Best Practices for Infection Control in Medical and Dental Offices

Healthcare-associated infections (HAI’s) continue to be a concern in many of our healthcare facilities across the United States. According to the Centers for Disease Control (CDC), HAI’s affect between five and ten percent of the hospitalized patients in the US each year. Furthermore, HAI’s can account for approximately 99,000 deaths and can incur an estimated $20 billion in healthcare costs.

One of the key factors to prevent HAI’s is through education and personal training. Setting up Infection Control guidelines and Policy and Procedures can help individuals understand and comply with the necessary strategies’ to limit the spread of infection. This information needs to be reviewed will ALL employees at the time of his/her hire and available for review at any time throughout employment (intranet, manuals, etc). Infection control policies need to be strictly enforced to assure compliance.

This newsletter will focus on proper hand hygiene, personal protective equipment (PPE), safe injections and cleaning of medical devices.

Proper Hand Hygiene

Tips:
Wash hands with soap and water when visibly soiled (bodily fluids, blood, etc) and/or after providing care to patients with suspected and/or known infectious diarrhea (C-difficile, norovirus).
Remember to wash hands for at least 20 seconds and be sure to scrub all surfaces including the top of hands, wrists, between your fingers and under your fingernails.

Liquid soap is ideal; Antibacterial soaps are not necessary for routine use.

When:

• Wash hands before any contact with patients
• Wash hands before performing aseptic technique such as an IV insertion or administering medication injections
• Wash hands after contact with a patient and/or after being in the patient room and/or touching any objects near the patient
• Wash hands after any contact with blood, bodily fluids or contaminated surfaces
• Wash hands when moving from a contaminated body site to a clean body site while providing patient care
• Wash hands after removal of personnel protective equipment

Personal Protective Equipment (PPE)

• Facilities need to make sure they have the appropriate PPE readily available and accessible for staff needs
• All PPE should be removed and discarded before exiting a patients room
• If a respirator is used, it needs to be removed after leaving a patients room and disposed of properly
• Hand hygiene needs to be performed immediately after removing PPE
• Wear gloves for potential contact with patients bodily fluids, blood, contaminated equipment or non-intact skin
• DO NOT wear the same pair of gloves for more than one patient
• DO NOT wash gloves for reuse
• Wear PPE during a procedure where there may be potential for coming in contact with bodily fluids or blood

Safe Injections

• Use aseptic technique when preparing and administering medications
• Use alcohol (wipes,etc) to cleanse the diagrams of medication vials prior to inserting a device into the bottle
• Never administer medications from the same syringe for multiple patients even if you change the needle and/or use the syringe through an intervening length of intravenous tubing
• DO NOT administer medications for single-use or single-dose vials, ampules, or bags/bottles of intravenous fluids for more than one patient
  • DO NOT reuse a syringe to enter a medication vial or container
  • DO NOT use fluid infusion or administration sets for more than one patient
• If using multidose vials, please dedicate these vials to a single patient whenever possible. If used for more than one patient, the medication should be kept in a centralized medication area and should not enter the immediate patient treatment area (patient room, procedure room)
• Dispose of sharps in the appropriate containers that is closable, puncture-resistant, and leak proof

Medical Devices

• Facilities need to make sure that reusable medical devices such as glucose meters, other point-of-service devices and surgical instruments are cleaned and reprocessed appropriately prior to use on another patient
• Reusable medical devices must be cleaned and re-processed (disinfection or sterilization) and maintained according to the manufacturer’s instructions. If the device does not have these instructions, it MAY NOT be suitable for multi-patient use
• Health Care professionals who are responsible for reprocessing medical devices need to be properly trained- (have documentation to prove competency)
• Maintain copies of the manufacturer’s instructions for reprocessing of devices in use at your facility; post instructions at locations where reprocessing is performed
• Hands-on training on proper selection and use PPE and recommended steps for reprocessing assigned devices should be provided upon hire, annually and when new devices are introduced or policies/procedures change.
• Remember to have documented competencies and education of staff readily available for proof of training- Return demonstration is highly recommended by a trained individual in use of a particular device

If an Autoclave is being used in your facility, please be sure to read the Manufacturer guidelines for the type of autoclave you are operating and the correct sterilization process for the instruments being utilized in your facility. Be sure the temperature and time of autoclaving is being followed for optimal results and successful sterilization. If at any time you have any questions/concerns, please contact the Manufacturer.

Resources:
Richmond Library. (2018, June 25). Infection Control Guidelines for Dental &Medical Offices. Retrieved from https://www.richmonddental.net/library/infection-control-guidelines-for-dental-medical-offices/

Guide to Infection Prevention in Outpatient Settings: Minimum Expectations for Safe care, Centers for Disease Control and Prevention. (2018, January 18). Retrieved from https://www.cdc.gov/infectioncontrol/pdf/outpatient/guide.pdf