Development of CDC s Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care

Transcription

1 Development of CDC s Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care Michele Junger, DDS, MPH Division of Oral Health OSAP June 3, 2016 National Center for Chronic Disease Prevention and Health Promotion Division of Oral Health

2 Disclosures The findings and conclusions of this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention Disclosure: Neither I nor members of my immediate family have any financial relationships with commercial entities that may be relevant to this presentation. National Center for Chronic Disease Prevention and Health Promotion Division of Oral Health

3 Objectives To discuss CDC s role in infection prevention To describe documented transmissions of infectious agents in dental settings from and discuss their implications To discuss the need and purpose of the new CDC Summary and Checklist

4 CDC Develops Guidelines

5 CDC Investigates Assist in identifying the source of the transmission and, hopefully, eliminating it Present an opportunity to evaluate existing prevention strategies and identify gaps Allow us to describe new diseases and to learn more about known diseases Identifying breaches in infection prevention allows us to determine the risk of transmission Patient notification and testing

6 Dental Transmissions,

7 Transmission of Bloodborne Pathogens in US Dental Settings, Since the release of the 2003 guidelines, CDC s Division of Oral Health has continued to review the scientific literature Literature review to identify documented reports of bloodborne pathogen (BBP) transmission in dental settings since 2003 Reviewed summary from the Division of Viral Hepatitis of suspected health care-associated hepatitis transmissions during

8 Transmission of Bloodborne Pathogens in US Dental Settings, No confirmed reports of HIV transmission in dental settings Setting Year Pathogen No. Infected Comments OMS Practice 2001 HBV 1 Pt-to-Pt U.S. Portable Dental clinic in school gymnasium 2009 HBV 5 Of the 5 cases, 3 were patients and 2 were non-healthcare worker volunteers U.S. Multiple procedural and infection control breaches were identified. OMS Practice 2013 HCV 1 Pt-to pt U.S. Multiple breaches in injection safety documented. Redd, et al. J Infect Dis. 2007;195(12):1874]. Radcliffe, et al. JADA. 2013;144(10): Bradley, OK State Department of Health, 20Report_2_17_15.pdf.

9 Conclusions Pending Manuscript Reports describing the transmission of BBPs in dental settings since 2003 were rare. Failure to adhere to CDC recommendations for infection control in dental settings likely led to disease transmission in identified cases. Practical implications: Emphasizes the need to improve dental health care personnel's understanding of the basic principles and implementation of standard precautions

10 Reports of Non-bloodborne Pathogen Transmissions in Dental Settings, Setting Year Pathogen No. Infected Comments General Dental General Dental 2010 M. tuberculosis 1 DHCP to DHCP U.S. TB was misdiagnosed 2011 L. pneumophila 1 82 yo woman - Italy Unknown if waterlines treated Pediatric Dental Clinic 2015 Mycobacterium abscessus Ongoing Children - U.S. Potentially linked to untreated waterlines Merte JL, et al. JADA. 2014;145(5): Ricci ML, et al. Lancet. 2012;379(9816):684. Peralta, G, et al. MMWR Morb Mortal Wkly Rep 2016;65:

11 Resources for Investigating Outbreaks

12 Resources for Investigating Outbreaks

13 What Are We Missing? Asymptomatic infection Underreporting of cases Underrecognition of healthcare as risk IDENTIFIED OUTBREAKS Difficulty identifying single healthcare exposure Barriers to investigation Resource constraints

14 Advancing Infection Control in Dental Care Settings Objective To estimate the percentage of U.S. dentists using four new CDC infection control recommendations and to identify factors associated with their adoption Cleveland J, et al. J Am Dent Assoc 2012;143(10):

15 Methods Surveyed a random sample of 6825 U.S. dentists (response rate 49%) Assessed implementation of 4 new infection control recommendations Having an IC coordinator Referring persons with sharps injuries Trying/adopting safety devices Maintaining and monitoring dental water quality Cleveland J, et al. J Am Dent Assoc 2012;143(10):

16 Results Implementation of practices 34% none or one 40% two 26% three or four The likelihood of implementation was higher among dentists who Acknowledged the importance of infection control Had practiced dentistry for less than 30 years Had received more continuing dental education credits in infection control Had received multiple modes of training Cleveland J, et al. J Am Dent Assoc 2012;143(10):

17 Conclusions Implementation of infection control recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control and increasing continuing education requirements may increase implementation. Cleveland J, et al. J Am Dent Assoc 2012;143(10):

18 Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care Summary of basic infection prevention expectations for safe care in all dental settings Based on Standard Precautions Supplements existing CDC recommendations (not a replacement) Links to references & additional resources

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20 Program Evaluation Systematic way to ensure procedures are useful, feasible, ethical, and accurate Develop standard operating procedures Evaluate infection prevention practices Document adverse outcomes Document work-related illnesses Monitor health care associated infections

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22 Infection Prevention Checklist for Dental Settings Checklist to evaluate compliance with infection prevention practices Administrative policies Observation of personnel and patient-care

23 Fillable Checklist

24 Compendium Document

25 Infection Prevention Checklist Mobile App CDC s Division of Oral Health and Office of Informatics and Information Resources Management are developing a mobile app to provide dental health care personnel with access to an interactive version of the Infection Prevention Checklist for Dental Settings in a portable, easy to use, and streamlined format.

26 App Objectives To facilitate use of CDC s evidence-based infection prevention recommendations To make recommendations more accessible by providing access offline To provide structure and guidance for evaluation of infection prevention practices

27 Potential App Functionality Check Yes/No to acknowledge compliance Notes section for documentation Ability to export results for records management Links to related resources Glossary of terms

28 User Research and Testing Will be conducting user research at the 2016 OSAP Symposium CDC is also recruiting volunteers for user testing throughout the development process If you would like to volunteer to participate in future studies, please sign up today!

29 QUESTIONS