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Solution Manual for Basics of Anesthesia, 6th Edition

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    TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition 1 Scope of Microbiology and Infection Control ANSWER KEY Chapter Review Questions 1. C 2. D 3. A 4. B 5. C 6. B 7. A 8. B 9. C 10. A 11. C 12. C

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    TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition 2 Characteristics of Microorganisms ANSWER KEY Chapter Review Questions 1. D 2. D 3. C 4. B 5. C 6. B 7. D 8. D 9. C 10. B 11. D 12. B 13. B 14. A 15. A

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    TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition 3 Development of Infectious Diseases ANSWER KEY Case Scenario Disease Spread Potential Consequences: The winter season is the most prominent time for colds and influenza. People infected with an influenza virus shed virus and may be able to infect others from 1 day before getting sick up to 5 to 7 days or more after. Some people can be infected with an influenza virus and have no symptoms but may still spread the virus to others. Influenza viruses are spread when infectious droplets directly contact mucous membranes, by inhalation of aerosol particles and by indirectly touching respiratory droplets on contaminated surfaces. June touched the outside of her mask with bare hands and then rubbed her nose before any hand hygiene was performed. Remember , the outside of masks worn at chairside are commonly contaminated with patients’ oral fluids. Also June removed some of her contaminated protective equipment in the break/locker room where there may have been food, personal items, and nonclinical surfaces that could have become contaminated. Prevention: It’s essentially impossible to determine if a given patient is carrying pathogenic microbes that can make you sick. Patients with detectable symptoms such as coughing or sneezing become suspect. The latter can and do shed microbes. Thus , we have to consider ALL patients, as well as ourselves, potential carriers of pathogenic microbes and apply our infection - control protocols universally. In regard to the scenario presented, don’t touch your body with contaminated hands. Avoid those hands - to - nose and hands - to - eyes motions. Whenever you remove your gloves, wash your hands or use an alcohol hand rub, and do the same if your bare hands become contaminated with patient materials. Remove masks by touching the elastic bands or ties, which are less likely to be contaminated. Some Related Regulations and Recommendations: • “Remove barrier protection, including gloves, mask, eyewear and gown before departing work areas (e.g., dental patient, instrument processing, or laboratory areas)” (CDC). • “When personal protective equipment is removed it shall be placed in an appropriately designated area or container for storage, washing, decontamination or disposal” (OSHA). Reprinted with permission from: Miller CH. Special series on consequences: The spread of diseases. Infect Contrl in Pract 2010; 9(1):1 - 2. Chapter Review Questions 1. D 2. A 3. A 4. D 5. D 6. C 7. A 8. C 9. A 10. C 11. A 12. B 13. D 14. B 15. A

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    TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition 4 Emerging Diseases ANSWER KEY Chapter Review Questions 1. A 2. C 3. A 4. C 5. B

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    TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition 5 Oral Microbiology and Plaque - Associated Diseases ANSWER KEY Chapter Review Questions 1. D 2. A 3. D 4. C 5. A 6. B 7. B 8. D 9. A 10. A

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    TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition 6 Bloodborne Pathogens ANSWER KEY Case Scenario Hepatitis B Potential Consequences: Hepatitis B is an occupational hazard of nonimmune health care personnel who have a potential for exposure to human body fluids. Unvaccinated members of the dental team are about 2 to 5 times more likely to become infected with the hepatitis B virus than the general population. Hepatitis B virus carriers who are also positive for HBeAg are more highly infectious than carriers who are HBeAg negative. The risk of acquiring clinical hepatitis from a needle contaminated with HBsAg - positive but HBeAg - negative blood was found to be 1% to 6%. With both HBsAg - positive and HBeAg - positive blood, the risk jumped to 22% to 31%. It’s not clear why Jenna originally refused the hepatitis B vaccination when in school. Ideally the school had Jenna sign the required OSHA Vaccine Declination form for its protection. Also, ideally, the school greatly emphasized to Jenna the importance of avoiding exposure to potentially infective body fluids since she had not been immunized against hepatitis B. A sometimes unrecognized consequence of being exposed to a patient’s body fluid is the anxiety related to waiting for the results of blood tests . Prevention: Jenna needed to take action to stay healthy. There are two approaches to preventing virus diseases. One is to become immunized against the disease (if the appropriate vaccine exists), and the other is to avoid exposure. Sometimes we simply cannot avoid exposure, for example when we interact with an asymptomatic carrier of a disease. Fortunately there is a vaccine for the prevention of hepatitis B. Maybe if Dr. D had asked for proof of Jenna’s immunization at the time of hiring, he could have provided her with training that would have helped her make an informed decision about the vaccination. Of course hindsight is always more clear. Jenna could have told Dr. D that she had not been immunized but would like to receive the vaccination series so she would not become infected and possibly pass on the disease to his patients. This type of language would be more positive than saying, “Yes, I want to be protected from getting hepatitis from your patients.” PS: Thank goodness Jenna did not develop hepatitis B. She apologized to Dr. D for lying. Some Related Regulations and Recommendations: • “Hepatitis B vaccination shall be made available after the employee has received the required training and within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons” (OSHA). • “The employer shall assure that employees who decline to accept hepatitis B vaccination offered by the employer sign the Vaccine Declination statement” (OSHA). • “Develop a written comprehensive policy on immunizing dental healthcare personnel (DHCP), including a list of all required and recommended immunizations” (CDC). • “ Develop policies for work restriction and exclusion that encourage personnel to seek appropriate preventive and curative care and report their illnesses, medical conditions, or treatments that may render them more susceptible to opportunistic infection or exposures; do not penalize DHCP with loss of wages, benefits, or job status” (CDC). Adapted from: Miller CH. Special series on empowerment: Take action to stay healthy. Infect Contrl in Pract 2011; 10(1):3 - 4.

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    Chapter 6 : Bloodborne Pathogens 2 TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition Chapter Review Questions 1. A 2. B 3. B 4. D 5. D 6. A 7. B 8. C 9. A 10. B 11. B 12. D

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    TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition 7 Oral and Respiratory Diseases ANSWER KEY Case Scenario Eye Infection Potential Consequences: A pitfall of not wearing proper protective eyewear can be the development of acute infectious conjunctivitis (also known as pinkeye ). This can be caused by viruses (e.g., adenovirus, enterovirus, coxsackievirus) or bacteria (e.g., Chlamydia trachomatis , Haemophilus influenzae , Staphylococcus aureus , Streptococcus pneumoniae , Moraxella lacunata ). It is spread through contact with contaminated respiratory fluids and hands. Health care workers with conjunctivitis should be restricted from patient contact and contact with patients’ environments. Conjunctivitis usually subsides in 2 - 5 days without treatment. Antibiotics are sometimes prescribed. While pinkeye can be painful and irritating, Marta is fortunate she did not develop a herpes eye infection that can recur with a potential to cause blindness. Most people are infected with herpesvirus type 1 that resides in the nerve tissue associated with the upper respiratory tract. About 10% of those infected experience recurrent oral/facial skin lesions that contain the live virus until the lesions are crusted over. A few percent of those infected can also shed the virus in their saliva even when they have no active lesions. Prevention: A pitfall of not wearing proper protective eyewear can be the development of acute infectious conjunctivitis (also known as pinkeye ). This can be caused by viruses (e.g., adenovirus, enterovirus, coxsackievirus) or bacteria (e.g., Chlamydia trachomatis , Haemophilus influenzae , Staphylococcus aureus , Streptococcus pneumoniae , Moraxella lacunata ). It is spread through contact with contaminated respiratory fluids and hands. Health care workers with conjunctivitis should be restricted from patient contact and contact with patients’ environments. Conjunctivitis usually subsides in 2 - 5 days without treatment. Antibiotics are sometimes prescribed. While pinkeye can be painful and irritating, Marta is fortunate she did not develop a herpes eye infection that can recur with a potential to cause blindness. Most people are infected with herpesvirus type 1 that resides in the nerve tissue associated with the upper respiratory tract. About 10% of those infected experience recurrent oral/facial skin lesions that contain the live virus until the lesions are crusted over. A few percent of those infected can also shed the virus in their saliva even when they have no active lesions. Some Related Regulations and Recommendations: • “Wear a surgical mask and eye protection with solid side shields or a face shield to protect mucous membranes of the eyes, nose and mouth during procedures likely to generate splashing or spattering of blood or other body fluids” (CDC). • “Masks in combination with eye protection devices, such as goggles or glasses with solid side shields, or chin - length face shields shall be worn whenever splashes, sprays, spatter or droplets of blood or other potentially infectious materials may be generated and eye, nose or mouth contamination can be reasonably anticipated” (OSHA). Adapted from: Miller CH. Plotting a course around infection prevention pitfalls. Infect Contrl in Pract 2013; 12(4):1 - 2. Chapter Review Questions 1. C 2. A 3. B 4. D 5. C 6. A 7. C 8. A 9. C 10. A 11. A 12. C 13. B 14. D 15. B 16. D

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    TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition 8 Infection Control Rationale and Regulations ANSWER KEY Case Scenario s Postexposure Management Potential Consequences: Phil didn’t use the proper procedures for postexposure follow - up. Although his sharps injury healed without further problems, it could have led to an infection with bloodborne or other infectious agents. It is important for a dental practice to contract with a qualified health care provider (QHP) to provide medical evaluation, counseling, and follow - up care to dental employees exposed to blood or other potentially infectious materials. Timely follow - up after an exposure is critical, particularly if the administration of human immunodeficiency virus (HIV) prophylaxis is decided upon by the QHP. Also the QHP should have as much information as possible about the exposure incident, including source patient information, so the appropriate risk assessment and medical follow - up can be administered. Since the QHP knew nothing about the source patient involved in Phil’s exposure, the physician likely assumed the possibility of bloodborne pathogen exposure requiring subsequent blood testing. Prevention: The lack of staff coordination in this office could be addressed by designating an Infection Control Coordinator (ICC) to make sure everyone is in compliance with patient and provider safety procedures. The CDC recommends the appointment of such a person to manage safety. Coordination can be greatly improved by establishing a daily team huddle to discuss the day’s schedule and to allow the ICC to present relevant information about office safety. In Dr. G’s office, the ICC could (among other duties): • organize a postexposure management program. • promote the importance of adding multiple scalers to instrument set - ups to eliminate the need for sharpening contaminated scalers at chairside. • develop (along with the office staff) an infection prevention and safety manual that includes current CDC recommendations and OSHA regulations. (This should include the written exposure control plan required by OSHA for all health care facilities.) • facilitate the appropriate on - site exposure response (e.g., first aid, identification of the source patient and acquiring informed consent for source patient testing, access to timely medical follow - up for the exposed dental health care provider). Some OSHA Regulations: OSHA states: “Following a report of an exposure incident, the employer shall make immediately available to the exposed employee a confidential medical evaluation and follow - up, including at least the following elements: • documentation of the route(s) of exposure, and the circumstances under which the exposure incident occurred • identification and documentation of the source individual, unless the employer can establish that identification is infeasible or prohibited by state or local law • the source individual ’ s blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity; if consent is not obtained, the employer shall establish that legally required consent cannot be obtained; when the source individual ’ s consent is not required by law, the source individual ’ s blood, if available, shall be tested and the results documented • when the source individual is already known to be infected with HBV or HIV, testing for the source individual ’ s known HBV or HIV status need not be repeated • results of the source individual ’ s testing shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual” Additional OSHA regulations are given in Appendix G of the textbook.

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    Chapter 8 : Infection Control Rationale and Regulations 2 TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition Adapted from: Miller CH. Defining the role of the dental safety coordinator – part 1. Infect Contrl in Pract 2015; 14(2):1 - 2. Compliance with Regulations Potential Consequences: It was obvious that there was no substantial culture of safety in Dr. Corner’s practice, and there was poor coordination of safety efforts with little monitoring of compliance with regulations. Complacency had set in. Some of the staff knew about some safety items, and others did not. Certain safety procedures, products, or equipment had changed over the years but were not noted in the 8 - year - old ECP. For example, since the Needlestick Safety and Prevention Act (as part of OSHA’s bloodborne pathogens standard) was established, there was likely no ongoing consideration and evaluation of safety devices, which should be reflected in the ECP. A specific postexposure evaluation program was only partially organized and not given the important priority needed. Delays in the evaluation result in jeopardizing the success of the time - critical postexposure testing and prophylaxis when indicated. Also, not providing the evaluating physician with necessary information about the exposure can jeopardize the evaluation and treatment. The absence or unavailability of OSHA - required SDSs may prolong necessary actions needed to control or lessen potential damage from exposure to hazardous chemicals. It is clear that this office was not aware of many of the safety regulations and recommendations for dentistry, so compliance was indeed at risk. Prevention: Designation of an ICC who manages the safety program for this office will challenge complacency about infection prevention procedures and provide support for monitoring compliance with regulations and recommendations and maintaining a culture of safety for the practice. OSHA requires that the ECP be updated at least annually. The procedures described in this plan must coincide with what is actually done in the office, so it can be used for training new employees and serve as a checklist for monitoring compliance. The office’s ECP will be used as a guide by an OSHA inspector should one ever be in the office monitoring compliance with the bloodborne pathogens standard. So its contents certainly must match current office activity. Having personal physicians evaluate employees’ exposure incidents is fine, if everything is prearranged and if the physicians are qualified for such counseling and evaluations; are readily available; and are provided with critical information about the exposed person, the source patient, and circumstances surrounding the incident. A better choice would be an occupational injury medical facility located close to the practice. The practice’s workman’s compensation insurance provider can provide a list of occupational injury medical facilities that provide testing for employees and source patient, if needed. OSHA and the CDC indicate that a postexposure evaluation needs to be prompt. OSHA also requires that each dental facility have a written hazard communication program. Some Related Regulations and Recommendations: • “Assign at least one individual trained in infection prevention responsibility for coordinating the program” (CDC). • “The ECP must be updated at least annually and made available to all employees with a potential for exposure to blood or saliva” (OSHA). • “The employer shall maintain in the workplace copies of the required safety data sheets for each hazardous chemical, and shall ensure that they are readily accessible during each work shift to employees when they are in their work area(s)” (OSHA). • “Employers shall develop, implement, and maintain at each workplace, a written hazard communication program which at least describes how the criteria for labels and other forms of warning, safety data sheets, and employee information and training will be met, and which also includes a list of the hazardous chemicals known to be present and the methods the employer will use to inform employees of the hazards of non - routine (periodic) tasks and the hazards associated with chemicals contained in unlabeled pipes in their work areas” (OSHA).

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    Chapter 8 : Infection Control Rationale and Regulations 3 TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition • OSHA states: “If you are stuck by a needle or other sharp or get blood or other potentially infectious materials in your eyes, nose, mouth, or on broken skin, immediately flood the exposed area with water and clean any wound with soap and water or a skin disinfectant if available. Report this immediately to your employer and seek immediate medical attention.” • CDC states: “If you experienced a needlestick or sharps injury or were exposed to the blood or other body fluid of a patient during the course of your work, immediately follow these steps: wash needlesticks and cuts with soap and water; flush splashes to the nose, mouth, or skin with water; irrigate eyes with clean water, saline, or sterile irrigants; report the incident to your supervisor; immediately seek medical treatment.” Reprinted with permission from: Miller CH. Defining the role of the infection control coordinator – part 2. Infect Contrl in Pract 2015; 14(3):1 - 2. Chapter Review Questions 1. A 2. C 3. B 4. C 5. A 6. D 7. B 8. D 9. C 10. A

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    TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition 9 Preparing for Patient Safety and Occupational Health ANSWER KEY Case Scenario s Culture of Safety Potential Consequences: The potential consequences of exposure to patient materials in the office relate to possible transmission of bloodborne diseases such as hepatitis B in nonimmune persons and of hepatitis C, for which there is no vaccine. HIV disease may be a small risk. Other nonspecific infections (usually localized rather than systemic in nature) also may occur at the injury site as a result of exposure to bacteria or other viruses in the blood or saliva involved. Another often overlooked consequence to sharps injuries is the anxiety one goes through waiting for the results of the tests for bloodborne virus exposure – which, by the way, were all negative for Roberta on both occasions. This anxiety was the main reason for Roberta’s New Year’s resolution. Prevention: If Dr. Walgang and his staff had empowered themselves by developing a sharps injury prevention program and a “Culture of Safety” for the office, it’s likely that Roberta’s injuries would not have occurred. The chairside assistants put Roberta at risk by not following proper procedures. Sharps need to be disposed of in a sharps container placed near chairside and not put into instrument cassettes or on instrument trays. This puts someone else (e.g., sterilization assistant) at risk because now he or she must handle the sharp. Instruments need to be returned to cassettes or trays in a stable fashion. Based on Olivia’s and Marty’s comments, there was not a culture of safety in Dr. Walgang’s office. A culture of safety refers to factors that influence overall attitudes and behavior about safety in the office. It’s one general strategy recommended by the Centers for Disease Control and Prevention (CDC) – National Institute for Occupational Safety and Health (NIOSH). A culture of safety reflects the shared commitment of the employer and employees toward ensuring the safety of the work environment. The employer should openly support a safety culture by: • providing an adequate supply of resources; • engaging worker participation in safety planning; • making available appropriate safety devices and protective equipment; • introducing workers to a safety culture when they are first hired. Other components of a safety culture include: • identifying and removing sharps injury hazards; • developing feedback systems to communicate safety (e.g., newsletters, bulletin boards, brochures, meeting agendas, rewards for identifying dangerous situations, celebrations for success and improvements); • promoting individual accountability (e.g., assess safety compliance, have staff sign a pledge to promote safety); • measuring improvements in safety (e.g., before - and - after survey of staff perception of safety in the office, sharps injury reports). Some Related Regulations and Recommendations: • “Place used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture - resistant containers located as close as feasible to the area in which the items are used” (CDC). • “Immediately or as soon as possible after use, contaminated reusable sharps shall be placed in appropriate containers until properly reprocessed” (CDC). • “Contaminated sharps shall be discarded immediately or as soon as feasible in containers that are closable, puncture resistant, leakproof on sides and bottom, and labeled or color - coded” (OSHA).

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    Chapter 9 : Preparing for Patient Safety and Occupational Health 2 TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition • “During use, containers for contaminated sharps shall be: o Easily accessible to personnel and located as close as is feasible to the immediate area where sharps are used (e.g., near chairside) or can be reasonably anticipated to be found (e.g., laundries); o Maintained upright throughout use; and o Replaced routinely and not be allowed to overflow” (OSHA). Reprinted with permission from: Miller CH. Empower by connecting with compliance. Infect Contrl in Pract 2012; 11(1):1 - 2. Needlestick and Culture of Safety Potential Consequences: Contaminated needlesticks can transmit bloodborne infectious agents of hepatitis B, hepatitis C, and human immunodeficiency virus disease (HIV disease). Hepatitis B is a well - recognized risk for dental health care personnel (DHCP), but vaccination and use of standard precautions have greatly reduced this risk. Hepatitis C is not easily transmitted through occupational exposure, and the low risk for DHCP is similar to that among people in other occupations. As of December 2002, the CDC has confirmed occupational HIV seroconversion in 57 American health care workers, none of which have been DHCP. Thus the risk of acquiring HIV - disease after percutaneous exposure of DHCP to HIV - infected blood is surely quite low. In fact to date, no DHCP are known to have become HIV - positive following documented occupational exposure to an infected patient’s blood or body fluid (though 6 dental personnel/138 HCWs are possible occupationally acquired HIV patients). Since saliva is teeming with microbes, needlesticks involving saliva can result in bacterial infections at the injury site. Prevention: Dr. M should have taken care of the used needle himself after injecting Ms. Handlemeyer by safely recapping the needle, followed by its removal and disposal in a sharps container. It’s best to take care of a disposable sharp yourself rather than put someone else at risk. This is why sharps containers should be near the site where sharps are used and found. Unfortunately disposable dental syringes are not in common use, so the needle has to be removed from the syringe for disposal. This is a dangerous activity, and the fact that there are sharp points on both ends of a dental needle make it worse. When Pantella decided to handle the needle, she should have safely recapped the needle before she tried to remove it from the syringe. Considering this scenario, it’s important to develop a solid “culture of safety” in the atmosphere for all of the staff to avoid contact with patients’ blood and saliva. For example each staff person can choose a safety topic (see below for a few examples) and prepare a related, step - by - step compliance checklist for discussion at a staff meeting. Also a contest can be held for the best hand - made safety poster, phrase, or jingle. Maybe the doctor would provide a free lunch for the winner. Some S afety T opics for C hecklists : • Sharps safety • Postexposure procedures • Operatory prep • Operatory clean - up • Donning and removing personal protective equipment (PPE) • Location of safety data sheets, chemical lists, OSHA standards, exposure control plan, emergency exit plan, eyewash stations, PPE, fire extinguishers Some Regulations and Recommendations: • “ Develop a written personnel health program for DHCP that includes policies, procedures, and guidelines for education and training; immunizations; exposure prevention and post - exposure management; medical conditions, work - related illness, and associated work restrictions; contact dermatitis and latex hypersensitivity; and maintenance of records, data management, and confidentiality” (CDC).

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    Chapter 9 : Preparing for Patient Safety and Occupational Health 3 TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition • “Ensure that DHCP who handle and dispose of potentially infective wastes are trained in appropriate handling and disposal methods and that they are informed of the possible health and safety hazards” (CDC). • “Disposable contaminated sharps shall be discarded immediately or as soon as feasible after use … in proper containers easily accessible to personnel and located as close as is feasible to the immediate area where sharps are used or can be reasonably anticipated to be found” (OSHA). Reprinted with permission from: Miller CH. Special series on empowerment: Avoid contact with blood and other body fluids. Infect Contrl in Pract 2011; 10(3):4. Chapter Review Questions 1. C 2. D 3. A 4. B 5. C 6. D 7. A

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    TEACH Answer Key MILLER : Infection Control and Management of Hazardous Materials for the Dental Team , 6th Edition 10 Immunization ANSWER KEY Case Scenario Vaccination Potential Consequences: Determining where one “caught” a specific disease is usually difficult, and different respiratory illnesses are difficult to distinguish based on signs and symptoms alone. However, one plausible explanation of this scenario is that Ember became infected with the influenza virus from her daughter and spread the agent to at least two of her patients when she returned to work. Ember had never been immunized against the flu, and she was apparently already infected when she did get the shot. Other considerations are that influenza can be spread to others up to about 6 feet away. Influenza has a short incubation time of 1 to 4 days, with an average 2 days. So Ember could have been infected by Mona over the weekend. Also influenza is characterized by an abrupt onset of symptoms, and one is usually contagious 1 day before the symptoms appear to 5 to 10 days after the onset of illness. Ember felt fine on Tuesday at work but was symptomatic on Wednesday. The two patients scheduled to return on Friday likely became infected by Ember on Tuesday, and by Friday they had developed respiratory symptoms. All of these events are within the common contagious and incubation periods for influenza. While the two “Friday patients” may indeed have developed colds, the early symptoms of influenza are often confused with those of the common cold or other respiratory diseases. Prevention : Influenza is mainly spread by the larger droplets of respiratory fluids generated when an infected person coughs, sneezes, or maybe even talks. Less often a person also may get influenza by touching a surface contaminated with the influenza virus and then touching his or her own mouth or nose. It’s not known how Ember interacted with her patients. For example, did she talk to them while not wearing her mask? Did she perform proper gloving and surface asepsis? Did she sneeze or clear her throat near patients? Prevention includes staying home when sick and recognizing that one can be contagious without having symptoms of a disease. It is likely that asymptomatic carriers are more important in spreading diseases than those who are obviously ill – the latter are recognizable and can be avoided. Proper hand hygiene and surface asepsis of touch surfaces in health care facilities are important in preventing the spread of a variety of disease agents. If Ember had been immunized against influenza, there would have been less concern for her spreading influenza directly to her patients. Some Related CDC Recommendations: • The CDC recommends annual immunization against influenza for all persons (with few exceptions) ages 6 months and older, which includes all health care workers. • “ Develop a written personnel health program for dental health - care personnel (DHCP) that includes policies, procedures, and guidelines for education and training; immunizations; exposure prevention and post - exposure management; medical conditions, work - related illness, and associated work restrictions; contact dermatitis and latex hypersensitivity; and maintenance of records, data management, and confidentiality. • Develop a written comprehensive policy on immunizing DHCP, including a list of all required and recommended immunizations. • Refer DHCP to a prearranged qualified health - care professional or to their own health - care professional to receive all appropriate immunizations based on the latest recommendations as well as their medical history and risk for occupational exposure. • Develop and have readily available to all DHCP comprehensive written policies regarding work restriction and exclusion that include a statement of authority defining who may implement such policies. • Develop policies for work restriction and exclusion that encourage personnel to seek appropriate preventive and curative care and report their illnesses, medical conditions, or treatments that may render them more susceptible to opportunistic infection or exposures; do not penalize DHCP with loss of wages, benefits, or job status.” Adapted from: Miller CH. Steering towards patient safety. Infect Contrl in Pract 2013; 12(6):1 - 2.

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