Protocol for Post-Exposure Management

The United States Centers for Disease Control and Prevention Guidelines for Infection Control in Dental Health-Care Settings, 2003 state: "Avoiding exposure to blood is the primary way to prevent transmission of hepatitis B, hepatitis C, and human immunodeficiency virus."¹ A splash to the mucous membrane through the mouth, nose, eyes, or nonintact skin is considered an occupational exposure incident, just as a percutaneous or "sharps" injury would be.¹ Performing first aid is the first step in handling an exposure incident. The next course of action is to follow the dental office's exposure control plan because you were potentially exposed to several patients' blood or other potentially infectious material (OPIM) in the ultrasonic cleaner. The Occupational Safety and Health Administration requires that dental offices maintain a written protocol that is followed whenever an exposure incident occurs.² It is the employer's responsibility to ensure an exposure control plan is in place and to provide training on the protocol, as well as the risks posed by bloodborne pathogens for all employees who may be exposed to blood and/or OPIM. The incident should be reported to the office's infection control coordinator, who will write a report about the incident. The report will include the date and time of exposure, how it occurred, information about the severity of the exposure, whether the source material was known, and status of the exposed individual's vaccination record. This report should then accompany you to an evaluation appointment with a qualified health care professional who can assess the risk of exposure and recommend necessary treatment or follow-up. This type of exposure incident should be treated as a medical emergency and the evaluation visit should occur immediately following the exposure incident. If you did not initially see a health care provider, it is not too late. I would still recommend receiving an evaluation. It is the employee's responsibility to report the incident immediately so the post-exposure protocol can be quickly initiated. Despite safe work behaviors, exposure incidents do sometimes occur. To prevent this type of exposure, clinicians should always wear safety glasses when processing instruments or in other instances where splash/splatter or exposure to blood or OPIM is possible. Personal protective equipment (PPE) is the best way to protect yourself from exposure to blood and OPIM. Gloves, masks, protective eyewear (safety glasses) with side shields, and a protective garment (lab coat) are designed to be the first line of defense to protect clinicians from accidental splash and splatter. Masks and eyewear protect the mucous membranes from aerosols and splatter, while the lab coat and gloves protect exposed skin. Heavy duty punctureresistant utility gloves are recommended when handling contaminated instruments during instrument processing. PPE and safe work practice controls help prevent exposure incidents.

References

1. Kohn WG, Collins AS, Cleveland JL, et al. Guidelines for infection control in dental health-care settings—2003. MMWR Recomm Rep. 2003;52(RR-17):1–61.
2. Occupational Safety and Health Administration. Bloodborne Pathogen Exposure Incidents. Available at: osha.gov/OshDoc/data_BloodborneFacts/ bbfact04.pdf. Accessed March 11, 2016.