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Dental Tribune Pakistan Edition

Editor - Online Haseeb Uddin INTERNATIONAL NEWS6 DENTAL TRIBUNE Pakistan Edition May 2015 Infection control in an era of emerging infectious diseases 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 single 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 professionals to wear gloves during routine dental procedures. Many dental clinics did not use heat sterilization, and disinfection of surfaces was limited to a cursory 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 clinics of infected dentists and that dentists were clearly at occupational risk for acquiring 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 environment for providers and patients. HIV has fortunately proven to be easily controlled in a clinical environment using the same precautions as those effective for preventing the transmission of HBV and hepatitis C virus.[1] These standard precautions include the use of personal protective attire, such as gloves, surgical masks, gowns and protective eyewear, in combination with surface cleaning and disinfection, instrument sterilisation, hand hygiene, immunizations 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 practice of standard precautions.[2] Once-rare viruses now in headlines Emerging and re-emerging infectious diseases present a real challenge to all health care providers. Three of the more than 50 emerging and re-emerging infectious diseases 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 infectious diseases burst into the headlines in the past several years when they exhibited novel or uncharacteristic transmission patterns. Concern about emerging infectious diseases arises for several reasons. When faced with a particularly deadly infectious disease such as EVD, which can be spread through contact with an ill patient’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 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 precautions, treating patients with these diseases requires the use of transmission-based precautions. These encompass what are referred to as contact, droplet and airborne precautions for diseases with those specific routes of transmission. Transmission-based precautions may include patient isolation, placing a surgical mask on the patient when he or she is around other people, additional protective 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 professionals in identifying patients who are symptomatic for infectious diseases. Patients with respiratory symptoms, including productive cough and fever, should have their dental treatment delayed until they are no longer symptomatic. Additionally, health care professionals 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 therefore extraordinary screening and protection 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 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 protective eyewear are all positive actions Continued on page 11 M n one of the worst earthquakes in over 80 years, more than 10,000 people are believed to have died last week in the Federal Democratic Republic of Nepal. Living in and practising dentistry in the capital of Kathmandu, dentist Dr Sushil Koirala has been directly affected by the disaster. Dental Tribune Asia Pacific had the opportunity to talk to him briefly about the situation in the country and how the international community can help it to overcome the humanitarian crisis. Dental Tribune Asia Pacific: The earthquake on 25 April had a devastating effect on your country’s infrastructure and its people. What is the situation currently in Kathmandu, and how have you been affected personally? Dr Sushil Koirala: The situation in Kathmandu at present remains very difficult owing to the extensive damage to many public buildings, government offices and schools. Nearly 7,500 lives have been lost and 14,500 people have been injured. Those who survived the earthquake are traumatised. While physically my family and I are fine, we are still pretty much in shock. My children are very distressed because they were alone at home during the first episode of the earthquake. Some of my staff from the hospitals and clinics lost their houses unfortunately and have to stay with relatives for the moment. Have you heard from colleagues in other parts of the country, and if so what is their situation? Most of my dental colleagues are unharmed, but many of them are facing problems with their damaged clinics. Most of the dental hospitals in Kathmandu are still closed owing to the damage and employees not being able to work because they are busy rebuilding their lives. Various agencies have estimated that more than eight million people across 39 of the country’s 75 districts have been affected by the earthquake. The most severely affected areas include the Bhaktapur, Dhading, Dolakha, Kathmandu, Kavre, Lalitpur, Nuwakot, Ramechhap, Rasuwa, and Sindhupalchowk districts of Nepal’s Central Region, as well as the Gorkha District of its Western Region. Have you received any correspondence from the dental community? I am glad to have received many e-mails with best wishes and prayers from our dental friends around the world. It is so gratifying to know that many of them have pledged their support of the earthquake victims of Nepal. Some dental manufacturers have shown keen interest to help us in the rehabilitation of children who have been affected. Despite an immediate response from India and Western countries, relief efforts seem to be insufficient, according to reports. What is your impression? International communities have offered immediate support and we really Continued on page 11 Interview: “We are still pretty much in shock” By Eve Cuny, USA By DT Asia Pacific I

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