19 THE ADA PRACTICAL GUIDE TO EFFECTIVE INFECTION CONTROL The infection control coordinator may be a current team member or could be someone hired to specifically oversee infection prevention. He or she will most likely work closely with your practice’s OSHA coordinator. Immunizations Immunizations are an essential part of a disease prevention and infection control program. The dental team is at risk for exposure to, and possible infection with, a variety of vaccine-preventable diseases. Appropriate immunizations substantially reduce both the number of people susceptible to these diseases and the potential for disease transmission to other dental team members and patients. The Advisory Committee on Immunization Practices (ACIP) provides national guidelines for immunization of health care providers (HCP), which includes providers of dental care. On the basis of documented health care–associated transmission, HCP are considered at substantial risk of acquiring or transmitting hepatitis B, influenza, measles, mumps, rubella and chicken pox (varicella). All of these diseases are vaccine preventable. The ACIP recommends that all HCP be vaccinated or have documented immunity to these diseases. While the ACIP does not recommend routine immunization of health care workers against TB, dental team members who have contact with patients can be exposed to persons with infectious TB and should receive a two-step baseline tuberculin skin test (TST) at the beginning of employment. In this way, if an unprotected occupational exposure occurs, TST conversions can be distinguished from positive TST results caused by previous exposures. Immunization of the dental team before they are placed at risk of exposure remains the most efficient and effective use of vaccines in health care settings. In addition to persons providing direct patient care, non-patient care staff (e.g., administrative, housekeeping, laboratory) may be included in the immunization program depending on their risk of exposure to blood and OPIM. Dental facilities should develop a written comprehensive policy on immunizing dental team members, including a list of all required and recommended immunizations. Immunizations may be provided by a pre-arranged qualified health care professional or by the dental worker’s own health care professional based on the latest recommendations, as well as their medical history and risk for occupational exposure. While hepatitis B continues to be a well-recognized occupational risk for the dental team, rates of HBV infection have decreased dramatically since more people have received vaccinations over the last few decades. Since the introduction of the vaccine in 1982, studies have demonstrated substantial increases in hepatitis B vaccine use, especially among younger health care workers. From 1983 to 1992, the percentage of U.S. dentists reporting hepatitis B vaccination increased substantially from 22% to 85%.2 During that same time period, the percentage with serologic evidence of HBV infection decreased from 14% to 9%. Since the mid-1990s, the incidence of HBV infection among health-care workers has been lower than that among the general population.3 The rate of new HBV infections has declined by approximately 82% since 1991, when a national strategy to eliminate HBV infection was implemented in the United States.4 According to the Centers of Disease Control, 2,953 cases of acute hepatitis B were reported to the CDC from 48 states in 2014, while the overall incidence rate for 2014 was 0.9 cases per 100,000 population.5 Immunization of the dental team before they are placed at risk of exposure remains the most efficient and effective use of vaccines in health care settings.