Guidelines or rules – which are more important?

by Mary Govoni, CDA, RDA, RDH, MBA

The past several months have been very busy in the world of dental infection prevention. Media coverage of several breaches of infection-control protocol stimulated much dialogue between dental professionals and their patients, as well as among members of dental teams.

As a consultant and lecturer, I have been busy answering many questions that dental teams have had regarding the appropriate steps for them to do to ensure the safety of patients.

As I have stated in numerous articles and lectures, I believe that the vast majority of dental teams do a great job of protecting patients; however, I am always surprised and concerned when doctors and team members say: "But that's just a guideline, right?"

The guideline they typically refer to is from the CDC Guidelines for Infection Control in Dental Health-Care Settings – 2003. Once more for the record, these are not OSHA "rules" for which dental practices can be cited and fined for violations. Instead these guidelines are the prevailing standard of care.

OSHA rules are in place to protect the safety of employees. The 1991 Bloodborne Pathogens Standard is the set of infection-control rules that dental practices must follow. Dental regulatory boards and public health agencies are charged with protecting the safety of patients. Therefore, they hold dentists, hygienists, and assistants responsible for following the prevailing standard of care. This has been the issue at the heart of alleged incidents that have made the national news recently. In all of these cases, the dentists were cited for not following CDC guidelines.

For those still not familiar with CDC guidelines, they are a comprehensive set of recommendations regarding all aspects of infection prevention in a dental care facility. The guidelines address instrument sterilization, disinfection of environmental surfaces, use of personal protective equipment, dental unit water quality, and many more topics.

The guidelines are written in an easy-to-understand format, not the legalese of the OSHA standard. The CDC guidelines and the OSHA rules are not contradictory, but are complementary to each other. There is, in fact, a section of the CDC guidelines that summarizes the recommendations and cross-references them to regulatory standards, such as OSHA, FDA, and EPA rules.

Every dental facility should have a copy of the CDC guidelines and be familiar with these recommendations. The guidelines can be obtained from the CDC website at www.cdc.gov/ OralHealth/infectioncontrol/. This link has the current infection-control guidelines, as well as many other resources for dental professionals regarding infection prevention in dental facilities.

In addition, the CDC has an app for tablets and smartphones that can be used to reference the guidelines and obtain information pertinent to many types of health-care information. The link for the app, named CDC-24/7, is www.cdc.gov/24-7/.

The CDC also has a weekly newsletter, the Morbidity and Mortality Weekly Report or the MMWR, which is another great resource for dental professionals. It is a free subscription, and can be found at www.cdc.gov/mmwr.

I hope that you will become well acquainted with all of the guidelines and resources that the CDC has available for dentistry. As one of my favorite radio talk show hosts, Dr. Laura Schlessinger, would say: "Now go and do the right thing."

Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Mary Govoni & Associates, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at [email protected] or www.marygovoni.com.