Knowledge, attitude and compliance of infection control guidelines among dental faculty members and students in KSU.

BACKGROUND: Infection is one of the most crucial problems in health care services worldwide. It is considered one of the most important causes of morbidity and mortality associated with clinical, diagnostic and therapeutic procedures. Therefore, the purpose of this study was to investigate knowledge, attitude, and compliance with recommended infection control guidelines among dental faculty members and students at King Saud University, Riyadh, Kingdom of Saudi Arabia. METHODS: A cross-sectional study was conducted to obtain information regarding knowledge, attitude, and compliance with recommended infection control guidelines. The sample (n = 317) comprised of dental faculty members and students (3rd, 4th and 5th year) in both male and female campuses of College of Dentistry (KSU). This questionnaire contained three parts (knowledge, attitude, and compliance) and was distributed to the participants. After validation of the survey, data were collected, entered and analyzed by SPSS software. RESULTS: A total of 317 dental faculty members and students participated in this study. Out of the total study subjects, 141 (44.5%) were female and 176 (55.5%) were male. A comparison between dental faculty members and students was made based on their knowledge, attitude, and compliance, which resulted in almost equal percentages of knowledge (49.6, 49.0% respectively). In addition, it revealed that faculty members' attitude toward infection control in the dental clinic was more positive compared to their compliance with the infection control guidelines (70.6, 65.2% respectively) while with the students it was vice versa (67.2, 69.6% respectively). There is no statistically significant difference in the knowledge and attitude of dental faculty members and students regarding infection control guidelines (P > 0.05). CONCLUSION: Our study showed that dental undergraduate student and faculty members at KSU demonstrated a good adherence to infection control guidelines. On the other hand, there was a lack in the knowledge of the basics of infection control standards.

California Infection Control Regulations for Dental Professionals.

Infection control regulations that affect dental professionals come from several regulatory agencies and are increasingly complex. Staying up to date on changes and the overlapping requirements can challenge a busy dental practice. This article reviews the current regulations in California and suggests methods for ensuring every dental office is in compliance.

Keeping Patients and Staff Healthy and Safe.

New CDC document makes it easier to implement and follow infection control practices.

Effectiveness of a quality management program in dental care practices.

BACKGROUND: Structured quality management is an important aspect for improving patient dental care outcomes, but reliable evidence to validate effects is lacking. We aimed to examine the effectiveness of a quality management program in primary dental care settings in Germany. METHODS: This was an exploratory study with a before-after-design. 45 dental care practices that had completed the European Practice Assessment (EPA) accreditation scheme twice (intervention group) were selected for the study. The mean interval between the before and after assessment was 36 months. The comparison group comprised of 56 dental practices that had undergone their first assessment simultaneously with follow-up assessment in the intervention group. Aggregated scores for five EPA domains: 'infrastructure', 'information', 'finance', 'quality and safety' and 'people' were calculated. RESULTS: In the intervention group, small non-significant improvements were found in the EPA domains. At follow-up, the intervention group had higher scores on EPA domains as compared with the comparison group (range of differences was 4.2 to 10.8 across domains). These differences were all significant in regression analyses, which controlled for relevant dental practice characteristics. CONCLUSIONS: Dental care practices that implemented a quality management program had better organizational quality in contrast to a comparison group. This may reflect both improvements in the intervention group and a selection effect of dental practices volunteering for the first round of EPA practice assessment.

An evaluation of washer-disinfectors (WD) and dishwashers (DW) effectiveness in terms of processing dental instruments.

PURPOSE: The aim of this study is to consider the effectiveness of a small sample of dishwashers (DW) compared to washer-disinfectors (WD) for cleaning dental instruments prior to sterilisation. Processing instruments in the context of this article means cleaning and disinfecting the instruments. MATERIALS AND METHODS: A number of tests were carried out on three domestic dishwashers and two instrument washer-disinfectors. These tests included: visual test; soil test; residual protein test; and, the TVC of the final rinse water. RESULTS: The washer-disinfectors (one bench-top and one under-bench) passed all the tests. The results indicate that the instruments cleaned in the dishwashers were visibly clean and dishwashers passed the TOSI soil test. There was residual protein on some of the instruments cleaned in the all of the dishwashers and the final rinse water did not comply with standard ISO 15883. CONCLUSION: Dishwashers are not effective for cleaning instruments and they do not disinfect the instruments either. They cannot be validated and there is no record available outlining the parameters of the process. Dishwashers are not designed by manufactures for processing dental instruments prior to sterilisation. The authors do not recommend the use of dishwashers in dental clinical practice.

What are the costs and benefits of patient notification exercises following poor infection control practices in dentistry?

BACKGROUND: Allegations of serious failures in infection control practice were made against a dentist practicing in the South West of England. The dentist (who tested negative for Blood Borne Viruses (BBVs)) was immediately suspended. METHODS: Because inadequate infection control presents a potential risk of transmitting BBVs between patients, a notification exercise was undertaken. Of 7625 patients contacted, 2780 (37%) were tested. RESULTS: Nine cases of Hepatitis B (HBV) and four cases of Hepatitis C (HCV) were identified, of which seven were previously diagnosed. None of these were children. All of the six newly diagnosed cases had recognized risk factors for BBVs. The costs of the notification exercise were estimated at £311,500 of which £165,000 was staff costs, (£51,916 per newly diagnosed case). CONCLUSION: This study did not demonstrate any patient-to-patient transmission of blood-borne viruses but the response rate was relatively low. There are significant costs associated with undertaking notification exercises. These findings should inform future recommendations and practice in this area.

Evaluation of in-office dental unit waterline testing.

In-office dental unit waterline (DUWL) testing systems are commercially available for monitoring DUWL bacteria. The current study compared Aquasafe, Petrifilm, and Heterotrophic Plate Count Sampler (HPCS) with R2A plating methodology, considered the gold standard for enumerating heterotrophic bacteria in potable water. Samples were collected from 20 dental units. Heterotrophic bacterial counts of ≤500 CFUs/mL were used as the cut-off for assessing in-office testing compared to R2A laboratory plating. Validity was assessed using sensitivity and specificity, along with positive and negative predictive values. Results were also compared using concordance and kappa statistics. All in-office tests demonstrated 100% specificity and positive predictive values, while sensitivity and negative predictive values were low (Petrifilm, 57%/50%; HPCS, 50%/46%; Aquasafe, 21%/35%). Concordance and kappa values for agreement with R2A plating were as follows: Petrifilm 70% (κ = 0.44), HPCS 65% (κ = 0.38), and Aquasafe 45% (κ = 0.14). In-office DUWL testing with Aquasafe, Petrifilm, and HPCS agreed poorly with R2A plating methodology and is not valid or reliable as a means of accurately monitoring bacterial density in DUWL. These in-office test systems should not be used for assessing compliance with the ADA and CDC standard for acceptable heterotrophic bacterial counts in DUWLs (≤500 CFUs/mL).

Office accreditation experiences with 3 accrediting agencies and suggestions for changes in private oral and maxillofacial surgery facility evaluations.

Historically, oral and maxillofacial surgeons have had considerable autonomy in operating their offices. Oral and maxillofacial surgeons have had a singular history of safety, training, and success in outpatient anesthesia in their offices. However, preventable patient morbidity and mortality in private office-based surgical facilities of a variety of professions have brought increased scrutiny to the office environment. The present report describes the experiences of 3 oral and maxillofacial surgeons with 3 accrediting agencies in obtaining office accreditation and offers recommendations to be considered for the future of our specialty in terms of private office certification.

Development of a validated process for manual preparation of dental transmission instruments.

The goal of the study was to develop a validated manual preparation process that conforms to the requirements of validation guidelines. Twelve dental transmission devices from various manufacturers (turbines, handpieces, and contra-angle handpieces) were artificially contaminated with bovine hemoglobin for the test. Ten microliters (corresponding to 800 µg) of bovine hemoglobin solution (concentration 80 mg/ml) was pipetted into the spray water and spray air channels. The manual preparation was conducted by blowing air through the spray channels of the transmission instruments through an attachment to a treatment unit (model 1060T, KaVo, Biberach, Germany) for 5 s. The spray channels were cleaned with WL-Clean (Alpro, Georgen, Germany) as directed by the manufacturer. The spray channels were disinfected with WL-Cid (Alpro) and the spray channels were blow-dried with WL-Dry (Alpro) at the end of the exposure time as directed by the manufacturer. To determine the protein content (protein residue analysis) in the channels of the transmission instruments, 2 ml of an alkaline SDS solution (1%; pH 11) was flushed through the channels. For the quantitative protein residue analysis, the Biuret method was used as described in DIN EN 15883-1:2006. After the application of this method, all results of the protein residue analysis were within the acceptance criteria of the validation guideline. The newly developed manual preparation process is therefore confirmed as suitable from a hygienic viewpoint for preparation of transmission instruments in the dental practice.

COVID-19 Outbreak and Dentistry: Guidelines and Recommendations for the Provision of Dental Healthcare Services.

After lockdown beginning from the third week of March 2020, face-to-face dentistry is gradually resuming with dental healthcare personnel feeling encouraged to safely provide treatment to the patients amid stringent infection control strategies. Having alerted to the associated infection threat, dentists will be better responding to the challenges of infection control in their clinics. Infection control strategies will follow the rapidly evolving guidelines of the local and international regulatory bodies that are relevant to this pandemic. Despite this, a concern exists as both the dental team members and the patients do not want to be the vectors for this deadly infection; and hence, the need for guidance. This article aims to inform dental healthcare professionals of the guidelines and recommendations to follow when receiving and treating patients in reopened practices. It appears that the novel coronavirus disease 2019 (COVID-19) outbreak has significantly and adversely impacted dentistry. The impacts seem to have long-term effect on the pattern of dental care; and a need for significant changes in the way dentists will provide dental care from now onwards. A wider use of tele-dentistry consultation platforms will obviously reduce the need for patients 2019; visits to dentists and dental hospitals. Key Words: COVID-19, Dentistry, Guidelines, Standards, Healthcare services.

Dentistry and the ethics of infection.

Currently, any dentist in the UK who is HIV-seropositive must stop treating patients. This is despite the fact that hepatitis B-infected dentists with a low viral load can continue to practise, and the fact that HIV is 100 times less infectious than hepatitis B. Dentists are obliged to treat HIV-positive patients, but are obliged not to treat any patients if they themselves are HIV-positive. Furthermore, prospective dental students are now screened for hepatitis B and C and HIV, and are not allowed to enrol on Bachelor of Dental Surgery degrees if they are infectious carriers of these diseases. This paper will argue that: (i) the current restriction on HIV-positive dentists is unethical, and unfair; (ii) dentists are more likely to contract HIV from patients than vice versa, and this is not reflected by the current system; (iii) the screening of dental students for HIV is also unethical; (iv) the fact that dentists can continue to practise despite hepatitis B infection, but infected prospective students are denied matriculation, is unethical; and (v) that the current Department of Health protocols, as well as being intrinsically unfair, have further unethical effects, such as the waste of valuable resources on 'lookback' exercises and the even more damaging loss of present and future dentists. Regulation in this area seems to have been driven by institutional fear of public fear of infection, rather than any scientific evidence or ethical reasoning.

Joint Commission of Accreditation of Healthcare Organization accreditation for the office-based oral and maxillofacial surgeon.

Office-based surgery has become a vital component of the practice of oral and maxillofacial surgeons and periodontists. It has enabled these specialties to provide needed service to patients in an outpatient setting, including the option of intravenous sedation. It is the stance of this article to promote professional oversight and quality assurance through accreditation by the Joint Commission to maintain a standard in the delivery of office-based surgical services, thus upholding the integrity of the profession in the clinical setting.

Bacterial contamination of water in dental unit reservoirs.

The aim of this study was bacteriological assessment of water in dental unit reservoirs--concentration and composition of the aerobe and facultative anaerobe bacterial microflora. Reservoir water samples were taken from 25 units. Bacterial flora were determined with the plate culture method. Bacteria were identified with biochemical microtests: API 20E, API 20NE (bioMérieux, France) and GP2 MicroPlateTM (BIOLOG, USA). The concentration of total bacteria isolated from one site was 201,039 cfu/ml, on average; the minimum was 22,300 cfu/ml, and the maximum - 583,000 cfu/ml. The following bacteria were identified: Gram-negative bacteria--Brevundimonas vesicularis, Moraxella lacunata, Moraxella spp., Ralstonia pickettii, Sphingomonas paucimobilis, Stenotrophomonas maltophilia; Gram-positive cocci--Micrococcus luteus, Micrococcus lylae, Staphylococcus cohnii, Staphylococcus hominis ss novobiosepticus, Staphylococcus spp., Streptococcus spp.; actinomycetes--Streptomyces albus. The prevailing bacteria were: Ralstonia pickettii (96.46%), found in all the units. Sphingomonas paucimobilis (1.32%) and Brevundimonas vesicularis (1.07%) were the next most frequently occurring bacteria. Bacteria concentration in dental unit reservoirs reached excessive values, and the bacterial flora were composed of the bacteria characteristic for water supply systems, opportunistic pathogens, and bacteria of the oral cavity flora. Continuous microbiological monitoring of the DUWL water, including application of a disinfecting procedure, is necessary.

Clinical quality assurance surveillance and targeted interventions: managing unfavorable trends in a dental school clinic.

Dental schools establish quality assurance (QA) programs that are intended to improve patient care, comply with requirements of liability carriers and regulatory agencies, and maintain accreditation. Data collection, trend analysis, and interventions are typically used in QA programs to monitor and improve compliance. The purpose of this article is to discuss unfavorable trends and examine the effect of targeted interventions in three clinical operations: infection control, removable prosthodontics, and case reviews of students' patient care in progress (interim case reviews) at a U.S. dental school. Infection control compliance was evaluated and interventions were implemented beginning in 2002 to correct unfavorable trends in two protocols: placement of students' mobile supply cart and the use of overgloves. A predelivery esthetic consent was introduced in spring 2004 to decrease esthetic failures in removable prosthodontics. For interim case reviews, two areas received interventions going back to 2003: reevaluation following initial periodontal therapy and orthodontic screening. The data presented are not meant to show conclusive success of particular interventions, but to display broad trends and suggest methods to manage quality assurance parameters. These trends suggest we had better success with the interventions that were simple, valuable, measurable, and repeatable than with interventions that less fit these criteria.