The CDC's infection control pyramid, also called the hierarchy of controls, is something that all dental practices need to follow. It helps you deal with another triangle that's common in dental practices, the Epidemiologic Triangle. Otherwise known as the Epidemiologic Triad, this represents the known hazard that infections create in a dental practice. The CDC's hierarchy of controls is a response to that hazard.
A Brief Primer on the Epidemiologic Triad
The Epidemiologic Triad covers the three components that are necessary to create an epidemic – or the widespread occurrence of an infectious disease.
- The Agent: In the dental office, these are disease-causing microbes like bacteria, viruses, fungi, and protozoa
- The Host: These are the workers and patients in the office who are carrying those microbes.
- The Environment: The environment must be one that is hospitable to allow the microbe to spread. For the dental team, this is the office itself and all its physical spaces and instruments.
When a microbe is spread by a worker into a vulnerable population, all the conditions needed for an epidemic are met.
One thing to keep in mind is that microbes are widespread. The average human carries about 100 trillion of them every single day. However, most of them never experience the right environment they would need to cause a widespread event. They either aren't spread at all, or when they are, they die before they can be transmitted.
While that may seem like good news, it's actually a double-edged sword. While few microbes can make it through, the ones that do are particularly good at adapting to new environments. That's why to address them, we also must address our environment.
The CDC's Infection Control Pyramid
Infection risk is high in the dental office and following proper controls is critical for keeping workers and the public safe. The CDC's infection control pyramid, or the Hierarchy of Controls, is a simple way for them to remember the most effective ways to control the risks.
The most effective means of hazard control is to eliminate the hazard from the environment. In a dental office, we do this through pre-screening tools that happen before the patient comes into the office to avoid treatment when they may have an infection.
Immunization is also a common elimination control. Workers receive vaccinations against common diseases like hepatitis B, measles, mumps, rubella, varicella, chickenpox, tetanus, diphtheria, and pertussis. They're also screened for tuberculosis. This prevents these conditions from passing from workers to vulnerable patients and vice versa.
Substitution is the second most effective means of hazard control as it involves removing the dangerous item and replacing it with another. This is not an easy solution in a dental office, as you can't exactly swap out patients and workers. However, tools that put workers at an increased risk can be replaced.
Sharps injuries are among some of the most common that put dental assistants at risk of exposure. Trading out old-fashioned dental instruments for ones with safety guards and other features is an example of substitution to minimize infection risk.
Engineering controls are designed to separate people from the hazard when the issue can't be replaced or eliminated. We can again return to the example of the sharps injuries above. You can't entirely remove sharps from the equation, but there are ways to separate workers from their risks through engineering controls.
Consider the cassette-style storage systems some dental practices use. Instruments are kept in a cassette to minimize the risk of contact with the blade or needle. For cleaning, the entire cassette is inserted into an Instrument Management System (IMS) that cleans the implement without the dental assistant needing to make direct contact with it.
Administrative controls depend on your workers. You must trust them to follow the proper safety and sanitation procedures to minimize the risk of infections. One big part of that is annual training. All dental office team members who encounter blood or OPIM must have annual training on bloodborne pathogens, but the bare minimum may not be enough.
Regular, detailed training on specific risks and microbes is more effective when it comes to administrative infectious disease controls. The more your team knows, the better prepared they are to respond to the risk.
The final stage of protection is PPE. Team members should have access to gloves, masks, eye shields, and other items they need to protect themselves at work. These workers should also be trained on when to dispose of PPE, when to change it and where it's appropriate to wear it.
Training Your Dental Team on Infection Risks
One of the most important parts of minimizing hazards in the dental office is training. Your team needs to understand the risks and how to respond to an exposure. While the CDC's infection control pyramid is a great starting point, every dental practice needs a detailed program in place to protect their environment and their staff.