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ePaper created 2015-02-16, 09:59:52 | version 1.33.01
science & practice26 Show Preview IDS Cologne 2015 More than three decades have passed since the emergence of human immunodeficiency virus (HIV)asaglobalpandemic.Morethan anyotherinfection,itispossibletosin- gle out HIV as the primary stimulus for changing infection control prac- tices in dentistry. Prior to the mid- 1980s, it was uncommon for dentists and allied professionals to wear gloves during routine dental proce- dures. Many dental clinics did not use heat sterilisation, and disinfection of surfaceswaslimitedtoacursorywipe with an alcohol-soaked gauze sponge. This was despite our knowledge that hepatitis B virus (HBV) had been spread in clusters in the offices and clinics of infected dentists and that dentists were clearly at occupational risk for acquiring HBV. Today, many take safe dental care for granted, but there is still reason to remain vigilant in ensuring an infec- tion-free environment for providers and patients. HIV has fortunately proventobeeasilycontrolledinaclin- ical environment using the same pre- cautions as those effective for pre- venting the transmission of HBV and hepatitisCvirus.1 Thesestandardpre- cautions include the use of personal protectiveattire,suchasgloves,surgi- cal masks, gowns and protective eye- wear, in combination with surface cleaning and disinfection, instrument sterilisation, hand hygiene, immuni- sations and other basic infection con- trol precautions. Sporadic reports of transmission of blood-borne diseases associated with dental care continue, but are most often linked to breaches in the practice of standard precau- tions.2 Emerging and re-emerging infec- tiousdiseasespresentarealchallenge to all health care providers. Three of the more than 50 emerging and re- emerging infectious diseases identi- fiedbytheCentersforDiseaseControl and Prevention and the World Health Organization (WHO) include Ebola virus disease (EVD), pandemic in- fluenza and severe acute respiratory syndrome.3, 4 These previously rare or unidentifiedinfectiousdiseasesburst 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. When faced with a particularly deadly infectious disease such as EVD, which can be spread through contact with an ill patient’s body flu- ids, health care workers are naturally concernedabouthowtoprotectthem- selves if an ill patient presents to the dental clinic. With diseases such as pandemic influenza and severe acute respiratory syndrome, which may be spread via inhalation of aerosolised respiratory fluids when a patient coughs or sneezes, the concern is whether standard precautions will be adequate. In addition to standard precau- tions, treating patients with these dis- eases requires the use of transmis- sion-based precautions. These encom- pass what are referred to as contact, droplet and airborne precautions for diseases with those specific routes of transmission. Transmission-based precautions may include patient iso- lation, placing a surgical mask on the patientwhenheorsheisaroundother people,additionalprotectiveattirefor care providers, and in some cases the use of respirators and negative air pressure in a treatment room. In most cases,patientswhoarecontagiousfor infections requiring droplet or air- borne precautions should not be treated in a traditional dental clinic setting. Updating a patient’s medical his- tory at each visit will assist dental healthprofessionalsinidentifyingpa- tients who are symptomatic for infec- tious diseases. Patients with respira- tory symptoms, including productive cough and fever, should have their dental treatment delayed until they are no longer symptomatic. Addition- ally, health care professionals who are symptomatic should refrain from coming to work until they have been free of fever without taking fever-re- ducing medication for 24 hours. In most cases, a patient with symptoms as severe as those experi- enced with EVD will not present for dental care and therefore extraordi- nary screening and protection proto- colsarenotrecommended.Ifapatient is suspected of having a highly conta- gious disease, he or she should be re- ferred to a physician, hospital or pub- lic health clinic. Dental professionals should take actiontoremainhealthybybeingvac- cinated according to accepted public health guidelines, understanding that the recommendations may differ according to country of residence. Performing hand hygiene procedures at the beginning of the day, before placing and after removing gloves, changing gloves for each patient, wearing a clean mask and gown or laboratory coat, and wearing protec- tive eyewear are all positive actions that help prevent occupational infec- tions. In addition, cleaning and heat sterilisation of all instruments and disinfection of clinical surfaces en- sure a safe environment for patients. There is solid evidence that dental care is safe for patients and providers when standard precautions are fol- lowed, but patients and dental health care workers are placed at risk when precautions are compromised and breaches occur.7 Eve Cuny is an associate professor at the Arthur A. Dugoni School of Den- tistry at the University of the Pacific in San Francisco in California in the US. She is also a consultant to the Ameri- can Dental Association’s Council on Scientific Affairs and expert reviewer fortheCentersforDiseaseControland Prevention. References: 1. Centers for Disease Control and Preven- tion,“OccupationalHIVtransmissionand prevention among health care workers”