CDC Infection Prevention Checklist for Dental Settings

Use the CDC Checklist for Dental Offices to ensure infection control, hygiene practices, sterilization procedures, etc. are followed in dental settings.

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CDC Infection Prevention Checklist for Dental Settings

Administrative Measures

1. Are written infection prevention policies and procedures specific to the dental setting available, current, and based on evidence-based guidelines (e.g., CDC / Healthcare Infection Control Practices Advisory Committee [HICPAC]), regulations, or standards? Note: Policies and procedures should be appropriate for the services provided by the dental setting and should extend beyond the Occupational Safety and Health Administration (OSHA) bloodborne pathogens training

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5. Does the facility have a system for early detection and management of potentially infectious persons at initial points of patient encounter? Note: The system may include taking a travel and occupational history, as appropriate, and elements described under respiratory hygiene/cough etiquette.

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Infection Prevention Education And Training

1. Does DHCPr receive job- or task-specific training on infection prevention policies and procedures and the OSHA Bloodborne Pathogens Standard: • Upon hire? • Annually? • When new tasks or procedures affect the employee’s occupational exposure? • According to state or federal requirements?

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Dental Health Care Personnel Safety

11. Does the facility have well-defined policies concerning contact of personnel with patients when personnel have potentially transmissible conditions, including: • Work-exclusion policies that encourage reporting of illnesses and do not penalize staff with loss of wages, benefits, or job status? • Education of personnel on the importance of prompt reporting of illness to a supervisor?

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Program Evaluation

Hand Hygiene

Personal Protective Equipment (PPE)

Respiratory Hygiene / Cough Etiquette

1. Have policies and procedures been implemented to contain respiratory secretions in people who have signs and symptoms of a respiratory infection, beginning at the point of entry to the dental setting? Do these measures include: • Posting signs at entrances instructing symptomatic patients to cover their mouths/noses when coughing or sneezing, use and dispose of tissues, and perform hand hygiene? • Providing tissues and no-touch receptacles for tissue disposal? • Providing resources for patients to perform hand hygiene in or near waiting areas? • Offering face masks to coughing patients and other symptomatic persons upon entry to the setting? • Providing space and encouraging symptomatic persons to sit as far away from others as possible (if feasible, using a separate waiting area)?

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Sharps Safety

Safe Injection Practices

Sterilization And Disinfection Of Patient-Care Items And Devices

Environmental Infection Prevention And Control

2. Does DHCP performing environmental infection prevention procedures receive job-specific training about infection prevention and control management of clinical contact and housekeeping surfaces: • Upon hire? • When procedures or policies change? • At least annually?

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Dental Unit Water Quality

1. Are policies and procedures in place for maintaining dental unit water quality that meets Environmental Protection Agency (EPA) regulatory standards for drinking water (i.e., ≤ 500 CFU/mL of heterotrophic water bacteria) for routine dental treatment output water?

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Hand Hygiene Is Performed Correctly

1. Is hand hygiene performed in the following situations: • When hands are visibly soiled? • After barehanded touching of instruments, equipment, materials, and other objects likely to be contaminated by blood, saliva, or respiratory secretions? • Before and after treating each patient? • Before putting on gloves? • Immediately after removing gloves? • Before putting on a sterile surgeon’s gloves for all surgical procedures?

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Personal Protective Equipment (PPE) Is Used Correctly

Protective Clothing

Respiratory Hygiene/Cough Etiquette

Sharps Safety

Safe Injection Practices

8. When using multidose vials: • Are they dedicated to individual patients whenever possible? • Are multidose vials used for more than one patient kept in a centralized medication area and not brought into the immediate patient treatment area? • Are multidose vials dated when first opened and discarded within 28 days unless the manufacturer specifies otherwise?

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Sterilization And Disinfection Of Patient-Care Items And Devices

19. If digital radiography is used: • Are FDA-cleared barriers used to cover the sensor and changed between patients? • After barrier removal, is the sensor cleaned and sterilized/disinfected per manufacturer instructions, or at a minimum, cleaned and disinfected with an intermediate-level EPA-registered hospital disinfectant?

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Environmental Infection Prevention And Control

Dental Unit Water Quality

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CDC Infection Prevention Checklist for Dental Settings

Use the CDC Checklist for Dental Offices to ensure infection control, hygiene practices, sterilization procedures, etc. are followed in dental settings.

2. Are infection prevention policies and procedures reassessed at least annually or according to state or federal requirements, and updated if appropriate?

3. Is at least one individual trained in infection prevention assigned responsibility for coordinating the program?

4. Are supplies necessary for adherence to standard precautions readily available? (e.g., hand hygiene products, safer devices to reduce percutaneous injuries, and personal protective equipment [PPE])

5. Does the facility have a system for early detection and management of potentially infectious persons at initial points of patient encounter? Note: The system may include taking a travel and occupational history, as appropriate, and elements described under respiratory hygiene/cough etiquette.

2. Are training records maintained in accordance with state and federal requirements?

1. Does the facility have an exposure control plan that is tailored to the specific requirements of the facility (e.g., addressing potential hazards posed by specific services provided by the facility)?

2. Are DHCPs for whom contact with blood or OPIM is anticipated trained on the OSHA Bloodborne Pathogens Standard? • Upon hire? • At least annually?

3. Are current CDC recommendations for immunizations, evaluation, and follow-up available? Is there a written policy regarding immunizing DHCP, including a list of all required and recommended immunizations (e.g., hepatitis B, MMR, varicella, Tdap)?

4. Is hepatitis B vaccination available at no cost to all employees who are at risk of occupational exposure to blood or OPIM?

5. Is post-vaccination screening for protective levels of hepatitis B surface antibody conducted 1-2 months after completion of the 3-dose vaccination series?

6. Are all DHCPs offered an annual influenza vaccination?

7. Do all DHCPs receive baseline tuberculosis (TB) screening upon hire, regardless of the risk classification of the setting?

8. Is a log of needlesticks, sharps injuries, and other employee exposure events maintained according to state or federal requirements?

9. Are referral arrangements in place to qualified health care professionals to ensure prompt and appropriate provision of preventive services, occupationally-related medical services, and postexposure management with medical follow-up?

10. Following an occupational exposure event, is postexposure evaluation and follow-up, including prophylaxis as appropriate, available at no cost to employees and supervised by a qualified health care professional?

1. Are written policies and procedures for routine monitoring and evaluation of the infection prevention and control program available?

2. s adherence to certain practices such as immunizations, hand hygiene, sterilization monitoring, and proper use of PPE monitored, and is feedback provided to DHCP?

1. Are supplies necessary for adherence to hand hygiene for routine dental procedures (e.g., soap, water, paper towels, alcohol-based hand rub) readily accessible to DHCP?

2. If surgical procedures are performed, are appropriate supplies available for surgical hand scrub technique (e.g., antimicrobial soap, alcohol-based hand scrub with persistent activity)?

3. Are DHCP trained regarding appropriate indications for hand hygiene, including handwashing, hand antisepsis, and surgical hand antisepsis?

1. Is sufficient and appropriate PPE available and readily accessible to DHCP (e.g., examination gloves, surgical face masks, protective clothing, protective eyewear/face shields, utility gloves, sterile surgeon’s gloves for surgical procedures)?

2. Does DHCP receive training on the proper selection and use of PPE?

2. Does DHCP receive training on the importance of containing respiratory secretions in symptomatic individuals?

1. Are written policies, procedures, and guidelines for exposure prevention and postexposure management available?

2. Does DHCP identify, evaluate, and select devices with engineered safety features (e.g., safer anesthetic syringes, blunt suture needles, safety scalpels, or needleless IV systems): • At least annually? • As they become available in the market?

1. Are written policies, procedures, and guidelines available for safe injection practices, including aseptic technique for parenteral medications?

2. Are injections always prepared using an aseptic technique in a clean area, free from contamination or contact with blood, body fluids, or contaminated equipment?

1. Are written policies and procedures available to ensure reusable patient-care instruments and devices are cleaned and reprocessed appropriately before use on another patient?

2. Are policies, procedures, and manufacturer reprocessing instructions for reusable instruments and dental devices available, ideally in or near the reprocessing areas?

3. Are DHCP responsible for reprocessing reusable dental instruments and devices appropriately trained: Upon hire? • At least annually? • Whenever new equipment or processes are introduced?

4. Are training and equipment available to ensure DHCP wears appropriate PPE (e.g., examination or heavy-duty utility gloves, protective clothing, masks, eye protection) to prevent exposure to infectious agents or chemicals?

5. Is routine maintenance for sterilization equipment: • Performed according to manufacturer instructions? • Documented by written maintenance records?

6. Are policies and procedures in place outlining the dental setting's response (e.g., recall of device, risk assessment) in the event of a reprocessing error or failure?

1. Are written policies and procedures available for routine cleaning and disinfection of environmental surfaces (i.e., clinical contact and housekeeping surfaces)?

2. Does DHCP performing environmental infection prevention procedures receive job-specific training about infection prevention and control management of clinical contact and housekeeping surfaces: • Upon hire? • When procedures or policies change? • At least annually?

3. Are training and equipment available to ensure DHCP wears appropriate PPE (e.g., examination gloves, heavy-duty utility gloves, protective clothing, masks, eye protection) to prevent exposure to infectious agents or chemicals?

4. Are cleaning, disinfection, and use of surface barriers periodically monitored and evaluated to ensure that they are consistently and correctly performed?

5. Are procedures in place for the decontamination of spills of blood or other body fluids?

1. Are policies and procedures in place for maintaining dental unit water quality that meets Environmental Protection Agency (EPA) regulatory standards for drinking water (i.e., ≤ 500 CFU/mL of heterotrophic water bacteria) for routine dental treatment output water?

2. Are policies and procedures in place for using sterile water as a coolant or irrigant when performing surgical procedures (e.g., biopsy, periodontal surgery, apical surgery, implant surgery, surgical extractions of teeth)?

3. Are written policies and procedures available outlining the response to a community boil-water advisory?

1. Is PPE removed before leaving the work area (e.g., dental patient care, instrument processing, or laboratory areas)?

2. Is hand hygiene performed immediately after the removal of PPE?

3. Does DHCP wear surgical masks during procedures that are likely to generate splashes or sprays of blood or other body fluids?

4. Does DHCP wear eye protection with solid side shields or a face shield during procedures likely to generate splashes or sprays of blood or other body fluids?

5. Does DHCP change masks between patients and during patient treatment if the mask becomes wet?

6. Does DHCP wear gloves for potential contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated equipment?

7. Does DHCP change gloves between patients and avoid wearing the same pair of gloves for more than one patient?

8. Does DHCP avoid washing examination or sterile surgeon’s gloves for the purpose of reuse?

9. Does DHCP wear puncture and chemical-resistant utility gloves when cleaning instruments and performing housekeeping tasks involving contact with blood or other potentially infectious materials (OPIM)?

10. Does DHCP wear sterile surgeon’s gloves for all surgical procedures (e.g., biopsy, periodontal surgery, apical surgery, implant surgery, surgical extractions of teeth)?

11. Does DHCPr remove gloves that are torn, cut, or punctured and perform hand hygiene before putting on new gloves?

1. Does DHCP wear protective clothing (e.g., reusable or disposable gowns, laboratory coats, or uniforms) that cover personal clothing and skin (e.g., forearms) likely to be soiled with blood, saliva, or OPIM?

2. Does DHCP change protective clothing if it becomes visibly soiled and immediately or as soon as possible if penetrated by blood or other potentially infectious fluids?

1. Are signs posted at entrances with instructions for patients with respiratory symptoms on covering their mouths/noses when coughing or sneezing, using and disposing of tissues, and performing hand hygiene?

2. Are tissues and no-touch receptacles for tissue disposal provided?

3. Are resources available for patients to perform hand hygiene in or near waiting areas?

4. Are face masks offered to coughing patients and other symptomatic individuals upon entering the facility?

5. Are individuals with respiratory symptoms encouraged to sit as far from others as possible, or is a separate waiting area provided?

1. Are engineering controls (e.g., self-sheathing anesthetic needles, safety scalpels, needleless IV ports) used to prevent injuries?

2. Are work practice controls (e.g., one-handed scoop technique for recapping needles, removing burs before disconnecting handpieces) implemented to prevent injuries?

3. Does DHCP avoid recapping used needles using both hands or any technique that directs the point of a needle toward any part of the body?

4. Does DHCP use a one-handed scoop technique or a mechanical device for holding the needle cap when recapping needles?

5. Are all sharps disposed of in puncture-resistant sharps containers located as close as possible to the area where they are used?

6. Are sharps containers disposed of in accordance with federal, state, and local medical waste regulations?

1. Are injections prepared using an aseptic technique in a clean area free from contaminants or contact with blood, body fluids, or contaminated equipment?

2. Are needles and syringes used for only one patient (including prefilled syringes and insulin pens)?

3. Is the rubber septum on medication vials disinfected with alcohol before piercing?

4. Are medication containers (single-dose and multidose vials, ampules, and bags) accessed using a new needle and syringe each time, even for the same patient?

5. Are single-dose vials, ampules, and IV solution bags used for only one patient?

6. Are leftover contents from single-dose vials, ampules, and bags of IV solutions discarded and not combined for later use?

7. Are single-dose vials used whenever possible?

9. Are fluid infusion and administration sets (IV bags, tubings, and connections) used for only one patient and disposed of appropriately?

1. Are single-use devices discarded after one use and not reused for multiple patients?

2. Are reusable critical and semicritical dental items and devices cleaned and heat-sterilized according to manufacturer instructions between patient use?

3. Are items thoroughly cleaned according to manufacturer instructions and visually inspected for residual contamination before sterilization?

4. Is FDA-cleared automated cleaning equipment (e.g., ultrasonic cleaners, instrument washers) used to remove debris to improve cleaning effectiveness and decrease worker exposure to blood?

5. Are work-practice controls used to minimize contact with sharp instruments (e.g., long-handled brushes), and is appropriate PPE worn during manual cleaning?