#221 Why Dentistry Still Needs to Trust the CDC and It's Guidelines

In this episode, the Divas discuss recent developments at the CDC that suggest that the public's trust in the CDC has diminished.  Although the Division of Oral Health has been eliminated, all of the infection control guidelines for dental settings are still intact, and the Divas will discuss the importance of following these guidelines and how they are recognized as standards of care.

Resources:

• CDC Dental Infection Prevention and Control         https://www.cdc.gov/dental-infection-control/hcp/index.html
• Association for Dental Safety https://www.myads.org/

                                                 https://www.thecompliancedivas.com

Transcript

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SPEAKER_01 0:05

Welcome. I'm Leslie Cannum. I'm Mary Gavoni. I'm Linda Harvey. I'm Olivia Juan. And together we are the Compliance Divas. Welcome to the Compliance Divas podcast. I'm Mary Gavoni and I'm going to be the moderator for this episode. Linda Harvey and Leslie Cannum and I are going to be discussing an issue that's come up over the last several months. And very recently, you may have seen some little background chatter on the news about people not having a high level of trust in the CDC. And if you have been a frequent listener to the Compliance Deepest podcast, you know we always recommend following CDC guidelines. And we're going to discuss what are some alternatives and what are maybe some causes of this distrust. But the bottom line is that in most states, not all, but most states, the dental practice acts require states to follow either all or certain parts of CDC guidelines. Now, CDC guidelines have been around for a long time, and Linda's going to address that a little bit in a minute, but we want to urge all of our listeners to sort of leave the politics out of what's going on at the CDC right now and trust that especially our dental guidelines, even though the division of oral health has been eliminated at CDC, those guidelines are like our Bible to follow to keep our patients safe. And we can't let these underlying feelings of distrust affect what we know is tried and true. So, Linda, can you just go into a little bit more detail about what I just talked about?

SPEAKER_00 2:03

Sure, Mary, happy to. I think amidst the changes, it is a good idea for us to kind of step back and go back to the CDC guidelines for dentistry. They go back to 2003. So they are really time-tested, they're scientifically based guidelines. And of course, yes, if there's been a few updates, we're working on dental water lines here in recent years, but over the long haul, all the infection control practices that we've been following, universal protocols, hand hygiene, sterilization, those things have only improved with the new scientific information related to new technology that's on the market, but it still stems from the guidelines. And as you mentioned, Mary, many states either have the entire CTC guidelines written into the Dental Practice Act or some portion of it. So we are still required to follow them in many states. So I recommend that we stick close to the 2003 guidelines and always remember to incorporate the manufacturer's instructions for use because combined, those are your best practices. Thanks, Mary.

SPEAKER_01 3:06

Thank you, Linda. And I just want to add to that by saying that in the past, and there's still some reaction to that word guidelines on the part of some dental professionals. Well, they're just guidelines. We can decide if we want to follow them or not. They're suggestions. They're really not, they are the accepted standards of care in dentistry.

SPEAKER_00 3:28

Mary, I was just going to echo that. I was going to say, yes, they are the standard of care. So even if the entire CEC guidelines are not written into your State Dental Practice Act, if you have a complaint to the let's get filed with the Board of Dentistry by a patient or even a team member, from what attorneys have told me over the years, Mary, those complaints rise to the top of the list because of the patient safety or public health interest. And they treat them like they would an impaired practitioner. It goes right up to that severity. And they will either be investigated or um called in question, maybe even shut down. So there's all different ways that every state general practice act board handles that. But it's important that we realize that they are the crux of the matter. And we just can't throw those out because we have to follow the sound and scientific guidelines that they've provided us.

SPEAKER_01 4:14

Absolutely, Linda. And I also wanted to mention that although the division of oral health at the CDC was eliminated, the information is still there. You can still access the guidelines, you can still access information about respiratory viruses. We may not get updates as frequently as we have before. And I think I remember hearing something about the MMWR, the Morbidity Mortality Weekly Report right now, because of the shutdown, isn't being published, but there still is access to that information. It is still there. It is not affected by any of the other changes being made at this point. Leslie?

SPEAKER_02 4:55

So one thing I wanted to remind our listeners is that the 2003 CDC Guidelines for Best Practices in Infection Control for Dental Settings, it's actually categorized on the basis of existing scientific data, theoretical rationale, and applicability. And there's rankings that are based on the system used by CDC and the Healthcare Infection Control Practices Advisory Committee to categorize the recommendations. So here's my favorite part. Category 1A is strongly recommended for implementation and strongly supported by well-designed experimental clinical or epidemiologic studies. And Category 1B is similar. It's strongly recommended for implementation and supported by experimental, clinical, or epidemiologic studies and a strong theoretical rationale. And then the category one C is the one that we all have to pay close attention to. It's a recommendation because it's required for implementation as mandated by federal or state regulations or standard. So that's where we look at OSHA may mandate it or state dental boards may mandate it. So our CDC guidelines for infection control have science, theoretical rationale, and regulatory compliance all built in. And when you go through them, you can see which category a recommendation falls into. So it's like we had said earlier, it may be a recommendation. Many states require the recommendations as their infection control minimum standards, but also standard of care. And when it comes to patient care dentists and dental team members need to practice at the standard of care. And these recommendations give us a foundation for that.

SPEAKER_01 6:54

You are so right, Leslie. And thank you for bringing that up. And again, that has not been changed, that's not been deleted, but we all know, and we've said this among ourselves, that wow, 2003 is a long time ago that those guidelines were published, and they were actually in the process of being updated when our beloved division of oral health was eliminated. So what we do know at this point is also our beloved Association for Dental Safety has established an institute to complete this task. And Leslie, you've got a couple of things that you wanted to share with us about that.

SPEAKER_02 7:38

Yes, I'm so excited to know that we're going to be moving forward because the CDC guidelines for dental settings had typically been updated about every 10 years. We saw that in 1990, I believe it was in the early 90s, and then again in 2000 and earlier, like uh 2010, I had expected to see a new set of CDC guidelines. And what happened was we didn't get a new set of CDC guidelines for dentistry, but we got a companion called the Basic Expectations for Safe Care. And I always thought there was going to be a replacement or a redo of the guidelines, but I was told from CDC Division of Oral Health that no, this is a companion to the 2003 guidelines because we vetted the 2003 guidelines and they're still good. They still meet the requirements of, you know, they're still basically the Bible. But as you mentioned, it was time for an update based on new science, new technology, new emerging infectious diseases. So Association for Dental Safety, who was formerly OSEP, has now a new institute to fill the role of where CDC's Division of Oral Health left off. And it looks like it's going to be using the same resources and get information to the public and the profession because of the long-term association that OSEP, now ADS, has had with the Division of Oral Health. They're actually an institute that will be a separate entity from ADS to set up guidance, resources, tools, and education around infection prevention and patient safety in oral healthcare settings. And it looks like they're going to be putting together an advisory committee with a broad range of expertise. And once that's in place, they tell us that they're going to set their priorities and strategies and work groups on very specific topics. One of the hot topics I know that we have circulating is on dental unit water and the outbreaks that we've seen and experienced. And they are aiming to address that as one of their first order of business. But I'm excited to know that we're not going to be left without continuing and ongoing research, scientific evidence, and then information and guidelines to continue to follow.

SPEAKER_01 9:59

Well said, Leslie. And in sort of summarizing our conversation today, what we really want our listeners to know is that despite all the chatter, despite everything you hear, the information is still available from the CDC website. And remember that if your regulatory body or dental board in your state says that you must follow them, then that is what you need to be following. And you need to be following standards of care, not only to keep your patients safe, but for you all to be safe as well. And one of the things that I want to point out is that the CDC, and we will put a link in the show notes, the CDC has lots of free continuing education or training courses that you can access if you need some additional training on any number of topics. And there also are a number of resources, not only access to the guidelines, but specific topics, as Leslie mentioned earlier: dental unit water lines, sterilization monitoring, best practices for sterilization, all those things are still there and still available to all of our listeners. So we thank you for joining us for this episode. The Compliance Divas podcast brings clarity and simplicity to your world by navigating compliance to keep you on course. You can subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website, thecompliancedivas.com. We will include any resources that we either have mentioned or are relevant to this particular episode on the show notes on your podcast app. You can always submit questions to the compliance divas at support at thecompliancedivas.com. And we would ask that you scroll down to the bottom of your podcast app and leave us a comment, leave us a rating, and we'd be happy to receive your feedback. Thanks for joining us.