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TRANSCRIPT
Development of CDC’s Summary of
Infection Prevention Practices in Dental
Settings: Basic Expectations for
Safe Care
Michele Junger, DDS, MPH
Division of Oral Health
OSAPJune 3, 2016
National Center for Chronic Disease Prevention and Health Promotion
Division of Oral Health
Disclosures
Division of Oral Health
National Center for Chronic Disease Prevention and Health Promotion
The findings and conclusions of this presentation are those of the
authors and do not necessarily represent the official position of the
Centers for Disease Control and Prevention
Disclosure: Neither I nor members of my immediate family have
any financial relationships with commercial entities that may be
relevant to this presentation.
Objectives
� To discuss CDC’s role in infection prevention
� To describe documented transmissions of
infectious agents in dental settings from 2003-
2015 and discuss their implications
� To discuss the need and purpose of the new CDC
Summary and Checklist
CDC Develops Guidelines
CDC Investigates
� Assist in identifying the source of the transmission
and, hopefully, eliminating it
� Present an opportunity to evaluate existing
prevention strategies and identify gaps
� Allow us to describe new diseases and to learn
more about known diseases
� Identifying breaches in infection prevention
allows us to determine the risk of transmission
� Patient notification and testing
Dental Transmissions, 2003-2015
Transmission of Bloodborne Pathogens in US Dental Settings, 2003-2015
� Since the release of the 2003 guidelines, CDC’s
Division of Oral Health has continued to review
the scientific literature
� Literature review to identify documented reports
of bloodborne pathogen (BBP) transmission in
dental settings since 2003
� Reviewed summary from the Division of Viral
Hepatitis of suspected health care-associated
hepatitis transmissions during 2003-2015
http://www.cdc.gov/hepatitis/Outbreaks/HealthcareHepOutbreakTable.htm
Transmission of Bloodborne Pathogens in US Dental Settings, 2003-2015
No confirmed reports of HIV transmission in dental settingsSetting Year Pathogen No.
Infected
Comments
OMS Practice 2001 HBV 1 Pt-to-Pt – U.S.
Portable
Dental clinic in
school
gymnasium
2009 HBV 5 Of the 5 cases, 3 were patients
and 2 were non-healthcare
worker volunteers – U.S.
Multiple procedural and
infection control breaches were
identified.
OMS Practice 2013 HCV 1 Pt-to pt – U.S.
Multiple breaches in injection
safety documented.
Redd, et al. J Infect Dis. 2007;195(12):1874].
Radcliffe, et al. JADA. 2013;144(10):1110-1118.
Bradley, OK State Department of Health, www.ok.gov/health2/documents/Dental%20Healthcare_Final%
20Report_2_17_15.pdf.
Pending Manuscript
� Conclusions
� Reports describing the transmission of BBPs in dental
settings since 2003 were rare.
� Failure to adhere to CDC recommendations for
infection control in dental settings likely led to disease
transmission in identified cases.
� Practical implications:
� Emphasizes the need to improve dental health care
personnel's understanding of the basic principles and
implementation of standard precautions
Reports of Non-bloodborne Pathogen Transmissions in Dental Settings, 2003-2015
Setting Year Pathogen No. Infected Comments
General
Dental
2010 M. tuberculosis 1 DHCP to DHCP – U.S.
TB was misdiagnosed
General
Dental
2011 L. pneumophila 1 82 yo woman - Italy
Unknown if waterlines
treated
Pediatric
Dental Clinic
2015 Mycobacterium
abscessus
Ongoing Children - U.S.
Potentially linked to
untreated waterlines
Merte JL, et al. JADA. 2014;145(5):464-471
Ricci ML, et al. Lancet. 2012;379(9816):684.
Peralta, G, et al. MMWR Morb Mortal Wkly Rep 2016;65: 355-356.
Resources for Investigating Outbreaks
www.cdc.gov/injectionsafety/pntoolkit/index.html
Resources for Investigating Outbreaks
http://www.cdc.gov/hepatitis/Outbreaks/
IDENTIFIED OUTBREAKS
�Asymptomatic infection
�Under-reporting of
cases
�Under-recognition of healthcare as
risk
�Barriers to investigation
�Difficulty identifying
single healthcare exposure
�Resource constraints
What Are We Missing?
Objective
� To estimate the
percentage of U.S.
dentists using four new
CDC infection control
recommendations and
to identify factors
associated with their
adoption
Advancing Infection Control in
Dental Care Settings
Cleveland J, et al. J Am Dent Assoc 2012;143(10):1127–1138
Methods
� Surveyed a random sample of 6825 U.S. dentists
(response rate 49%)
� Assessed implementation of 4 new infection
control recommendations
� Having an IC coordinator
� Referring persons with sharps injuries
� Trying/adopting safety devices
� Maintaining and monitoring dental water quality
Cleveland J, et al. J Am Dent Assoc 2012;143(10):1127–1138
Results
� Implementation of practices
� 34% none or one
� 40% two
� 26% three or four
� The likelihood of implementation was higher
among dentists who
� Acknowledged the importance of infection control
� Had practiced dentistry for less than 30 years
� Had received more continuing dental education
credits in infection control
� Had received multiple modes of training
Cleveland J, et al. J Am Dent Assoc 2012;143(10):1127–1138
Conclusions
� Implementation of infection control
recommendations varied among U.S. dentists.
� Strategies targeted at raising awareness of the
importance of infection control and increasing
continuing education requirements may
increase implementation.
Cleveland J, et al. J Am Dent Assoc 2012;143(10):1127–1138
Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care
� Summary of basic infection
prevention expectations
for safe care in all dental
settings
� Based on Standard
Precautions
� Supplements existing CDC
recommendations
(not a replacement)
� Links to references &
additional resources
http://www.cdc.gov/OralHealth/infectioncontrol/guidelines/index.htm
Program Evaluation
� Develop standard operating procedures
� Evaluate infection prevention practices
� Document adverse outcomes
� Document work-related illnesses
� Monitor health care associated infections
“Systematic way to ensure procedures are useful,
feasible, ethical, and accurate”
Checklist to evaluate
compliance with infection
prevention practices
– Administrative
policies
– Observation of
personnel and
patient-care
Infection Prevention Checklist for
Dental Settings
http://www.cdc.gov/oralhealth/infectioncontrol/index.htm
Fillable
Checklist
http://www.cdc.gov/OralHealth/infectioncontrol/guidelines/index.htm
Compendium
Document
CDC’s Division of Oral Health and
Office of Informatics and
Information Resources
Management are developing a
mobile app to provide dental
health care personnel with access
to an interactive version of the
Infection Prevention Checklist for Infection Prevention Checklist for Infection Prevention Checklist for Infection Prevention Checklist for
Dental Settings Dental Settings Dental Settings Dental Settings in a portable, easy
to use, and streamlined format.
Infection Prevention Checklist
Mobile App
App Objectives
� To facilitate use of CDC’s evidence-based
infection prevention recommendations
� To make recommendations more accessible
by providing access offline
� To provide structure and guidance for
evaluation of infection prevention practices
� Check Yes/No to acknowledge compliance
� Notes section for documentation
� Ability to export results for records
management
� Links to related resources
� Glossary of terms
Potential App Functionality
� Will be conducting user research at the 2016
OSAP Symposium
� CDC is also recruiting volunteers for user
testing throughout the development process
If you would like to volunteer to participate in
future studies, please sign up today!
User Research and Testing
