dental health care personnel to patient, and from patient to patient. The following is an overview highlighting major updates and additions in the 2003 CDC guidelines. It is not intended to be a comprehensive review. Readers can access the complete document (Figure 1) by visiting www.cdc.gov/oralhealth/ infectioncontrol.

Centers for Disease Control and Prevention, U.S.↗

Dental infection control at the year 2000. Accomplishment recognized.

OVERVIEW: Health care providers have strived to address the many elements necessary to achieve effective infection control. Historical progress in microbiology and hospital asepsis provided the foundation for advances in dental preventive practices. Evidence supporting the application of current practices includes a long history of scientific and clinical investigations, technological advances in equipment and materials, and periodic publication of updated recommendations by professional health care organizations. CLINICAL IMPLICATIONS: The routine application of precautions such as multiple aseptic procedures, latex gloves, masks, protective eyewear, clinic coats, automated instrument decontamination devices, time-efficient heat sterilization modalities, chemical disinfectants, waste management procedures and single-use disposable items have created a safer environment for dental personnel and patients alike.

Asepsis↗

Dental infection control at the year 2000: accomplishment recognized.

OVERVIEW: Health care providers have strived to address the many elements necessary to achieve effective infection control. Historical progress in microbiology and hospital asepsis provided the foundation for advances in dental preventive practices. Evidence supporting the application of current practices includes a long history of scientific and clinical investigations, technological advances in equipment and materials, and periodic publication of updated recommendations by professional health care organizations. CLINICAL IMPLICATIONS: The routine application of precautions such as multiple aseptic procedures, latex gloves, masks, protective eyewear, clinic coats, automated instrument decontamination devices, time-efficient heat sterilization modalities, chemical disinfectants, waste management procedures and single-use disposable items have created a safer environment for dental personnel and patients alike.

Asepsis↗

Dental dams: the secret tool for infection control.

Dental dams, although in existence for over 100 years, are the most widely underused tool of infection control. This article addresses the many benefits of using dental dams and discusses simplified methods of incorporating dams into the dental practice.

Humans↗

Factors affecting the role of dental surgery assistants in cross-infection control in dental practice.

A study of cross-infection control in general dental practices in the North Western Health Region of England suggested that much of its quality might lie in the hands of dental surgery assistants (S. Doohan, 1991, personal communication). The present paper describes part of a programme of work intended to improve cross-infection control in general dental practices and to discover any factors which might affect this control. A qualitative study of dental surgery assistants' behaviour was used to devise an interview schedule for making quantitative assessments; these were made in visits to 82 general dental practices. A high proportion of DSAs were aware that they are failing to carry out cross-infection control procedures and were worried by this.

Cross Infection↗

Infection control and dental practice: frequently asked questions.

The principles of infection control are constantly evolving to meet the challenges presented by newly emerging diseases. The Centers for Disease Control and Prevention (CDC) Guideline for Infection Control in Dental Health-Care Settings, 2003, is an important update of current infection control practices that will help the dental profession be better prepared to reduce the transmission of infectious disease(s) in the foreseeable future. However, basic questions still abound. This article reviews frequently asked questions and formats their answers according to recommendations from the 2003 CDC document.

Centers for Disease Control and Prevention, U.S.↗

Infection control practices for dental radiography.

Infection control for dental radiography employs the same materials, processes, and techniques used in the operatory, yet unless proper procedures are established and followed, there is a definite potential for cross-contamination to clinical area surfaces and DHCP. In general, the aseptic practices used are relatively simple and inexpensive, yet they require complete application in every situation.

Asepsis↗

Infection control for dental radiographic procedures in US dental hygiene programmes.

Infection control in dental radiographic procedures in US dental hygiene programmes has been investigated by means of a questionnaire and 76% (n = 148) responded. For intra-oral radiography, all but two programmes required the use of gloves during exposure procedures and 94% also required them during processing. Glasses, masks and other protective clothing were required less frequently than gloves. Equipment and working surfaces in the radiographic operatory were generally either disinfected or draped. Equipment and working surfaces in the darkroom were not usually afforded the same degree of diligence in disinfection. Most programmes dried film packets before processing and gave no special treatment to films after processing. Waste products were generally either tied off and marked as a biohazard or sterilized.

Dental Hygienists↗

Environmental barriers in dental office infection control.

The emphasis of this article is to explain the utility of incorporating disposable, single-use environmental-surface infection control barriers into dental office infection control programs. Use of barriers in dental operatories and x-ray rooms can increase infection control effectiveness, reduce operatory turn-around time between patients, and actually reduce office time and expenses associated with infection control. This article is not intended to be a cookbook on how to do it, but rather a guide to the understanding of why dentists should consider using disposable barriers in place of chemical disinfectants wherever possible. Understanding the barrier concept will enable readers to problem-solve their own facility's needs and to select appropriate materials on their own.

Communicable Disease Control↗

Guidelines for infection control in dental health care settings--2003.

BACKGROUND: The Centers for Disease Control and Prevention, or CDC, is the lead federal agency for disease prevention in the United States. It has been 10 years since CDC infection control guidelines for dental health care settings were last published. During those 10 years, new technologies and issues have emerged, and other CDC infection control guidelines for health care settings have been updated. RESULTS: In light of these developments, CDC collaborated with experts in infection control to revise its infection control recommendations for dental health care settings. Existing guidelines and published research pertinent to dental infection control principles and practices were reviewed. This article provides background information, describes the process used to create these guidelines, and lists the new recommendations. CLINICAL IMPLICATIONS: CDC believes that dental offices that follow these new recommendations will strengthen an already admirable record of safe dental practice. Patients and providers alike can be assured that oral health care can be delivered and received in a safe manner.

Blood-Borne Pathogens↗

Progress in infection control in dental education.

While guidelines on proper infection control practices for dentistry have been available for over a decade, evidence suggests that recommended infection control practices are not universally employed in dentistry or dental education. A self-administered written survey was mailed to all U.S. dental schools in spring 1986 to assess the status of infection control curricula, standards, and practices. From the 47 schools that responded it is evident that, while progress is occurring in dental education relative to improved infection control standards and practice, much remains to be accomplished.

American Dental Association↗

Infection control for dental radiographic procedures.

The employment of proper infection control procedures in the dental office is necessary to prevent the spread of infectious agents. The potential for cross contamination between dental personnel and the patient is considerable when exposing intraoral radiographs. The dental office darkroom or daylight loader can also be a potential contamination source if good infection control measures are not followed. By utilizing PPE, plastic barriers and disinfectants, DHCPs can minimize the likelihood of problems with contamination.

Dental Disinfectants↗