Core Competencies for Infection Prevention & Safety for Oral Healthcare
April 2012
Vision
Bolstering the public and private health infrastructure with professionals uniquely qualified to provide
leadership in infection prevention and safety in oral healthcare settings will help to assure the safe
delivery of care.
The Organization for Safety, Asepsis and Prevention (OSAP), together with key global partners,
intends to spearhead the development of a competency-based educational curriculum and leadership
development process in infection prevention and safety tiered to address the needs of dental
educators, consultants, practitioners and the dental industry. The first step in this process is to
develop infection prevention and safety core competencies for dentistry.
Statement of Need
Oral diseases and conditions affect people throughout their life span and nearly every American has
experienced the most common oral disease, tooth decay.i Forty-four percent of the community
population visits a dentist each year and there are more than 300 million dental encounters annuallyii
presenting the potential for a variety of infection and injury-related risks associated with the provision
and receipt of oral healthcare. Whether providing or receiving oral healthcare, risks of potential
infection and injury should be minimized and benefits to receiving care maximized.
Compared to inpatient acute care settings, ambulatory care settings including dentistry have
traditionally had inadequate infrastructure and resources to support infection prevention and
surveillance activities. While data describing risks for healthcare-associated infections (HAI) are
lacking for oral healthcare settings, there have been documented outbreak reports describing
transmission of gram-negative bacteriaiii and virusesiv and reports in the news media of potential
breaches.v,vi,vii All of the breaches described were associated with breakdowns in basic infection
prevention procedures. There is currently no repository or surveillance system tracking oral
healthcare-associated infections and injuries.
Currently there are national and international guidelines and regulations, school-based and continuing
education courses, and many opportunities for education on infection prevention and safety in oral
healthcare. While these documents and programs help guide infection control for oral healthcare
workers, they do not identify the competencies required to assure a safe environment for workers and
their patients.
With the increased need for dental services, emerging workforce models and varied educational
levels of providers, it is important to define the elements that guide infection prevention and safety for
oral healthcare workers and their patients. Accreditation standards focus on the need for workforce
competence as a means of assuring patient safety. Establishing evidence-based practices and
practice outcome measures are essential components for an oral healthcare system that prioritizes
patient safety and provider success.
Potential Applications for Infection Prevention and Safety Competencies
 Provide a safe working environment
 Prevent healthcare-associated infections
 Prevent injuries and occupational exposures
 Serve as a basis for curriculum development
 Serve as a basis for a certification program
 Provide the standards of practice recognized and accepted by the oral healthcare environment
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Provide a framework for developing skills for new practitioners and to inform trainings
Drive adoption and iterate the necessity and importance of adopting these competencies
Serve as a standardized consistent approach to evaluate skills
Form a foundation for self-assessment and peer evaluation
Develop sound evidence-based policies
Assist dental regulatory boards in defining and setting up requirements
Guide equipment development and design
Other
Key Partners
In order to develop competencies with broad-based application, governmental agencies; professional
organizations; clinical care organizations; education, accreditation, and standard setting bodies;
dental corporations and trade associations; third-party payers; international health organizations; and
infection prevention and safety experts should be involved.
OSAP would like to convene an Advisory Committee to include Education (the American Dental
Education Association), Practice (American Dental Association, American Dental Hygienists
Association, American Dental Assistants Association, Dental Assisting National Board), Policy and
Science (US Centers for Disease Control and Prevention), Consultants and Industry (Dental Trade
Alliance).
Resources Required
Resources are required to develop the competency framework, domains and activities including:
 Conducting the literature review and compiling the resources on infection prevention and
safety,
 Developing the competencies,
 Hosting four to six conference calls,
 Supporting a minimum of two full-day face-to-face meetings.
Additional resources will be required for the implementation of the competencies.
Next Steps
OSAP will serve as the lead by obtaining support of initiative by key partners, convening an Advisory
Committee to develop the work plan and identifing sustainable resources for project development and
implementation.
i
U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon
General. Rockville, MD.: U.S. Department of Health and Human Services, National Institute of
Dental and Craniofacial Research, National Institutes of Health; 2000.
ii
Manski RJ, Brown E. Dental Use, Expenses, Private Dental Coverage, and Changes, 1996 and
2004. Rockville (MD): Agency for Healthcare Research and Quality. 2007. MEPS Chartbook No. 17.
http://www.meps.ahrq.gov/mepsweb/data_files/publications/cb17/cb17.pdf.
iii
Ricci ML, Fontana S, Pinci F, et al. Pneumonia associated with a dental unit waterline. Lancet. 2012;
379(9816):684.
iv
Redd FT, Baumbach J, Kohn W, Nainan O, Khristova M, Williams I. Patient-to-patient transmission
of Hepatitis B Virus associated with oral surgery. J Infect Dis. 2007;195(12):1874.
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v
An apparent breach of standardized practice related to dental instrument reprocessing occurred at
the John Cochran Veterans Administration Medical Center (VAMC) in St. Louis, MO. The
facility recently mailed notification letters to 1,812 veterans treated at the dental clinic between
February 2009 and March 2010 stating their internal quality inspections determined that some
instrument processing steps for dental instruments were not in compliance with their standard
policies, creating a low risk of exposure to hepatitis B virus, hepatitis C virus and HIV.
vi
June 2009 United Way of the Eastern Panhandle and Healthy Smiles West Virginia provided free
medical screenings and dental services to over 1,100 patients at a Mission of Mercy (MOM) Dental
Clinic at the Hedgesville High School in Berkeley Country. Approximately 700 volunteers participated
in the clinic. In November 2009, five cases of acute Hepatitis B were reported to local health
departments in WV. Two of these individuals were volunteers at the MOM clinic, and three individuals
received dental treatment. An extensive investigation of the outbreak and review of MOM practices
and protocols was conducted by the WV Division of Infectious Disease Epidemiology and the
Berkeley County Health Department with assistance from the Centers for Disease Control and
Prevention (CDC), United Way of the Eastern Panhandle and Health Smiles WV. The investigation
resulted in recommendations to improve infection control at future mass dental clinics.
vii
Wahlberg D. Access says eight children given dental care with improperly sterilized instruments. WI
State Jrl. 2012; Mar 3.
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