P A T I E N T S P O P U L A T I O N S

P R O V I D E R S I N T E G R A T I N G I N F E C T I O N P R E V E N T I O N A N D S A F E T Y I N T O P U B L I C H E A L T H P O L I C Y A N D

P R A C T I C E

Infection Prevention and Safety 1

OSAP 2012

Presentation Created by:

Kathy Eklund, RDH MHP, The Forsyth Institute Therese Long, MBA CAE, Executive Director of

OSAP Kathy Mangskau, RDH MPA, ASTDD Consultant Don Marianos, DDS MPH, ASTDD Consultant

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Infection Prevention and Control

State oral health programs have a shared responsibility for the safe delivery of oral health care. ASTDD is partnering with the Organization for Safety, Asepsis and Prevention (OSAP) to link states to technical assistance, educational materials, information on policy development and other resources on infection prevention and safety. http://www.osap.org/?page=DentPH_IpAndSafety

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Background

Reports of actual and potential cross contamination in dental healthcare settings, including one involving a public health outreach program to deliver care to a population that has difficulty gaining access to the traditional dental care delivery system underscores the need for strong, integrated infection prevention and control policies and continued vigilance in administration and enforcement.

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ASTDD Response

ASTDD determined that it was necessary to: articulate infection prevention and safety efforts as part of

already existing ASTDD programs and codify their importance as part of all state oral health

program’s (SOHP’s) infrastructure and competencies

ASTDD requested and received supplemental funding from the Centers for Disease Control and Prevention, Division of Oral Health to enhance infection safety and prevention efforts with SOHPs to complement the SOHP Infrastructure Enhancement Project.

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ASTDD Partnered with OSAP

ASTDD partnered with OSAP, the leading non-governmental organization focusing exclusively on infection prevention and safety for oral healthcare, to link SOHPs with other infection prevention and safety

agencies and resources foster coordination of efforts with public/private partners to

manage emergency response requirements provide leadership in assuring the safety of oral health services

for which the states have responsibility

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Core Team

The core team consisted of infection control experts and a consultant; and the advisory team included ASTDD staff and consultants, a CDC epidemiologist, a representative of a dental supply company, and webmasters of ASTDD and OSAP.

The core and advisory teams developed a program work plan as well as an evaluation plan to assess short, intermediate and long term outcomes of the project.

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Purpose

To assess the status of infection control in state oral health programs and develop recommendations to integrate current resources and policies into ASTDD programs, projects and emergency response activities.

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Assessment of State Oral Health Plans

An initial review of state oral health plans revealed only four of the available plans mentioned infection control; however, data from other surveys (PEW, State Synopsis) indicated that 24 state programs provide direct preventive or restorative clinical services and 46 states collect Basic Screening Survey data.

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Assessment of State Oral Health Plans

In the summer of 2011, an ASTDD survey of SOHPs indicated 20 of the 30 states responding reported having programs that include direct patient care through screening, surveys, sealant and varnish programs and community clinics. Twelve of the states reported being involved in infection

prevention and safety activities by providing training, conducting clinic inspections, handling complaints of disease transmission and assisting in the development of oral health infection control rules and protocols.

Infection control challenges/issues identified by state oral health program directors were varied, with the majority relating to mobile-portable programs

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Assessment of State Boards of Registration In Dentistry

A review of the 2011 edition of “Composite”, a publication of the American Association of Dental Boards, showed that all states address regulation of infection control as “Established Board regulation or official Board guidelines to control the spread of infection to patients in the dental office”.

States communicated this regulation either by specifying compliance with CDC guidelines and OSHA regulations or by providing state-specific guidance.

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Assessment of State Boards of Registration In Dentistry

The publication also addressed infection control as part of continuing education (CE) requirements for licensing renewal. Twenty states specifically list infection control and/or

HIV/HBV courses as required for at least one member of the dental team.

Six states make infection control a requirement for dentists, hygienists and assistants (Arkansas, Maryland, Massachusetts, Minnesota, New Mexico and North Dakota)

North Carolina requires that dentists and hygienists take a sterilization/infection control exam.

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Assessment Of ASTDD Surveys, Guidelines, Policies and Competencies

To assess the current status of infection prevention and safety efforts in SOHPs and within ASTDD, the core and advisory teams looked at current ASTDD surveys, guidelines, policies and competencies and reviewed OSAP information for relevant applications.

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Assessment Of ASTDD Surveys, Guidelines, Policies and Competencies

The team reviewed the current ASTDD policy statements and issue briefs, the ASTDD webpage on infection control, the Safety Net Dental Clinic Manual, the Mobile-Portable Dental Clinic Manual and the Basic Screening Survey documents and identified gaps in infection control information Each document was scrutinized to determine if infection

control information was included, if the content was adequate, and recommendations for additions/changes were noted

Images were reviewed for infection control accuracy A tickler file of infection control enhancement opportunities

beyond the scope of this project was created for future referenc

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Recommendations

The review of ASTDD documents found that a number of issue briefs, strategy documents and the infection control area of the website needed to be updated to include current infection prevention and safety information.

Recommendations were developed specific to each of the ASTDD documents reviewed.

In order to assure continued integration of infection control information, the team concluded that an infection control review protocol should be included in the final review of all ASTDD documents and projects.

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Progress/Dissemination and Promotion

General information about the ASTDD/OSAP Infection Prevention and Safety Program was shared with members of the Associations through their newsletters.

The findings of the documents review were shared with the ASTDD Board of Directors, committees and consultants to inform them of the recommended changes.

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Progress/Dissemination and Promotion

The Policy Committee updated the policy statement review form to include the infection control review protocol and the ASTDD Board of Directors agreed to consider the need for infection prevention and safety information in future projects and contracts.

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Progress/Dissemination and Promotion

ASTDD collaborated with OSAP to develop Guidance on Infection Control Considerations for Dental Services in Sites Using Portable Equipment or Mobile Vans to include a checklist and program assessment form. These documents were shared with ASTDD members via the

listserv, at the annual meeting state sharing session, to attendees of the 2011 National Oral Health Conference and the AACDP meeting, and posted to the ASTDD website. http://www.astdd.org/infection-control-and-worker-safety/

http://www.osap.org/?page=ChecklistPortable

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ASTDD and OSAP Websites

Information to update the Infection Control area of the ASTDD website to include all the latest infection control guidelines was prepared, but as a result of HRSA funding cuts, the core team was concerned that there may not be adequate infrastructure in ASTDD to maintain the web page.

The team determined it would be better to create a link to the OSAP website where the information could be maintained on a regular basis.

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ASTDD and OSAP Websites

In order to keep the ASTDD information current, OSAP provides a quarterly update to post on the ASTDD infection control page. http://www.astdd.org/ http://www.astdd.org/infection-control-and-worker-safety/

The team also discussed the importance of having current infection control information available to all public health providers and as a result a public health portal was created on the OSAP website. http://www.osap.org/?page=DentPH_IpAndSafety

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Sharing Project work products were shared with Oral Health Stakeholders… ADA, ADHA, NDA, HDA, ADAA, NNOHA and the ASTDD members, committees, consultants and to those companies that market products and equipment to portable and mobile oral healthcare programs.

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Being Responsive

During the many natural disasters this past year, information on boil water advisories and OSAP infection and prevention resources were distributed to the man stakeholder groups.

Boil Water Advisory. An online toolkit for areas experiencing a boil-water alert.

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Evaluation

Results of the process evaluation show that three major objectives were met. These were: Objective A: Obtain input from state oral health programs on

current infection prevention and safety strategies, their roles in these strategies, who they partner with, gaps in knowledge, practices or policies, and need for more focused efforts.

Objective B: Develop recommendations to integrate appropriate resources and policies from the OSAP and U.S. Public Health Agencies into ASTDD’s culture and documentation.

Objective C: Disseminate, promote, and evaluate the impact of integrating infection prevention and safety resources into ASTDD and ASTDD resources into OSAP.

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Intermediate and Longer Term Outcomes

A model for evaluating the intermediate and longer term outcomes was developed and will be implemented, resources permitting.

Longer term, the focus will be on reduced risk of infection.

In the intermediate term, the focus will be on increased awareness and use of resources increased inclusion of infection control strategies in plans,

policies, and other documents greater utilization of effective infection control strategies.

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OSAP, ASTDD and Beyond

The processes used in the project can be used as a model for OSAP collaboration with other public and private organizations to enhance infection control efforts.

To continue to share information on this project, abstracts have been submitted to the 2012 National Oral Health Conference and the 2012 OSAP Symposium.

Your role(s) and opportunities to influence public health policy and practice.

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Y O U R R O L E ( S ) A N D O P P O R T U N I T I E S T O I N F L U E N C E P U B L I C H E A L T H P O L I C Y A N D

P R A C T I C E .

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Infection Prevention and Control Professionals

A C A S E S T U D Y

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Case Study 1

State A has a new mobile oral health program. The mobile program has self-contained water systems for

each dental unit. Staff were not regularly checking the dental unit

waterlines. When they did test, the first test showed higher colony forming units (CFUs) than recommended (<500 CFUs.)

What should staff be doing on a regular basis? Why is monitoring bacteria in dental unit water lines important?

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Case Study 2

Recent news about a potential infection of students on a mobile program due to unsterile instruments stimulated discussion on what the sterilization monitoring process should be.

Staff were not sure they were using all the proper procedures and wanted a review.

What should the staff be doing routinely to monitor the sterilization of instruments?

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What is Wrong with the Image 31

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What is Wrong with this Image 32

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P A T I E N T S P O P U L A T I O N S

P R O V I D E R S

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