Dental Patient Safety in the Military Health System: Joining Medicine in the Journey to High Reliability.

INTRODUCTION: Delivering consistent high quality care in a safe environment is the goal of the modern dental delivery system. Preventable adverse events, however, are still commonplace in dentistry. As has been demonstrated in the medical field, a concerted and persistent effort will be required to objectively understand and begin to eliminate the sources of dental error. In civilian dental practice this effort is hampered by the underreporting of patient safety events in comparison to the medical field. Patient safety reporting in the Military Health System (MHS) is robust and includes dentistry. This provides an important opportunity to analyze these data as the foundation for improvements in dental care and the elimination of preventable harm. The purpose of this article is to review MHS dental patient safety data, identify the primary sources of dental error and describe current initiatives based on the adoption of the High Reliability Organization (HRO) model of care that has been profitably embraced by the medical community. METHODS: Dental patient safety report data from the Defense Health Agency Patient Safety Analysis Center (PSAC) for the period 2013-2016 were analyzed to determine the type, incidence, contributing factors, setting and trends for dental errors occurring within the MHS. Comparison to medical data was also performed. RESULTS: From 2013 to 2016, there was a 32.1% increase in dental patient safety reports in the MHS. For this period, dentistry accounted for the highest number of Sentinel Events (SEs) compared to other clinical specialties and accounted for 32.7% of all SEs for the period. From 2013 to 2016, there was a five-fold increase in reported dental SEs. Wrong-Site Surgeries (WSS) comprised the highest proportion of SEs followed by intraoperative or immediate post-operative/post-procedure or surgery issues (63% and 14%, respectively). Within the WSS category, wrong-site anesthesia and wrong-tooth treated were the two largest sub-categories (40% and 32%, respectively). The data reviewed are not rates and do not take into account the total number of procedures performed by dentistry in comparison to medicine. Root cause analysis identified communication failures and inconsistent adoption of the Universal Protocol as the leading contributing factors for WSSs. CONCLUSION: Safety initiatives in the dental profession remain immature in comparison to the medical field and the use of an HRO framework is just beginning to emerge in dentistry. The MHS benefits from a robust dental patient safety reporting system when compared to civilian practice in the United States. Review of these data demonstrates that a high priority focus should be the elimination of WSS. Initiatives based on high reliability strategies to address this issue will be discussed. A commitment to reporting and analyzing its performance and adopting the principles and behaviors of HROs will accelerate the MHS goal of providing ever increasing safety and quality in the dental care it provides.

Effectiveness of various decontamination methods on CAD/CAM camera mirror sleeves.

AIM: The purpose of this study was to evaluate the effectiveness of several methods of disinfection and sterilization of computer-aided design/computer-aided manufacturing (CAD/CAM) camera mirror sleeves (Omnicam; Dentsply Sirona). MATERIALS AND METHODS: The outer surface of seven groups of mirror sleeves were inoculated by submerging them in suspensions of Staphylococcus aureus and Pseudomonas aeruginosa. Post inoculation, the groups were decontaminated as follows: Group A: no decontamination or sterilization following inoculation (positive control); Group B: surface cleaning with a neutral soap (Dawn Dish Soap, Procter & Gamble) and water only; Group C: surface disinfection with 17% isopropanol (CaviWipes; Metrex). Groups D to F received a different high-level disinfection (HLD) solution in an HLD container (Dentsply Sirona) as follows: Group D: 0.55% ortho-phthalaldehyde (OPA) (Cidex OPA; Johnson & Johnson); Group E: 7.5% hydrogen peroxide (H2O2) (Sporox II; Sultan); Group F: 7.35% H2O2 and 0.23% peracetic acid (PAA) (Compliance; Metrex). Group G received dry-heat sterilization (Rapid Heat Sterilizer; Cox). Also, dry-heat sterilized mirror sleeves that were not exposed to bacteria and not disinfected served as a negative control. The presence of bacteria was tested on the inside and outside of the sleeves by plating samples on TSA II. A percent reduction in CFU/ml from the positive control group was determined per group. RESULTS: All methods of disinfection except Dawn Dish Soap resulted in greater than 99.99% reduction in CFU/ml compared with the positive control group. CONCLUSIONS: Both HLD or dry-heat sterilization resulted in no growth of microorganisms in cultures taken from both the outside and inside surfaces of the bacteria-contaminated mirror sleeves.