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today IDEM Singapore 04 April

news06 IDEM Singapore 2014—4 April n Standing in for Prof. John Molinari, who was originally intended to present at IDEM Singapore this year, Prof. Laurence Walsh from the University of Queensland’s School of Dentistry in Brisbane in Australia is going to present the latest insights in infection control practiceduringalectureandwork- shop to be held today as part of the scientific programme. today international had the opportunity to speak with him beforehand about new threats and why in- fection control does not have to be a costly endeavour. todayinternational:Prof.Walsh, infection control in dental prac- ticesdifferswidelyinAsia.What are the main reasons for that? Prof. Laurence Walsh: In fact, standards of infection control vary around the world and part of the reason for that is the way dental services are regulated in each country, as well as the amount of effort national governments put into things like practice inspec- tions and audits. At the moment, the weakest area is how instruments are being processed. There is good evidence that, in several parts of the world, this is still mostly done by hand rather than by mechanical de- vices, such as ultrasonic cleaners or thermal disinfectors. We know thatthesemachine-basedsystems do the job not only faster and better, but also with less risk to the staff. It is probably not uncom- mon for people to still be cleaning one instrument at a time in some parts of the world. In that sort of situation, it is easier to overlook one area or another of an instru- ment. When cleaning is done with a mechanical system, however, the design of the system ensures that all the surfaces of the instru- ment are given equal exposure to the disinfecting agent. Greater use of mechanical cleaning is some- thing we will likely see more often in areas of the developing world. I think this is something that will happen gradually as the gen- eral awareness of the public con- cerning infection control practice increases. When wearing gloves became routine in dentistry in the early 1980s, for example, it took probably around five to ten years for patients to expect the person treating them during a dental visit to use gloves. Sometimes, these expectations take a while to work theirwaythroughthesystem.This is just the reality of the world we live in. With tens of millions of new infections expected to occur in this decade in Asia alone, HIV/Aidshasbeenidentifiedas one of the main threats to infec- tion control. What other threats should health professionals, in- cluding dentists, be concerned about? HIV is still very much on the world stage, particularly in large, populous countries, such as India and China. While the percentage of HIV infections is very low owing to the large populations in these countries, it is important not to forget about the virus or think that it has been eradicated. In my home country, Australia, for ex- ample, the rate of HIV infections has not changed much, despite ef- forts such as education and public health measures. AgreaterissueinAsia,however, is the various forms of influenza viruses and other infections. With theexceptionofthe2009swineflu outbreak, many of these (SARS, Asianflu,HongKongflu,etc.)have originated on the continent. There are some unusual practices in many countries concerning peo- ple’s proximity to different sorts of birds, particularly domestic chickens. When animals and peo- ple live in such close proximity, opportunities for the potential spread of infection from animals to people arise. In Australia, we currently have some major problems with viruses thatarecarriedbylargecoloniesof bats. If one has a colony of several thousand of these animals in one’s district, one probably does not want to spend too much time around them and risk being ex- posed to the virus. People now think about birds and chickens in much the same way and this awarenessisperhapsanimportant message to be taken from these incidences. There is ongoing con- cern about the equatorial regions because large numbers of people and birds live very close together in those areas. A second serious concern, mainly in developed parts of the world, is antibiotic resistance. There are many types of these today. The different varieties of resistant bacteria include tuber- culosis and a whole range of gut- type bacteria. We now even have resistant bacteria in the mouth. This is a phenomenon that a few years ago was only seen in hos - pitals and infectious disease pa- tients. Now, resistant bacteria are much more common in nursing homesandothercareinstitutions. The number of newly developed antibiotics has been going down progressively over the last ten years, so there are fewer wea- pons being brought into the war against resistant bacteria each year. There is a large push in coun- tries like Australia, the UK and the US to limit the way health pro- fessionals use antibiotics. I was looking at some data recently for different regions in the US and there are actually parts of the country where more prescrip- tions for antibiotics are given out every year than there are people in that state. This means that every person in the state receives one or two prescriptions for anti- bioticseveryyear!Thishascreated enormous potential for developing resistance. Many governments aroundtheworldarenowstarting to change regulations around the use of antibiotics in an attempt to restrict their use to essential indications, so that they are not used unnecessarily. So, breaking it down, we have a high-technology problem in the developed world and a low-tech- nology problem in developing countries. How often do incidences of failed infection control occur? In 2012, for example, the Uni- versity of Hong Kong Health Service’s Dental Unit had to call in over 300 patients owing to in- complete sterilisation of dental instruments. There were quite a number of instances in the media last year. I guess the most famous one occurred in Oklahoma in the US, where 6,000 patients treated at a dental practice had to be re- called for blood tests. The practice had treated large numbers of pa- tients who were known to have HIV and viral hepatitis, so it is likely that there might have been patients who were exposed to these sorts of conditions because of very poor sterilisation prac- tices. That happens even in the developed world. I expect not all make the front page of the local newspaper but they keep consult- ants or investigators like me, who are brought in to unravel these problems, busy. These incidences are not nec- essarily limited to a very affluent country or a country that is still developing. They actually happen because health professionals sim- ply cut corners or do not know the correct way of doing things. It comes down to continuing edu- cation and the way our students are trained in dental school. This is probably more important than government regulations, accredi- tations or practice inspections, whicharethingsthatoftenhappen after the problem has occurred. They are more of a reaction to the problem than a preventative measure, which would be to train studentsproperlyinthefirstplace. How prepared are dental professionals for dealing with threats? 5 Prof. Laurence Walsh “Infection control does not have to be more expensive or complex” An interview with IDEM presenter Prof.LaurenceWalsh,Australia “Standard precautions,such as using gloves and the routine processing of instruments, are expected to be followed around the world.” 8 page 08 (DTI/Photo courtesy of KPG_Payless) TDI0614_06-08_Walsh 28.03.14 12:08 Seite 1