Orthotown July/August 2020 - 67

continuing education

Universal, standard and
transmission-based precautions
Universal precautions, which were
formally introduced in 1985, are described
by the Occupational Safety and Health
Administration (OSHA) as an approach
to infection control to treat all human
blood and certain human body fluids as if
they were known to be infectious for HIV,
HBV and other bloodborne pathogens.
Although these precautions were created
with primarily bloodborne pathogens in
mind, they were later expanded to include
any "other potentially infectious materials"
(OPIM), including saliva.
By the 1990s, the CDC had led the
effort to further evolve the precautions
needed for health care providers, resulting
in a two-tiered approach. The fi rst tier,
standard precautions, includes a number of
precautions and emphasizes frequent hand
hygiene and the use of PPE.
Because of widespread use of vaccines,
standard precautions have long been considered sufficient for practice in dental settings.
The second tier, transmission-based
precautions, adds enhancements to standard
precautions in the face of highly transmissible
or emerging and infectious diseases about
which there is inadequate information.
Transmission-based precautions are further
subcategorized into contact, droplet and
airborne precautions. One easily controlled
component of transmission-based precautions
is the use of PPE.
In a orthodontic setting, the aerosolization of saliva-a potentially infectious
material- occurs even with the use of an air/
water syringe. OSHA currently discourages
the use of aerosol generation, including
minimizing the use of air/water syringes
and high-speed handpieces.
Although orthodontic procedures in
general produce fewer aerosols than other
dental procedures, orthodontic practices
tend to see a higher volume of patients

and practice in open-bay settings. In the
absence of engineering controls to prevent
the flow of aerosols, it becomes critical for
orthodontists to space patients out physically
and temporally, and to be well versed in
infection prevention practices, including
the use of advanced PPE.
At the time of publication, both the CDC
(which focuses on sharing and interpreting
scientific evidence) and OSHA (which focuses
on protecting employees) recommends:
* Dental settings have unique
characteristics that warrant
additional infection-control
considerations.
* Proactively communicate to
both staff and patients the need
for them to stay at home if sick.
* Screen patients for COVID-19
symptoms before they enter your
facility.
Because this is a fluid situation with
emerging science, guidance from these
organizations is expected to change. Health
care providers are encouraged to frequently
check their websites.

Point-of-care testing
Until a vaccine is widely available or
more is learned about the potential for
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Orthotown July/August 2020

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