The Joint Commission offers dental practices the opportunity to achieve accreditation as part of its Ambulatory Health Care Accreditation Program (if freestanding clinic) or under the Hospital Accreditation Program (if hospital affiliated).
To promote a better understanding of standards compliance, The Joint Commission provides the following clarifying information for dental clinics (in hospital-affiliated as well as freestanding dental environments) regarding the standards- based performance areas of infection control and environment of care.
Joint Commission standards are written to allow organizations flexibility in determining the compliance solutions that are most appropriate for their practice environment; accordingly, it is generally not the policy of The Joint Commission to prescribe any particular guideline or reference standard. Rather, Joint Commission surveyors will inquire which nationally recognized reference standard or guideline an organization employs in developing its policies for assessing infection control and environment of care issues—particularly regarding sterilization and high- level disinfection. Surveyors will then assess an organization’s compliance with its own chosen reference standard or guideline.
It is important to note that when surveying health care organizations in hospital settings that include on-site and off- site ambulatory clinics under the same Centers for Medicare
& Medicaid Services Certification Number (CCN), surveyors defer to organization-specific policies when assessing infection control and environment of care issues. If the organization- specific policies do not distinguish processes according to
location, dental clinics are held to the standards outlined in the organization’s policies.
Common nationally recognized, evidence-based reference standards for high-level disinfection, sterilization, and environment of care issues include, but are not necessarily limited to, the following:
l The Association for the Advancement of Medical Instru- mentation’s (AAMI) Sterilization, Part 1: Sterilization in Health Care Facilities 2014.2 Edition1
l The Centers for Disease Control and Prevention’s (CDC) Guideline for Disinfection and Sterilization in Healthcare Facilities, 20082
l The CDC’s Guidelines for Infection Control in Dental Health-Care Settings—20033
l The Facility Guideline Institute’s (FGI) Guidelines for Design and Construction of Health Care Facilities, 2010 4
When utilizing these guidelines in developing their policies relative to infection control and environment of care issues, it is important for organizations to note that, while the 2010 edition of the FGI’s Guidelines does not address the monitoring of temperature and humidity in sterilization areas located within dental settings, this edition does recommend provisions for monitoring in the storage area.
Also, the CDC’s Guidelines for Infection Control in Dental Health-Care Settings—2003 recommends using manufacturer and building code specifications to determine placement
and ventilation requirements for sterilizers. Of course, if an organization is using chemicals that pose health and safety risks in its sterilization/disinfection process, other ventilation
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requirements may apply (in particular, air exchanges).
Neither the Guidelines for Infection Control in Dental Health-Care Settings nor the 2010 FGI Guidelines address the topic of air flow and pressure relationships in the freestanding dental clinic environment. Therefore, Joint Commission surveyors do not survey for airflow or pressurization issues in this environment if organizations are utilizing the Guidelines for Infection Control in Dental Health-Care Settings as their reference standard. P
Association for the Advancement of Medical Instrumentation. Steriliza-
tion, Part 1: Sterilization in Health Care Facilities 2014. 2 Edition. Arlington, VA: Oct 2014.
Rutala WA, et al. Guideline for Disinfection and Sterilization in Health- care Facilities, 2008. Centers for Disease Control and Prevention. Atlanta: Nov 2008. Accessed Dec 19, 2014. http://www.cdc.gov/hicpac/ pdf/guidelines/disinfection_nov_2008.pdf
Kohn WG, et al. Guidelines for Infection Control in Dental Health-Care Settings—2003. Centers for Disease Control and Prevention. Atlanta: Dec 19, 2003. Accessed Dec 19, 2014. http://www.cdc.gov/Mmwr/ preview/mmwrhtml/rr5217a1.htm
American Society for Healthcare Engineering. FGI Guidelines for Design and Construction of Health Care Facilities, 2010. Chicago: Jan 2010.