Please activate JavaScript!
Please install Adobe Flash Player, click here for download

today AEEDC Dubai 2015

science & practice10 AEEDC Dubai 2015 More than three decades have passed since the emergence of human immunodeficiency virus (HIV) as a global pandemic. More thananyotherinfection,itispossible tosingleoutHIVastheprimarystim- ulus for changing infection control practices in dentistry. Prior to the mid-1980s,itwasuncommonforden- tistsandalliedprofessionalstowear gloves during routine dental proce- dures. Many dental clinics did not use heat sterilisation, and disinfec- tion of surfaces was limited to a cur- sory wipe with an alcohol-soaked gauze sponge. This was despite our knowledge that hepatitis B virus (HBV)hadbeenspreadinclustersin theofficesandclinicsofinfectedden- tistsandthatdentistswereclearlyat occupationalriskforacquiringHBV. Today,manytakesafedentalcare forgranted,butthereisstillreasonto remainvigilantinensuringaninfec- tion-free environment for providers and patients. HIV has fortunately proven to be easily controlled in a clinicalenvironmentusingthesame precautions as those effective for preventing the transmission of HBV and hepatitis C virus.1 These stan- dard precautions include the use of personal protective attire, such as gloves, surgical masks, gowns and protective eyewear, in combination with surface cleaning and disinfec- tion, instrument sterilisation, hand hygiene, immunisations and other basic infection control precautions. Sporadic reports of transmission of blood-borne diseases associated with dental care continue, but are most often linked to breaches in the practiceofstandardprecautions.2 Emerging and re-emerging infec- tious diseases present a real chal- lenge to all health care providers. Threeofthemorethan50emerging andre-emerginginfectiousdiseases identifiedbytheCentersforDisease Control and Prevention and the World Health Organization (WHO) include Ebola virus disease (EVD), pandemic influenza and severe acute respiratory syndrome.3,4 These previously rare or unidenti- fied infectious diseases burst into the headlines in the past several years when they exhibited novel or uncharacteristic transmission pat- terns. Concern about emerging infec- tious diseases arises for several rea- sons.Whenfacedwithaparticularly deadly infectious disease such as EVD, which can be spread through contactwithanillpatient’sbodyflu- ids, health care workers are natu- rally concerned about how to pro- tectthemselvesifanillpatientpres- ents to the dental clinic. With dis- eases such as pandemic influenza and severe acute respiratory syn- drome, which may be spread via in- halation of aerosolised respiratory fluids when a patient coughs or sneezes, the concern is whether standard precautions will be ade- quate. In addition to standard precau- tions, treating patients with these diseases requires the use of trans- mission-based precautions. These encompass what are referred to as contact, droplet and airborne pre- cautionsfordiseaseswiththosespe- cific routes of transmission. Trans- mission-based precautions may in- cludepatientisolation,placingasur- gicalmaskonthepatientwhenheor she is around other people, additio- nal protective attire for care providers,andinsomecasestheuse of respirators and negative air pres- sure in a treatment room. In most cases, patients who are contagious for infections requiring droplet or airborne precautions should not be treated in a traditional dental clinic setting. Updating a patient’s medical his- tory at each visit will assist dental health professionals in identifying patientswhoaresymptomaticforin- fectious diseases. Patients with res- piratory symptoms, including pro- ductive cough and fever, should havetheirdentaltreatmentdelayed until they are no longer symp- tomatic. Additionally, health care professionals who are symptomatic should refrain from coming to work until they have been free of fever without taking fever-reducing med- icationfor24hours. In most cases, a patient with symptomsassevereasthoseexperi- enced with EVD will not present for dentalcareandthereforeextraordi- naryscreeningandprotectionproto- cols are not recommended. If a pa- tientissuspectedofhavingahighly contagiousdisease,heorsheshould be referred to a physician, hospital orpublichealthclinic. Dentalprofessionalsshouldtake action to remain healthy by being vaccinated according to accepted public health guidelines, under- standingthattherecommendations may differ according to country of residence. Performing hand hy- gieneproceduresatthebeginningof the day, before placing and after re- moving gloves, changing gloves for each patient, wearing a clean mask and gown or laboratory coat, and wearing protective eyewear are all positive actions that help prevent occupationalinfections.Inaddition, cleaning and heat sterilisation of all instrumentsanddisinfectionofclin- ical surfaces ensure a safe environ- ment for patients. There is solid evi- dence that dental care is safe for pa- tientsandproviderswhenstandard precautions are followed, but pa- tients and dental health care work- ers are placed at risk when precau- tions are compromised and breachesoccur. EveCunyisanassociateprofessor attheArthurA.DugoniSchoolofDen- tistry at the University of the Pacific in San Francisco in California in the US. She is also a consultant to the AmericanDentalAssociation’sCoun- cilonScientificAffairsandexpertre- viewer for the Centers for Disease Control and Prevention. At AEEDC Dubai 2015, she will be presenting two papers discussing infection con- trol in dentistry on Tuesday and Thursday. References: 1. Centers for Disease Control and Preven- tion,“OccupationalHIVtransmissionandpre- vention among health care workers” accessed20Jan.2015. 2. Radcliffe, R.A. et al., “Hepatitis B virus transmissions associated with a portable den- tal clinic, West Virginia, 2009”, Journal of the American Dental Association, 144/10 (2013), 1110–8. 3. Centers for Disease Control and Pre- vention, “Infectious disease information: Emerginginfectiousdiseases” accessed20Jan.2015. 4. World Health Organization, “Pandemic and epidemic diseases” accessed20Jan.2015. Infection control in an era of emerging infectious diseases ByAEEDC Dubai 2015 presenter Eve Cuny,USA Eve Cuny During treatment the most contaminated areas are around the dentist’s nose and his or her in- ner corner of the eye. (DTI/PhotoJasminMerdan) AD

Pages Overview