Journal of Dental Research, Essay Example

Abstract

This assignment examines cross infection control between dental clinics and dental technology laboratories. By referencing the Dental Council Codes of Practice a discussion regarding potential sources of infection; routes of transmission and measures adopted by the School of Dentistry to manage cross infection between clinics and dental technology laboratories a research was conducted and relevant findings exposed. It was discovered that potential sources of infection are saliva and blood, which can be transmitted when infected instruments become contaminated. Routes refer to how they have been transmitted? Primarily, viruses and bacteria are defined as the most known routes of clinical dental to laboratory cross infection. They include HVB, HVC, HVD (viruses) and staphylococcus bacteria group. HIV is also a concern, but the likelihood of it transference during dental procedures is not as high as the hepatitis viruses. It was identified that health care providers become contaminated and transfer organisms from one environment to the next through their body fluids. Hence, mandatory testing for viruses of dental officials is a provision within the code of ethics. If they are infected this they ought to notify their dentistry department and take the necessary precautions. Measures that can be taken to reduce the incidences are adapting proper aseptic techniques through sterilization of instruments and use of disposable devices when attending to highly infectious items. Dental technicians ought to engage in regular handing washing as well as along with developing appropriate gloving strategies. The School of Dentistry urges nurse and technicians to follow these guidelines in limiting cross infection from clinical practice into the laboratory.

Dental clinics are establishments where clients visit for dental services. These services include extractions, teeth cleaning, management of plaque formations and gum diseases. Professionals who function within a dental clinic environment are dentists; dental nurses and dental aides. A dental technology laboratory is a manufacturing unit within the dental profession. Technicians produce dentures, crowns, bridges and many other types of orthodontic devices. The certification process of these laboratories falls under state regulations and may not be mandatory. While these two entities may not function in the same geographic space cross infection from laboratory to clinical setting is highly likely. There are marked incidence increases when they operate in close proximity to each other or in the same building (National Board of Certification, 2013).

Shalhoub and al-Bagieh (1990) from the Department of Biomedical Dental Sciences, College of Dentistry, King Saud University, Saudi Arabia conducted studies, which revealed that cross-infection in dentistry is a professional hazard. This insidious occurrence happens when pathogens are transferred through instruments used within the clinical setting. If they are inappropriately sterilized they can be transferred to the dental technology laboratory environment. Dental personnel can also be a strong source of cross infection transference as well. Subsequently, pathogens from patient attending clinicians can be transferred though direct contact into the laboratory environment. Clinicians’ interactions with saliva/blood and instruments can be considered viable vehicles through, which cross infection occurs in the dental discipline (Shalhoub & al-Bagieh, 1990).

Part I of this study assessed dental instruments sterilization procedures at the College of Dentistry, King Saud University. Random samples of instruments used in the department were taken to assess bacterial growth after sterilization. They found no bacterial growth after autoclaving instruments. In summarizing their findings it was revealed that proper sterilization of dental equipment is a basic prophylactic measure, which could be instituted to address this crisis of cross infection in dental clinical settings moving into the dental technology laboratory (Shalhoub & al-Bagieh, 1990).

In elaborating on the insidious occurrence of pathogens being transferred when instruments are used from the clinical setting to dental technology laboratory environments, even if attempts at sterilization were made; it is highly suggestive that, perhaps, the code of practice pertaining to infection control in dental surgical intervention may not be fully enforced in the clinical environment. The code has identified major sources of infection being viral including hepatitis B (HBV); hepatitis C (HCV) and Human immunodeficiency virus (HIV). Hepatitis B is the most common viral infection in New Zealand. It has reached endemic proportions being a very difficult infection to manage, since many carriers are asymptomatic. The mostly affected ethnic groups are Maori, Chinese; people of South East Asian descent and Polynesians. It is can be found in saliva (Code of Dental Practice, 2013).

Hepatitis C is completely blood borne. Techniques developed to minimize cross infection of HVB are effective when applied to HVC. The HIV virus has become an international dental clinical cross infection concern. Due to its nature of transmission progression and subsequences precautionary measures are more stringent. However, while it is not the most likely virus transmitted within dental pathology, necessary preventative measures are still active against the smallest potential of transference (Code of Dental Practice, 2013).

While these are the major life threatening categories bacterial infections are commonly transferred, especially, when plaque formation infections arrive within the dental clinical settings. These include streptococci, lactobacilli, staphylococci, corynebacteria, lactobacilli as well as a number of bacteroides. In many cases these are resistant strains of the organism making control under normal conditions very difficult (Shaw & Wyne, 2010).

Bacterial infections manifest as various forms of gum disease. Periodontitis is among the most dangerous because these bacteria can enter the blood stream and create systemic damage. They are very powerful. Gingivitis is another dangerous bacterial infection. While plaque formations is not an infection but is occurs in response to bacterial invasion in the oral cavity. Then air borne bacteria in the dental environment itself include tuberculin bacillus and that family for sore forming organisms. Therefore, if proper sterilization methods are not used by dental service agencies cross infection becomes inevitable form clinical setting to the technology laboratory (Shaw & Wyne, 2010).

Importantly, it was discovered that dental technicians whose bodies are inhabited by these organisms become potent sources of cross infection. Studies reveal that by using adequate infection control measures dental laboratory technicians are protected from bacteria and virus transference into their environment from clinical dentistry alternative settings such as dental laboratories. When contaminated items inclusive of casts impressions, prosthetic appliances such orthodontics are mingled with bacteria and viruses cross-contamination occurs even among technicians functioning within laboratory (Fluent & Molinari, 2013). .

If a dental clinician or laboratory technician does not change cloves a cross infection is highly likely when using the device during interventions. The Dental Council of New Zealand code of practice identified direct contact of blood or saliva with mucous membranes and/or open wounds; or penetrating injury from surgical instruments to be the major ways in which this infection passed from clinic to laboratory and laboratory to clinical setting. Capping needles; an/ cleaning and sterilizing instruments or equipment is another common way of promoting cross infection from dental clinic to dental lab oratory and vise-versa (The Dental Council of New Zealand, 2007).

Subsequently, the School of dentistry has adapted measures consistent with the codes of practice reiterating principles of the ‘Health Practitioners Competence Assurance Act 2003. It embodies a framework to protect the health and safety of members of the public by providing mechanisms of ensuring that health practitioners are competent and fit to practice their profession’ (The Dental Council of New Zealand, 2007, section 2.5). Competence includes being fully aware of how cross infection does not only occur from clinician to technician, but also the wider environment of the laboratory and clinical interactions. Therefore, prevention should be inclusive of these pertinent elements emerging from transmission of harmful organisms (Fluent & Molinari, 2013).

Primarily, the rationale behind adapting prophylactic measures is to protect patients and dental health care technicians against the risks of cross-infection in the dental surgery environment. Major risks have been cited as continuous exposure to blood and/or saliva contaminated by the wide range of microorganisms inclusive of the transmissible major viral infections such as Hepatitis B, C and HIV. Hence, dentists have a responsibility to offer employees a safe working environment, which must be maintained according to the code of practice standards. They are expected to make sure that their employees and persons coming in contact with the work place are not unduly exposed to hazards (Shaw & Wyne, 2010).

Al-Dwairi (2007) with reference and in support of the dental code of ethics advanced that cross infections between dental clinics and laboratories have spurred concerns in the science. He was referring to studies conducted in Jordon. Further the research cited that code compliance was the greatest deficiency since approximately 75% dental technicians in that county were not following the code of ethnic as they ought. Ultimately, procedures for addressing emergencies were not integrated into the control mechanism protocol. These guidelines pertain mainly to dentists who own a practice involving dental technicians and auxiliary (Al-Dwairi (2007)

In controlling transmission of viruses the code specifies legal obligations of dentists conducting practice in New Zealand and across other territories where similar codes existed, the researcher pointed out. Oral Health Care Practitioners must be prescreened for viral infections by submitting to testing procedures if suspected of being exposed to an infectious environment. Subsequently, they must submit to being vaccinated if it is not contraindicated in their medical profile (Al-Dwairi (2007).

During the execution of dental procedures the code provisions enforce regulations based on the assumption that all body fluids, identified as blood and saliva, are potentially infectious. Therefore, addressing any exposure requires adherence to protocol. These include ‘staff training;

local wound care; take blood at baseline from the source (if known) and from the injured party if

parties consent; seek appropriate expert advice on the need for post exposure immunoglobulin, vaccination, antiviral drugs or other preventive measures; fully document the event; seek counseling for the exposed individual long term follow up and file ACC claim if’ (The Dental Council of New Zealand, 2007, section 7.3) necessary.

Precisely, precautionary measures relate to medical history taking for dental care staff and patients. In relation to patients thorough medical history is required before any procedure is performed. It enables diagnosing medical disorders which the patient may wish to hide. Patients may be asymptomatic but are carriers of deadly viruses. In terms of health care providers

vaccination is recommended if it has been have been discovered that they are exposed to transmittable viruses or bacteria (Fluent & Molinari, 2013 ).

With continued referenced to the New Zealand code of ethics as a model for Jordon Al-Omari & Al-Dwairi (2005) cited strengths by indicated that the code allows the School of Dentistry to enforce rules that all clinical dental personnel be vaccinated against HBV, which is nonexistent in Jordon. This is the most effective strategy in offering personal protection against acquiring HBV when conducting procedures. It does not mean that this can be used to eliminate the need for other control measures. The idea is that all these techniques ought to be combined is resolving chronic virus carrier states. Many of these viruses have not been rendered a vaccination solution (Al-Omari & Al-Dwairi, 2005).

Practicing personal hygiene for dentists and dental technicians is another strategy employed in cross infection control. This reflects the importance of carrying short clean nails; removal of wrist watches, rings and arm jewelry while conducting procedures; hand washing with surgical soap before and after contact with patients and covering any open wounds when executing a procedures in the work environment. This has been proven to be simple, but very effective cross infection control mechanism (The Dental Council of New Zealand, 2007)

Again there are definite steps to be completed for hand washing to serve as a compete prophylactic invention. After washing hands must be dried using a single use disposable paper towel or drying device. It reduces incidences of resident and transient micro-organisms that are potentially dangerous in transmitting disease. Hand washing, importantly, ought to be developed as a routine procedure before and after contact with patients directly and indirectly because organism are air borne and can infiltrate the environment without physical contact (Shaw & Wyne, 2010).

Combining hand washing as a transmission control measure is wearing clean protective clothing or devices. Cuts/open skin lesions must not be left exposed when in the work environment. A waterproof dressing is advocated to protect from harmful bacteria and viruses invading skin surface. Technicians with leaking puss filled lesions or running dermatitis contained in the lower arms/hands or face ought not to be removed from active duty until the condition has been treated and cured. Besides, clean unsoiled uniforms, gloves; chin length masks and shields and eye wear ought to be worn during execution of procedure. One caution is that these clothing must not be worn outside of the clinical setting where procedures are not being performed (The Dental Council of New Zealand, 2007, section 3.1-3.5).

Other significant control measures are associated with control of transmission within the dental technology environment itself. These pertain to generation of aerosols and splatter, which increase bacterial load. The prophylactic intervention advocated is using high-volume evacuators that exhaust externally when executing aerosolcreating procedures like ultrasonic and airturbine procedures. Rubber dam was also recommended in reducing contamination risk by infective aerosols (Al-Omari & Al-Dwairi, 2005).

In culminating this discussion it must be understood that controlling the transmission of dental infections from clinical settings to the dental technology laboratory is crucial towards effective dental care in the twenty-first century. Research has shown where methods of sterilization and dental care providers are leading causes in the transmission of bacteria and viruses crises occurring between clinical practice and laboratory interventions (Fluent & Molinari, 2013).

Therefore, it is imperative that the School of Dentistry practice these strategies to control cross infection from dental clinics to dental laboratories. So far effective prophylactic measures have been instituted by adapting a comprehensive code of ethics to guide future interventions in the discipline and implementation is evidenced in the school of dentistry. As a student I am obligated to practice them in the daily execution of my duties. These implementations are continuously being evaluated to test their efficacy to twenty first century health care standards within my school environment.

References

Al-Dwairi , Z. (2007). Infection control procedures in commercial dental laboratories in Jordan. J Dent Educ, 71(9), 1223-7.

Al-Omari, M., & Al-Dwairi, Z (2005). Compliance with Infection Control Programs in Private Dental clinics in Jordon. Journal of Dental Education. 69(6), 693-698

Shalhoub, Y., & al-Bagieh, H. (1991). Cross-infection in the dental profession. Dental Instruments sterilization: assessment 1. Odontostomatol Trop. 14(2), 13-6.

Fluent, M & Molinari, J. (2013). Dental Laboratory Infection Control. Retrieved on April, 4^th, 2013 from http://www.cdeworld.com/courses/4530

National Board for Certification (2013). Certified Dental Laboratory (CDL), Retrieved on April 4^th, 2013 from http://www.nbccert.org/CDL.cfm

Shaw, A., & Wyne, A. (2010). Cross infection control in Dentistry: A Review. Pakistan Oral and Dental Journal, 30(1), 168-180

The Dental Council of New Zealand (2007.). Code of Practice: Transmissible Major Viral

Infections. Retrieved on March 22^nd, 2013 from http://www.dentalcouncil.org.nz/Documents/Codes/COP_TransmissibleMajorViralInfections.pdf

The Dental Council of New Zealand (2007). Control of Cross infection in Dental Practice.

Retrieved on March 22^nd, 2013 from http://www.dentalcouncil.org.nz/Documents/Codes/COP_Infection_Control.pdf

Mohammad Ahmad Al-Omari, B.D.S., M.S.C., Ph.D., F.F.D.R.D.C.I. and Ziad Nawaf Al-Dwairi, B.D.S., Ph.D.