Dental Tribune United Kingdom Edition

Fig 2: Twenty-five experts attended the AESIC/ACTA conference in Amsterdam. (Photo courtesy of ACTA) Fig 1: Dr Hans de Soet June 4-10, 2012Infection Control Tribune United Kingdom Edition Flags of the Europe 20 not mandatory in other countries. The situation in the UK is not ideal either, in that all local au- thorities perform their own re- search and establish their own regulations, owing to apparent regional differences. In this case, political considerations under- mine efficiency, which stresses the need for a European organi- sation like AESIC, which does not serve political goals, but focuses on science. Infection control is currently a hot topic in Dutch dentistry, owing to the strict enforcement of equally strict regulations. How does this compare with the rest of Europe? By comparison, our regulations are well developed: they are ex- tensive, clear and realistic. Al- though some dentists regard them as too strict, they are actually more flexible than those of some other countries. For instance, Dutch dentists are not obligated to publish an annual record of their activities with reference to patient safety. Dutch regulations are also unique in that they are developed by an independent party. Regulations also require en- forcement. How does foreign regulation enforcement differ from that in the Netherlands? The Dutch situation is very good, partly because of its well-func- tioning government-owned moni- toring agency. The England moni- tor is of high standard as well, especially compared with most other European countries. Often, patients need to file a personal complaint before any action is tak- en against a dental practitioner. The goal of the conference was to establish a European working group. What activities will this group undertake? The working group is not primar- ily concerned with formulating European regulations. We are mainly interested in sharing our thoughts on patient safety. We can all benefit from sharing our knowledge at an academic level and performing research using data from all over Europe. The ultimate goal is to give infection control the place it deserves in academic research programmes. Once we have finished map- ping the current state of infec- tion control, we can determine whether it is possible to formulate regulations at a European level. As our situations do not differ sig- nificantly, it makes no sense that our regulations do. Does the subject of infection control receive enough atten- tion in dental education? No, it is substandard in all Euro- pean countries. Students learn all about every possible dental treatment, but the students’ and teachers’ knowledge of infection control is minimal. ACTA has a small research department that investigates and teaches dental microbiology. However, this de- partment was not spared in recent budget cuts. In general, infection control is continually neglected in dental education, even though poor oral hygiene leads to serious health risks. If all experts agree on this, why doesn’t infection control take up a more prominent place in den- tal education? The problem is that the risks are difficult to prove, and on a rela- tive scale few cases can be linked to poor oral hygiene. In our opin- ion, however, every case is one too many. The Lancet published a case about an 82-year-old Italian pa- tient who died of Legionella in- fection after seeing a dentist. The Netherlands has never seen a serious case like this, but if infec- tion control is neglected, we just might. As I indicated, the smaller education budgets force universi- ties to make certain choices. Un- fortunately, microbiology is not a priority for most dentists. By the way, AESIC does not confine itself to infection control alone. We also discuss infection treatment. Antibiotics are too easily prescribed, even when not necessary or desirable. Students should also be taught the alterna- tives in infection treatment. You indicated that infection control in the Netherlands is of a relatively high standard. Does this mean that other countries could benefit more from a Euro- pean working group? There is room for improvement for us as well. The regulations for infection control in dentistry are largely based on general medi- cine, which means that some regulations may be too strict. We lack empirical evidence of the risk of infections like Legionella and MRSA. Therefore, it is difficult to de- termine whether and how the regulations should be adjusted: should they be stricter or more flexible? There is some data about MRSA in general medicine, but not in dentistry. Now, we could wait until something goes wrong, or we could cooperate with other dental professionals and experts for whom MRSA is increasingly problematic. AESIC was set up in 2010. What has the organisation accom- plished so far? Eighteen months is too short for any tangible accomplishments, but we have achieved a wonder- ful goal in bringing together so many academics and commercial representatives. The latter are of crucial importance too: we can do all this research, but it’s the manu- facturers that have to produce the desired devices and products. AESIC aims to anticipate new developments, enabling it to steer manufacturers in a cer- tain direction. For instance, few dental chairs are equipped with an automatic drainage cleaning system. Were such a system to be made compulsory, manufacturers should be able to anticipate this at an early stage. Dental manufacturers are probably hoping for very strict regulations on infection control, thus forcing dental practitioners to make large investments in this field. Some companies may think like that, but those that join AESIC adopt a responsible stance, dem- onstrating their passion for den- tistry and their willingness to achieve optimal infection control. We sincerely value their contribu- tion. Aside from that, conferences like this one need funding and we need commercial parties in that respect as well. How close are you to establish- ing a European working group? We have now inventoried the main similarities and differ- ences between the regulations in European countries. In doing so, a practical problem imme- diately became apparent: The Netherlands is the only country that has translated its regulations into English. Also, they are often split up into various reports, rules and regulations. We have now de- cided to take one set of regulations as starting point and compare it with those of other countries. This could be done by students. Another important project is to develop an educational curricu- lum that clearly states our mini- mal requirements for infection control knowledge for all dental professionals. We will also investi- gate how to get funding for collab- orative research in our focus area, so that we can gather stronger empirical evidence. Will the Netherlands be represented at subsequent AESIC meetings? We have decided to meet once a year. It could well be that the next conference will again take place in Amsterdam because of its cen- tral location. In that case, we will definitely play a substantial role again. My colleague Wilma Morsen and I were strongly involved in the organisation of the conference, but even if the next meeting takes place abroad, the Netherlands will certainly be represented. DT ‘Once we have finished mapping the current state of infection control, we can determine whether it is pos- sible to formulate regulations at a European level’ ‘The Dutch situation is very good, partly because of its well-functioning government- owned monitoring agency’ page 19DTß