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Hygiene Tribune Middle East & Africa Edition

hygiene tribune Dental Tribune Middle East & Africa Edition | September-October 20156B Infection control in an era of emerging infectious diseases ByEveCuny,USA 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 single out HIV as the primary stimulus for chang- ing infection control practices in dentistry. Prior to the mid- 1980s, it was uncommon for dentists and allied profession- als to wear gloves during rou- tine dental procedures. Many dental clinics did not use heat sterilization,anddisinfectionof surfaces was limited to a curso- ry 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 occupa- tional 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 us- ing the same 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 at- tire, such as gloves, surgical masks, gowns and protective eyewear, in combination with surface cleaning and disinfec- tion, instrument sterilisation, hand hygiene, immunizations and other basic infection con- trol precautions. Sporadic re- ports of transmission of blood- borne diseases associated with dental care continue, but are most often linked to breaches in the practice of standard pre- cautions.2 Once-rare viruses now in headlines Emerging and re-emerging in- fectious diseases present a real challengetoallhealthcarepro- viders. Three of the more than 50 emerging and re-emerging infectious diseases identi- fied by the Centers for Disease Control and Prevention and the World Health Organization (WHO) include Ebola virus dis- ease (EVD), pandemic influen- za and severe acute respiratory syndrome.3,4 These previously rare or unidentified infectious diseases burst into the head- lines in the past several years when they exhibited novel or uncharacteristic transmission patterns. Concern about emerging infec- tious 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 flu- ids, 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 inha- lation of aerosolised respiratory fluids when a patient coughs or sneezes, the concern is wheth- er standard precautions will be adequate. In addition to standard precau- tions, treating patients with these diseases requires the use of transmission-based precau- tions. These encompass what are referred to as contact, drop- let and airborne precautions for diseases with those specific routes of transmission. Transmission-based precau- tions may include patient iso- lation, placing a surgical mask on the patient when he or she is around other people, addi- tional protective attire for care providers, and in some cases, the use of respirators and nega- tive air pressure in a treatment room. In most cases, patients who are contagious for infec- tions requiring droplet or air- borne precautions should not be treated in a traditional den- tal 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 dis- eases. Patients with respiratory symptoms, including produc- tive cough and fever, should have their dental treatment delayed until they are no lon- ger 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 medica- tion 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 pro- tocols are not recommended. If a patient is suspected of hav- ing 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 accord- ing to accepted public health guidelines, understanding that the recommendations may differ according to country of residence. Performing hand hygiene procedures at the be- ginning of the day, before plac- ing and after removing 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 infec- tions. In addition, cleaning and heat sterilization of all instru- ments and disinfection of clini- cal surfaces ensure a safe envi- ronment for patients. There is solid evidence that dental care is safe for patients and provid- ers when standard precautions are followed, but patients and dental health care workers are placed at risk when precautions are compromised and breaches occur. References 1. CDC. Occupational HIV Transmission and Prevention Among Health Care Workers. Fact Sheet. 2014 (Jan) www. cdc.gov/hiv/risk/other/occupa- tional.html. Accessed 20 Janu- ary, 2015. 2. Radcliffe RA1, Bixler D, Moorman A, Hogan VA, Green- field VS, Gaviria DM, Patel PR, Schaefer MK, Collins AS, Khudyakov YE, Drobeniuc J, Gooch BF, Cleveland JL. Hep- atitis B virus transmissions associated with a portable dental clinic, West Virginia, 2009. J Am Dent Assoc. 2013 Oct;144(10):1110-8. 3. CDC. Infectious Disease In- formation. Emerging Infec- tious Diseases. www.cdc.gov/ ncidod/diseases/eid/disease_ sites.htm Accessed 20 January, 2015 4. WHO. Pandemic and Epi- demic Diseases. www.who.int/ csr/disease/en/ Accessed 20 January, 2015. Editorial note: This article was published in Hygiene Tri- bune U.S. Edition, Vol. 8, No. 3, March 2015 issue. A complete list of references is available from the publisher. It’s critical to remain vigilant in ensuring an infection-free environment “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” Eve Cuny is the director of environmental health and safety and associate profes- sor at Pacific Dugoni School of Dentistry in San Francis- co. She is a consultant to the ADA Council on Scientific Af- fairs and expert reviewer to the Centers for Disease Con- trol and Prevention. Cuny is past chairperson of the Or- ganization for Safety, Asepsis and Prevention (OSAP) and is a member of the National Oc- cupational Research Agenda Council with the U.S. De- partment of Health and Hu- man Services. She has pub- lished articles and textbook chapters on safety and infec- tion control and presented numerous continuing educa- tion programs domestically and internationally. About the Author Step 1: Pinch the palm of the left glove and begin to pull glove down to fingers. Step 3: After the glove is pulled off, form it into a ball in the fist of your right hand. Step 6: Grasp gloves with left hand and remove them from your right hand. Figs 1–7: Steps from the Centers for Disease Control and Prevention for disposable-glove removal. Latex, vinyl or nitrile gloves reduce hand con- tamination, 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/Kim- berly Smith, CDC Health care providers should practice hand hygiene at key points to disrupt transmission of microorganisms to patients, including: before patient contact; after contact with blood, body fluids or contaminated surfaces (even if gloves are worn); before invasive procedures; and af- ter removing gloves (gloves are not enough to prevent transmission of pathogens). Photo/Amanda Mills, CDC Step 2: Continue to pull the palm of the left glove down and off your fingers. Step 5: With the left hand, push the glove down the right palm covering the balled glove. Step 4: Insert 2 fingers of the left hand under the rim of your right glove on palm side. Step 7: Discard the gloves into an infectious waste container and wash your hands.

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