Appendix A: Infection Prevention Checklist for Dental Settings: Basic Expectations for Safe Care
The following is a companion to the Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. The checklist should be used—
- To ensure the dental health care setting has appropriate infection prevention policies and practices in place, including appropriate training and education of dental health care personnel (DHCP) on infection prevention practices, and adequate supplies to allow DHCP to provide safe care and a safe working environment.
- To systematically assess personnel compliance with the expected infection prevention practices and to provide feedback to DHCP regarding performance. Assessment of compliance should be conducted by direct observation of DHCP during the performance of their duties.
DHCP using this checklist should identify all procedures performed in their setting and refer to appropriate sections of this checklist to conduct their evaluation. Certain sections may not apply (e.g., some settings may not perform surgical procedures or use medications in vials, such as for conscious sedation). If the answer to any of the applicable listed questions is no, efforts should be made to determine why the correct practice was not being performed, correct the practice, educate DHCP (if applicable), and reassess the practice to ensure compliance. Consideration should also be made to determine the risk posed to patients by the deficient practice. Certain infection prevention and control lapses (e.g., re-use of syringes on more than one patient, sterilization failures) can result in bloodborne pathogen transmission and measures to address the lapses should be taken immediately. Identification of such lapses may warrant immediate consultation with the state or local health department and appropriate notification and testing of potentially affected patients.
Section I lists administrative policies and dental setting practices that should be included in the site-specific written infection prevention and control program with supportive documentation. Section II describes personnel compliance with infection prevention and control practices that fulfill the expectations for dental health care settings. This checklist can serve as an evaluation tool to monitor DHCP compliance with the CDC’s recommendations and provide an assurance of quality control.[/cdc_textbox]
Infection Prevention Checklist
Section I:
Policies and Practices
I.1 Administrative Measures
| Elements To Be Assessed | Assessment | Notes/Areas For Improvement |
|---|---|---|
| A. Written infection prevention policies and procedures specific for the dental setting are 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. |
Yes No | |
| B. Infection prevention policies and procedures are reassessed at least annually or according to state or federal requirements, and updated if appropriateNote: This may be performed during the required annual review of the dental setting’s OSHA Exposure Control Plan. | Yes No | |
| C. At least one individual trained in infection prevention is assigned responsibility for coordinating the program | Yes No | |
| D. Supplies necessary for adherence to Standard Precautions are readily availableNote: This includes, but is not limited to hand hygiene products, safer devices to reduce percutaneous injuries, and personal protective equipment (PPE). | Yes No | |
| E. Facility has system for early detection and management of potentially infectious persons at initial points of patient encounterNote: System may include taking a travel and occupational history, as appropriate, and elements described under respiratory hygiene/cough etiquette. | Yes No |
I.2 Infection Prevention Education and Training
| Elements To Be Assessed | Assessment | Notes/Areas For Improvement |
|---|---|---|
| A. DHCP receive job or task-specific training on infection prevention policies and procedures and the OSHA bloodborne pathogens standard—a. upon hire b. annually c. when new tasks or procedures affect the employee’s occupational exposure d. according to state or federal requirementsNote: This includes those employed by outside agencies and available by contract or on a volunteer basis to the dental setting. |
Yes No | |
| B. Training records are maintained in accordance with state and federal requirements | Yes No |
I.3 Dental Health Care Personnel Safety
| Elements To Be Assessed | Assessment | Notes/Areas For Improvement |
|---|---|---|
| A. Facility has an exposure control plan that is tailored to the specific requirements of the facility (e.g., addresses potential hazards posed by specific services provided by the facility)Note: A model template that includes a guide for creating an exposure control plan that meets the requirements of the OSHA Bloodborne Pathogens Standard [PDF – 523 KB] is available. | Yes No | |
| B. DHCP for whom contact with blood or OPIM is anticipated are trained on the OSHA Bloodborne Pathogens Standard:a. upon hire b. at least annually |
Yes No | |
| C. Current CDC recommendations for immunizations, evaluation, and follow-up are available. There is a written policy regarding immunizing DHCP, including a list of all required and recommended immunizations for DHCP (e.g., hepatitis B, MMR (measles , mumps, rubella), varicella (chickenpox), Tdap (tetanus, diphtheria, pertussis) | Yes No | |
| D. Hepatitis B vaccination is available at no cost to all employees who are at risk of occupational exposure to blood or other potentially infectious material (OPIM) | Yes No | |
| E. Post-vaccination screening for protective levels of hepatitis B surface antibody is conducted 1-2 months after completion of the 3-dose vaccination series | Yes No | |
| F. All DHCP are offered annual influenza vaccinationNote: Providing the vaccination at no cost is a strategy that may increase use of this preventive service. | Yes No | |
| G. All DHCP receive baseline tuberculosis (TB) screening upon hire regardless of the risk classification of the setting | Yes No | |
| H. A log of needlesticks, sharps injuries, and other employee exposure events is maintained according to state or federal requirements | Yes No | |
| I. Referral arrangements are in place to qualified health care professionals (e.g., occupational health program of a hospital, educational institutions, health care facilities that offer personnel health services) to ensure prompt and appropriate provision of preventive services, occupationally-related medical services, and postexposure management with medical follow-up | Yes No | |
| J. Following an occupational exposure event, postexposure evaluation and follow-up, including prophylaxis as appropriate, are available at no cost to employee and are supervised by a qualified health care professional | Yes No | |
| K. Facility has well-defined policies concerning contact of personnel with patients when personnel have potentially transmissible conditions. These policies include—a. work-exclusion policies that encourage reporting of illnesses and do not penalize staff with loss of wages, benefits, or job status b. education of personnel on the importance of prompt reporting of illness to supervisor |
Yes No |
I.4 Program Evaluation
| Elements To Be Assessed | Assessment | Notes/Areas For Improvement |
|---|---|---|
| A. Written policies and procedures for routine monitoring and evaluation of the infection prevention and control program are available | Yes No | |
| B. Adherence with certain practices such as immunizations, hand hygiene, sterilization monitoring, and proper use of PPE is monitored and feedback is provided to DHCP | Yes No |
I.5 Hand Hygiene
| Elements To Be Assessed | Assessment | Notes/Areas For Improvement |
|---|---|---|
| A. Supplies necessary for adherence to hand hygiene for routine dental procedures (e.g., soap, water, paper towels, alcohol-based hand rub) are readily accessible to DHCPa. if surgical procedures are performed, appropriate supplies are available for surgical hand scrub technique (e.g., antimicrobial soap, alcohol-based hand scrub with persistent activity)
Note: Examples of surgical procedures include biopsy, periodontal surgery, apical surgery, implant surgery, and surgical extractions of teeth. |
Yes No | |
| B. DHCP are trained regarding appropriate indications for hand hygiene including handwashing, hand antisepsis, and surgical hand antisepsisNote: Use soap and water when hands are visibly soiled (e.g., blood, body fluids). Alcohol-based hand rub may be used in all other situations. | Yes No |
I.6 Personal Protective Equipment (PPE)
| Elements To Be Assessed | Assessment | Notes/Areas For Improvement |
|---|---|---|
| A. Sufficient and appropriate PPE is available (e.g., examination gloves, surgical face masks, protective clothing, protective eyewear/face shields, utility gloves, sterile surgeon’s gloves for surgical procedures) and readily accessible to DHCP | Yes No | |
| B. DHCP receive training on proper selection and use of PPE | Yes No |
I.7 Respiratory Hygiene/Cough Etiquette
| Elements To Be Assessed | Assessment | Notes/Areas For Improvement |
|---|---|---|
| A. Policies and procedures to contain respiratory secretions in people who have signs and symptoms of a respiratory infection, beginning at point of entry to the dental setting have been implemented. Measures include—a. posting signs at entrances (with instructions to patients with symptoms of respiratory infection to cover their mouths / noses when coughing or sneezing, use and dispose of tissues, and perform hand hygiene after hands have been in contact with respiratory secretions) b. providing tissues and no-touch receptacles for disposal of tissues c. providing resources for patients to perform hand hygiene in or near waiting areas d. offering face masks to coughing patients and other symptomatic persons when they enter the setting e. providing space and encouraging persons with respiratory symptoms to sit as far away from others as possible—if possible, a separate waiting area is ideal |
Yes No | |
| B. DHCP receive training on the importance of containing respiratory secretions in people who have signs and symptoms of a respiratory infection | Yes No |
I.8 Sharps Safety
| Elements To Be Assessed | Assessment | Notes/Areas For Improvement |
|---|---|---|
| A. Written policies, procedures, and guidelines for exposure prevention and postexposure management are available |
Yes No | |
| B. DHCP identify, evaluate, and select devices with engineered safety features (e.g., safer anesthetic syringes, blunt suture needle, safety scalpels, or needleless IV systems)—a. at least annually b. as they become available in the marketNote: If staff inquire about the availability of new safety devices or safer options and find none are available, DHCP can document these findings in their office exposure control plan. |
Yes No |
I.9 Safe Injection Practices
| Elements To Be Assessed | Assessment | Notes/Areas For Improvement |
|---|---|---|
| A. Written policies, procedures, and guidelines for safe injection practices (e.g., aseptic technique for parenteral medications) are available | Yes No | |
| B. Injections are required to be prepared using aseptic technique in a clean area free from contamination or contact with blood, body fluids, or contaminated equipment | Yes No |
I.10 Sterilization and Disinfection of Patient-Care Items and Devices
| Elements To Be Assessed | Assessment | Notes/Areas For Improvement |
|---|---|---|
| A. Written policies and procedures are available to ensure reusable patient care instruments and devices are cleaned and reprocessed appropriately before use on another patient | Yes No | |
| B. Policies, procedures, and manufacturer reprocessing instructions for reusable instruments and dental devices are available, ideally in or near the reprocessing areas | Yes No | |
| C. DHCP responsible for reprocessing reusable dental instruments and devices are appropriately trained—a. upon hire b. at least annually c. whenever new equipment or processes are introduced |
Yes No | |
| D. Training and equipment are available to ensure that DHCP wear appropriate PPE (e.g., examination or heavy duty utility gloves, protective clothing, masks, eye protection) to prevent exposure to infectious agents or chemicalsNote: The exact type of PPE depends on infectious or chemical agent and anticipated type of exposure. | Yes No | |
| E. Routine maintenance for sterilization equipment is—a. performed according to manufacturer instructions b. documented by written maintenance records |
Yes No | |
| F. Policies and procedures are in place outlining dental setting response (e.g., recall of device, risk assessment) in the event of a reprocessing error/failure | Yes No |
I.11 Environmental Infection Prevention and Control
| Elements To Be Assessed | Assessment | Notes/Areas For Improvement |
|---|---|---|
| A. Written policies and procedures are available for routine cleaning and disinfection of environmental surfaces (i.e., clinical contact and housekeeping) | Yes No | |
| B. DHCP performing environmental infection prevention procedures receive job-specific training about infection prevention and control management of clinical contact and housekeeping surfaces—a. upon hire b. when procedures / policies change c. at least annually |
Yes No | |
| C. Training and equipment are available to ensure that DHCP wear appropriate PPE (e.g., examination or heavy duty utility gloves, protective clothing, masks, and eye protection) to prevent exposure to infectious agents or chemicals | Yes No | |
| D. Cleaning, disinfection, and use of surface barriers are periodically monitored and evaluated to ensure that they are consistently and correctly performed | Yes No | |
| E. Procedures are in place for decontamination of spills of blood or other body fluids | Yes No |
I.12 Dental Unit Water Quality
| Elements To Be Assessed | Assessment | Notes/Areas For Improvement |
|---|---|---|
| A. Policies and procedures are 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 | Yes No | |
| B: Policies and procedures are in place for using sterile water as a coolant/irrigant when performing surgical procedures Note: Examples of surgical procedures include biopsy, periodontal surgery, apical surgery, implant surgery, and surgical extractions of teeth. |
Yes No | |
| C. Written policies and procedures are available outlining response to a community boil-water advisory | Yes No |