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Exposure to Bloodborne Pathogens Control Plan

CCP's Exposure to Bloodborne Pathogens Plan is aligned with the Centers for Disease Control and Prevention (CDC): Guidelines for Infection Control in Dental Health Care Settings,2003 and the 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. It can be accessed at: https://www.cdc.gov/oralhealth/infectioncontrol/statement-COVID.html

Updated: DH 2023-2024

PURPOSE

The purpose of this Dental Hygiene (DH) Exposure Bloodborne Pathogens Control Plan, in conjunction with other already existing College safety and health policies, is to provide a safe working environment that limits occupational exposure to blood and other potentially infectious materials in the DH clinic and laboratories (W1-24).  All employees and students should be aware that any exposure to blood or other potentially infectious materials could result in disease and/or death, and
therefore, employees and students should take all precautions identified in the plan.

COVERAGE

This Exposure Control Plan covers all employees and students who work in the DH clinic and laboratories and who could be “reasonably anticipated” as a result of performing their job duties and course requirements, and patients treated in the clinic, to face contact with blood or other potentially infectious materials.

COMPLIANCE WITH THIS PLAN IS MANDATORY

ACCESSIBILITY

A copy of the Exposure Control Plan will be available and accessible to all employees and students.  It may be found in the DH clinic and DH program office.

This Exposure Control Plan will also be available to the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) of the U.S. Department of Health and Human Services.

EXPOSURE DETERMINATION

1. DH Clinic/Laboratory Users with Exposure Risk

  1. Clinic Instructors
  2. Clinic Assistants
  3. Students
  4. Patients

Tasks in which there is potential exposure risk

Examination/Treatment of Patients                                        1,3,4*
Clean-up of Treatment areas                                                  1,2,3
Instrument Cleaning/Autoclaving                                          1,2,3
Handling/Disposing contaminated waste                               1,2,3
Handling dental impressions/study casts/extracted teeth       1.3
Handling contaminated gowns                                               1,2,3
Handling Patient Records                                                       1,2,3               
*numbers refer to clinic/lab users listed in IV.1
                       

The following protective personal equipment and engineering controls shall be used when performing the following tasks:

Examination/Treatment of Patients –
Gown, examination gloves, eye protection with side shields, mask, needle guards if needed, dispose of contaminated materials in biohazard containers.

Clean-up of Treatment Areas –
Gown, heavy-duty gloves (utility), eye protection with side shields, mask, disinfectant, germicidal detergent, biohazard containers.

Instrument Cleaning/Autoclaving/Cold Sterilization –
Gown, heavy-duty gloves (utility), eye protection with side shields, mask, antimicrobial scrub, ultrasonic cleaner, ultrasonic solution, autoclave.  Industrial gloves must be worn over latex/vinyl examination gloves when placing and removing instrument cassettes from the ultrasonic bath at the end of the clinic session.  The outer surface of the industrial gloves must be washed, the excess water shaken off, and another student must wipe them with chemical disinfectant.  Remove gloves and place under sink.

Handling/Disposing of Contaminated Waste –
Gown, heavy-duty gloves (utility), eye protection with side shields, mask, biohazard containers.

Handling Dental Impressions/Study Casts/Extracted Teeth –
Gown/lab coat, examination gloves, eye protection with side shields, mask, disinfectant, biohazard containers.

Handling Contaminated Gowns –
Contaminated gowns will be disposed in biohazard containers after each use.

Patient Records –
Gown/lab coat, examination gloves.  Computer mouse and Keyboard are to be considered contaminated and patient examination gloves are to be used.

Students will supply their own gowns, lab coats, examination gloves, heavy-duty gloves (utility), eye protection with side shields and masks.

Disinfectant solution, germicidal detergent and antimicrobial soap are located under each sink in the clinic and laboratories.

Red biohazard sharps receptacles are located under the sink in each dental unit in the clinic.

Biohazard containers are in the alcove outside the materials laboratory.

SCHEDULE AND METHOD OF IMPLEMENTATION OF EXPOSURE CONTROL PLAN

This plan will take effect immediately (October 1993 and updated annually (August 2023)

Cleaning Schedule:

Daily – for each Treatment Session

  1. Wipe counter tops, sinks, carts with disinfectant and let stand until dry before and after treatment.
  2. Wipe chairs with germicidal detergent and let stand dry before and after treatment.
  3. Wipe control buttons on chair, lights, units and x-ray units with disinfectant before and after treatment.
  4. Attach contaminated materials bag on cart and dispose in biohazard container after treatment.
  5. Cover mobile cart with napkins, patient chair with disposable plastic, unit tray with autoclave wrap and control buttons/levers with barrier tape.
  6. Use water that meets EPA regulatory standards for drinking water for routine dental treatment output water and follow the dental unit manufacturer’s recommendations for appropriate methods and equipment to maintain the quality of dental water.
  7. After each patient, discharge water and air for a minimum of 20-30 seconds from any device connected to the dental water system that enters the patient’s mouth (i.e. air/water syringe, ultrasonic scalers, handpieces).
  8. Run contaminated instruments through ultrasonic bath (lid must be used at all times and chemical ID label affixed to Ultrasonic) for 5 minutes, rinse, wrap/bag autoclavable instruments (Non-autoclavable instruments will not be bagged), and placed on autoclave cart for autoclaving/sterilization.
  9. Follow manufacturer’s recommendations for protection of associated computer hardware.
  10. Scrub sinks at the end of treatment session before disinfectant wipe.
  11. Clean saliva ejector completely.
  12. Suction 1 quart of cleaning solution through high velocity suction every other day.

Dail – when laboratories are in use.

  1. Scrub sinks with cleanser and wipe with disinfectant.
  2. Wipe counter tops with disinfectant and let dry before and after use.
  3. Wipe mixing bowls and spatulas with disinfectant before and after use.
  4. Wipe trimmer wheels after use.
  5. Alginate impressions will be disinfected and wrapped in a wet towel until poured.
    Study casts will be disinfected immediately after being separated from impressions.

Daily – when clinic/laboratories are in use:

  1. Change Ultrasonic solutions and clean ultrasonic unit.

All daily and weekly cleaning procedures are the responsibility of the students and overseen by the clinical/laboratory faculty.

Daily – Autoclaving/Sterilization

  1. Autoclave all instruments, handpieces and engines.
  2. Flushing 2 min the waterlines prior to patient

Weekly – when clinic/laboratories are in use.

  1. Materials and supplies containers will be autoclaved.
  2. Protocols for OE-30 Concentrate and Z-3 Evacuation Cleaner/Enzyme for Clinic Maintenance schedule will be followed.
  3. Adex water bottles stay in place up until Friday. Units are purged and water bottle is left off. Water bottle are refilled on Mondays with filtered water from all and a Adex tab is placed.

Monthly – when clinic/laboratories are in use.

  1. Spore testing will be done on autoclaves.
  2. Non-used instruments will be re-autoclaved.


 Quartey -

  1.  Shock waterlines after long breaks.

All daily sterilization, weekly and monthly procedures are the responsibility of the clinic assistant.

 

VI. METHODS OF COMPLIANCE

Compliance requires the adoption of a variety of procedures to ascertain that all employees and students are provided the necessary education and protective measures to minimize risk.  The methods to be utilized are a.  Universal Precautions/Infection-Control Practices for Dentistry, b.  Engineering Controls,
c. Work Practice Controls, d. Personal Protective Equipment/Clothing, and e.  Housekeeping.

A. UNIVERSAL PRECAUTIONS/INFECTION CONTROL PRACTICES FOR DENTISTRY

Universal Precautions and Recommended Infection Control Practices for Dentistry shall be observed to prevent contact with blood or other potentially infectious materials.  Whenever it is difficult to determine the risks associated with potentially infectious materials, the materials shall be considered infectious.

Universal Precautions and Recommended Infection Control Practices for Dentistry may be found on CCP’s Dental Hygiene Program Website.

ENGINEERING CONTROLS

Engineering controls shall be used to eliminate or minimize employee and student exposure.  Where occupational exposure remains after institution of these controls, personal protective equipment shall also be used.

Engineering controls shall be consistent with the potential level of
exposure anticipated.  If the exposure potential is minimal and the likelihood of exposure is very low, less stringent personal protective equipment will be necessary.

HANDWASHING FACILITIES

Hand-washing facilities are located at each treatment operatory, instrument preparation area, dispensary and laboratory.  Each hand-washing facility is supplied with an antimicrobial liquid soap and paper towels.  In addition, a mounted alcohol-based hand rub container is located at the back of the clinic to remove or destroy transient microorganisms and reduce resident flora.

Employees and students must wash their hands or other skin with antimicrobial soap and water, or flush mucous membranes with water immediately, or as soon as possible, following contact of such body areas with blood or other potentially infectious materials.

EYE WASH STATIONS

The sinks located at the instrument preparation area, dispensary and laboratories are equipped with a continual eye wash apparatus.

NEEDLES AND SHARPS DISPOSAL

All contaminated needles and sharps shall not be bent or removed from disposable holders.  Shearing or breaking of contaminated needles is prohibited.

All contaminated needles and sharps are disposed of immediately, or as soon as possible, in a rigid receptacle designed and labeled for disposal of such equipment.  The sharps container must have a Biohazard label affixed to it.  The container must be kept upright throughout use and shall be disposed of in biohazard waste and replaced when they become three-quarters full.

When moving containers of contaminated sharps from the clinical area, the containers shall be:
-Closed immediately prior to removal or replacement
-Placed in a secondary container if leakage is possible. The secondary container must be closable, leak-proof, and red in color and have appropriate biohazard warning labels.

CONTROLLED ACCESS TO CLINIC/LABORATORY AREA (W1-24)

Free access to the DH Clinic/Laboratories will be limited to faculty and employees.  Students may not enter the area without a faculty member present.  Patients may not enter the clinic without a dentist faculty member present.  Housekeeping and maintenance personnel shall have access on an “as needed basis.”

PROTECTIVE COVERINGS

Protective coverings of adhesive film will be placed on control knobs and switches during use.
Protective coverings will be placed on ultrasonic units when not in use.

STORAGE CONTAINERS AND RECEPTACLES

Plastic bag receptacles for contaminated materials (except for sharps) shall be placed on each mobile cart.  These bags shall be discarded in the biohazard container, located in the alcove outside the materials laboratory, at the end of each treatment session.

BIOHAZARD LABELS

Warning labels, including the orange or orange-red biohazard symbol, are affixed to containers of regulated waste and sharps containers.

WORK PRACTICE CONTROLS

Work practice controls shall be used to eliminate or minimize employee and student exposure.

EATING, DRINKING, SMOKING, APPLYING COSMETICS OR MEDICATIONS

Eating, drinking, smoking, applying cosmetics or lip balm, handling contact lenses, or applying other body lotions in the DH clinic is prohibited.

PROCEDURES FOR MINIMIZING STICKS FROM NEEDLES AND SHARPS.

Needles will be re-sheathed using protective shields and will be done under supervision of the assigned faculty member only using a one-person operator technique.  No four-handed techniques will be employed.
Needles will not be bent or broken for disposal.
Needles and cartridges will be disposed of in a rigid container designed for this purpose found at each unit.  The container will have a Biohazard label affixed to it.
Sharps containers will be sealed and disposed of when they are three-quarters filled.

CONTAMINATED WASTE

Contaminated waste shall be handled using Universal Precautions and the appropriate personal protective clothing to minimize risks.  Contaminated waste (not including sharps) shall be placed in the plastic receptacle connected to each cart.  Upon completion of a treatment session the plastic bag shall be placed in the clearly marked biohazard receptacle in the alcove outside the materials laboratory.  These bags shall not be placed with other materials that do not pose the potential for contamination.  Any contaminated waste that may leak or is a fluid shall be placed into a second labeled receptacle to protect against leaks during transport and handling.

CONTAMINATED GOWNS AND MASKS

Contaminated Gowns and masks shall be disposed in biohazard containers after each use.
Non-contaminated gowns and masks shall be discarded in the non-contaminated trash container, in the alcove outside the materials laboratory.

RESPIRATORY HYGIENE/COUGH ETIQUETTE

If patients have symptoms of respiratory infection, instructions will be given to them to cover their mouth/noses when coughing or sneezing, to use and dispose of tissues, and to perform hand hygiene after hands have been in contact with respiratory secretions.

PERSONAL PROTECTIVE EQUIPMENT/CLOTHING

College employees will be provided with impervious gowns, impervious headcovers, lab coats, eye protection, face shields, and gloves.
Students are required to purchase their own impervious gowns, lab coats, eye protection, face shields, gloves, and masks.

USE AND CHANGING OF PERSONAL PROTECTIVE EQUIPMENT/CLOTHING

As a general guideline to the use and changing of personal protective equipment and clothing, the following standards shall apply:

  • If protective equipment is penetrated by blood or other potentially infectious materials, the protective equipment shall be removed immediately, or as soon as possible, and replaced with a clean protective article.
  • All personal protective clothing and equipment shall be removed prior to leaving the clinic area.  When the personal protective equipment is removed, it shall be placed in an appropriate container for disposal; contaminated in biohazard container and non-contaminated in non-contaminate trash container.
  • Gloves should be worn when it can be reasonably anticipated that the hands may become exposed to blood or other potentially infectious materials, when handling or touching contaminated items or surfaces or cleaning such surfaces or items.
  • Examination gloves will be worn for all intraoral procedures.  Gloves that become torn, punctured or if their ability to function as a barrier is compromised, shall be disposed of as soon as possible.  If it is necessary to leave the treatment area, gloves must be removed, and hands washed immediately to avoid transfer of microorganisms to other patients or environments.  Upon return to the treatment area, wash hands, and don a new pair of examination gloves.  Disposable gloves shall not be washed or disinfected for reuse.  Examination gloves are single use items.
  • Gloves shall be worn during the handling of alginate impressions, pouring of study casts and trimming of study casts.
  • Hypoallergenic gloves, glove liners, powder-free gloves, or other similar alternatives are accessible to those employees who are allergic/sensitive to gloves normally provided.
  • Utility or household gloves (vinyl or nitrile) will be worn for pre-treatment operatory disinfecting only (not pre-treatment set-up), instrument cleaning and post-treatment operatory procedures. The outer surface of the household gloves will be washed, dried and then swabbed with Cavi-wipes before and after use.
  • Nitrile/Vinyl examination gloves will be worn by clinic assistants/ work study students during handling of materials for patient use, equipment, instruments, supplies and patient charts or clinic forms that have been present in a treatment area.
  • All recordings must be made in the patient’s chart using treatment gloves. This is considerate a contaminated area.
  • Industrial gloves must be worn over Nitrile/vinyl gloves when placing and removing instrument cassettes  from the ultrasonic bath at the end of the clinic. -The outer surface of gloves must be washed, the excess water shaken off, and another student must wipe them with biocide. Remove gloves and place under sink.
  • No gloves should be worn when greeting/dismissing patient in the waiting room.

GOWNS AND LAB COATS

  • Clothing Uniforms (surgical scrubs) -While in the clinic, students must wear the program uniform (surgical scrubs), the disposable surgical gown, disposable hair bonnet with all hair covered. This includes assisting other DH students.
  • Scrubs should be removed as soon as the student returns home and laundered separately from other clothing.
  • Lab coats / disposable gowns will be selected by the DH faculty.-Disposable gowns will be worn during all laboratory course sessions.
  • Disposable gowns will be worn over scrubs in the clinic and removed and discarded before leaving the clinic.
  • Lab coats (if worn) will be taken home and they should be laundered separately from other clothing.
  • Impervious headcovers are to be worn during all clinic session. They will be removed and disposed at the end of the session.

EYE PROTECTION, GOGGLES, MASKS, AND FACE SHIELDS

  • Glasses will be worn for all patient treatments, and they must be surface disinfected after each patient treatment.
  • Glasses will be worn during disinfecting/unit set up and breakdown and instrument cleaning procedures.
  • Glasses will be worn by patients when intraoral procedures are being performed on them.                                                                                       
  • Glasses will be worn when performing all laboratory procedures.
  • N95 Facemasks will be worn during aerosol generating procedures only. (ultrasonic instrumentation, polishing, and air polishing)
  • Level 3 mask will be worn during all nonaerosol generating procedures.
  • Facemasks will be worn during disinfecting/unit set up and breakdown and instrument cleaning procedures.
  • Level 3 Facemasks will be worn when laboratory lathes and model trimmers are use
  • Level 3 Facemasks will be worn during the handling of any contaminated laboratory materials.
  • A full-face shield must be worn during all patient treatment involving an aerosol.
  • Shield is wiped with an antimicrobial agent or replaced between patients
  • Face shield must be disinfected after patient treatment and placed under unit sink.

HOUSEKEEPING

HANDLING CONTAMINATED WASTES

All materials that have the potential for contamination from blood or infectious materials shall be placed in the marked biohazard receptacle in the alcove outside the materials laboratory.  The biohazard receptacle will be disposed of by the appropriate outside biowaste disposal contractor according to College policy.

Contaminated waste will not be disposed with the general College refuse.  Housekeeping will not remove the biohazard container from the clinic area.  All biohazardous waste will be removed by the outside biowaste disposable contractor according to College policy.

EQUIPMENT/INSTRUMENTS CONTAMINATED WITH INFECTIOUS MATERIALS

Equipment or instruments that are contaminated with blood, saliva or other potentially infectious material shall be disinfected or autoclaved after each treatment session.  Any instrument, handpiece cones and engines, air/water syringe tips, beakers, or any non-heat sensitive item will be autoclaved.  Non-autoclavable items should be protected with a Food and Drug Administration cleared barrier to reduce contamination during use, followed by cleaning and high-level disinfection between patients. All equipment and surfaces will be disinfected with disinfectant or germicidal detergent.

Any instrument or equipment being serviced, shipped or removed from the clinic for repair will be autoclaved or disinfected prior to removal or shipment.  Any part or component of equipment being shipped or removed for repair that cannot be disinfected completely shall be labeled with a biohazard label indicating which part or parts have not been disinfected or remain contaminated.

HEPATITIS B VACCINATION PROGRAM

All DH faculty and employees are encouraged to receive the Hepatitis B vaccine with the College reimbursing for the cost of the vaccinations.  Documentation of vaccination shall be kept in the employee file.

DH students are required to have the Hepatitis vaccine or begin the series of inoculations prior to beginning the DH curriculum.  Documentation of Hepatitis B vaccination shall be kept in the student’s department file.

COMMUNICATION AND TRAINING OF HAZARD TO EMPLOYEES

All employees shall receive a copy of this Exposure Control Plan and be updated annually on procedures.

RECORDKEEPING (See College Exposure Control Plan)

  1. Medical Records
    Medical records for employees shall be kept for the duration of service to the College plus thirty (30) years.
  2. Training Records
    Training records shall be maintained for a period of three (3) years after date of training.
  3. Custody and Retention of Records
    The medical and training records created for the purposes of this plan shall be treated with confidentiality by the College with custody of said records to be determined by the College.

EVALUATION OF EXPOSURE INCIDENTS

(See College Bloodborne Pathogen Exposure Information Packet)

Medical Consultation and Examination

Vybe urgent care to treat students and employees who have a suspected or actual bloodborne pathogen injury.  They are located at 1500 Spring Garden Street, Philadelphia, PA 19130 (267) 728-4033. Their operating hours are from 8:00 a.m. to 8:00 p.m., Monday thru Friday.

In the event of an exposure, a “Clinical Incident Report” shall be filled out by the faculty member present.  All procedures for a clinical incident shall be followed.  Consultation, counseling and follow-up treatment shall be in accordance with the College Policies and Procedures Memorandum No. 308

REVIEW AND UDATING OF EXPOSURE CONTROL PLAN 

This plan must be reviewed and updated at least annually during Fall in-service week.

Please note that CCP’s Exposure to Bloodborne Pathogens Plan is aligned with the Centers for Disease Control and Prevention (CDC):  Guidelines for Infection Control in Dental Health Care Settings which can be accessed at https://www.cdc.gov/oralhealth/infectioncontrol/statement-COVID.html