Recent Oklahoma Case Highlights Importance of Reviewing Office Sterilization Procedures

By Thomas J. Weber, Esq.

As a licensed practicing dentist, either you are aware, or should be, of the Oklahoma dentist who recently had his office shut down due to violations of appropriate infectious disease controls.

The state of Oklahoma’s investigation began when one of the dentist’s patients was found to be HIV positive and all other likely causes had been eliminated. The Oklahoma Board of Dentistry’s surprise inspection uncovered the regular use of a rusty set of instruments and the practice of pouring bleach on wounds until they “turned white.” The dentist also allegedly reused needles.

The incident has not only caused concern in the dental community, but also with those who regulate dentists. Just as the Watkins case resulted in heightened scrutiny on the administration of anesthesia in the practice of dentistry and eventually the overhaul of the regulations pertaining to its administration, it is safe to assume the Oklahoma incident will have a similar affect in terms of office sterility protocols and infectious disease control.

While it is uncertain whether the Pennsylvania Department of State is likely to launch a series of random office inspections, it nonetheless is a good time for every dental office to examine its infectious disease protocols. Furthermore, it is likely that anytime an investigator has reason to visit an office they will pay closer attention to infection control even if that is not the reason for their visit.

Currently the regulations define it as unprofessional conduct for a dentist to fail to follow current infection-control recommendations issued by the Federal Centers for Disease Control or to ensure that auxiliary personnel and other supervisees follow these guidelines. 49 Pa. Code §33.211(a)(7). Likewise it is unprofessional conduct for a dental hygienist or expanded function dental assistant to fail to follow current infection-control recommendations issued by the Federal Centers for Disease Control. 49 Pa. Code §33.211(b)(4) and §33.211(c)(4). There are a number of steps that dental offices can take to ensure their compliance with their regulatory obligations, as well as protect the health and safety of their patients. Please allow me to set forth some of the most important.

The Commonwealth of Pennsylvania will rely on the “Guidelines for Infectious Control in Dental Health-Care Settings, 2003,” as developed by the Centers for Disease Control and Prevention.” A copy of the guidelines can be obtained by a simple Internet search for “CDC dental guidelines.” It can also be accessed at cdc.gov/oralhealth/infectioncontrol/guidelines. Every dentist should have a thorough understanding of these guidelines. 

In addition to reviewing the guidelines, dentists should review the manufacturer’s suggested guidelines for the sterilization products used in the office. However, caution must be used in relying on the verbal instructions provided by sales representatives due to the possibility of an error occurring during the communication. Furthermore, should there be a discrepancy between the manufacturer’s guidelines and those of the CDC, the Commonwealth will rely on the CDC.
 
Finally, it is essential that all staff involved in the sterilization process receive proper training, and are informed of and understand, the importance of adhering to the required sterilization protocols. The CDC website contains a slide presentation that can be used to assist in staff training. This training should be conducted regularly and be made a part of every new employee’s orientation. Recognize that although it is appropriate to delegate the sterilization procedures, as the regulations state, a dentist commits unprofessional conduct if he or she fails to ensure that auxiliary personnel and other supervisees follow these guidelines. Therefore, although it may be the employee who violates the guidelines, the dentist’s license will be subject to discipline as well.