Maintenance of sterility in SMS packaging in dental environments: concern with biosafety

Healthcare services must be guided by biosafety practices and microbial control. This control is highly influenced by humidity, which directly impacts the maintenance of sterility of the materials used in the appointments. High concentration of moisture, in the form of aerosol, splashes and spills, is caused during dental care. During the COVID-19 times the contamination by aerosol and droplets worries greatly. Considering that it could cause harm to the sterility of an autoclaved material, especially in dental environments, the objective was to evaluate the behavior of SMS sterilization packages (Spunbonded / Meltblown / Spunbonded) against microbial penetration in an aqueous vehicle. SMS of three brands were challenged, equally divided into two groups: virgin and processed (subjected to a single autoclaving cycle). Each specimen was aseptically deposited on Macconkey agar. Subsequently, 5 µL of Escherichia coliATCC 25922 saline solution [108CFU mL-1] was deposited in center of the SMS specimen and the dish incubated at36°C/ 48h. Reading was performed by the presence or absence of bacterial growth typical of the species under the SMS, observed on the back of Petri dish. The lowest penetration rate observed was 60% for one of the brands in the virgin condition, and 75% for two brands in the processed condition. Statistical analysis showed an association between bacterial penetration and the evaluated group, this association being valid only in the virgin condition. The different SMS behave similarly in terms of resistance to bacterial penetration after being processed. The data show that moisture can assist in bacterial transport through sterilized SMS. Therefore, SMS packages are not able to prevent bacterial penetration, and possibly other microorganisms, when in aqueous vehicles, offering a potential risk of breaking the aseptic chain. Thus, care must be taken in routines for handling and storage sterile packaging.

Analysis of the reliability of patient COVID-19 screening data compared against their actual test data.

OBJECTIVES: This study aimed to evaluate the truthfulness of patients about their pre-appointment COVID-19 screening tests at a dental clinic. METHODS: A total of 613 patients were recruited for the study from the dental clinic at the Faculty of Dentistry, Najran University, Saudi Arabia. The data collection was done in three parts from the patients who visited the hospital to receive dental treatment. The first part included the socio-demographic characteristics of the patients and the COVID-19 swab tests performed within the past 14 days. The second part was the clinical examination, and the third part was a confirmation of the swab test taken by the patient by checking the Hesen website using the patient ID. After data collection, statistical analysis was carried out using SPSS 26.0. Descriptive analysis was done and expressed as mean, standard deviation, frequency, and percentage (%). A cross-tabulation, also described as a contingency table, was used to identify trends and patterns across data and explain the correlation between different variables. RESULTS: It was seen from the status of the swab test within 14 days of the patient's arrival at the hospital for the dental treatment that 18 (2.9%) patients lied about the pre-treatment swab test within 14 days, and 595 (97.1%) were truthful. The observed and expected counts showed across genders and diagnosis a statistically significant difference (p < 0.001), and there was no significant difference seen across different age groups (p = 0.064) of the patients. CONCLUSIONS: Dental healthcare workers are worried and assume a high risk of COVID-19 infection as the patients are not truthful about the pre-treatment COVID-19 swab test. Routine rapid tests on patients and the healthcare staff are a feasible option for lowering overall risks.

The Impact of COVID-19 Related Lockdown on Dental Practice in Central Italy-Outcomes of A Survey.

The COVID-19 pandemic has affected lives and professions worldwide. We aimed to determine the behavior of dentists during the lockdown in Central Italy through an online survey. We demonstrated that the most frequent of urgencies, not otherwise manageable through telemedicine, was dental pulp inflammation. Although a statistically significant increase in the use of some of the personal protective equipment (PPE) from pre to during lockdown was shown, dentists were afraid of being infected during the dental procedures. Moreover, we showed that digital dentistry, telemedicine, use of the rubber dam, distancing of the appointments and further structural changes at the dental office are necessary to reduce the contagion among dentists and patients. No significant differences were shown between gender.

Clínica Dental: norma técnica No. 016-2019 ­DRACES / Dental Clinic: technical standard No. 016-2019 ­DRACES

DRACES [Departamento de Regulación, Acreditación y Control de Establecimientos de Salud] Este documento tiene como objeto: "la Regulación, Autorización y Control de las Clínicas Dentales, en concordancia con el Reglamento para la Regulación, Autorización, Acreditación y Control de Establecimientos de Atención para la Salud, Acuerdo Gubernativo 376-2007." Es de carácter obligatorio, por lo que se aplica tanto al sector público, privado, social o subsector de la seguridad social, en todo el territorio nacional. Contiene además, las definiciones de los conceptos relacionados al tema principal, además de la infraestructura que deberá tener cada clínica, incluidos el equipo y recurso humano y técnico.

Desafíos y alternativas de la Universidad de Ciencias Médicas Cubana / Challenges and Alternatives of the University of Cuban Medical Sciences

RESUMEN Introducción: la Universidad de Ciencias Médicas enfrenta desafíos en su labor, a su vez se beneficia de elementos que contribuyen de manera positiva al cumplimiento de su misión. Objetivos: identificar algunos aspectos que pueden considerarse retos que enfrenta la Universidad de Ciencias Médicas Cubana y proponer algunas alternativas a ellos. Materiales y métodos: se realizó un estudio descriptivo de corte transversal en la Facultad de Ciencias Médicas "Miguel Enríquez", La Habana, marzo 2017. El universo quedó constituido por 20 profesores pertenecientes al departamento de Estomatología General Integral, a los que se les aplicó una encuesta. Resultados: el total de encuestados opinó que el bloqueo económico impuesto por Estados Unidos, así como la presencia de pocos profesores con categoría principal e investigativa, poca orientación vocacional brindada a estudiantes y pobre posibilidad en el uso de las tecnologías de la información y comunicación constituyen retos a los que se enfrenta la universidad. Algunas alternativas propuestas son; mejorar las condiciones de las unidades dentales dedicadas a la docencia (85%), incrementar el uso de la información científica (80%) y acrecentar la labor en la orientación vocacional. Conclusiones: los profesores con categoría de instructor y con menos años de experiencia identificaron más desafíos. Los profesores auxiliares y con más de 10 años de experiencia fueron los que brindaron alternativas para compensar estas dificultades (AU).

Introduction: the University of Medical Sciences faces challenges in its daily work and at the same timethis institution benefits from elements that positively contribute to fulfill its mission. Objective: toidentify some aspects considered as challenges faced by the Cuban University of Medical Sciences and to propose some alternatives as well. Materials and methods: A transversal and a descriptive study was carried out at the "Miguel Enríquez" Faculty of Medical Sciences, Havana City, March 2017. The universe was composed of twenty professors who belong to the Integral General Stomatology Department and who were also surveyed. Results: all of them agree that the U.S. economic blockade, the lack of professors with research and maindegrees, little vocational guidance and the few possibilities to have access to information and communication technologies result in challenges faced by the university. Some proposed alternatives are:to improve the dental unit conditions (85%), to increase the use of scientific information (80%) and to foster the students' vocational guidance (70%). Conclusions: instructing professors with less years of experience identified more challenges. More alternativesso as to compensate these challenges were offered by the auxiliary professors with more than 10 years of experience (AU).

Gestão de manutenção em clínicas e consultórios odontológicos aplicado a compressores de ar: gestão de manutenções preventivas baseada na confiabilidade dos compressores de ar / Maintenance management in clinics and dental practices applied to air compressors: management of preventive maintenance based on the reliability of air compressors

Manutenções preventivas ou manutenções centradas na confiabilidade são ações sistemáticas, normalmente programadas, de controle e monitoramento, objetivando a redução de falhas com o aumento da usabilidade de equipamentos. Defeitos em máquinas, equipamentos ou em processos são fonte de prejuízos para clínicas e consultórios odontológicos, caso estes venham apresentar falhas de funcionamento ou simplesmente deixem de cumprir a função fim. Tais manutenções já são usufruídas pela indústria que visam programar paradas em equipamentos ou processos antes que falhas ocorram. Estas programações levam em consideração: a) o tempo que o equipamento ou processo deverá ficar parado para a execução de ajustes de variáveis de processo; b) substituição de componentes antes do fim da vida útil prevenindo dano pelo uso; c) planejamento da substituição do equipamento como um todo ou parte deste, no próprio local ou fora das instalações, conforme necessário. Falhas ocasionam algum impacto no faturamento em postos de serviço odontológico, pois geram retrabalho para o odontologista que tem parte de seu tempo que deveria ser produtivo, indisponível para o trabalho. Neste trabalho foi realizada uma pesquisa com diversos profissionais da área de odontologia, que utilizam equipamentos sujeitos a falhas. A partir da pesquisa foi identificado que compressores de ar são os equipamentos que mais geram prejuízos. Um equipamento embarcado de gestão, monitoramento e aviso foi projetado e desenvolvido para o .. falta

Preventive maintenance or maintenance focused on reliability are systematic actions, usually scheduled, of control and monitoring, aiming to reduce failures with increasing usability of equipment. Defects in machines, equipment or processes are a source of damage to clinics and dental offices, if they are malfunctioning or simply fail to fulfill the purpose. Such maintenance is already used by the industry, which aims at scheduling stops at equipment or processes before failures occur. These schedules take into consideration: a) the time that the equipment or process should be stopped for the execution of adjustments of process variables; b) replacement of components before the end of the useful life preventing damage by the use; c) planning the replacement of the equipment as a whole or part thereof, on-site or off-site as required. Failures cause some impact on the billing at dental service stations, because they generate rework for the dentist who has part of his time that should be productive, unavailable for work. In this work a research was carried out with several dentistry professionals, who use equipment subject to failure. From the research it was identified that air compressors are the most damaging equipment. An embedded management, monitoring and warning equipment has been designed and developed to assist in the management of preventive maintenance of air compressors in clinics and dental offices falta

Segurança do paciente: embalagens, acondicionamento e tempo de guarda de materiais esterilizados na atenção básica / Seguridad del paciente: envases, acondicionamiento y tiempo de guarda de materiales / Safety: packages, packing and storage period of sterilized materials in primary care

RESUMO As unidades básicas de saúde possuem grande demanda de procedimentos médicos, de enfermagem e odontológicos, dos quais dependem a segurança da assistência e do paciente. O objetivo deste estudo foi compreender como enfermeiros, técnicos, auxiliares em enfermagem e auxiliares de consultório dentário procedem no cuidado com embalagens, acondicionamento e tempo de guarda de materiais esterilizados nas unidades de saúde da atenção básica. Trata-se de uma pesquisa de caráter descritivo e exploratório, com abordagem qualitativa. Os participantes da pesquisa foram enfermeiros, técnicos de enfermagem e auxiliares de consultório dentário, atuantes em unidades básicas de saúde de três cidades do interior do Estado do Rio Grande do Sul. Os dados foram produzidos por meio de entrevistas semiestruturadas realizadas nos meses de outubro e dezembro de 2015 e submetidos a análise de conteúdo. Evidenciou-se que os serviços estudados carecem de estruturação, organização e definição de processos no que tange o tipo de embalagem e o acondicionamento de artigos críticos. Conclui-se que a assistência aos usuários, no que se refere a procedimentos que utilizam materiais esterilizados, está exposta a riscos, fragilizando a segurança do paciente, evidenciando a necessidade de capacitação continua dos profissionais.

RESUMEN Las unidades básicas de salud poseen gran demanda de procedimientos médicos, de enfermería y odontológicos, de los cuales depende la seguridad de la atención y del paciente. El objetivo de este estudio fue comprender cómo enfermeros, técnicos, auxiliares en enfermería y auxiliares de consultorio dentario proceden en el cuidado con envases, acondicionamiento y tiempo de guarda de materiales esterilizados en las unidades de salud de la atención básica. Se trata de una investigación de carácter descriptivo y exploratorio, con abordaje cualitativo. Los participantes de la investigación fueron enfermeros, técnicos de enfermería y auxiliares de consultorio dentario, actuantes en unidades básicas de salud de tres ciudades del interior del Estado de Rio Grande do Sul-Brasil. Los datos fueron producidos por medio de entrevistas semiestructuradas realizadas en los meses de octubre y diciembre de 2015 y sometidos al análisis de contenido. Se evidenció que los servicios estudiados carecen de estructuración, organización y definición de procesos con relación al tipo de envase y el acondicionamiento de artículos críticos. Se concluye que la atención a los usuarios, en lo que se refiere a procedimientos que utilizan materiales esterilizados, está expuesta a riesgos, fragilizando la seguridad del paciente, evidenciando la necesidad de capacitación continua de los profesionales.

ABSTRACT The basic health units have great demand for medical, nursing and dentistry procedures, on which the security of the assistance and the patient depends. The objective of this study was to understand how nurses, nursing technicians, assistants and dental office assistants proceed in managing packaging, guard and distribution of sterile materials in the health units of the primary care. This is a descriptive and exploratory research, with a qualitative approach. The participants of the research were nurses, nursing technicians and assistants of dental office operating in basic health units of three cities in the State of Rio Grande do Sul. The data were generated through semi-structured interviews between October and December 2015 and assessed through content analysis. One evidenced that the studied services lack structure, organization and process definition with regard to the packaging of critical objects. The conclusion is that the assistance to users with respect to procedures using sterile materials are exposed to risks, weakening the patient's safety, emphasizing the need for continuous training of professionals.

Increasing Nonemployer Dental Establishments in New York State: A Component of a Changing Landscape.

The increasing numbers of nonemployer dental establishments in the counties of New York State are a component of the evolving landscape for the delivery of dental services throughout the country. Limited attention has been directed to the more than 4,000 of these facilities in the state and the more than 43,000 in the nation. Increased attention needs to be directed to nonemployer facilities as the profession comes to terms with its economic concerns, legal challenges to delivery modalities and evolving population characteristics.

The preparedness of private dental offices and polyclinics for medical emergencies. A survey in Western Saudi Arabia.

OBJECTIVES: To assess preparedness for medical emergencies in private dental offices in Jeddah, Kingdom of Saudi Arabia (KSA). METHODS: In this cross-sectional study, a survey was distributed to 70 dental offices and polyclinics in Jeddah, Saudi Arabia between October 2013 and January 2014. The questionnaire gathered information on the prevention of medical emergencies, the preparedness of the office personnel, and availability of emergency drugs and equipment. RESULTS: For prevention, 92% (n=65) of the offices reported that they obtain a thorough medical history prior to treatment; however, only 11% (n=8) obtain vital signs for each visit. Using a preparedness percent score (0 to 100), the mean level of preparedness of the office personnel in all surveyed dental offices was 55.2±20. The availability of emergency drugs was 35±35, and equipment was 19±22. CONCLUSION: We found a deficiency in personnel training, availability of drugs, and emergency equipment in the surveyed dental clinics. More stringent rules and regulations for emergency preparedness must be reinforced to avoid disasters in these clinics.

Medical emergencies in the dental surgery. Part 1: Preparation of the office and basic management.

STATEMENT OF THE PROBLEM: Medical emergencies can and do happen in the dental surgery. In the 20- to 30-year practice lifetime of the typical dentist, he/she will encounter between five and seven emergency situations. Being prepared in advance of the emergency increases the likelihood of a successful outcome. PURPOSE OF THE PAPER: To prepare members of the dental office staff to be able to promptly recognize and efficiently manage those medical emergency situations that can occur in the dental office environment. MATERIALS AND METHODS: Preparation of the dental office to promptly recognize and efficiently manage medical emergencies is predicated on successful implementation of the following four steps: basic life support for ALL members of the dental office staff; creation of a dental office emergency team; activation of emergency medial services (EMS) when indicated; and basic emergency drugs and equipment. The basic emergency algorithm (P->C->A->B->D) is designed for implementation in all emergency situations. RESULTS AND CONCLUSIONS: Prompt implementation of the basic emergency management protocol can significantly increase the likelihood of a successful result when medical emergencies occur in the dental office environment.

Dentists United to Extinguish Tobacco (DUET): a study protocol for a cluster randomized, controlled trial for enhancing implementation of clinical practice guidelines for treating tobacco dependence in dental care settings.

BACKGROUND: Although dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions, dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence. METHODS/DESIGN: Guided by a multi-level, conceptual framework that emphasizes changes in provider beliefs and organizational characteristics as drivers of improvement in tobacco treatment delivery, the current protocol will use a cluster, randomized design and multiple data sources (patient exit interviews, provider surveys, site observations, chart audits, and semi-structured provider interviews) to study the process of implementing clinical practice guidelines for treating tobacco dependence in 18 public dental care clinics in New York City. The specific aims of this comparative-effectiveness research trial are to: compare the effectiveness of three promising strategies for implementation of tobacco use treatment guidelines-staff training and current best practices (CBP), CBP + provider performance feedback (PF), and CBP + PF + provider reimbursement for delivery of tobacco cessation treatment (pay-for-performance, or P4P); examine potential theory-driven mechanisms hypothesized to explain the comparative effectiveness of three strategies for implementation; and identify baseline organizational factors that influence the implementation of evidence-based tobacco use treatment practices in dental clinics. The primary outcome is change in providers' tobacco treatment practices and the secondary outcomes are cost per quit, use of tobacco cessation treatments, quit attempts, and smoking abstinence. DISCUSSION: We hypothesize that the value of these promising implementation strategies is additive and that incorporating all three strategies (CBP, PF, and P4P) will be superior to CBP alone and CBP + PF in improving delivery of cessation assistance to smokers. The findings will improve knowledge pertinent to the implementation, dissemination, and sustained utilization of evidence-based tobacco use treatment in dental practices. TRIAL REGISTRATION: NCT01615237.

Screening for coronary heart disease and diabetes risk in a dental setting.

OBJECTIVES: Diabetes mellitus (DM) and heart disease, among the most prevalent chronic conditions worldwide, are increasing among younger adults who are unaware of their risk status. Previous studies in the United States have shown the efficacy of screening for risk of heart disease and diabetes in a dental setting. A screening strategy was applied to facilitate early identification of individuals at increased disease risk in a single Indian dental institute. METHODS: 158 patients >30 years old, with no reported heart disease or diabetes, and unaware of any increased disease risk were enrolled. Blood pressure, total cholesterol, high-density lipoprotein levels and body mass index were collected. The Framingham Risk Score (FRS) was calculated as an indication of global risk of developing a coronary heart disease (CHD) event within 10 years; hemoglobin A1c level was used to determine DM risk. RESULTS: Eleven percent had increased risk of heart disease (FRS >10%) and 32% had abnormal A1c levels (>5.7%). At least one risk factor was present in 61 and 39% presented with two or more risk factors. Hypertension and obesity were the most common risk factors. CONCLUSIONS: The use of a dental setting in a developing country could serve as a resource for early identification of patients at increased risk of developing CHD and DM, yet unaware of their increased risk. The dental setting can also serve as an entry point into the medical care system by identifying asymptomatic patients at increased risk of disease and referring these individuals to a primary care provider.