Infection prevention is a requirement, and 1 of the keys to success is to have 1 person spearheading the practice’s efforts.
The Dentist’s Professional Pledge covers such themes as professional development, ethics, as well as the patient’s overall well-being. Certainly, patient safety includes protection from harm that they might encounter at the practice. Optimal infection prevention measures are, clearly, important and to best deliver that care, the practice should designate a point person to coordinate and manage all of those details.
The infection prevention coordinator (IPC) is someone who, in addition to their own duties, is responsible for ensuring the team’s ongoing training, managing documentation, and coordinating all the other housekeeping routines. Typically, that role is assigned and becomes part of that team member’s job. That job tends not re-appointed very often, but, what happens if that position needs to be reassigned?
While there is no official requirement for the practice to appoint an IPC, that role has been promoted by Centers for Disease Control (CDC) since 2003. CDC’s Guidelines for Infection Control in Dental Health-Care Settings – 2003 state, “An infection-control coordinator (e.g., dentist or other dental health care personnel) knowledgeable or willing to be trained should be assigned responsibility for coordinating the program. The effectiveness of the infection control program should be evaluated on a day-to-day basis and over time to ensure that policies, procedures, and practices are useful, efficient, and successful. Although the infection control coordinator remains responsible for overall management of the program, creating and maintaining a safe work environment ultimately requires the commitment and accountability of all dental health care personnel.”
Though there is no mandate for the position, practices are wise to fill that role, especially as states embrace CDC’s guidance.
“CDC makes recommendations,” Jonathan Rudin, DDS, MS, MPH, observes. Dr Rudin is a safety and infection control consultant at San Diego Healthcare Compliance. “Some states have been adopting recommendations from the CDC as requirements for those states. It saves them a lot of work from having to come up with their own requirements. Having that safety officer is a smart thing to do.”
Re-appointing that position can be somewhat rare, because typically, the same person tends to fill that role for years at a time.
“Usually, the same person that’s been at the practice for years continues in it,” Dr Rudin says. “Occasionally, that person will assign someone else to take over the role while the original safety officer steps back from it. There can be an overlap period where the original safety officer is still engaged in the role while the replacement is being trained. Then the original safety officer will relinquish totally to the new person.”
Further, Dr Rudin points that practices need not be limited to just 1 infection prevention coordinator.
“Having a single person in the role of safety officer is a minimum standard,” he says. “Optimally, there would be at least 2 people cross-trained in this role so that if 1 is out sick or on vacation then critical protocols are maintained.”
Roles and Responsibilities
There is no 1 “right” person for the job. That is, the role can be filled by anyone at the practice, assuming they are able to conscientiously perform the duties. However, some team members may be better suited to the role than others.
“When selecting the IPC, I feel it best to select someone who is clinical, works at the practice, and has a working knowledge of the infection control procedures and policies of the practice,” Mary Bartlett, President SafeLink Consulting, advises. ”Also, since the CDC guidelines for dentistry are recognized by most State Boards as the basis for infection control policies, the IPC must be completely familiar with those guidelines. This is especially true when it comes to how to protect patients and team members from COVID-19.”
“It doesn’t really matter who does it,” Dr Rudin adds. “I typically find that the dental assistants are the ones that have been assigned as the safety officers. There are even some dentists—the practice owners—who will insist on being in charge. I think that’s probably optimal, in a way, assuming the dentist has the time for it. That shows me that the practice owner is directly involved with safety in the office. And, at other times, the dental assistant is taking over and the dentist is kind of oblivious. They almost have their head in the sand, and that’s unfortunate.”
Whoever fills the IPC role adds those duties to whatever they already do at the practice.
“That’s the way I’ve always seen it—as an adjunct responsibility,” Dr Rudin says. “I have seen some practices that hire, for example, a sterilization tech whose exclusive role is sterilization. Typically, I have not seen that person take on the expanded role of safety officer for the facility. Usually, it’s someone at the practice who has a desire to expand their duties into other realms.”
In addition to having infection prevention skills, the IPC must also have the people skills to lead his or her fellow team members.
“Because this IPC will be responsible for overseeing the daily infection control practices, it is important for the dentist and other team members to respect this person,” Bartlett says. “This individual must be tactful when bringing gaps in the infection control processes to the attention of team members and must select the proper time and place to discuss where improvements need to be made. The dentist must show support of the IPC in front of team members and make it clear to the team that the IPC has the responsibility of keeping patients and team members safe. When the infection control policies are developed the dentist should enlist the opinions of all team members in the development of these policies so there’s a buy-in by everyone. When the team plays a role in development of the policies there is ownership that is important when they are held to complying with the policies and procedures.”
Because the position is so important, the person filling that role must come to it with his or her own unique set of skills.
“Optimally, they would have the skillset, because they have performed in this role before, say, at another practice,” Dr Rudin observes. “But certainly, it should be somebody that has an understanding of infection prevention and control. And, everybody who comes to the dental field through their training, should have a significant understanding of infection prevention and control. Either way works. That is, they can be well-trained ahead of time or step into it and expand their skills. The qualities of such a person includes a great attention to detail. Which, in dentistry, should be virtually everybody that’s on the staff. Details are very important.”
The IPC will pull his or her professional knowledge from a broad range of sources.
“The IPC also needs to be well-versed on the OSHA standards, such as the Bloodborne Pathogens Standard in order to ensure that the health and safety of all teams members is protected,” Bartlett adds. “Infection control is a critical part of protecting workers. With the challenges that COVID-19 has brought into the workplace, the IPC needs to be an integral part of developing and monitoring the infection control program to ensure that patients, staff, and any visitors allowed into the practice are protected.”
That doesn’t mean that the safety officer should know everything before being assigned to the role.
“The IPC should have outside courses on infection control, made available to them by the dentist so that they can maintain an awareness of new technology and protocols,” Bartlett points out.
But, whoever takes on the job isn’t just performing a-few-minutes-a-week task. The job is as important as it sounds.
“It is a substantial workload,” Dr Rudin observes. “Basically, they’re in charge over the entire office. They have to document the maintenance of equipment. For example, any equipment, sterilizers, eye wash stations, lasers, anything that has a maintenance schedule. They have to document the spore testing for sterilizers. I recommend that they divide and conquer. That is, the safety officer will deputize other staff members to break up or minimize the increased workload for the one in charge of everything. Some people are happy to do that. Other people don’t want to relinquish their control, and they might wind up needing to spend much more time and effort taking care of things.”
Whoever does take on that role should be paid accordingly for their extra responsibilities.
“People should be compensated for the work they perform,” Dr Rudin advises. “It’s definitely more work than what a dental assistant does in his or her role.”
Ultimately, the infection prevention coordinator must have the knowledge, skills, and experience necessary to guide the practice towards operational safety.
“I certainly think that an experienced dental assistant or somebody with experience is optimal in the role,” Dr Rudin says. “Not necessarily somebody that’s fresh out of school—unless they came out of their training program with a great understanding of infection prevention and control. They could step right into the safety officer role provided they have a lot of initiative and drive and they’re very detail-oriented. I think it’s probably more likely that somebody with a number of years of experience in the dental field in the back office would be the best choice.”
The practice’s infection prevention efforts are not just representative of on oath’s noblest element. Infection prevention is a requirement, and 1 of the keys to success is to have 1 person spearheading the practice’s efforts.