Problem
Dr. Flyger was thinking about retiring from practice in 6 to 12 months and had identified a possible associate (Dr.Plotter, a recent Doctor of Dental Surgery graduate) to take over the practice. The building was just 10 years old, and the office had three fairy modern dental units, a nice film x-ray unit and darkroom, and small laboratory and storage room. There was one hygienist, one dental assistant, and one front office person in the practice. Dr. P was invited to visit the office to review the day-to-day operations before committing to come on board. Dr. P found the business end of the practice and patient load to be in good shape for not being computerized, but there was concern about the outdated infection prevention program.
Dr. P noted that impressions were not being decontaminated before sending out to the dental laboratory, and there was no written information about the asepsis status of the impressions. There was no indication of the asepsis status of items received from the dental laboratory, and these appliances were placed directly into patient's mouth without any decontamination. Handpieces were not being sterilized; they were just wiped off. Instruments were packaged after being processed through the autoclave, and no system was in place to ensure good quality treatment water. The written exposure control plan was dusty and dated 6 years ago. After speaking with the hygienist and assistant, it was obvious they had not received adequate training on bloodborne pathogens; however, they had both been vaccinated against hepatitis B. Dr. P said to Dr. F, "Let me work with you for 6 months to see if we can modernize your patient records and bring your infection prevention program into compliance where I'll feel comfortable buying your practice."
Identify potential opportunities for disease transmission in this scenario. Which preventive measures could have been used?