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Infection Control Training for dental Settings, 2014

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* North Carolina General Statute 130A-135 requires a physician or other licensed medical ... Module B discusses the OSHA ... including dental offices ... – PowerPoint PPT presentation

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Title: Infection Control Training for dental Settings, 2014


1
Infection Control Training for dental
Settings, 2014
  • Meeting the requirements of 10A NCAC 41A .0206
    Infection Prevention healthcare Settings

2
Patients deserve effective infection control
wherever they receive healthcare.
Adapted from Jarvis WR Emerg Infect Dis.
20017170-3. Macedo de Olivera et al. Annals
of Int Med. 2005, 11
3
Modules
  • Module A - North Carolina Laws Concerning
    Infection Prevention in Dental Settings
  • Module B - Complying with OSHA Bloodborne
    Pathogen Rule
  • Module C - Epidemiology and Risk of Infections in
    Dental Settings
  • Module C - Outbreaks and Safe Injection Practices
  • Module D - Principles and Practices Asepsis and
    Hand Hygiene
  • Module E - Principles of Disinfection and
    Sterilization
  • Module F - Environmental Issues in Dental
    Settings

4
NC Laws Concerning Infection Prevention in Dental
Settings
Module A
  • Statewide Program for Infection Control and
    Epidemiology (SPICE)

5
Module A Objectives North Carolina infection
control laws and regulations
  • Describe pertinent rules for infection prevention
    (10A NCAC 41A .0206 and .0207)
  • Discuss control measures for Human
    Immunodeficiency Virus (HIV), hepatitis B and
    hepatitis C
  • Explain NC communicable disease reporting rules

6
Background
  • 1990 CDC becomes aware of a possible
    transmission of HIV from a dentist to 6 patients
    (Kimberly Bergalis case)
  • July 1991 CDC publishes Recommendations for
    Preventing Transmission of HIV and hepatitis B
    Virus to Patients During Exposure-Prone Invasive
    Procedures
  • October 1991 Congress passes Public Law
    102-141, requiring states to adopt CDC Guidelines
    or equivalent guidelines drafted by the state

7
10A NCAC 41A .0207 HIV and hepatitis B Infected
HCP
  • All healthcare providers who perform or assist in
    surgical or obstetrical procedures or dental
    procedures and who know themselves to be infected
    with HIV or hepatitis B shall notify the NC State
    Health Director

8
10A NCAC 41A .0207 NC State Health Director
Responsibilities
  • Investigate practice
  • Reported needle sticks, types of procedures
    performed, practice during procedures
  • Evaluate clinical condition
  • Viral loads and antigen levels
  • Determine risk of transmission to patients
  • Based on clinical activities, viral burden
  • Convene expert panel
  • Issue isolation order pursuant to findings of the
    investigation and/or recommendations of the panel
  • Can occur prior to expert panel hearing if there
    is imminent risk to the public health

9
10A NCAC 41A .0206
  • Each healthcare organization in which invasive
    procedures are performed must
  • Implement a written infection control policy
  • Designate one on-site staff member to direct
    infection control activities
  • Designated staff member must complete a State
    approved course in infection control
  • On the job training is not sufficient
  • Must have certificate documenting course
    completion

10
10A NCAC 41A .0206 Infection Prevention in
healthcare Settings
  • (1) "healthcare organization" means a hospital
    clinic physician, dentist, podiatrist,
    optometrist, or chiropractic office home care
    agency nursing home local health department
    community health center mental health facility
    hospice ambulatory surgical facility urgent
    care center emergency room Emergency Medical
    Service (EMS) agency pharmacies where a health
    practitioner offers clinical services or any
    other organization that provides clinical care.

11
10A NCAC 41A .0206 Infection Prevention in
healthcare Settings
  • (2) "Invasive procedure" means entry into
    tissues, cavities, or organs or repair of
    traumatic injuries. The term includes the use of
    needles to puncture skin, vaginal and cesarean
    deliveries, surgery, and dental procedures during
    which bleeding occurs or the potential for
    bleeding exists.

12
Changes to 10A NCAC 41A .0206
  1. Adds safe injection practices to list of topics
    covered in state-approved courses
  2. Explicitly addresses hepatitis C and other
    bloodborne pathogens in addition to HBV and HIV
  3. Requires one designated staff member for each
    noncontiguous healthcare facility

non-contiguous defined as two facilities that
are not physically connected.
13
healthcare provider with Exudative Lesions or
Dermatitis on hands/wrists
  • Shall refrain from
  • Handling patient care equipment
  • Handling devices used for invasive procedures
  • All direct care activities likely to have contact
    with lesion

14
Infection Control Training of Employees
  • Infection control and OSHA Bloodborne Pathogen
    (BBP) training can be combined, but must include
  • Sterilization and disinfection
  • Include sterilizer monitoring and maintenance
  • Sanitation of rooms and equipment
  • Appropriate agents, procedures and frequencies
  • Accessibility of infection control devices and
    supplies
  • Personal protective equipment (PPE), sharp safety
    devices, etc.

15
Knowledge Check
  • What constitutes an invasive procedure under
    .0206?
  • Surgery
  • Vaginal deliveries
  • Dental procedures
  • Use of needles to puncture skin
  • All of the Above

16
Knowledge Check
  • Which of the following is not required by .0206
    rule for healthcare organizations that do
    invasive procedures of any type?
  • Have a written infection control policy
  • Conduct infection control training for healthcare
    providers
  • Monitor compliance with infection control
    requirements
  • Investigate needlesticks and other exposures to
    bloodborne pathogens (BBP)
  • Update policy as needed to prevent transmission
    of BBP

17
Module A Objectives North Carolina infection
control laws and regulations
  • Describe pertinent rules for Infection Prevention
  • Discuss control measures for Human
    Immunodeficiency Virus (HIV), hepatitis B and
    hepatitis C
  • 10A NCAC 41A .0202, .0203, and .0214
  • Explain NC communicable disease reporting rules

18
Exposure
  • A needlestick
  • Non-sexual contact that
  • Exposes non-intact skin or mucous membranes to
    blood and potentially contaminated body fluids
    of a patient, AND
  • Poses a significant risk of transmission of HIV,
    hepatitis B, or Hepatitis C if source was
    infected with those viruses

Potentially contaminated body fluids include
cerebrospinal, pericardial, joint, peritoneal,
pleural, amniotic, vaginal secretions, semen, and
any fluid with visible blood. Sweat, tears,
saliva, respiratory tract secretions, vomitus,
stool, and urine (unless contaminated with blood)
are NOT potentially contaminated body fluids.
19
Source and Exposed Person
  • Source Person
  • Person who contributes blood or potentially
    contaminated body fluids to the exposure incident
  • Exposed Person
  • Individual who has needlestick or non-sexual
    exposure to blood and potentially contaminated
    body fluids

20
Control Measures HIV, HBV, HCV 10A NCAC 41A
.0202, .0203, and .0214
  • Determine if exposure constitutes significant
    risk
  • Needlesticks
  • For all other exposures must consider
  • Type of body fluid or tissue
  • Volume of body fluid or tissue
  • Concentration of pathogen
  • Infectiousness or virulence of pathogen
  • Route of exposure - percutaneousgtmucous
    membranesgtnon-intact skingtintact skin

21
Control Measures HIV, HBV, HCV 10A NCAC 41A
.0202, .0203, and .0214
  • Required Follow-up Measures
  • Known Source
  • Exposed persons attending physician or
    occupational healthcare provider must notify
    source persons attending physician.
  • Source persons physician must test source for
    HIV, HBV, and HCV and notify exposed persons
    physician of results.
  • Exposed persons physician offers follow-up in
    accordance with the rules and CDC guidelines (per
    OSHA).

22
Control Measures HIV, HBV, HCV 10A NCAC 41A
.0202, .0203, and .0214
  • Required Follow-up Measures
  • Unknown Source
  • Offer HIV testing to exposed person
  • Determine whether exposed person has been
    vaccinated for hepatitis B
  • Vaccinate for hepatitis B if indicated
  • Offer hepatitis C testing to exposed person

23
Confidentiality
  • The attending physician of the exposed person
    shall instruct the exposed person regarding the
    necessity for protecting confidentiality.
    Exposed persons are instructed to maintain this
    confidentiality.

24
Knowledge Check
  • True or False You have to know or suspect a
    source person has HIV, hepatitis B or hepatitis C
    for the control measures rules to apply?
  • False.

25
Knowledge Check
  • True or False A source person must give informed
    consent before being tested?
  • No.

26
Module A Objectives North Carolina infection
control laws and regulations
  • Describe pertinent rules for Infection Prevention
  • Discuss control measures for Human
    Immunodeficiency Virus (HIV), hepatitis B and
    hepatitis C
  • Explain communicable disease reporting rules

27
NC General Statute 130A-135
  • A physician licensed to practice medicine who
    has reason to suspect that a person about whom
    the physician has been consulted professionally
    has a communicable disease or condition declared
    by the Commission to be reported, shall report
    information required by the Commission to the
    local health director

28
Mandatory Communicable disease (CD) Reports in NC
  • Routine
  • Only if ordered
  • Physicians, labs specified others must report
    CDs designated reportable by NC Commission for
    Public Health
  • 71diseases/conditions
  • 10A NCAC 41A .0101
  • Timeframe for report varies (7 days, 24 hours, or
    immediately)
  • NC State Health Director may issue order to
    report symptoms, diseases, conditions, trends in
    use of services, other information needed to
    investigate a potential outbreak
  • Order must specify who must report what and may
    not exceed 90 days

29
Diseases and Conditions Reportable in North
Carolina
30
What about HIPAA?
  • HIPAA section 164.512(a) Can disclose
    information when required by law
  • Mandatory reporting laws are examples of laws
    requiring disclosure.
  • HIPAA section 164.512(b) Can disclose
    information to public health authorities that are
    authorized by law to receive it for purposes
    including disease control, surveillance, etc.
  • Sometimes have voluntary reporting covered by
    this section if public health authority is
    authorized by law to receive the information
  • GS 130A-142 provides immunity from liability for
    persons who make reports in good faith.
  • This immunity applies not only to physicians, but
    to all the other reporters as well

31
Confidentiality of records (GS 130A-143)
  • General rule Written consent is required to
    disclose any information that identifies a person
    who has or may have a reportable communicable
    disease or condition, including HIV.
  • Exceptions More limited than HIPAA, but allow
    for
  • Disclosures for treatment purposes
  • Disclosures required or allowed by the NC
    communicable disease laws and rules
  • A few other purposes

32
Communicable Disease Investigation
  • NC law supports access to information as part of
    an investigation - GS 130A-144(b)
  • Medical facilities, labs, physicians shall
    provide access to and copies of medical or other
    records that pertain to
  • Diagnosis, treatment, or prevention of a
    communicable disease for a person known to be, or
    reasonably suspected of being, infected or
    exposed
  • Investigation of known or reasonably suspected
    outbreak

33
Control Measures
  • Public health endeavors for controlling
    communicable disease
  • Sanitation
  • Immunizations
  • Screening or diagnostic tests
  • Partner notification
  • Treatment regimens
  • Isolation and quarantine
  • May be population-based or directed to individuals

34
Control measures
  • In NC, all persons must comply with communicable
    disease control measures established by the
    Commission for Public Health. GS 130A-144(f).
  • Commission adopts rules establishing control
    measures and publishes them in the NC
    Administrative Code. 10A NCAC 41A.0200.

35
What are the control measures?
  • NC rules specify the control measures for HIV,
    hepatitis B, hepatitis C, sexually transmitted
    infections, tuberculosis, smallpox/vaccinia, and
    SARS
  • For all other communicable diseases, NC rules
    incorporate control measures specified in
  • CDC guidelines and recommended guidelines, if
    available
  • APHAs Control of Communicable Diseases Manual

36
Communicable disease Law Enforcement
  • Two Approaches
  • Civil enforcement
  • The health director can ask a superior court
    judge for a court order directing a person to
    comply with the law. GS 130A-18. A person who
    refuses to comply with a court order could be
    held in contempt of court.
  • Criminal enforcement
  • A person who violates a public health law can be
    charged with a misdemeanor. GS 130A-25.

37
Where to find Communicable disease Laws and Rules
  • General Statutes are available through NC General
    Assemblys website
  • http//www.ncga.state.nc.us
  • Click on General Statutes
  • Under Look up type in 130A
  • The NC Administrative Code is found online
  • http//www.reports.oah.state.nc.us/ncac.asp
  • Click on Title 10A
  • Click on Chapter 41
  • Click on .0206, .0207, .0202, .0203, .0214
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