Ensure Safe Practice with the Infection Control Coordinator

Click here to download a sample job description for the infection control coordinator.

The primary goal of in an infection prevention and control program is to prevent health care-associated infections in patients and prevent exposures and illnesses in personnel, thus, ensuring safe practice.¹ To achieve these goals, health care settings—including dental health care settings—must have an operational infection control and safety program consistent with current United States Centers for Disease Control and Prevention (CDC) guidance, Occupational Safety and Health Administration (OSHA) regulations, and relevant state and local regulations and standards. The site-specific program requires management and oversight. This is the primary responsibility of the infection control coordinator, also referred to as the infection prevention coordinator.^1,2 The roles and responsibilities of the infection control coordinator may vary from one setting to another, depending on the size of the dental practice setting or institution, but, ultimately, he or she is responsible for the safe practice of dentistry.

INFECTION CONTROL COORDINATOR ROLE

The role of the dental infection control coordinator has been supported by the CDC since 2003. The Guidelines for Infection Control in Dental Health-Care Settings—2003 state: “An infection-control coordinator (eg, dentist or other dental health care personnel) knowledgeable or willing to be trained should be assigned responsibility for coordinating the program. The effectiveness of the infection control program should be evaluated on a day-to-day basis and over time to help ensure that policies, procedures, and practices are useful, efficient, and successful. Although the infection control coordinator remains responsible for overall management of the program, creating and maintaining a safe work environment ultimately requires the commitment and accountability of all dental health care personnel.”¹

Cleveland et al³ reviewed reports of transmissions of bloodborne pathogens (BBPs) associated with dental health care settings between 2003 and 2015. The authors concluded that bloodborne disease transmission in dental settings since 2003 was rare. The authors noted that the oral health professionals’ lack of adherence to the CDC guidelines most likely caused the cases of disease transmission. They suggested that this conclusion be used to motivate oral health professionals to ensure they have a broad depth of knowledge on infection control protocols and that strategies, such as checklists and printed policies, should be used to improve adherence.³

In March 2016, the CDC introduced a Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care, which summarized current infection prevention recommendations and included a two-part checklist to evaluate compliance with the CDC recommendations.² In this document , the CDC further reinforces support for the infection control coordinator, citing the need for this position to be a priority in all dental settings. The summary suggests that the employee with the most expertise in infection control should be designated as the infection prevention coordinator. This role would be in charge of creating written infection prevention policies and procedures based on high-level sources.² Table 1 summarizes CDC guidance for administrative measures, including the support for the infection prevention coordinator.

RESPONSIBILITIES OF INFECTION CONTROL COORDINATOR

In 2017, the Organization for Safety, Asepsis and Prevention (OSAP) developed a sample job description, which is intended to facilitate discussion about the role and responsibilities of the infection control coordinator. Site-specific responsibilities may vary from one practice setting to another. Some of the general responsibilities of the infection control coordinator are:

• Developing site-specific policies and standard operating procedures that are consistent with CDC guidelines, OSHA regulations, state and local regulations, and relevant standards.
• Reviewing existing policies and standard operating procedures to identify gaps and outdated information.
• Acting as a resource for personnel in the dental health care setting.
• Maintaining relevant documentation, records, permits, licenses, etc.
• Providing infection prevention and control education and training for new and existing personnel.
• Monitoring compliance with written policies and procedures through observations, checklists, and other evaluation methods.

Developing and implementing sound policies and procedures set the foundation of the infection prevention and control program. The CDC summary asserts that these policies and procedures should be tailored to the characteristics of each dental setting and reviewed regularly (with the bare minimum at once per year). Policies and procedures will be affected by the type of oral health services provided and the patient populations utilizing this setting.²

Written policies and procedures must be implemented into day-to-day practice. The employee designated as the infection control coordinator is responsible for all equipment and supplies, such as ensuring hand hygiene products and personal protective equipment supplies are well stocked and purchasing safety devices to reduce the risk of needle sticks. This employee is also in charge of communicating all information and concerns regarding infection control.²

Education and training should be provided to all personnel when new tasks or procedures are introduced and, at a minimum, annually.² OSHA also addresses training in its Bloodborne Pathogens Standards and the need for a qualified individual to conduct the training. Standard 910.1030(g)(2)(viii) states: “The person conducting the training shall be knowledgeable in the subject matter covered by the elements contained in the training program as it relates to the workplace that the training will address.”⁴ The infection control coordinator may be responsible for providing on-site education and training to ensure personnel understand and follow the site-specific infection prevention and control policies and procedures. Associated responsibilities include documentation of the training and maintenance of training records.⁴

MONITOR AND EVALUATION

Another responsibility of the infection control coordinator is to monitor and evaluate the site-specific infection control and safety program. According to the CDC guidelines, this provides the infection control coordinator with the ability to improve the efficacy of the practice’s standards, as well as its infection control protocol.¹

A variety of tools and checklists are available to assist monitoring and evaluation. The CDC encourages the use of the Infection Prevention Checklist for Dental Settings to periodically evaluate site-specific policies, procedures, and practices and to assess compliance with CDC guidance and identify lapses in infection control.² The CDC provides resources describing approaches to evaluate and manage infection control breaches identified in health care settings, including those involving lapses related to reprocessing of medical devices.^5,6 To assist site-specific evaluation, the CDC created a mobile application—the CDC DentalCheck Mobile App—to help infection control coordinators in monitoring and evaluating the dental setting to ensure it is meeting minimum requirements.⁷ OSAP has additional monitoring and evaluation checklists available on its website: osap.org.⁸

ADMINISTRATIVE SUPPORT

To ensure a successful infection control and safety program, the infection control coordinator must have support of management and administration. This support includes adequate time and access to resources to effectively complete the responsibilities of the infection control coordinator. Some key resource categories include:

• Relevant guidelines, regulations, and standards
• Professional journals, such as the Journal of Dental Infection Control and Safety (available at: osapjdics.scholasticahq.com)
• Continuing professional education in infection prevention and control
• Professional membership in organizations, such as OSAP, to access resources and network with other professionals who are infection control coordinators

EDUCATION

A strong educational foundation is key to the success of the infection control coordinator. The CDC notes that the infection control coordinator must be well-versed in infection control protocol and be willing to continually update his or her knowledge on the subject.¹ At the time of the publication of the CDC Guidelines for Infection Control in Dental Health-Care Settings—2003, nationally-accepted and standardized core curriculum elements for dental infection prevention and control education did not exist. (While the Commission on Dental Accreditation had broad guidelines, they did not offer curriculum elements specific to dentists, dental hygienists, and dental assistants).

In 2014, seven national dental organizations formed an Infection Control Consortium in which CDC’s Division of Oral Health participated. The Consortium’s charge was to “provide a framework for infection control education of oral health care professionals responsible for performing and/or overseeing infection control procedures in oral healthcare settings.”⁷ Table 2 lists participating organizations.

The Infection Control Consortium used the CDC Guideline for Infection Control in Dental Health-Care Settings—2003 and OSHA’s Bloodborne Pathogens Standard (29CRF 1910.1030) as a foundation for its work. In 2016, the consortium published Master Curriculum Elements, which serves as a practical resource for oral health professionals, as well as educators, consultants, and state regulatory agencies, to promote patient and provider safety.^9,10

Building from the work of the Infection Control Consortium, OSAP, the Dental Assisting National Board, and the Dental Auxiliary Learning and Education Foundation (DALE Foundation) collaborated to develop a multiyear infection control education and certification initiative to support the education of the dental infection control coordinator.¹¹ A standardized educational program on infection control has since been created—the OSAP-DALE Foundation Dental Infection Prevention and Control Certificate Program.™ The partnership is developing two professional certification programs in the near future: the clinically focused Certified in Dental Infection Prevention and Control™ and the industry-focused Dental Industry Specialist in Infection Prevention and Control^TM.¹² These collaborative initiatives advance the organizations’ missions of enhancing patient and practitioner safety.

CONCLUSION

Patient and personnel safety and preventing the transmission of infections are at the core of any infection prevention and control ­program. A knowledgeable infection control coordinator plays a ­vital role in ensuring the site-specific program is both compliant and effective.

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. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. Atlanta: Centers for Disease Control and Prevention, US Dept of Health and Human Services; October 2016.
3. Cleveland JL, Gray SK, Harte JA, Robison VA, Moorman AC, Gooch BF. Transmission of blood-borne pathogens in US dental health care settings: 2016 update. J Am Dent Assoc. 2016;147:721–738.
4. Occupational exposure to bloodborne pathogens; needlesticks and other sharps injuries; final rule. Occupational Safety and Health Administration (OSHA), Department of Labor. Final rule; request for comment on the Information Collection (Paperwork) Requirements. Fed Regist. 2001;66:5318–5325.
5. United States Centers for Disease Control and Prevention. CDC’s Steps for Evaluating an Infection Control Breach. Available at: cdc.gov/ hai/ outbreaks/ steps_ for_ eval_ IC_ breach. html. Accessed December 17, 2018.
6. United States Centers for Disease Control and Prevention. Patient Notification Toolkit. Available at: cdc.gov/ injectionsafety/ pntoolkit/ index.htm. Accessed December 17, 2018.
7. United States Centers for Disease Control and Prevention. CDC DentalCheck Mobile App. Available at: cdc.gov/ oralhealth/ infectioncontrol/ dentalcheck.html. Accessed December 17, 2018.
8. Organization for Safety, Asepsis and Prevention (OSAP) Charts and Checklists. Available at: osap.org/page/CDC_Checklist_Toolkit. Accessed December 17, 2018.
9. OSAP. Infection Control Consortium Supports Education to Advance Patient and Provider Safety. Available at: osap.org/ news/ 425276/ Infection-Control-Consortium-Supports-Education-to-Advance-Patient-and-Provider-Safety-.htm Accessed December 17, 2018
10. Infection Control Consortium. Master Curriculum Elements. Available at: dentalinfectioncontrol.org/ sitefiles/ wpcontent/ uploads/ 2018/ 11/ ICC_ MasterCurriculum_ Elements_ 052518.pdf Accessed December 17, 2018.
11. Durley C, Garrett JH, Long T. Advancing patient safety through a new education and credentialing initiative in dentistry. Journal of Dental Infection Control and Safety. Available at: osapjdics.scholasticahq.com/ article/ 5077-advancing-patient-safety-through-a-new-education-and-credentialing-initiative-in-dentistry. Accessed December 17, 2018
12. The Organization for Safety, Asepsis and Prevention, Dental Assisting National Board Inc, and Dental Auxiliary Learning and Education Foundation Dental Infection Control Education and Certification. Available at: dentalinfectioncontrol.org. Accessed December 17, 2018.

From Dimensions of Dental Hygiene. January 2019;17(1):22–25.