NEVADA STATE BOARD

of

DENTAL EXAMINERS

INFECTION CONTROL

RESOURCE GROUP

MEETING

AUGUST 1, 2014

8:00 a.m.

PUBLIC BOOK

Red numbers correspond to current IC audit form. P ease review Dr Heliwinkle’s suggestionsin black, along with the current audit form for discussion and/or changes/no changes

Record Keeping - Each Practice must have:

1. Written Infection Control Program that is specific for the ownerMicensee at that location YINlevel 3

This IC program must include:

Personnel Health Elements:

1. Education and training:

(1k Documentation of review of the written infection control plan at least annually to ensurecompliance with best practices. YIN level 3

(2 Documentation of Bloodborne Pathogen training at the date of hire for that practice andannually thereafter. YIN level 3

(35/36 Education and training should be appropriate to the assigned duties of the specific DHCPand include hands on training for all staff assigned to process semi critical and criticalinstruments. YIN level 3

(9) d. Training records kept for 3+ years YIN level 3

(4) e. Documents corrective actions for all deviations from written policy. YIN level 3

2. Immunization Programs/Maintenance of Records, Data Management, and Confidentiality

(5) a. Up to date confidential employee health records Y/N level 3

(20) b. Employee health records include documentation of vaccinations offered to DHCP per CDCguidelines. Y/N level 3

(10) c. Employee health records include informed consent of risk and proper documentation ofvaccinations/immunizations declined by DHCP. YIN level 3

(22) d. Employee health records include vaccination records for all DHCR Y/N level 3

(6) e. Employee health records kept for duration of employment plus thirty years. YIN level 3

(7) f. Employee health records include any exposure and post- exposure and follow-up records.

YIN level 3

3. Exposure and Postexposure Management:

(25) a. Written policies and procedures regarding all occupational exposures which include postexposure medical evaluation plan ( e.g. use CDC needle stick/sharps injury/exposure protocol)Y/N level 3

(25) b. 2417 contact telephone number listed for qualified designated health care provider. V/Nlevel 3

Text c. Exposure and incident reporting forms available V/N level 3

(24)ci Includes a sharps injury log YIN level 3

5. Medical Conditions, Work Related Illness, and Work Restrictions:

(32) a. Written policy and procedure for patients known to have communicable disease on arrival.V/N level 3

b. Written policy and procedure for work restrictions for employees infected with or exposedto communicable diseases. YIN level 3

Bloodborne Pathogens Elements:

1) Written Policies and Procedures for the Prevention of Transmission of BloodbornePathogens:

a. Includes written policies for hand hygiene. Y/N level 3

(38)~~ Provides and documents training in hand hygiene, including selection of antiseptic agentsY/N level 3

(1 ~. Includes written policies for use of personal protective equipment (PPE). YIN level 3

(37)cj. Monitors and documents compliance with use of PPE. V/N levels 3

(23) e. Includes written policies and procedures for handling and management of sharps. YIN

level 3

2) Sterilization and Disinfection of Patient Care Items:

a. Includes a written process for managing semi critical and critical items YIN level 3

b. Includes a written system of the ENTIRE sterilization process, (a written process fortransporting and processing of contaminated critical and semi critical instruments, the

instrument processing area, preparation and packaging of instruments, sterilization, and storageof sterilized instruments and clean dental items) YIN level 3

(1 6) c. Includes a written procedure for sterilization monitoring YIN level 3

(1 2)d. Includes biological weekly monitoring logs YIN level 1

Includes up to date maintenance log for sterilization equipment YIN level 3

(15)f. Includes weekly biological testing log for 2+ years or since opening Date: YIN level 3

(1 8) g. Includes a written process for managing failed chemical, heat or biological monitoring YIN

level 3

(11 ~h. Includes equipment and maintenance logs. YIN levelS

3) Environmental Infection Control Elements:

(29) a. Includes written policies and procedures for aseptic management during patient care. YIN

level 3

(30) b. Includes written policies and procedures for surface disinfection and environmental barrierprotection Y/N level 3

(27) c. Includes written policies and procedures for medical waste management YIN level 3

(28) d. Includes name and telephone number of licensed waste hauler for regulated waste. YIN

level 3

e. Includes written policies and procedures for decontaminating spills of blood and other bodyfluids. YIN level 3

f. Includes written policies and procedures to improve dental unit water quality Y/N level 3

(67) g. Includes documentation of dental unit water lines testing to meet the potable waterstandard of EPA (<500 CFUImI). Y/N level 4

(99) h. Includes written policies and procedures to prevent cross contamination when taking andprocessing dental radiographs YIN level 3

(31) i. Includes written policies and procedures for laboratory procedures YIN level 3

4) Other:

(33) a. A comprehensive medical history form is used to evaluate patients YIN level 3

Patient medical history is routinely reviewed and updated. YIN level 3

Regarding Communicable Disease Control Procedures:

(58)1 would reduce item 58 to a level 2 (Sterile Surgical Gloves)

(82) I would rephrase item 82 to how it is stated in the CDC guidelines: Use a biological indicator forevery sterilizer load that contains an implantable device. Verify results before using theimplantable device, whenever possible. YIN level 1

Otherwise I would not change anything on pages 3 and 4.

For IC committee members: (and board members, if interested)

OSAP’s course for IC committee members to take prior to August 1 meeting:

CDC power point presentation for IC committee members to view prior to August 1meeting:

New media campaign targeting patients Oust FYI):III

— a

For all board members:Report from OSAP annual symposium June 2014

Entire OSAP 2014 Symposium Content:htto: //www.osap.org/?page=2Ol4SvmFinCont

The following are the courses that I was able to attended, with the direct link tocourse content and a few pearls of information picked up.

*Infectious diseases in a crazy modern worldI ii

H7N9-bad one, CDC unsure how its going to be stopped since birds are notshowing signs of being sick. MERS-likely from camels will reduce in summer but beback in early spring. Polio is middle east prominent and cases increasing.tlnfection control at the intersection of guidelines, regulations and standards

P I I • I II’ ~I - II I~

‘I

• I I 1’

II

I I I — I_Il. • I PS P

MMWR 2003-review will be published with articles. 2003 is still relevant,some areas will have newer reviews, no new recommendations, focus is oncompliance. Figuring out how to format and publish, maybe in 2015.FDA-If no instructions are provided by company then treat as single use. ALLdiamond coated burs, instruments, etc. are defined by FDA as SINGLE USE.Dental standards: ANSI, 150, ADA, AAMI.Shorter time for 81(2 hour)

tConspiracy Theories in Science- It’s not possible to get evidence based in all aspectsof dentistry

tlnfection control in Dentistry-then, now and what’s next-H IV

I

* laboratory infection control protocols• ‘II — I

-clean lab (IC done in op) vs. dirty lab (IC done in lab) Communication withlaboratory on disinfection process. disposable rag wheels $0.75

teffective written and spoken communication skills needed to achieve compliance

tlnfection control challenges in Multi-location settings

III - • - •• I—

I ••‘‘: -‘ . . I III

III III - - I - •I I- —I II

- A 1.11’ - I — 1 III

I~I• —. II p

VA uses internal site inspection forms, inspectors review docs, walk through lookthrough storage and drawers, then get staff member one on one and ask what theywould do in certain situations-office is only as good as their weakest link. Set up asystem that is universal that lets others know the operatory is clean-such as napkinon tray.

*instrument processing update

MMI- ST 79 guide to steam sterilization. AAMI ST 58:2013 chemical sterilizationand high level disinfection. Have and review all manufacturers instructions for useand follow for each tool. Chemical indicators

thow to develop policies and protocols that promote complianceI I I

From policy to practice: OSAP’s interactive guide to the CDC guidelines courseobjectives:

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A• ~ I

I I I

Nevada Board of Dental Examiners Page 1 of 46010 S. Rainbow Blvd., Bldg A, Ste. 1 • Las Vegas, NV 89118(702) 486-7044 • (800) DDS-EXAM • Fax (702) 486-7046

Date of Inspection:

Licensee Name: ACKNOWLEDGEMENT AND RECEIPT OF COPY BY OWNER/AUTHORIZED AGENT

Owner Dentist The owner of the dental practice and/or its authorized agent hereby acknowledges that byexecuting this document below and initialing each page’s lower right hand corner on the

Dental Office Name: line “Licensee Initials,” receipt of a copy of this inspection/survey form is acknow edged.In the event the dental practice has satisfactorily completed the inspection, as noted in this

Address: inspection/survey form, the owner/licensee will receive from the Board’s Executive Directorand/or representative, written notice of satisfactorily completing the inspection conducted.

City: State: Zip Code: If an owner/licensee has commenced the practice of dentistry prior to an Initial InspectionNevada (NAC 631.1785) at any given location that inspection shall be deemed to be a Random

• . Inspection pursuant to NAC 631.179.

Inspector(s): Re-Inspection Inspector(s): If the inspection indicates “critical” deficiencies (items listed as “#1’s”) the owner/licenseewill receive written notice from the Board’s Executive Director and/or representative of the

(1) ___________________________________ (1) “critical” deficiencies and that a re-inspection will be conducted within seventy-two (72)

(2) ___________________________________ (2) ____________________________________ hours of the written notice. However in the event the “critical” deficiencies noted, pose animmediate threat to the public health, safety and/or welfare the President of the Board,

Initial inspection:Q Random Inspection:~ Re-Inspection may without any further action of the Board, issue an Order of Summary SuspensionDate: pursuantto NAC631.179(4).I I,) - In the event the inspection indicates “remedial action required” deficiencies (items listed as

- • • : - : “#2’s”), the owner/licensee will receive written notice from the Board’s Executive Director

# 1 - “Critical” deficiencies: and/or representative of the “remedial action required” deficiencies and that a re

# 2 - “RemedialAction Required” deficiencies: inspection will be conducted within seven (7) days of the written notice.

# 3 - “Action Required” deficiencies: In the eventthe inspection indicates “action required” deficiencies (items listed with a“#3”), the owner/licensee will receive written notice from the Board’s Executive Director

# 4- “Action Recommended” deficiencies: and/or representative of the “action required” deficiencies and that a re-inspection will beconducted within thirty (30) days of the written notice.

Receipt of a copy of the foregoing is hereby acknowledged;By __________________________________________

• . ‘ this _____ dayof ______________.20_at_:_.m.

#1 - CRITICAL: MUST BE MEt COULD RESULT IN IMMEDIATE TERMINATION OF Print name:_________________________________PATIENT CARE AND EXTENDED OFFICE INABILITY TO TREAT PATIENTS. Title and/or position/capacity: ____________________________________

#2 - REMEDIAL ACTION REQUIRED: REQUIRES CORRECTIVE COMPLIANCE WIThIN 7 - . -

DAYS. Re-Inspection Receipt of copy of the foregoing is hereby acknowledged;By ________________________________________

#3 - ACTION REQUIRED: REQUIRES CORRECTIVE COMPLIANCE WITHIN 30 DAYS. this ______ day of________________ 20 at m#4 - ACTION RECOMMENDED: NOT REQUIRED FOR COMPLIANCE AT THIS TIME — . . — —.

COMPLIANCE REQUIREMENTS SUBJECT TO CHANGE AS CENTER FOR DISEASE Print name.CONTROL CDC REQUIREMENTS MAY CHANGE. Title and/or position/capacity:

00000 15T iNsPEctioN Inspector Initials _____________ Licensee Initials RE.INSPECflON Inspector Initials _____________ Licensee Initials ___________

Re-Inspection Only - Mark Box With: V = Corrected/Compliant N = Not Corrected/Not Compliant Page 2 of 4

Y Y1•1 A ••A

N NReview the written infection control plan at least annually to 3 ~ N 22 Includes vaccination records for all employees with exposure 3 V N

1ensure corn liance with best ractices risksDocumentation of bloodborne Pathogen training at date of

2 3 V N 23 Includes written policies and procedures for handling and 3 V Nhire and annuall thereafter mana ement of shar $Documentation of training of health-care employees in 3 ~ N 24 Includes a Sharps Injury log exist 3 V N

3selection and use of PPE

Includes a written post exposure medical evaluation plan (useDocuments corrective actions for all deviations frorn written

4 3 V N CDC: needle stick/sharps injury/exposure protocol) and 24/7policy 25 contact telephone number for qualified designated health

5 Up-to-date confidential employee health records 3 Y N care roviderEmployee health records kept for: 3 ~ N 26 Includes docurnentation of post exposure follow-up for all 3 ~ N6 30+ ears: IZI Since o enin : 0 Date: sharps injuries involving contaminated instrurnents

7 Injury / Incident records 3 V N 27 Includes written policies and procedures for medical waste 3 ~ N

8 Emergency telephone numbers posted 3 y N rnana ernentLicensed waste hauler used for regulated waste---Name 3 ~ N

9 Training records kept for 3+ years 3 V N 28 and/or Tele hone Number:Informed refusal declination records of indicated

10 3 V N 29 Includes written policies and procedures for aseptic 3 V Nimmunizations/vaccination mana ement during patient care

11 Equipment repair and maintenance logs 3 V N Includes written policies and procedures for surface3 V N30 disinfection and environmental barrier rotection

12 Biological weekly monitoring logs 1 Y N

13 post exposure evaluation and follow-up records 3 y N 31 Includes written policies and procedures for laboratory 3 V Nrocedures

14 Maintenance log for sterilization equipment is up-to-date 4 V N 32 Includes written policy and procedure for patients known to 3 V N

Weekly biological testing logs maintained for:15 2+ years: Since openin :0 Date: 3 V N have communicable disease on arrival TB, InfluenzaComprehensive medical history form in use to evaluate 3 V N

- patients

16 Includes a written system of sterilization process monitoring 3 V N 34 Ensures patient information routinely reviewed and updated 2 V N

Includes a written process for managing semi critical and17 3 V N - - • •

critical itemsIncludes a written process for managing failed chemical, heat Provides and documents appropriate training for all staff 2 Y N

18 3 V N assi ned to rocess semi-critical and critical instrumentsor biolo ical monitoringIncludes written policies for use of personal protective 36 a) provide hands-on training 3 V N

19 3 V Ne ui ment PPE 37 Monitors and documents compliance with use of PPE 2 V NIncludes documentation of vaccinations offered to HCW with

20 3 V Ninfectious ex osure risk He atits B, lnfuenza 38 Provides and documents training in hand hygiene 2 V N

Includes documentation that vaccinations declined by health21 3 V N 39 Provides annual infection control training 2 V N

care workers

00000 1H INSPECTION Inspector Initials _____________ Licensee Initials RE-INSPECTION Inspector Initials _____________ Licensee Initials ____________

N

63 Appropriate barrier products available ( dental dams,rotective e ewear, other

Basic first aid products and equipment available64 (Recommended to include: nitrogylerin, Benadryl, epi

en, ox en, as inn, albuterol, glucose, luca on

65 Dental unit water lines flushed between patients for aminimum of 20 seconds

66 Dental unit water lines are treated to remove biofilm

67 Dental unit water lines are tested to meet the potablewater standard of EPA (<500 CFU/mlDental unit water lines not meeting the potable waterstandard of EPA are treated and retested

Biofilm and organic matter are removed from critical69 and semi-critical instruments using detergents or

enzymatic cleaners prior to sterilization70 Sterilization equipment available and fully functional

71 Number of working autoclaves: _________________

72 Number of working chemiclaves: __________________

73 Number of working dry heat sterilizers: ______________

74 Number of working Flash steam sterilizers (Statim): —

75 Number of working ultrasonic cleaners:

76 Endodontic files/instrumentation sterilized or disposed

77 Is Biological testing of sterilizer completed weekly

78 If independent biological testing service,Name:

79 If in-office biological testing, is control processed?Sterilization cycles are verified with chemical/heatindicator. Both interior and external indicatorsCritical items (any instrument that penetrates soft tissueor bone instruments are sterilized after each useImplantable equipment is quarantined and tested with

82 biological indicator until the biological indicator has ane ative readin

83 Proper sterilization loading technique, not overloading

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Re-Inspection Only - Mark Box With: V = Corrected/Compliant N = Not Corrected/Not Compliant

VN I . - . •. -

40 Single use or sterilization for critical items

a) if yes, used only on one patientb) Disposed of after single use?

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41 MultI - dose vials used

42 a) if yes, vials are only entered with new, sterile syringewith a new, sterile needle

~ b) Cap of multi-dose vial cleaned with alcohol basedwi e before bein accessedc) Are multi-use vials discarded when expired or 28 days

44 after initial access (as applicable) - Must have datewhen f rst accessed

45 d) is initial access dated on the multi-use vials

46 Fluid infusion and administration sets (IV bags, tubingand connectors used?

4748

~ c) Single IV bag is ~ used to mix medications for morethan one atient

~o d) Single dose medication/infusions are used for onlyone atlent and discarded after use

~ Personnel wear utility gloves when processingcontaminated instruments - Not latex e for atient care

52 Supplies for hand hygiene accessible to employees atoint of need53 Soap and water easily accessible54 Alcohol based rubs easily accessible-if used

~ Team members display appropriate hand hygienetechni ues

56 Gloves (Latex and latex free orjust latex free)57 Masks

58 Sterile Surgical Gloves—-for surgical proceduresExam les:

59 Safety glasses with side shield or full face shields60 Disposable gowns/laundered gowns offered

61 Health care workers display appropriate use of PPEbarriers

62 Running water eye wash station accessible

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rIE-INspEaloN Inspector Initials00000 ~~Inspector Initials Licensee Initials Licensee Initials ___________

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Heat Tolerant Handpleces are sterilized after each use(including high & low speed handpieces, prophylaxis

84 angles, ultrasonic and sonic scaling tips, air abrasiondevices, air and water syringe tips, and motors—withexce tion of electric e models)Sterile packs are inspected for integrity, compromised

acks are re rocessedEvent-related monitoring is used to monitor package

86 integrity and packages are appropriately stored with aminimum of an initial date stam

87 Single use instruments or devices are not processed andre-used

88 Semi-critical items are ~t~iliiëdIft~reTcWJ~1if,notheat sensitiveHeat sensitive semi-critical are at a rniñi~ñi7i~ihijh1leveI

89 disinfected after each use or chemical sterilized aftereach use

90 Practice is using an FDA approved chemical sterilantAll applicable label instruction are followed on EPA-

91 registered chemical sterilant (dilution, shelf life, storage,safe use, dis osal and material com atibili

92 Practice is using an FDA approved high level disinfectantChemical used for high level disinfection are prepared

93 according to manufacturers instructions (dilution, shelflife, stora e, safe use, dis osal and material com atibiliChemical used for high level disinfection are dated withex iration dates and discarded before ex iration dates

Splash shields and equipment guards used on dentallaborato lathes

96 Fresh pumice and a sterilized, or new rag wheel usedfor each patientAre devices used to polish, trim or adjust contaminatedintraoral devices bein disinfected or sterilizedlntraoral items such as impressions, bite registrations,

98 prostheses and orthodontic appliances are cleaned anddisinfected

99 Dental radiology aseptic techniques are followed -single usefilm or barriers on electronic sensors

- . .

Semi-critical environmental surfaces (frequently touched

100 surface that could potentially allow secondary transmissionto HCW or patients) are decontaminated between patientsusing a high level surface disinfectant

101 Noncritical environmental surfaces are decontaminatedbetween atientsObjects and environmental surfaces are disinfected with an

102 EPA registered tuberculocidal disinfectant at beginning ofda

103 Objects and environmental surfaces are disinfected with anEPA re istered tuberculocidal disinfectant between .atientsObjects and environmental surfaces are disinfected with an

104 EPA registered tuberculocidal disinfectant at the end of theda

105 EPA registered tuberculocidal disinfectants are used at thedilutions ecified b the manufacturerAll clinical contact surfaces are protected with barriers(especially areas that are difficult to clean)

107 Clinical contact barriers are changed between patients

log Decontamination and clean areas separated in theinstrument rocessin area

109 Biohazardous waste is disposed of properly

N~a~N Inspector Initials ______________ Licensee Initials ____________

Re-Inspection Only - Mark Box With: V = Corrected/Compliant N = Not Corrected/Not Compliant

YN

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110 Approved sharps containers utilized and accessible

~ Sharps container taken out of service and processeda ropriately

112 safe recapping techniques/devices used

113 Sharps (needles, blades..) are single use

114 Employees use engineering controls (e.g., forceps) toretrieve contaminated shar s from tra s or containers

00000 ~ INSPEcTIoN Inspector Initials Licensee Initials