24 THE ADA PRACTICAL GUIDE TO EFFECTIVE INFECTION CONTROL Previous infection control recommendations for dentistry focused primarily on the risk of transmission of bloodborne pathogens and the use of universal precautions to reduce that risk. Universal precautions were based on the concept that all blood and body fluids that might be contaminated with blood should be treated as infectious because patients with bloodborne infections can be asymptomatic or unaware that they are infected. The relevance of universal precautions to other aspects of disease transmission was recognized, and in 1996, the CDC expanded the concept and changed the term to standard precautions. Standard precautions expand the elements of universal precautions to protect health care professionals and patients from pathogens that can be spread by blood or any other body fluid, excretion (except sweat), or secretion—regardless of whether they contain blood. As saliva has always been considered a potentially infectious material in dental infection control, no operational difference exists in clinical dental practice between universal precautions and standard precautions. Standard precautions include the use of PPE (e.g., gloves, masks, protective eyewear with solid side shields, face shields and gowns) intended to prevent skin and mucous membrane exposures. Engineering controls are the primary method to reduce occupational exposures to blood though sharp instruments and needles. These controls often incorporate safer design of instruments and devices (e.g., self-sheathing anesthetic needles, dental units designed to shield burs in handpieces) to reduce percutaneous injuries. Work practice controls establish practices to protect dental team members whose responsibilities include handling, using, assembling or processing sharp devices (e.g., needles, scalers, laboratory utility knives, burs, explorers, etc.) or sharps disposal containers. Work practice controls for needles and other sharps include: • Placing used disposable syringes and needles, scalpel blades and other sharp items in appropriate puncture-resistant containers located as close as feasible to where the items were used • Never recapping used needles, or otherwise manipulating them by using both hands or any other technique that involves directing the point of the needle toward any part of the body. If a needle is to be recapped, use a one-handed “scoop” technique, a mechanical device designed for holding the needle sheath, or a device with a needle re-sheathing mechanism • Never bending or breaking needles before disposal as this practice requires unnecessary manipulation • Always recapping needles on non-disposable aspirating syringes before removing them • For procedures involving multiple injections with a single needle, recapping the needle between injections by using a one-handed technique or using a device with a needle re-sheathing mechanism • Never hand-passing sharps • Using verbal alerts and remaining aware of your surroundings when moving sharps