Dental Infection Control Rule Modifications

The Dental Quality Assurance Commission (commission) is amending existing rules and establishing new rule sections in WAC 246-817-601 through -660 for dental infection control standards. The commission evaluated the Centers for Disease Control and Prevention (CDC) Guidelines for Infection Control in Dental Health-Care Settings 2003, MMWR Vol. 52., No. RR-17, and the Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care, March 2016 as the basis for the rules development. Case reports and public health events regarding the transmission of diseases from patient to patient, dental health care provider to patient, and patient to dental health care provider have been published that demonstrate risk that was either unrecognized in the past or new. A strong educational component is necessary to prevent disease transmission.

The infection control rules incorporate many of the CDC recommendations including:

• Written policies and procedures with annual staff training;
• Sterilization of low-speed hand piece motors (effective August 2022);
• Sterilization of single-use items when appropriate;
• Storage and wrapped packages, container, or cassette requirements;
• Identification of appropriate disinfectants;
• High volume evacuation; and
• Water line testing (effective December 2021).

These rule amendments are necessary to ensure the safety of the citizens of Washington. Antibiotic-resistant bacteria persistent on surfaces or skin are becoming more common and more dangerous. Aerosols have long been recognized as a source of transmission of pathogens. This is evidenced by the current COVID-19 pandemic, for example, and aerosol transmission of many diseases in the medical and public health literature.

Waterborne pathogens have long been recognized as a potential source of disease. That has become evident in multiple outbreaks traced to dental waterlines in recent years, as well as past clusters of cases discovered forensically by the CDC.

The rule amendments are based on science, research, and best industry practice. As of 2019, 30 state dental boards already require that dental health care providers follow the CDC guidelines; the commission determined that it is reasonable for Washington state-licensed dentists and dental health care providers to follow these well-tested guidelines as requirements for infection control and prevention in the dental practice setting.

The commission adopted these rules on October 23, 2020. The rules will become effective 31 days after the CR103 Final Rule Making is filed with the code revisers office. Sterilization of low-speed hand piece motors and water line testing have delayed implementation dates.