How Can I Protect Myself Against Pathogenic Transmission?

QUESTION: I am starting a position in a practice that serves a large number of patients who are medically compromised due to infectious diseases. I know wounds and needle sticks that occur during dental procedures are a common avenue of pathogenic transmission. How can I best protect myself?

ANSWER: As a staff member who has exposure to blood or bodily fluids, you are protected under the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard.¹ To comply with this regulation, dental practices are required to provide training on the dental office’s infection control policies and procedures; personal protective equipment (PPE), including masks, gloves, eyewear, and protective garments, such as lab coats; and a free hepatitis B vaccination. Hepatitis B is a bloodborne pathogen that is a major concern for oral health professionals because blood is a “critical vehicle of transmission” in health care.² Vaccination with post-vaccine titer testing demonstrating the presence of sufficient antibodies prevents contraction of this disease. Dental offices must also have an exposure control plan in the event of an exposure incident (eg, a needlestick or splash to a mucous membrane), and provide training on how staff members should handle such events. All dental practices must comply with OSHA requirements. Those that do not are subject to fines and possible license revocation by their state board of dentistry.

All patients should be treated as potentially infectious—not just those who report having transmissible diseases. As such, employing universal precautions is the standard of care. They are necessary, due to the following:

• Patients with an infectious disease may not report it
• There is typically an incubation period when patients do not show signs of disease, so they may not know they are infectious
• You cannot tell by looking at patients if they have a disease

To best protect yourself, attend the training provided by your employer and visit the OSHA website (osha.gov) for more information. The Organization for Safety and Prevention (osap.org) and the American Dental Association (ada.org) also offer helpful resources regarding infection prevention measures.

In addition, you need to consider the safety of your patient population. The medically compromised patients in your practice are at increased risk of contracting a range of illnesses, especially influenza. Asymptomatic unvaccinated health care workers may inadvertently carry influenza that could easily be contracted by medically compromised patients. The Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention recommend that all health care workers receive an annual influenza vaccine.

Adhering to the aforementioned guidelines and continuing to learn more about infection control protocol will best help you protect yourself and your patients from microbial disease transmission.