shall ensure that at least one (1) of the following sterilization procedures is
utilized daily for instruments and equipment:
(a) Steam autoclave
(c) Chemical vapor
(d) Disinfectant/chemical sterilant. U.S.
Environmental Protection Agency (EPA) approved disinfectant shall be used in
dilution amounts and specified time periods.
(e) Any procedure listed in MMWR, Vol 41, No.
RR8, pp. 1-12, May 28, 1993 or successor publications.
The following instruments, unless
disposable, shall be sterilized between patients, after removal of debris, by
one (1) of the above methods provided in paragraph (1):
(a) Low speed handpiece contra angles, prophy
angles and nose cone sleeves
High speed handpieces and surgical handpieces
(c) Hand and orthodontic
(d) Burs and bur
changers, including contaminated laboratory burs and diamond
(f) Air-water syringe
(g) High volume evacuator
(h) Sonic or ultrasonic
scalers and tips
(k) Metal impression
(l) Intra-oral radiographic
equipment that can withstand heat sterilization
(3) All heat sterilizing devices must be
tested for proper function by means of a biological monitoring system that
indicates microorganism kill. The biological monitoring system used must
include a control to verify proper microbial incubation. In the event of a
positive biological spore test, the dentist must take immediate action to
ensure that heat sterilization is being accomplished. Immediate action is
defined as following manufacturer guidelines and performing a second
(2nd) biological spore test. In the event a second
(2nd) positive biological spore test occurs, the
device must be removed from service until repaired. Proof of such repair must
be maintained with the testing documentation.
(4) Documentation must be maintained on all
heat sterilizing devices in a log reflecting dates and person(s) conducting the
testing, or by retaining copies of reports from an independent testing entity.
The documentation shall be maintained for a period of at least two (2) years ,
and shall be maintained in the dental office and be made immediately available
upon request by an authorized agent of the Tennessee Department of
(5) Environmental surfaces
that are contaminated by blood or saliva must be properly cleaned prior to
(6) Disinfection must
be accomplished with an appropriate disinfectant that is registered with the
EPA and used in accordance with the manufacturer's instructions or with bleach
used in a dilution ratio of one (1) to ten (10) or one hundred (100) [1:10 or
1:100]. The disinfection process must be followed between each patient in the
absence of a barrier.
such as impervious backed paper, aluminum foil or plastic wrap must be used to
cover surfaces or items that may be contaminated by blood or saliva and that
are difficult or impossible to disinfect. The barrier must be removed,
discarded, and then replaced between patients.
(8) All single use or disposable items,
labeled as such, used to treat a patient must be discarded and not
(9) Items such as
impressions contaminated with blood or saliva must be thoroughly rinsed,
disinfected, placed in, and transported to the dental laboratory in an
appropriate case containment device that is properly sealed and labeled
"Biohazard", or labeled with the universal symbol for hazardous materials, or
placed in a red container.
Oral prosthetic appliances received from a dental laboratory must be washed
with soap or a detergent and water, rinsed well, appropriately disinfected, and
rinsed well again before the prosthetic appliance is placed in the patient's
(11) Surgical or examination
gloves, surgical masks, and eye protection with eye shields shall be worn by
all dentists, dental hygienists and dental assistants while performing, or
assisting in the performance of, any intra-oral dental procedure on a patient
in which contact with blood and/or saliva is imminent in accordance with CDC
recommendations. Surgical or examination gloves must be changed between
patients. Gloves are never to be washed and reused. Surgical or examination
gloves that are punctured or torn must be removed and replaced immediately with
new gloves following rewashing of the practitioner's hands with soap and
All dentists, dental
hygienists, and dental assistants shall follow hand hygiene guidelines in
accordance with current CDC recommendations. Hand hygiene guidelines include,
but are not limited to:
(a) Hands shall be
washed with soap and water when hands are visibly dirty or contaminated with
proteinaceous material, are visibly soiled with blood or other body fluids,
before eating, and after using a restroom.
(b) Use alcohol-based hand rubs for routine
decontamination of hands for all clinical indications, except as provided in
for hand hygiene include contact with a patient's intact skin, contact with
environment surfaces/inanimate objects in the immediate vicinity of patients,
before donning surgical or examination gloves, and after removal of
(13) To minimize
the need for emergency mouth-to-mouth resuscitation, a practitioner shall
ensure that mouthpieces, resuscitation bags, or other ventilation devices,
appropriate to the patient population served, are available.
All dental health care workers shall
take appropriate precautions, pursuant to OSHA standard
, "Bloodborne Pathogens" or its
successor, to prevent injuries caused by needles, scalpels, and other sharp
instruments or devices during procedures. If a needlestick injury occurs, the
dentist shall comply with the requirements established by OSHA.
(15) All sharp items and contaminated wastes
must be packaged and disposed of according to the requirements established by
any federal, Tennessee state, and/or local government agencies which regulate
health or environmental standards.
(16) All dental health care workers who have
exudative lesions or weeping dermatitis shall refrain from contact with
equipment, devices, and appliances that may be used for or during patient care,
where such contact holds potential for blood or body fluid contamination, and
shall refrain from all patient care and contact until condition(s) resolves
unless barrier techniques would prevent patient contact with the dental health
care worker's blood or body fluid.