Multiple Infection Control and Sterilization Violations Result in Dental Board Action
This dental licensing board matter involves a general dentist who owned their own practice and had been licensed to practice dentistry for over five years at the time of events. Pursuant to a complaint filed by one of the dentist’s former employees, an investigator from the State Board of Dental Examiners (“the Board”) presented to the dentist’s office one day for an unannounced infection control and sterilization inspection. During this initial inspection of the dental office, the investigator observed several apparent violations of state regulations regarding dental office maintenance, infection control, and sterilization. These issues included staff failing to consistently, properly use disposable gowns and lab coats, including when in contact with patients, as well as counters and floors in clinical areas being visibly soiled.
Shortly after this initial inspection, Board investigators obtained additional information indicating that the dentist was not training employees properly in infection control and sterilization procedures, and that certain dental instruments were being re-used between patients improperly. Therefore, the Board investigator presented to the dentist’s office again just five days after the initial inspection for a follow-up inspection. During this follow-up visit, the investigator observed continued violations of infection control regulations, including evidence corroborating the allegations about reuse of certain dental instruments without proper sterilization.
After the second inspection, which confirmed apparent violations of infection control regulations, the Board requested that the dentist enter a one-year voluntary agreement consenting to further infection control inspections. The agreement allowed the Board to determine if the dentist could become and remain compliant with all applicable infection control regulations over the next year.
Pursuant to the agreement, six months later, a Board investigator conducted an unannounced third inspection of the dental office. During the inspection, the investigator observed apparent improvement in some areas, but also noted several other violations of state infection control regulations, including a dead cockroach in the hallway, apparent reuse of sterilization pouches, and staff improperly donning and doffing gloves.
During each inspection up to this point, the Board’s investigators were told they had to wait in the dental office’s lobby before they were allowed into the clinical area of the dental practice to conduct their inspections. As a result, two months later, the Board decided to send two investigators to conduct a fourth inspection, and this time they did not allow any time between their introduction and starting the inspection of the clinical area of the dental practice. Without any delay before the inspection was conducted, the investigators observed and documented several infection control regulations, including:
- Local anesthetic vials, labeled as single use only, which were punctured and remained in the office for potential reuse;
- Soiled, unsanitary gloves placed back into a box with unused gloves, from which gloves were seen being taken out for use on patients;
- Expired spore testing kits, including in the autoclave equipment;
- Soiled, unsanitary PPE stored in drawers along with sterilized, packaged instruments;
- Cockroaches were found in various areas of the office, including in an operatory where patients were treated;
- Restroom facilities not being kept clean and in good repair.
Investigators also discovered several concerning statements on the dentist’s practice website. First, the website listed the dentist as a DDS with “over 20 years” of experience practicing dentistry. However, while the dentist had previously practiced as a dental hygienist, they had only held an active dental license for less than ten years. The dentist’s practice website also included information and a biography about another dentist, indicating that there were perhaps two dentists practicing in the office, but no other dentist was employed by or worked in the office. Once investigators asked the dentist about the information regarding the other dentist, it was removed from the practice website.
Based on the findings from each inspection, including the last inspection, the Board concluded that the dentist repeatedly violated state statutes regarding sterilization and infection control, including potential cross-contamination and transmission of infections. As a result, the Board entered a disciplinary order against the dentist, which indefinitely suspended the dentist’s license to practice.
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