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Postexposure Prophylaxis, Monitoring, and the Exposure Control Plan

  • Guadalupe Garcia FayEmail author
  • Janet Naglik
Chapter

Abstract

Prevention is paramount and the development of standard operating procedures modeled after evidence-based infection control measures designed to prevent or limit the spread of infection in dentistry are key to the safety of both workers and patients alike. Equally important is the training and education of dental health-care providers about these procedures and their use, monitoring for compliance to see where there is need for improvements, and implementing measures for change to prevent or minimize future noncompliance. Unfortunately, noncompliance with safety measures will always be an issue for some, and despite the use of safety measures, accidents will still occur and occupational exposures will occur. These must be managed according to the various national guidelines. This includes prompt referral to a qualified health-care provider for evaluation of the exposed individual and, where warranted, postexposure prophylaxis (PEP) and appropriate monitoring and follow-up. All of these policies should be clearly written in the office’s Exposure Control Plan. Therefore, it is of the upmost importance for all institutions and private offices to have an exposure control plan (ECP) with clear policies and procedures designed to help dental health-care providers, not only to prevent the spread of infection, but also to know how to manage an occupational exposure incident. This chapter will review the principles of Postexposure Monitoring and Prophylaxis and what goes into an Exposure Control Plan.

Keywords

Regimens for postexposure prophylaxis, and follow-up Dental office exposure control plan National agencies overseeing blood-borne pathogen standards Occupational exposure reporting document Engineering controls Work practice controls Exposure prevention training 

References

  1. 1.
    Kuhar D, Henderson D, Struble K, Heneine W, Thomas V, Cheever L, Gomaa A, Panilio A, US Public Health Service Working Group. Updated US Public Health Service guidelines for the management 10 of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013;34(9):875–92.  https://doi.org/10.1086/672271.CrossRefPubMedGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention (CDC). Exposure to blood; what healthcare personnel need to know 2003. Brochure from the CDC, and the Department of Health and Human Services. https://www.cdc.gov/HAI/pdfs/bbp/Exp_to_Blood.pdf.Clinician.
  3. 3.
    Consultation Center University of California, San Francisco. Exposures to HBV: PEP quick guide for occupational exposures. http://nccc.ucsf.edu/clinical-resources/pep-resources/pep-quick-guide-for-occupational-exposures/. Content source: Updated 1 Jul 2019.
  4. 4.
    Clinician Consultation Center University of California, San Francisco. Exposures to HCV: PEP quick guide for occupational exposures. http://nccc.ucsf.edu/clinical-resources/pep-resources/pep-quick-guide-for-occupational-exposures/. Updated 1 Jul 2019.
  5. 5.
    Centers for Disease Control and Prevention (CDC). Testing for HCV infection: an update of guidance for clinicians and laboratories. MMWR. 2013;62(18):362–5.. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6218a5.htm Google Scholar
  6. 6.
    Clinician Consultation Center University of California, San Francisco. Deciding whether to give HIV PEP: PEP quick guide for occupational exposures. http://nccc.ucsf.edu/clinical-resources/pep-resources/pep-quick-guide-for-occupational-exposures/. Content source: Updated 1 Jul 2019.
  7. 7.
    Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf. Published 2012. Accessed from https://aidsinfo.nih.gov/guidelines on 13 Sept 2019.
  8. 8.
    Gulick RM, Mellors JW, Havlir D, et al. Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy. N Engl J Med. 1997;337(11):734–9.CrossRefGoogle Scholar
  9. 9.
    Hirsch M, Steigbigel R, Staszewski S, et al. A randomized, controlled trial of indinavir, zidovudine, and lamivudine in adults with advanced human immunodeficiency virus type 1 infection and prior antiretroviral therapy. J Infect Dis. 1999;180(3):659–65.CrossRefGoogle Scholar
  10. 10.
    Wheeler WH, Ziebell RA, Zabina H, et al.; Variant, Atypical, and Resistant HIV Surveillance Group. Prevalence of transmitted drug resistance associated mutations and HIV-1 subtypes in new HIV-1 diagnoses, U.S.–2006. AIDS. 2010;24(8):1203–12.CrossRefGoogle Scholar
  11. 11.
    Kim D, Wheeler W, Ziebell R, et al. Prevalence of transmitted antiretroviral drug resistance among newly-diagnosed HIV-1-infected persons, US, 2007. Presented at CROI 2010: 17th Conference on Retroviruses and Opportunistic Infections, 2010, San Francisco.Google Scholar
  12. 12.
    World Health Organization. World Health Organization guidelines on post exposure prophylaxis for HIV recommendations for a public health approach; Nathan Ford and Kenneth H Mayer; for the World Health Organization Post Exposure Prophylaxis Guideline—WHO guidelines for HIV PEP. CID. 2015;60(S3):S161–4.Google Scholar
  13. 13.
    US Department of Labor, Occupational Safety and Health Administration. 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; needlesticks and other sharps injuries; final rule. Federal Register 2001;66:5317–25. As amended from and includes 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; final rule. Federal Register. 1991;56:64174–82. http://www.osha.gov/SLTC/dentistry/index.html.
  14. 14.
    CDC. National Institute for Occupational Safety and Health. NIOSH alert: preventing needlestick injuries in health care settings. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, CDC, National Institute for Occupational Safety and Health; 1999. NIOSH publication no. 2000-108. https://www.cdc.gov/niosh/docs/2000-108/pdfs/2000-108.pdf.Google Scholar
  15. 15.
    Laramie AK, Bednarsh HS, Isman B, Boiano JM, McCrone SH. Use of bloodborne pathogens exposure control plans in private dental practices: results and clinical implications of a national survey. Compend Contin Educ Dent. 2017;38(6):398–407.Google Scholar
  16. 16.
    Hbibi A, Kasouati J, Charof R, Chaouir S, El Harti K. Evaluation of the knowledge and attitudes of dental students toward. J Int Soc Prev Commun Dent. 2018;8(1):77–86.Google Scholar
  17. 17.
    Kasat V, Saluja H, Ladda R, Sachdeva S, Somasundaram K, Gupta A, et al. Knowledge, attitude and practices toward post exposure prophylaxis for human immunodeficiency virus among dental students in India. Ann Med Health Sci Res. 2014;4:543–8.CrossRefGoogle Scholar
  18. 18.
    Khandelwal V, Khandelwal S, Gupta N, Nayak UA, Kulshreshtha N, Baliga S, et al. Knowledge of hepatitis B virus infection and its control practices among dental students in an Indian city. Int J Adolesc Med Health. 2017:1–6.Google Scholar
  19. 19.
    Souza NP, Villar LM, Moimaz SA, Garbin AJ, Garbin CA. Knowledge, attitude and behaviour regarding hepatitis C virus infection amongst Brazilian dental students. Eur J Dent Educ. 2017;21:e76–82.CrossRefGoogle Scholar
  20. 20.
    Wu L, Yin YL, Song JL, Chen Y, Wu YF, Zhao L, et al. Knowledge, attitudes and practices surrounding occupational blood-borne pathogen exposure amongst students in two Chinese dental schools. Eur J Dent Educ. 2016;20:206–12.CrossRefGoogle Scholar
  21. 21.
    Centers for Disease Control and Prevention (CDC). Division of Healthcare Quality Promotion. Workbook for designing, implementing, and evaluating a sharps injury prevention program. http://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf.
  22. 22.
    Centers for Disease Control and Prevention (CDC). July, 2003, exposure to blood—what health-care workers need to know, 2003. http://www.cdc.gov/HAI/pdfs/bbp/Exp_to_Blood.pdf.
  23. 23.
    Centers for Disease Control and Prevention (CDC). Guidelines for infection control in dental health-care settings, 2003. MMWR Morb Mortal Wkly Rep. 2003;52(17):1–68.Google Scholar
  24. 24.
    American Dental Association (ADA), Post-exposure evaluation and follow-up requirements under OSHA’s standard for occupational exposure to bloodborne pathogens, a step-by-step guide to compliance. https://www.ada.org/en/member-center/oral-health-topics/occupational-safety-and-health-administration.
  25. 25.
    Occupational and Safety Health Administration (OSHA). Model plans and programs for the OSHA bloodborne pathogens and hazard communications standards, OSHA 3186-06R2003. 2003. www.osha.gov.
  26. 26.
    Occupational and Safety Health Administration (OSHA). 29 CFR Part 1910. Occupational exposure to bloodborne pathogens: Needle-stick and other sharps injuries; final rule. Fed Regist. 2001;66(12):5318–25.Google Scholar
  27. 27.
    Molinari JA, Harte JA. Cottone’s practical infection control in dentistry. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins. p. 271–82. Ch. 15 pp. 209–220; Ch. p. 21.Google Scholar
  28. 28.
    American Dental Association (ADA). Regulatory compliance manual. Your step-by-step-guide to OSHA compliance. Bloodborne pathogens. Chicago, IL: ADA; 2008.Google Scholar
  29. 29.
    US Department of Labor, Occupational Safety and Health Administration. 29 CFR Part 1910.1030. Occupational exposure to bloodborne pathogens; final rule. Federal Register. 1991;56(235):645175–82. with needlestick prevention update of 2001 added. http://www.osha.gov/SLTC/dentistry/index.html.Google Scholar
  30. 30.
    Miller CH. Infection control and management of hazardous materials for the dental team. 5th ed. Amsterdam: Elsevier. p. 70–88.Google Scholar
  31. 31.
    Cleveland JL, Foster M, Barker L, Brown GG, Lenfestey N, Lux L, Corley TJ, Bonito AJ. Advancing infection control in dental care settings. JADA. 2012;143(10):1127–38.PubMedGoogle Scholar
  32. 32.
    Kohn WG, Harte JA, Malvitz DM, Collins AS, Cleveland JL, Eklund KJ. Guidelines for infection control in dental health care settings—2003. JADA. 2004;135:33–47.PubMedGoogle Scholar
  33. 33.
    Sebastiani F, Dym H, Kirpalani T. Infection control in the dental office. Dent Clin N Am. 2017;61:435–57.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Advanced Oral Sciences and TherapeuticsSchool of Dentistry, University of MarylandBaltimoreUSA
  2. 2.Infection Control and Exposure ManagementSchool of Dentistry, University of MarylandBaltimoreUSA

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