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Legal Issues, Quality Assurance, and Infection Control Chapter 40 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

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Presentation on theme: "Legal Issues, Quality Assurance, and Infection Control Chapter 40 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved."— Presentation transcript:

1 Legal Issues, Quality Assurance, and Infection Control Chapter 40 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

2 Chapter 40 Lesson 40.1 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

3 Learning Objectives  Pronounce, define, and spell the Key Terms.  Describe the components of informed consent with regard to dental radiographs.  Describe the types of laws affecting the practice of dental radiography.  Describe the Consumer-Patient Radiation Health and Safety Act.  Identify the individual who “owns” dental radiographs. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

4 Introduction  As a dental assistant, it is your responsibility to understand the laws that apply to you when you are exposing dental radiographs.  Both federal and state regulations control the use of dental x-ray equipment.  To ensure the highest quality and minimal risk to patients in radiation exposure, a quality-assurance program is necessary.  Dental radiography procedures are not usually considered high-risk for the transmission of diseases. However, infectious diseases present a significant hazard in the dental office and dental professionals are at an increased risk of such diseases. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

5 Legal Issues  There are three major categories of legal considerations with which the dental assistant should be familiar in regard to the use of x- rays in dentistry:  Federal and state regulations regarding x-ray equipment and its use  Licensure for individuals exposing radiographs  Risk management for avoiding potential lawsuits Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

6 Federal and State Regulations  The use of dental x-ray equipment is regulated by both federal and state regulations.  All dental x-ray machines manufactured or sold in the United States after 1974 must meet federal regulations which include safety specifications for minimum filtration and accuracy of the milliamperage time and kilovoltage settings.  Many states require x-ray machines to be registered and charge a fee for this registration.  Most states have laws that require inspections of dental x-ray equipment on a regular basis, for instance, every 5 years. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

7 Licensure Requirements  The Consumer-Patient Radiation Health and Safety Act is a federal law that requires persons who take dental radiographs to be properly trained and certified.  It is up to the individual state to determine its own policy regarding the qualifications of individuals exposing radiographs.  X-ray certification requirements for the dental assistant vary from state to state.  Some states require certification by the Dental Assisting National Board; other states may require an additional examination.  Each state deals with dental radiography differently. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

8 Risk Management  Risk-management policies are designed to reduce the likelihood of a malpractice lawsuit against the dentist.  The dental assistant has an important role in risk management.  The dental assistant must be careful never to say anything negative about the x-ray equipment or how it is working.  Statements made without thinking—such as “The timer must be off,” “This thing never works right,” or “The solutions are weak”—are unnecessary and can make the patient feel uncomfortable.  Statements made by anyone at the time of an alleged negligent act are admissible as evidence in court. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

9 Informed Consent  It is the dentist’s responsibility to discuss the need for radiographs and treatment procedures with the patient.  The dental assistant may participate in the process of obtaining informed consent.  Patients must give informed consent for dental radiographs, as well as for other procedures. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

10 For Valid Informed Consent  The patient must be provided with the following information in lay terms:  The risks and benefits of the radiographs  The person who will be exposing the radiographs  The number and type of radiographs  The consequences of not having the radiographs  Any alternative diagnostic aids that may provide the same information as the radiographs Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

11 Liability  Under state laws, the supervising dentist is legally responsible, or liable, for the actions of the dental auxiliary.  This is called respondeat superior doctrine. It means that the employer is responsible for the actions of the employee.  However, even though dental assistants work under the supervision of a licensed dentist, they can also be held legally liable for their own actions. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

12 Patient Records  It is very important to document the exposure of dental radiographs.  The number of films exposed, as well as the quality of the radiographs, may be an important issue in a malpractice suit.  Radiographs that are of poor quality and are nondiagnostic reflect poorly on the dentist. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

13 Documentation of Dental Radiographs  The dental record must include the following information:  Informed consent  The number and type of radiographs exposed  The rationale for exposing the radiographs  The diagnostic interpretation Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

14 Ownership of Dental Radiographs  Radiographs are the property of the dentist, even though the patient, or the patient’s insurance company, paid for them.  This is because dental radiographs are a part of the patient’s records.  Patients have a right to reasonable access to their records.  Make an entry in the chart stating when and to whom duplicate radiographs were sent.  Never give or send the original radiographs to a patient. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

15 When Patients Refuse Dental Radiographs  When this occurs, the dentist must decide whether an accurate diagnosis can be made without radiographs and whether treatment can be provided.  The use of dental radiographs is now the accepted standard of care.  No document can be signed to release the dentist from liability. Even if the patient suggests signing a release or waiver that will release the dentist from liability, it would be considered invalid if an injury did result.  It should be recorded in the patient’s record if a patient refuses recommended radiographs. The dentist must then choose whether or not to continue treating this patient. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

16 Patient Education  As a dental assistant, you should understand and be sensitive to the patient’s concern and fears about exposure to radiation during dental radiographs.  The dental assistant is often the person to whom the patient feels most comfortable confiding these fears.  The dental assistant can explain to the patient just how important radiographs are in detecting diseases and planning treatment.  Patients can be informed of the federal and state laws enacted for their protection. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

17 Chapter 40 Lesson 40.2 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

18 Learning Objectives  Name the eight annual tests recommended for x-ray equipment.  Describe the components of a quality- assurance program.  Describe the quality-control tests for processing solutions.  Explain the use of a stepwedge.  Discuss the purpose of a reference radiograph. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

19 Quality Assurance in the Dental Office  Quality assurance is a means of ensuring that everything possible is being done to produce high-quality diagnostic radiographs.  It includes both quality-control tests to monitor the condition of dental x-ray equipment, view boxes, supplies, and film processing and quality-administration procedures, including records of maintenance and other logs. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

20 Fig. 40-2 Viewbox with clean Plexiglas and new bulb. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

21 Fig. 40-3 A, Unexposed film with coin on it. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

22 Fig. 40-3 B, Radiograph showing outline of coin. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

23 Fig. 40-4 Radiograph of a stepwedge. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

24 Chapter 40 Lesson 40.3 Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

25 Learning Objectives  Explain the infection-control requirements for preparation of a radiography operatory.  Implement the Centers for Disease Control and Prevention guidelines for infection control in dental radiology. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

26 Infection Control in Dental Radiography  Dental radiography presents unique infection- control problems because of the potential for operator contamination and cross- contamination of other patients and other members of the dental team.  Constant movement by the operator from the oral cavity to the exposure controls outside the operatory to the darkroom and finally to film mounting increases the risk that others will be exposed to infectious diseases. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

27 Surfaces Likely to Become Contaminated During Dental X-Ray Procedures  X-ray tubehead  Position-indicating device (PID)  X-ray control panel  Exposure button  Lead apron  Dental-chair controls  Operatory counter surfaces  Darkroom equipment  Sleeves on automatic processors Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

28 Radiography Operatory Preparation  The first step in the preparation of the operatory is to determine which surfaces need to be covered or disinfected with a high- level surface disinfectant.  In general, surfaces that cannot be easily cleaned and disinfected should be protected with a barrier, most commonly plastic or foil.  Surface barriers are preferred for electrical switches because of the possibility that the cleaner or disinfectant will cause an electrical short. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

29 Fig. 40-6 Radiography operatory with barriers in place. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

30 The X-Ray Machine  The tubehead, PID, control panel, and exposure button must all be covered or carefully disinfected. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

31 The Lead Apron  The lead apron should be considered contaminated and wiped down with a disinfectant after each use. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

32 The Dental Chair  The back and arms of the chair, the headrest, and the headrest-adjustment controls must all be covered or disinfected.  Once the radiography operatory is set up, the film and film-holding devices should be prepared. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

33 The Work Area  The work area where the x-ray film and film- holding devices are placed during exposure should be disinfected, after which a barrier should be placed.  This barrier may be a paper sheet, paper towels, or plastic cover.  Once the procedure has been completed, the barriers should be discarded. Surfaces that are not protected with barriers should be cleaned and disinfected. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

34 Fig. 40-7 A, Plastic surface barrier is placed over the work surface. B, After each exposure, the dental assistant wipes the film dry using a paper towel and then places the exposed film in a plastic bag that has been taped to the wall. (Courtesy of the University of California School of Dentistry, Oral Radiology Department; photographs by Thomas Cao.) A B Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

35 Preparation of Supplies and Equipment  To help decrease the chance of cross- contamination, gather all of the supplies that you might need before beginning the procedure.  For example, think about the type of film- holding devices, cotton rolls, and bite-wing tabs that may be needed if the patient has an edentulous area.  If you need additional supplies during the procedure, either use overgloves (food handler’s gloves) or ask someone for assistance. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

36 The Film  Dental film should be dispensed from a central area in a disposable container, such as a paper cup or envelope.  A clear plastic barrier envelope may be placed over the film packet to minimize contamination by saliva.  Films enclosed in clear plastic barrier packets are available commercially.  The barrier-protected film packets are exposed and brought to the processing area.  The barriers are contaminated; the dental assistant must remove them very carefully, without touching the inner packet, so that he or she can handle the packet with bare hands. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

37 Fig. 40-8 Protective barrier on x-ray film. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

38 Contaminated Film Packets  The contaminated film packet is the major source of cross-contamination during radiographic procedures.  When the packet is removed from the patient’s mouth, it is coated with saliva (or, on occasion, with blood).  For this reason the operator must always wear gloves while handling contaminated film packets. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

39 Decontamination of Film Packets  Wipe saliva from the film packet using a dry 2 × 2-inch gauze sponge or a paper towel.  Do not attempt to sterilize the film packet. Heat sterilization will destroy the image.  Some film manufacturers permit light spraying of film packets with a disinfectant spray; however, immersion of the packet in a disinfecting solution can allow solution to seeping into the emulsion, damaging the image. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

40 Film-Holding Devices  Film-holding instruments and bite-blocks that are placed in the patient’s mouth are semicritical items and must be sterilized or subjected to high-level disinfection before reuse.  The alternative is to use disposable film holders and discard them after a single use.  Sterilized film-holding devices should remain packaged until the patient is seated and the patient can view the opening of the package.  Patients appreciate knowing that proper infection- control procedures are in place throughout the office. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

41 Miscellaneous Items  Other useful items include cotton rolls that can be used to stabilize film placement and paper towels that can be used to wipe saliva from exposed films.  A disposable container, such as a paper cup labeled with the patient’s name, is also necessary to collect the exposed films.  All miscellaneous items should be dispensed from a central supply area. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

42 Preparation of the Operator Preparation of the Operator  Gloves and protective clothing must be worn by the dental assistant exposing radiographs and handling contaminated films.  Because radiographic procedures do not involve the aerosol produced by the dental handpiece, a mask and glasses are optional while radiographic films are being made. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

43 Fig. 40-9 Wearing the appropriate personal protection, the operator places the lead apron on the patient. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

44 Infection Control During Exposure  After gloving, the operator should be careful not to touch any surfaces that have not been covered.  The best way to do this is to develop a sequence in which the operator touches as few surfaces as possible.  After each exposed film is removed from the patient’s mouth, it must be wiped with a paper towel to remove excess saliva. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

45 Collection of Contaminated Films  Once dried, each film must be placed in a disposable container (plastic bag or paper cup) labeled with the patient’s name.  This container will be used to transport the films to the darkroom.  The outside surface of this container must not be touched by gloved hands.  As a means of preventing film fog caused by radiation, the container should never be placed in a room where additional films are being exposed.  Exposed films should never be placed in the operator’s laboratory or uniform pocket. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

46 Film-Holding Devices  During exposure, film-holding devices should be transferred from the covered work area to the patient’s mouth and then back to the same area.  Contaminated instruments should never be placed on an uncovered surface. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

47 Management of Contaminated Items After Exposure  After completion of film exposure, all contaminated items must be discarded and any uncovered surfaces must be disinfected.  Contaminated radiography items must be handled in the same manner as that recommended for other contaminated dental instruments.  The dental assistant must wear gloves to discard contaminated items, including the disposable surface coverings.  The operator should carefully unwrap all covered surfaces; the actual surfaces that are wrapped should not be touched by gloved hands. (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

48 Management of Contaminated Items After Exposure (Cont’d)  Film-holding devices  While the operator is wearing gloves, the contaminated film- holder must be removed from the treatment area and placed in the area designated for contaminated instruments.  Handwashing  After the removal and disposal of all contaminated items, gloves must be removed and the hands washed.  Surface disinfection  Any uncovered areas that were contaminated during exposure must be cleaned and disinfected with the use of an Environmental Protection Agency-registered hospital-grade disinfectant and utility gloves. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

49 Film Transport  The disposable container should never be touched by gloved hands.  Only after the gloves have been removed, the hands have been washed and dried, the patient has been dismissed, and the area has been cleaned and disinfected should the operator carry the disposable container holding the contaminated films to the darkroom. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.


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