(b) Each dental health care worker who performs or participates
in an invasive or exposure-prone procedure shall observe and adhere to
infection control practices and universal blood and body fluid precautions. For
the purpose of infection control, all dental staff members and all patients
shall be considered potential carriers of communicable diseases. Infection
control procedures shall be required to prevent disease transmission from
patient to doctor and staff, doctor and staff to patient, and patient to
patient. Each dentist shall be required to comply with the applicable standard
of care in effect at the time of treatment. Precautions shall include the
following minimum standards.
(1) Each dental health care worker shall routinely use
protective barriers and surface decontamination.
(A) Gloves shall be used by the dentist and direct care staff
during any treatment involving procedures or contact with items potentially
contaminated with the patient's bodily fluids or other dental debris. Fresh
gloves shall be used for each patient. Gloves that have been used for dental
treatment shall not be reused for any other purpose.
(B) Surgical masks and protective eyewear or chin-length
plastic face shields shall be worn to protect the face, the oral mucosa, and
the nasal mucosa when splashing or splattering of blood or other body fluids is
likely.
(C) Reusable or disposable gowns, laboratory coats, or uniforms
shall be worn when clothing is likely to be soiled with blood or other body
fluids. If reusable gowns are worn, they may be washed, using a normal laundry
cycle. Gowns shall be changed at least daily or when visibly soiled with blood.
(D) Surface decontamination and disinfection or protective
barriers shall be used in areas of the dental operatory that may be
contaminated by blood or saliva during treatment and are not removable to be
sterilized. Contaminated surface coverings shall be removed, discarded, and
then replaced with clean material between patients. Surfaces to be covered or
decontaminated and disinfected shall include the following:
(iv) the high-volume evacuator handle;
(v) x-ray heads and controls;
(E) Dental health care workers shall wash their hands after
glove removal if the hands have been contaminated by bodily fluids or other
dental debris.
(F) Dental health care workers who have exudative lesions or
weeping dermatitis shall refrain from all direct patient care and from handling
patient care devices used in exposure-prone invasive procedures, unless covered
by an effective barrier.
(2) Dental health care workers shall take appropriate
precautions to prevent injuries caused by needles, scalpels, and other sharp
instruments during and after procedures. If during a single visit a patient
needs multiple injections over time from a single syringe, the needle shall be
recapped or placed in a sterile field between each use to avoid the possibility
of needlestick injury or needle contamination. Used sharp items shall be placed
in puncture-resistant containers for disposal.
(3) Any heat-stable instrument or device that enters tissue or
contacts the mucous membranes shall be sterilized. Dental health care workers
shall comply with the following sterilization requirements:
(A) Before sterilization, all instruments shall be
decontaminated to remove all visible surface contamination, including blood,
saliva, tooth and dental restorative material cuttings and debris, soft tissue
debris, and bacterial plaque. Decontamination of instruments may be
accomplished by a thorough scrubbing with soap and water or detergent, or by
using a mechanical device, including an ultrasonic cleaner. Persons involved in
cleaning instruments shall take reasonable precautions to prevent injuries.
(B) Heat-stable dental instruments shall be routinely
sterilized between patient use by one of the following methods:
(i) Steam under pressure autoclaves;
(ii) heat plus pressurized chemical (unsaturated formaldehyde
or alcohol);
(iv) prolonged dry heat exposure;
(v) dry heat convection sterilizers;
(vi) ethylene oxide sterilizers; or
(vii) other equivalent methods.
(C) Biological spore testing devices shall be used on each
sterilization unit after each six days of use, but not less often than each
month, to verify that all pathogens have been killed. A log of spore testing
shall be kept for three years for each sterilization unit.
(D) Items to be sterilized shall include the following:
(i) Low-speed handpiece contra-angles and prophy-angles;
(ii) high-speed handpieces;
(v) endodontic instruments;
(vi) air-water syringe tips;
(vii) high-volume evacuator tips;
(viii) surgical instruments; and
(ix) sonic or ultrasonic periodontal scalers.
(E) When sterilizing the heat-stable instruments or devices
listed in paragraphs (b)(3)(D)(i) through (ix), each instrument or device shall
be placed in a closed bag or container for sterilization and thereafter
maintained in that bag or container until immediately before use.
(F) Following the sterilization of heat-stable instruments or
devices not listed in paragraphs (b)(3)(D)(i) through (ix), each instrument or
device shall be maintained in covered storage until immediately before use.
(G) Nondisposable items used in noninvasive procedures that
cannot be heat sterilized shall be decontaminated and disinfected with a
chemical sterilant that has been registered by the U.S. Environmental
Protection Agency and is tuberculocidal.
(H) Materials, impressions, and intra-oral appliances shall be
decontaminated and disinfected before being sent to and upon return from a
commercial dental laboratory.
(I) A dental health care worker who is HBeAg seropositive or
HIV seropositive, or who otherwise knows or should know that the worker carries
and is capable of transmitting HBV or HIV, shall not thereafter perform or
participate directly in an exposure-prone procedure unless the worker has
sought counsel from an expert review panel. The expert review panel shall be
composed of these individuals:
(i) The dental health care worker's personal physician;
(ii) an infectious disease specialist with expertise in HIV and
HBV transmission;
(iii) a dentist licensed in the state of Kansas with expertise
in procedures performed by the health care worker; and
(iv) a state of Kansas or local public health official.