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ePaper created 2016-01-08, 09:25:11 | version 1.38.0
I practice management _More than three decades have passed since the emergenceofhumanimmunodeficiencyvirus(HIV)as aglobalpandemic.Morethananyotherinfection,itis possible to single out HIV as the primary stimulus for changinginfectioncontrolpracticesindentistry.Prior to the mid-1980s, it was uncommon for dentists and alliedprofessionalstowearglovesduringroutineden- tal procedures. Many dental clinics did not use heat sterilisation, and disinfection of surfaces was limited to a cursory wipe with an alcohol-soaked gauze sponge.Thiswasdespiteourknowledgethathepatitis Bvirus(HBV)hadbeenspreadinclustersintheoffices and clinics of infected dentists and that dentists were clearlyatoccupationalriskforacquiringHBV. Today, many take safe dental care for granted, but thereisstillreasontoremainvigilantinensuringanin- fection-free environment for providers and patients. HIV has fortunately proven to be easily controlled in a clinical environment using the same precautions as thoseeffectiveforpreventingthetransmissionofHBV and hepatitis C virus.1 These standard precautions in- clude the use of personal protective attire, such as gloves,surgicalmasks,gownsandprotectiveeyewear, incombinationwithsurfacecleaninganddisinfection, instrument sterilisation, hand hygiene, immunisa- tions and other basic infection control precautions. Sporadic reports of transmission of blood-borne dis- eases associated with dental care continue, but are most often linked to breaches in the practice of stan- dardprecautions.2 Emerging and re-emerging infectious diseases present a real challenge to all health care providers. Threeofthemorethan50emergingandre-emerging infectious diseases identified by the Centers for Dis- easeControlandPreventionandtheWorldHealthOr- ganization (WHO) include Ebola virus disease (EVD), pandemicinfluenzaandsevereacuterespiratorysyn- drome.3, 4 These previously rare or unidentified infec- tiousdiseasesburstintotheheadlinesinthepastsev- eralyearswhentheyexhibitednoveloruncharacteris- tictransmissionpatterns. Concern about emerging infectious diseases arises for several reasons. When faced with a partic- ularly deadly infectious disease such as EVD, which can be spread through contact with an ill patient’s body fluids, health care workers are naturally con- cerned about how to protect themselves if an ill pa- tientpresentstothedentalclinic.Withdiseasessuch 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 precau- tions will be adequate. In addition to standard precautions, treating pa- tients with these diseases requires the use of trans- mission-based precautions. These encompass what are referred to as contact, droplet and airborne pre- cautions for diseases with those specific routes of transmission. Transmission-based precautions may include patient isolation, placing a surgical mask on thepatientwhenheorsheisaroundotherpeople,ad- ditional protective attire for care providers, and in somecasestheuseofrespiratorsandnegativeairpres- sure in a treatment room. In most cases, patients who are contagious for infections requiring droplet or air- borne precautions should not be treated in a tradi- tionaldentalclinicsetting. Updating a patient’s medical history at each visit will assist dental health professionals in identifying Infection control in an era of emerging infectious diseases Author_Eve Cuny, USA 26 I laser4_2015 [PICTURE: ©MELODIA PLUS PHOTOS]