The Centers for Disease Control and Prevention (CDC) is the lead federal agency for protecting the health and safety of people in the United States and internationally. The CDC provides credible information to enhance health decisions and promote health through strong partnerships. The CDC also serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and educational activities designed to improve the well-being of all people.
In December 2003 the CDC issued a set of new infection control recommendations (Guidelines for Infection Control in Dental Healthcare Settings—2003).1 These recommendations update those made in 1986 and 1993.2,3 They are available in print (MMWR 2003;52[RR-17]:1-68) or electronically (cdc.gov/mmwr/PDF/RR/RR5217.pdf).
The CDC guidelines consolidate recommendations for preventing and controlling infectious diseases and managing personnel health and safety concerns related to infection control within dental settings. They update several previous CDC recommendations, incorporate relevant infection control measures from other CDC guidelines, and discuss concerns not previously addressed in dentistry.
The CDC asks dental practices to develop a written infection control program to prevent or reduce the risk of disease transmission. Such a program must protect patients from care-associated infections and protect dental healthcare practitioners The Role of the Infection Control Coordinator
(DHCPs) from work-related injuries and illnesses. The program helps practices establish and implement necessary infection control policies, procedures, and practices. The process involves proper selection and use of technologies and products. The program should reflect the principles of infection control and occupational health. It should also adhere to all federal, state, and local regulations and guidelines of recommending agencies.1
The CDC indicates that a knowledgeable infection control coordinator (ICC—a member of the practice team, possibly the dentist) or a person willing to be trained should be given the responsibility for coordinating the program. The ICC will have a substantial number of important duties (Table 1). A collective charge, however, could be the overall responsibility for the effectiveness of the infection control program on a day-by-day basis over time. This includes the monitoring of practice policies, procedures, and practices. The practice program in the end must be both effective and efficient.1Although the ICC is responsible for the overall management of the practice infection control program, the ultimate responsibility for compliance remains with the employer.
| Table 1. Duties of an Infection Control Coordinator*
The infection control coordinator has many duties that can be roughly divided into 7 areas: Written Materials/Information Education and Training Record Keeping Product Evaluation Fire and Emergency Hazardous Materials Management Compliance Monitoring *Modified From References 4 and 5 |
IDENTIFYING THE BEST PERSON
There are many characteristics desired of an ICC (Table 2). No single person could likely possess full measures of all sought-after traits. However, given opportunity, time, and training, most employees could function effectively and efficiently.
| Table 2. Desirable Characteristics of an ICC*
• Respected by other employees of the practice as well as the management team |
MAKING IT WORK
The practice employer needs to identify several candidates for the position and recruit the best person. If this person is amenable, then additional training (eg, combination of continuing education, readings, and computer-assisted instruction) can begin.4-6 It is important for the employer to work with the coordinator to develop a safety mission statement and a set of safety goals (objectives). Meaningful objectives must have measurable outcomes. Meeting stated objectives should be expressed in concrete terms; eg, a 95% reduction in exposures to certain chemicals or 100% compliance in wearing protective eyewear.After a period of orientation, the ICC can then undertake fully his or her managerial duties. However, this new coordinator should first be formally introduced. This would be an ideal time to describe the activities the ICC will be performing. It is imperative to recognize the coordinator’s authority and to present in written form the due processes that will be applied to cases of noncompliance.The amount of time dedicated to safety issues will likely vary per the events of a given week. However, significant release time, especially during the first few months, must be afforded the new ICC. Infection control duties should not be added to the usually full list of other responsibilities. A separate area (ideally a room with a door) should be reserved for safety activities and record keeping.It is imperative that the coordinator be given significant latitude and power concerning health and safety issues. The correct person must be capable of handling supervisory authority. Employers must be aware of the ICC’s performance, yet must not undermine his or her leadership concerning safety issues. However, the ultimate responsibility for workplace safety rests with the employer. But, the ICC can handle many if not most of the required activities.
FINAL WORD
The goal of a practice infection control program is to assure a safe working environment that will reduce the risk of healthcare-associated infections among patients and occupational exposures among DHCPs. An effective program evaluation is a systemic way to ensure procedures are useful, feasible, ethical, and accurate. Program evaluation is an essential organizational practice; however, such evaluations are not usually practiced consistently across program areas, nor are they sufficiently well integrated into the day-by-day management of the majority of programs.1 Together, the employer-dentist and the ICC can determine the practice’s needs and then identify and prioritize them. Both parties must establish reasonably budgeted goals and a flexible timeline.The ICC should be considered the lead person concerning office compliance. These designated employees should serve as the practice’s resource for current and correct health and safety information.
References
1. Kohn WG, Collins AS, Cleveland JL, et al; Centers for Disease Control and Prevention. Guidelines for infection control in dental health-care settings — 2003. MMWR Recomm Rep. 2003;52(RR-17):1-61.
2. Centers for Disease Control and Prevention. Recommended infection control practices for dentistry. MMWR Weekly. 1986;35(15):237-242.
3. Centers for Disease Control and Prevention. Recommended infection control practices for dentistry, 1993. MMWR Recomm Rep. 1993;42(RR-8):1-12.
4. Palenik CJ. Selecting a safety coordinator. Dent Econ. Oct 2002;92:122.
5. Palenik CJ, Miller CH. Creating the position of office safety coordinator. Dent Assist. Mar-Apr 2002;71:10-14.
6. Miller CH, Palenik CJ. Infection Control and Management of Hazardous Materials for the Dental Team. 3rd ed. St Louis, Mo: CV Mosby. In press. (Available October 2004.)
Dr. Palenik has held over the last 26 years a number of academic and administrative positions at Indiana University School of Dentistry. These include professor of oral microbiology, director of human health and safety, director of central sterilization services, and chairman of infection control and hazardous materials management committees. Currently he is director of infection control research and services. Dr. Palenik has published 145 articles, more than 290 monographs, 3 books, and 7 book chapters, the majority of which involve infection control and human safety and health. Also, he has provided more than 100 continuing education courses throughout the United States and 8 foreign countries. All questions should be directed to OSAP at office@osap.org.
