26 THE ADA PRACTICAL GUIDE TO EFFECTIVE INFECTION CONTROL Medical Conditions, Work-related Illnesses and Work Restrictions Dental team members are responsible for monitoring their own health status. Persons who have acute or chronic medical conditions that render them susceptible to opportunistic infection should discuss with their personal physicians or other qualified authority whether the condition might affect their ability to safely perform their duties. Under certain circumstances, dental workers might need to be excluded from work or patient contact to prevent further disease transmission. Decisions concerning work restrictions are based on the mode of disease transmission and the period of infectivity of the disease. Exclusion policies should: • Be written • Include a statement of authority that defines who can exclude the dental worker (e.g., personal physicians) • Be clearly communicated through education and training Policies should encourage dental team members to report illnesses or exposures without jeopardizing wages, benefits or job status. Employee Medical Records and Confidentiality The health status of dental team members is best monitored by maintaining records of work- related medical evaluations, screening tests, immunizations, exposures and post-exposure management. Such records must be kept in compliance with all applicable state and federal laws. Examples of laws that might apply include the following: • Some states have laws protecting the confidentiality of employee medical records. In addition, state data breach law may require a dental practice to notify the individual if specific kinds of information are improperly disclosed. The HIPAA Privacy Rule does not apply to health information in employment records held by a covered entity in its role as an employer (however, if a dental practice is a HIPAA covered entity, HIPAA would apply to an employee’s dental records if the employee is also a patient). • Certain state and federal laws may require additional protection for designated categories of health information, such as HIV status, substance abuse, or mental health diagnosis. • The OSHA Occupational Exposure to Bloodborne Pathogens Final Rule 29 CFR 1910.1030(h)(1)(i-iv) (www.osha.gov). OSHA requires employers to ensure that certain information contained in employee medical records is 1) kept confidential 2) not disclosed or reported without the employee’s express written consent to any person within or outside the workplace except as required by the OSHA standard and 3) maintained by the employer for at least the duration of employment plus 30 years. Medical History and Standard Precautions The medical history is essential for identifying medical conditions that will require consultations, premedication and diagnostic workup. However, it cannot be relied on to identify all patients infected with bloodborne pathogens and other infectious conditions. In many cases, infections are subclinical (asymptomatic), that is, the infected person has no symptoms or signs of infection. For example, it is estimated that 738,000 individuals are chronically infected with HBV in the U.S.7 About one third may by unaware of their infection status.8 Therefore, the use of standard precautions is critical.