Fundamental Elements of an Effective Infection Prevention Strategy

While the transmission of pathogenic organisms in oral healthcare settings is rare, cross-infection (e.g., the transmission of pathogens from patient-to-patient, patient-to-provider, and provider-to-patient) does present a potential hazard to healthcare personnel (HCP) and patients alike.^3,4 To prevent or minimize HAIs, all healthcare facilities are mandated to develop a written infection prevention protocol predicated on a hierarchy of preventive strategies specific for oral healthcare settings.^2,4

The dentist has primary responsibility for compliance with infection prevention guidelines. However, an Infection Prevention Coordinator (IPC) may be assigned to coordinate the program.^1,4 The IPC should be knowledgeable to (1) develop and maintain the infection prevention protocol; (2) provide an explanation of its contents upon request; and (3) monitor the effectiveness of the program over time to ensure that the criteria are relevant, the procedures are efficient, and the practices are successful.^1,4

Infection prevention strategies should be appropriate for the setting and extend to all aspects of the clinical process. As the protocol deviates from optimal design and implementation, the quality (value, outcome) of the program decreases at an accelerated rate. Information from which inference can be drawn about the quality of infection control/exposure control practices may be classified under three headings: structure, process, and outcome.^1-4

Structure refers to the attributes of the healthcare setting. This includes the (1) availability of material resources (e.g., sterilization area and equipment), (2) human resources (e.g., number and qualification of personnel), and (3) organizational resources (e.g., the timely availability of post-exposure evaluation and follow-up). Structure affects the amenities of the healthcare setting, which may be either conducive or inimical to good infection control/exposure control practices.

Process refers to what is actually being done to prevent or minimize HAIs. It includes (1) compliance with establishment of standards, i.e., the hierarchy of preventive strategies based on knowledge derived from well conducted trials, extensive observations, or in the absence of such data it should reflect the best informed, most authoritative opinion available; (2) the development and execution of activities intended to meet those standards; and (3) continuous monitoring of compliance.

Outcome refers to the impact infection prevention strategies have on (1) enhanced knowledge, (2) changed behavior, and (3) improved health of HCP and patients. Because so many factors influence outcome, it is not possible to know with absolute certainty the extent to which an observed outcome is attributable to an antecedent structure or process. However, outcome assessment does provide a mechanism to monitor performance (compliance).