Exploring choices in the dental assisting profession: Infection control/prevention coordinator

There are so many opportunities in the dental practice for dental assistants who are ready to transition from the day-to-day chairside position. As dental assistants, we’re knowledgeable in many areas of dentistry and understand the important principles of infection control and prevention in the workplace.

An option for those who would like a little variety, more responsibility, and a greater challenge is the position of the infection control/prevention coordinator. In March 2016, the Centers for Disease Control and Prevention (CDC) released a new publication to promote infection prevention and safety in dentistry. This document, “Summary of infection pre­vention practices in dental settings: Basic expectations for safe care,” is written in simple terms and reinforces existing CDC guidelines as it summarizes the rudimentary expectations for safe care in the dental setting. This includes the need for a written, office-specific infection control program and the recommendation for an infection control coordinator. 

With ever-changing regulations in the area of infection control, every office needs an infection control and prevention program. This is an office-specific system of policies, procedures, and practices that minimize the risk of transmission of microorganisms and disease when properly implemented. This protects both patients and team members with the overall goal of safety. Some of the important essentials in reaching this include local, state, and federal guidelines, standards, and regulations; professional standards and best practices; ethics; and standard operating procedures specific to the dental practice. 

Commitment and accountability for infection prevention is required of the entire dental team. The infection control and prevention coordinator (ICPC) is in charge of coordinating the individualized program. Many are familiar with the designation of ICC (infection control coordinator). ICPC takes the role one step further with the prevention aspect. OSHA’s Hazard Communication Guidelines for Compliance stipulates that responsibility must be assigned for the necessary activities to comply with the regulation. Some are better at leading this charge than others, and dental assistants are often tasked with the charge. 

Responsibilities of the ICPC 

One of the ICPC’s specific roles includes overall documentation management. Documentation should include policies, procedures, and guidelines for education and training; immunizations; exposure prevention and post exposure management; medical conditions; work-related illness and associated work restrictions; contact dermatitis and latex hypersensitivity; and the maintenance of records, data management, confidentiality. 

The ICPC should lead policy development, implementation, and monitoring. The ICPC should review and update written policies (standard operating procedures), clinical and infection control procedures, and other documents that may be required locally, by the state, or by federal mandates. Only credible sources should be used, and expected outcomes should be assessed. This may also include doing a self-audit to assess areas that may need improvement. 

The ICPC should maintain relevant regulatory and guidance documents and make sure these are available to all personnel. Examples of this include the Bloodborne Pathogens Standard and personal protective equipment (PPE). 

The ICPC generates updates and maintains logs of other safety-related records in compliance with federal, state, and local regulations. This includes many of the following:

• Training
• Sterilization records
• Biological monitoring
• Medical records of employees
• Equipment maintenance logs
• Hazardous waste compliance records
• Fire extinguisher certificates
• Manifests from medical waste haulers
• Radiographic equipment certifications
• Hazardous waste manifests

The ICPC should provide or coordinate infection control and OSHA-mandated training to include updates on new information, equipment, products, chemicals, procedures, and technology used in the practice. Training for all dental personnel must occur at least annually. Initial training shall be upon hire, or when there is a change in staff responsibilities that may affect an employee’s occupational exposure, or in response to changes in recommendations or regulations.

The ICPC acts as a resource or point person on infection control/prevention in the practice. Many times, team members new to the profession have questions that need a true and courteous response. To do this, the ICPC must have adequate time to complete responsibilities, access relevant publications, and attend continuing education, topic specific workshops and seminars. Opportunities to network with other infection control professionals is highly beneficial and encouraged. 

A checklist is useful for monitoring infection prevention compliance. The ICPC can use the two-part checklist included with the summary to ensure quality control and to facilitate improvement and compliance with CDC guidelines. The checklist provides a review of basic expectations for safe dental care and assesses the correct performance of infection control protocols by dental team members.

• Monitor compliance by observation, sterilization logs, checklists, and other methods used in the workplace.
• Perform necessary tests on equipment, including sterilizers, ultrasonics, eyewash stations, dental unit waterlines, instrument washers, and radiographic equipment.
• Confirm team member immunizations are up to date. This is especially important with new hires.
• Confirm that supplies and equipment ordering systems are in place. 

Immunizations are an essential part of an infection control program and a written comprehensive immunization policy should be implemented for all dental practices. Recommended immunizations include the hepatitis B virus vaccination and many others. It is recommended following US Public Health Service and CDC recommendations for hepatitis B vaccination, serologic testing, follow-up, and any boosters needed. The ICPC should confirm and maintain documentation that employee immunizations are current. 

The ICPC should promote a culture of safety, the shared commitment of the dental team toward ensuring the safety of the work environment. In a culture of safety, all employees are empowered to voice safety concerns and implement solutions to prevent harm. The ICPC plays a vital role in patient and personnel safety, compliance with relevant guidelines and regulations, and efficient use of resources to ensure the safest dental visit for all. 

There are many basic things that an ICPC handles. The ICPC can help team members locate PPE and provide instructions on the proper disposal of paper gowns, gloves, single-use face shields, and surgical masks. For reusable items, the ICPC can reinforce proper decontamination techniques when needed.

Hand hygiene—The ICPC should evaluate whether proper hand hygiene procedures are followed. Team members must wash hands before donning gloves and every time gloves are removed. Effective handwashing includes vigorously rubbing together all surfaces of lathered hands for at least 20 seconds, followed by rinsing under a stream of water. If the hands are not visibly soiled, an alcohol-based hand rub may be used. 

Environmental surface disinfection—The ICPC should make sure that environmental surfaces such as dental carts, countertops, dental chairs, and -ray equipment are disinfected correctly using appropriate products. Items or surfaces that are likely to become contaminated and difficult to clean and disinfect should be protected with barriers. Barriers should be disposed of properly at the end of treatment and the surfaces cleaned and disinfected. 

The sterilization/reprocessing area—The ICPC is responsible for overseeing disinfection and sterilization of patient care items. When using sterilizers, ultrasonic tanks, instrument washers, or other cleaning devices, it is important to follow the manufacturers’ instructions or instructions for use (IFUs). Sterilizers should be properly maintained, serviced, and operated. The ICPC inspects instruments bags, cassettes, or wraps to ensure sterility. Any bags or cassettes that are compromised by punctures, tears, or contamination should be reprocessed. The ICPC must verify that sterilization monitoring is performed. Correct functioning of sterilization cycles should be verified for each sterilizer by the periodic use, at least weekly, of biological indicators. Biological indicators, also known as spore tests, are the most accepted method for monitoring the sterilization process. The infection-control coordinator is responsible for documenting the results of these tests, reviewing any failed tests, and maintaining the results in a log.