Hygiene Tribune U.S. Edition

should have their dental treatment de- layed until they are no longer symptom- atic. Additionally, health care profession- als who are symptomatic should refrain from coming to work until they have been free of fever without taking fever- reducing medication for 24 hours. In most cases, a patient with symptoms as severe as those experienced with EVD will not present for dental care and there- fore extraordinary screening and protec- tion protocols are not recommended. If a patient is suspected of having a highly contagious disease, he or she should be referred to a physician, hospital or public health clinic. Protect yourself and patients with vaccinations, proper hand hygiene Dental professionals should take action to remain healthy by being vaccinated according to accepted public health guidelines, understanding that the rec- ommendations may differ according to country of residence. Performing hand hygiene procedures at the beginning of the day, before placing and after remov- ing gloves, changing gloves for each pa- tient, wearing a clean mask and gown or laboratory coat, and wearing protective eyewear are all positive actions that help prevent occupational infections. In addi- HYGIENE TRIBUNE The World’s Dental Hygiene Newspaper ·U.S. Edition MARCH 2015 — Vol. 8, No. 3 www.dental-tribune.com By Eve Cuny Pacific Dugoni School of Dentistry M ore than three decades have passed since the emergence of human immunodeficiency virus (HIV) as a global pandemic. More than any other infection, it is possible to sin- gle out HIV as the primary stimulus for changing infection control practices in dentistry. Prior to the mid-1980s, it was uncommon for dentists and allied pro- fessionals to wear gloves during routine dental procedures. Many dental clinics did not use heat sterilization, and disin- fection 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) had been spread in clusters in the offices and clin- ics of infected dentists and that dentists were clearly at occupational risk for ac- quiring HBV. Plenty of reasons to remain vigilant Today, many take safe dental care for granted, but there is still reason to remain vigilant in ensuring an infection-free en- vironment for providers and patients. HIV has fortunately proven to be easily controlled in a clinical environment us- ing the same precautions as those effec- tive for preventing the transmission of HBV and hepatitis C virus.1 These stan- dard precautions include the use of per- sonal protective attire, such as gloves, surgical masks, gowns and protective eye- wear, in combination with surface clean- ing and disinfection, instrument ster- ilisation, hand hygiene, immunizations and other basic infection control precau- tions. Sporadic reports of transmission of blood-borne diseases associated with dental care continue, but are most often linked to breaches in the practice of stan- dard precautions.2 Once-rare viruses now in headlines Emerging and re-emerging infectious dis- eases present a real challenge to all health care providers. Three of the more than 50 emerging and re-emerging infectious dis- eases identified by the Centers for Disease 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 unidentified in- fectious diseases burst into the headlines in the past several years when they exhib- ited novel or uncharacteristic transmis- sion patterns. Concern about emerging infectious diseases arises for several reasons. When faced with a particularly deadly infec- tious disease such as EVD, which can be spread through contact with an ill pa- tient’s body fluids, health care workers are naturally concerned about how to protect themselves if an ill patient presents to the dental clinic. With diseases such as pan- demic influenza and severe acute respira- tory syndrome, which may be spread via inhalation of aerosolised respiratory flu- ids when a patient coughs or sneezes, the concern is whether standard precautions will be adequate. In addition to standard precautions, treating patients with these diseases requires the use of transmission-based precautions. These encompass what are referred to as contact, droplet and air- borne precautions for diseases with those specific routes of transmission. Transmission-based precautions may include patient isolation, placing a surgi- cal mask on the patient when he or she is around other people, additional protec- tive attire for care providers, and in some cases, the use of respirators and negative air pressure 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. Treatment delay can be best policy Updating a patient’s medical history at each visit will assist dental health pro- fessionals in identifying patients who are symptomatic for infectious diseases. Patients with respiratory symptoms, including productive cough and fever, ” See INFECTION, page C2 Figs 1–7, below: Steps from the Centers for Disease Control and Prevention for disposable-glove removal. Latex, vinyl or nitrile gloves reduce hand contamination, prevent cross-contamination and protect against infection. Gloves shouldn’t restrict movement, must accommodate individuals (i.e., allergies) and meet the requirements of the task performed. Photos/Kimberly Smith, CDC Infection control in an era of emerging infectious diseases It’s critical to remain vigilant in ensuring an infection-free environment Step 1: Pinch the palm of the left glove and begin to pull glove down to fingers. Step 2: Continue to pull the palm of the left glove down and off your fingers. Step 3: After the glove is pulled off, form it into a ball in the fist of your right hand. Step 4: Insert 2 fingers of the left hand under the rim of your right glove on palm side. Step 5: With the left hand, push the glove down the right palm covering the balled glove. Step 6: Grasp gloves with left hand and remove them from your right hand. Step 7: Discard the gloves into an infectious waste container and wash your hands. ‘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 precautions.’

Hygiene Tribune U.S. Edition

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