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Cross Infection Control In Dentistry. Cross infection involves the spreading of disease from one source to another and hence increasing the number of people suffering that specific disease. In dentistry, infection control is of particular importance as bacterial infections of the oral cavity, like infection anywhere else in the body, can be potentially life-threatening. The mouth carries a large number of potentially infectious micro-organisms; saliva and blood are known vectors in infection. It must be emphasised that cross infection related to dental procedures is not specifically limited to the oral cavity. Fortunately, antibiotics and effective dental care delivery has drastically reduced the frequency of oro facial infections.
Cross infection in dentistry is such a wide subject and includes: the different ways in which infections can be spread in the dental surgery the different diseases of varying severity that are most commonly spread the ways in which the chances of cross infection can be minimised action on complaints the legal and social implications on the dental practise should cross infection occur due to neglect Health and Safety Laws British Dental Association and General Dental Council guidelines Case studies where cross infection between dentist and patient (and vice versa) has occurred. However, in this essay, I shall only be discussing the practical methods of reducing risk of cross infection. It is the responsibility of every dentist to treat patients with the required skill and to be cautious enough in order to minimise harm caused to the patient which could lead to an allegation of negligence. It must also be remembered that diseases can pass from patient to dentist, which could prove devastating to the dentists health and career in an age of diseases such as Hepatitis B and AIDS. A dentist always has a duty of care to prevent the transference of any infection associated with a number of micro-organisms whilst performing dental treatment. Other micro-organisms that may be transmitted if hygiene and cross infection control procedures are not strictly followed include Tuberculosis and Herpes Simplex.
The current standards by which cross infection control is measured are those recommended by the British Dental Association and the Department of Health (in 1991). The same precautions should be implemented when treating every patient and every practitioner has a general obligation to treat patients known to be the carriers of infectious diseases. Confidentiality must be preserved and a careful medical history taking is vital. Ideally, the same precautions should be adopted for every patient during treatment (universal precautions).
The meaning of taking universal precautions is that the dentist should treat all patients as though they are infected with an incurable disease which is easily spread. It is imperative that all dental staff are vaccinated against Hepatitis B, Diphtheria, Pertussis, Poliomyelitis, Rubella, Tetanus and Tuberculosis and must undergo thorough training in cross infection control including how to use an autoclave. All new staff must be appropriately trained in infection control procedures prior to working in the surgery. Dentistry should be practised in a sterile environment which constitutes the dental surgery. Surfaces should be clean and disinfected and dental laboratory items should be disinfected also. Great care should be taken to avoid the contamination of these surgery surfaces.
Orientation of equipment in a surgery is an important but overlooked aspect of infection control ideally, it should be simple and uncluttered with, if possible, two distinct areas: one for the dental surgeon and one for the dental nurse. All instruments must first be cleaned, then sterilised using an autoclave (with a minimum temperature of 115 C for a duration of 30 minutes: the higher the temperature of the autoclave, the shorter the corresponding time period) before reuse. Also, special precautions are to be taken if certain items of equipment are to be reused e. g. hand-pieces must be sterilised by autoclaving after each patient. The storage of instruments after sterilisation is equally as important as the sterilisation itself.
They should be stored in a clean, covered and sterile environment and should not be handle without wearing protective clothing e. g. gloves (which should be well fitted and not powdered). In certain circumstances disposable items and instruments must be used e. g. impression trays and beakers.
However, disposable local anaesthetic needles must always be used and never reused on another patient As well as gloves, sterile masks and eye protection should be worn these reduce the risk of spreading of air-borne diseases and the risk of contaminating or being contaminated through touch or via the eyes (it is possible for disease to spread by dissolution of micro-organisms into the watery surface of the eye). Also thorough hand-washing with an anti-bacterial soap is advisable as it reduces the risk of cross-infection further. Lacerated, abraded and cracked skin can offer a portal to micro-organisms. Jewellery and watches should not be worn during clinical procedures.
Sharps injuries are a major factor by which cross-infection may occur, especially of the more serious diseases. Therefore, the utmost of care must be taken to avoid injuries which actually pierce the skin. Also, careful disposal of clinical waste is fundamental as these usually include items that have come into contact with bodily fluid such as blood (especially applicable to syringes and swabs). Rubber dam isolation offers substantial advantages and hence should be used whenever possible and practical. It increases the quality of the operative environment and virtually eliminates saliva / blood splatter and aerosols when working without a rubber dam, the use of high velocity aspiration is essential.
Each practice must have an infection control policy which describes the practice policy for all aspects of infection control and provides a useful guide to training necessary for each member of staff to be competent in its implementation. Carrying out infection control procedures requires co-operation from the dental team as a whole, whether it be in a practice or in a hospital environment. The responsibility of care that dentists have is, although not as widely recognised, extremely high and any slight lack of concentration could result in neglect and ultimately lead to serious illness or even death of the patient or practitioner. Therefore, infection control is a very important area of dentistry and should not be ignored as it can have serious implications on the reputation of dentistry as a profession.
References Infection Control in Dentistry (Advice Sheet 12) British Dental Association Advisory Service Occupational Hazards to Dental Staff C. Scully, R. A. Canon and M. Griffiths Dental Student Journal Dental Protection Society
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