today IDEM Singapore 04 April

news08 IDEM Singapore 2014—4 April Standard precautions, such as using gloves and the routine pro- cessing of instruments, are ex- pected to be followed around the world. These measures have to be applied to the treatment of every patienteverydayregardlessofwho they are. What we are dealing with now are patients who may have tu- berculosisortheseasonalinfluenza virus, which is quite a tricky situa- tion in a clinical practice because they are very easily spread. Probably one in four patients who contract the flu is known as asupersecretor,whichmeansthey shed massive amounts of the virus in the area around them and are much more able to infect other people. If a practice does not fol- low precautions additional to the standard precautions in this case, it is very likely that either mem- bers of the staff or another patient they see later in the day could contracttheflu.Intermsofserious- ness, it is well documented that patients who are over 65 have a much higher mortality if they contract the regular seasonal in- fluenza virus than most other patient groups. We tend to stress hepatitis B, HIV and hepatitis C, but, by sheer weight of numbers, patients are much more likely to contract in- fluenza in a dental practice that does not follow correct infect con- trolpracticesandthentakeithome to the other members of their fam- ily. The long-term consequences of that could be very severe. Wheninfectioncontrolistaught today, much time is given to things that can be inhaled, not just things that enter the body through a den- tal needle piercing the skin. When it became a hot topic in the early 1980s,thefocusofinfectioncontrol was very much around hepatitis and HIV but, in terms of the fre- quency of exposure, we see a great deal of awareness now of things like biofilms, Legionella and in- fluenza, things that dental staff canactuallyinhaleatwork.Iguess thatisamuchmorecommon-sense approach because it focuses on the exposure that dental staff may haveatworkeverydayratherthan things they are rarely exposed to in many parts of the world. Inmostcountries,therearepro- tocols for that. For example, in my country we use a pre-procedural mouth rinse, schedule the patient for the end of the day and clean all the surfaces in the dental surgery twice. There is a whole protocol of extra things that can be done to deal with the additional risk. Isthecorrectwayofperform- inginfectioncontrolaffordable, particularly for dentists in de- veloping countries? Some of the most simple and basic things in infection control come down to wearing a mask or gloves the correct way and en- suring that one is practising the correct hand hygiene. These are things that are not very expen- sive. The cost of putting on new disposable gloves for every pa- tient is only a fragment of the actual total cost of providing care to the patient, which includes the use of materials, such as compos- ites and bonding agents. When one looks at it in terms of the over- all running of a practice, it is prob- ably less than a couple of syringes or something else that we might have also used during the day. So while it does cost, relatively speakingitdoesnotcostquitethat much. In a number of countries, in- cluding my own, a great deal of work is being done in terms of sus- tainability,whichbasicallyfocuses on throwing fewer things away. There is all sorts of unnecessary waste. In some parts of the world, people put on too many plastic covers when they probably do not need to because the surface is designed to be wiped over with a disinfecting agent. It is almost like a pendulum: when the pendulum swings too far, one applies addi- tionalmeasuresandallthatresults are costs with no extra protection. Around the world, there has been a very strong push towards looking at the evidence for doing or not doing certain things. A very good example is that, during the swine flu outbreak in many parts of the world, people bought large numbers of high-filtration masks. A number of studies showed that, while the mask has a better filter, often the staff did not wear it prop- erly and therefore did not gain any benefit from having spent all the extra money and the discomfort of wearing the mask. So one might have a better protective measure, but people do not apply it properly or misunderstand it. That is probably a very impor- tant lesson. Sometimes, infection controldoesnothavetobemoreex- pensive or complex. It comes back to things like protecting against what people breathe in and en- suring that good hand hygiene is practised. These are some of the principlesthatarenotexpensiveto follow but, if one gets them wrong, things can go bad very quickly. Thank you very much for the interview. AD 7 page 06 TDI0614_06-08_Walsh 28.03.14 12:08 Seite 2