Metronidazole resistance: a hidden epidemic?

This is a personal reflection from working as a clinical microbiologist and becoming increasingly concerned over gaps in our knowledge of metronidazole resistance and its impact on clinical outcome.

Methods of Sterilization and Monitoring of Sterilization AcrossSelected Dental Practices in Karachi, Pakistan.

OBJECTIVE: To assess methods of sterilization in dental practices in Karachi and secondly to investigate methods of monitoring sterilization in dental practices in Karachi, Pakistan. STUDY DESIGN: Cross-sectional, descriptive study. PLACE AND DURATION OF STUDY: Dental colleges, hospitals and private clinics of Karachi, Pakistan, from January to March 2013. METHODOLOGY: A total of 251 questionnaires were obtained. Descriptive statistics were computed and differences between groups were assessed through chi-square test using Statistical Package for the Social Sciences (SPSS) version 16.0. P-value < 0.05 was taken as statistically significant. RESULTS: Autoclave, used by 155 (61.8%) dentists was the most common method of sterilization followed by more than one method, 65 (25.9%); dry heat, 24 (9.6%); and cold sterilization, 7 (2.8%). Majority of dentists, 126 (50.1%), never monitored sterilization and those who did monitored mostly monthly. Statistically significant difference was found amongst the three groups of dentists monitoring sterilization (p=0.09) and methods of sterilization (p < 0.01). CONCLUSION: Statistically significant difference was found in infection control practices of specialists, postgraduate trainees and general dentists regarding method of monitoring sterilization with majority of dentists never monitoring sterilization.

Compliance of Saudi dental students with infection control guidelines.

The aim of this study was to investigate compliance of dental students in a Saudi dental school with recommended infection control protocols. A pilot-tested questionnaire concerning various aspects of infection control practices was distributed to 330 dental students. The response rate was 93.9% (n = 311). About 99% of students recorded the medical history of their patients and 80% were vaccinated against hepatitis B. The highest compliance (100%) with recommended guidelines was reported for wearing gloves and use of a new saliva ejector for each patient. Over 90% of the respondents changed gloves between patients, wore face masks, changed hand instruments, burs and handpieces between patients, used a rubber dam in restorative procedures and discarded sharp objects in special containers. A lower usage rate was reported for changing face masks between patients (81%), disinfecting impression materials (87%) and dental prosthesis (74%) and wearing gowns (57%). Eye glasses and face shield were used by less than one-third of the sample. The majority of students were found to be in compliance with most of the investigated infection control measures. Nevertheless, further education is needed to improve some infection control measures including vaccination for Hepatitis B virus (HBV), wearing eye glasses, gowns and face shields and disinfecting impression materials and dental prostheses.

Percutaneous injuries amongst Greek endodontists: a national questionnaire survey.

AIM: To investigate amongst Greek endodontists the incidence of percutaneous injuries, the circumstances associated with them, the therapeutic measures taken after the injuries and their compliance with infection control measures. METHODOLOGY: One hundred and forty-seven endodontists met the inclusion criteria and were invited to participate in the survey. Personal and professional data, information on percutaneous injuries in the past 5 years and on infection control practices were gathered through interviews based on a questionnaire. Data were analysed using chi-square test, independent samples t-test, one-way anova and Pearson's correlation coefficient. The level of significance was set at P = 0.05. RESULTS: The response rate was 84%. The injury rate was estimated at 1.35 per endodontist per year. Endodontic files were associated with 37% of the injuries and fingers were injured in 75% of the most recent cases. Medical assistance was sought in 36% of the most recent injuries. Endodontists who always or usually practiced 4-handed endodontics (P = 0.007) as well as those not performing surgical endodontics (P = 0.007) reported significantly fewer injuries. In 91% of the participants, a complete hepatitis B virus vaccination was reported. Gloves, masks, rubber dam isolation and puncture-resistant containers for disposal of sharp instruments were always used by 98%, 94%, 100% and 81% of the respondents, respectively. CONCLUSIONS: The injury rate was low. The practice of four-handed endodontics was associated with a reduced number of percutaneous injuries; the performance of surgical endodontics increased their incidence. Greek endodontists showed a high level of compliance with infection control measures.

Changes in compliance with recommended infection control practices and affecting factors among dentists in Taiwan.

Compliance with recommended infection control practices in East Asia has not been clearly documented. To investigate changes in compliance with recommended infection control practices over a eleven-year period and to identify affecting factors, two nationwide cross-sectional surveys of dentists in Taiwan were conducted in 1999 and 2010. An anonymous questionnaire that assessed characteristics of dentists and practices of recommended infection control guidelines was mailed. Results showed that all infection control practices surveyed had improved in 2010. Factors affecting compliance with wearing basic protective barriers in 2010 were being female (odds ratio [OR]=3.631, p<0.001), aged forty-one to fifty years (OR=3.991, p<0.05), treating twenty-one to thirty patients per day (OR=2.690, p<0.05), and having information sources from seminars and conferences (OR=2.659, p<0.05). Although infection control practices have improved over time, there is still much room to increase rates of wearing a head cap, protective eyewear, and a face mask and disinfecting impression materials. Providing correct information about disinfection and sterilization processes through the Internet might be effective in improving compliance.

Advancing infection control in dental care settings: factors associated with dentists' implementation of guidelines from the Centers for Disease Control and Prevention.

BACKGROUND AND OVERVIEW: The authors set out to identify factors associated with implementation by U.S. dentists of four practices first recommended in the Centers for Disease Control and Prevention's Guidelines for Infection Control in Dental Health-Care Settings-2003. METHODS: In 2008, the authors surveyed a stratified random sample of 6,825 U.S. dentists. The response rate was 49 percent. The authors gathered data regarding dentists' demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the guidelines and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of those factors on the implementation of four recommendations: having an infection control coordinator, maintaining dental unit water quality, documenting percutaneous injuries and using safer medical devices, such as safer syringes and scalpels. The authors conducted bivariate analyses and proportional odds modeling. RESULTS: Responding dentists in 34 percent of practices had implemented none or one of the four recommendations, 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations. The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices and had at least three sources of instruction regarding the guidelines. Dentists with practices in the South Atlantic, Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied. CONCLUSIONS: Implementation of the four recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control, increasing continuing education requirements and developing multiple modes of instruction may increase implementation of current and future Centers for Disease Control and Prevention guidelines.

Preventive attitudes towards infection transmission in dental offices in North-East Romania.

AIM: The aim of this study was to evaluate the level of knowledge and the current attitudes towards infection control in the dental offices in the Northeast Romania. MATERIAL AND METHODS: Questionnaire-based study conducted on 152 dentists aged between 25-65 years practicing in 6 Northeast Romania counties. The questionnaire included questions related to current infection control procedures and attitudes. Data were statistically analyzed using SPSS 14.0 and chi-square test (p<0.05). RESULTS: The majority of the dentists (83.6%) consider that universities should provide a substantial education regarding infection control through postgraduate courses, but 7.2% of the respondents are not sure about their usefulness. The clinical decision related to patient's treatment is influenced by his infectious status for 67.8% of the dentists. Of these, 19.1% have over 20 years of practice and 48.0% are females. Almost all dentists (93.4%), regardless of gender (96.4% females and 87.8% males) undergo periodic testing for blood-borne viral infections (hepatitis B, C and HIV). Full protective equipment is used for all the patients by 86.2% of the dentists, while 12.5% use it only for the infectious ones. 65.2% of the dentists use steam sterilization equipment (autoclave), and 80,8% use dry heat. The majority of the dentists (82.6%) believe that the patient must always be informed about the adopted infection control measures, but 21.7% declare to do so only in some particular cases. CONCLUSIONS: Dentists knowledge and attitudes towards infection control must be improved by educational interventions in order to adhere to the European standards.

[Assessment of decontamination processes: cleaning, disinfection and sterilization in dental practice in Poland in the years 2011-2012]. / Ocena procesów dekontaminacji: mycia, dezynfekcji i sterylizacji w praktyce stomatologicznej w Polsce w latach 2011-2012.

OBJECTIVE: Effective decontamination of instruments is a key element of infection control and the provision of high quality in dental care. The aim of the study was to evaluate the efficiency of decontamination procedures including cleaning, disinfection and sterilization of re-usable instruments in dental practices in Poland. MATERIAL AND METHODS: The efficiency of disinfection and sterilization processes have been evaluated on the results of the questionnaires. The following information were taken into account: setting where disinfection and sterilization had been performed, preparation of dental equipment for sterilization (disinfection, washing and cleaning, packaging), the types of autoclaves and used types of sterilization cycles, routine monitoring and documentation of sterilization processes, treatment of handpieces and the frequency of surface decontamination. RESULTS: Data were collected from 43 dental practices (35 dental offices and 8 clinics). Disinfection and cleaning processes were performed manually in 63% of dental offices and ultrasonic baths were used in 53% of settings. Washer disinfectors were used in 23% of dental practices: in every researched clinic and in a few dental offices. All sterilization processes were performed in steam autoclaves, mainly in small steam sterilizers (81%). Dental handpieces were sterilized in 72% of practices, but only 33% of them performed sterilization in recommended cycle B. Sterilization processes were monitored with chemical indicators in 33% of practices. Biological monitoring of the processes was carried out at different intervals. Incorrect documentation of instruments and surfaces decontamination was recorded in several settings. CONCLUSIONS: There is still a need for improvement of decontamination processes in dental practice in Poland. Areas for improvement include: replacement of manual cleaning and disinfection processes with automatic processes, sterilization of dental handpieces after each patient, monitoring of a sterilization process with chemical and biological indicators. Reported incorrect procedures in decontamination of medical devices performed by questioned dentists and lack or inadequate response to asked questions indicate the lack of adequate knowledge about decontamination. Personnel who performs decontamination processes should be continuously trained.

Use of rubber dams during root canal treatment in Taiwan.

BACKGROUND/PURPOSE: Isolation of teeth with rubber dams is an important procedure for infection control in dentistry, especially in endodontic treatment. This study surveyed the prevalence of rubber dam usage in nonsurgical root canal treatment (RCT) by dentists under the National Health Insurance system in Taiwan. METHODS: A total of 1,332 completed RCT cases were randomly selected from a large database from the Bureau of National Health Insurance in Taiwan in 2004. The radiographs and dental charts of the selected cases were evaluated for the prevalence of rubber dam usage in RCT. The frequencies of rubber dam usage for RCT by dentists were compared between hospitals and private dental clinics and among six different regions in Taiwan. RESULTS: The overall prevalence of rubber dam usage for RCT by dentists under the National Health Insurance system in Taiwan was 16.5%. The frequency of rubber dam usage for RCT by dentists in hospitals (32.8%) was significantly higher than that (10.3%) in private dental clinics (p < 0.0001). However, there was no significant difference in the frequency of rubber dam usage for RCT by dentists among six different geographic regions in Taiwan. CONCLUSION: The prevalence of rubber dam usage for RCT by dentists in Taiwan is relatively low. Because rubber dam isolation of an endodontically-treated tooth can provide better infection control, increase patient protection, and improve treatment efficiency, there is an urgent need to advise dentists in Taiwan to use rubber dams for every RCT case.

An analysis of complaints against oral health professionals charged with misconduct at the HPCSA: 2004-2009.

AIM: This study investigates the nature, frequency, and outcome of complaints relating to misconduct laid against oral healthcare professionals (OHPs), charged with misconduct in South Africa. METHODS: Records of the Health Professions Council of South Africa (2004-2009) were analysed and classified using the ethical rules as a reference. "Clinically-related complaints" and "fraud" were added as extra categories. The nature and outcome of the complaints and the penalties were quantified, and the detailed nature of the complaints was qualitatively reported. RESULTS: Two percent of the registered dentists and 5.5% of the registered dental therapists were charged with misconduct. Clinically related complaints (59%) and fraud (29%) were most prevalent amongst the accused dentists. Fraud (46%), clinically related complaints (19%), advertising (15%), infection control (8%), and creating expectations that could not be met (8%) were the most common complaints against dental therapists. CONCLUSIONS: Substandard dental treatment and fraud were the main reasons for patient dissatisfaction that led to OHPs being charged with misconduct. Both these undesirable practices may be financially motivated. OHPs should take cognisance of these statistics and should adjust their professional approach accordingly in order to reflect acceptable ethical behaviour.

Disinfection of dental impressions - compliance to accepted standards.

INTRODUCTION: The responsibility of ensuring impressions have been cleaned and disinfected before dispatch to the dental laboratory lies solely with the dentist. Uncertainty of impression disinfection risks both the health of the receiving dental technician and potential repeat disinfection of an already disinfected impression with detrimental consequences for its dimensions. OBJECTIVE: To ascertain, from the perspectives of dentists and dental technicians, current impression decontamination and disinfection practices with, in the case of the technicians, an estimate of the relative prevalence of contaminated voids within apparently disinfected impressions. DESIGN: Anonymous postal questionnaire. METHOD: Dentist (n = 200) and dental technician (n = 200) potential participants, selected at random from the registers held by the General Dental Council, were invited to complete an anonymous postal questionnaire that sought to establish current practices and perceived effectiveness of impression disinfection. RESULTS: Questionnaire return rates of 42.1% and 31.2% were recorded for dentists and dental technicians respectively. A wide range of solutions, at different dilutions of the same product, was used by the dentists to disinfect dental impressions. 37.2% rinsed the impressions with water, and 2.6% always brushed debris away, before disinfection. 24.7% of dentists did not inform the laboratory of disinfection. Irrespective of the disinfection status of the received impressions, 50% of the responding dental technicians disinfected all impressions. 95% of them had received blood-contaminated impressions. 15% had encountered blood-filled voids upon trimming back the peripheries of impressions. 64.7% were confident that the impressions received by them had been disinfected by the dentists. CONCLUSIONS: Compliance with good practice is less than ideal and education in impression disinfection for both dentists and dental technicians is required to address this.

Utilização das normas de biossegurança pelos cirurgiões dentistas do serviço público de uma cidade do centro oeste de Minas Gerais

O controle de infecções nos consultórios tem sido um dos grandes desafios para os profissionais que atuam na Odontologia. Durante os atendimentos os profissionais devem utilizar meios que previnam e evitem o risco de infecção e transmissão cruzada. Foi realizada uma pesquisa com 41 cirurgiões dentistas que atuam no serviço público do município de Sete Lagoas/MG...

Attitudes and behavior of dental students concerning infection control rules: a study with a10-year interval.

The study compared the attitudes and behavior of 4th-year dental students regarding infection control rules in 1995 and 2005. Self-administrated questionnaires were applied to 592 students at 5 different dental schools in 1995 (n=350) and in 2005 (n=242). The chi-square and Fisher's exact tests were used for statistical analysis of data. Significance level was set at p<0.05. The response rate was 90.3% in 1995 and 81.0% in 2005. There was no improvement in the use of rubber gloves (p=0.316), face masks (p=0.572) or gowns (p=0.862) between 1995 and 2005. There was a lesser frequency of the use of protective eyewear in 2005 (p<0.001). No student used the individual protection equipment correctly. There was a decrease in the sterilization of burs in 2005 when compared to 1995 (p<0.001). No student could describe the correct use of the autoclave. Disinfection and use of a dental chair barrier were done correctly by a minority of students in 1995 (2.8%) and 2005 (6.1%) (p=0.069). Most students correctly discarded perforating/cutting instruments in both years (p=0.749). The attitudes and behavior of dental students concerning infection control are worrisome. There was no improvement and, for some parameters, there was a worsening in the procedures over the time period evaluated.

Infection control practices among a cohort of Brazilian dentists.

OBJECTIVE: To evaluate infection control practices among dentists in private and public practice. DESIGN: Survey and cross-sectional analysis. SETTING: Sertãozinho city, Brazil. PARTICIPANTS: All dentists who were currently working at the study city, and agreed to participate, resulting in a study population of 135 dentists. METHODS: Participants were personally interviewed and variables were submitted to chi2 or Fisher's exact test. RESULTS: Hand washing before and after each patient was reported by 86.7% of dentists, but private practitioners used liquid soap and paper towels more often than their public colleagues (p < 0.001). Most of the study population (97.8%) used gloves routinely during clinical sessions, but 8.2% reused them. Dry-heat was the main method employed for sterilisation of heat-stable devices by 80.0% of dentists, but adequate temperature and time of exposure was accomplished by only 32.1% of public and 70.0% of private professionals (p < 0.001). Heat-sensitive devices were disinfected with an adequate substance by 60.0% of both affiliation dentists (p = 0.908). CONCLUSIONS: There is a large gap between infection control recommendations and practices observed among the study population, and the situation is worse in public services. To reverse that situation, infection control issues must be openly debated by professional associations, dental schools and health authorities.

[Assessment of disinfection and sterilization processes in dental practice as an important factors in prevention of infections]. / Ocena prawidlowonci procesów dezynfekcji i sterylizacji w wybranych gabinetach stomatologicznych jako istotnych elementów zapobiegania zakazeniom.

The dental health-care settings is an environment where disease transmission occurs easily. Prevention of cross infection is therefore a crucial aspect of dental practice and dental clinic stuffmust adopt certain basic routines while practicing. Infections may be transmitted in the dental operatory through direct contact with blood, oral fluids or other secretions; via indirect contact with contaminated instruments, equipment or environmental surfaces; or by contact with airborne contaminants present in either droplet splatter or aerosols of oral and respiratory fluids. Strategies to prevent dental patient infections have focused on disinfection and sterilization. This study evaluates basic routines in prevention of cross-infection in the dentistry. The sample comprised 100 dentists, who completed questionnaires. Based on inquires the conditions for disinfection and sterilization of medical devices were assessed. The following issues were taken into consideration: the way of disinfection and preparation of the disinfectants, the localization of disinfection, preparing to disinfection, washing and packing of dental devices, the frequency of disinfection, methods of sterilization and the monitoring system, type of sterilizers and the available cycles. The dental practices are well equiped to proceed the steam sterilization, but 33% of dentists don't know the available cycles in their autoclaves. Only 35% of them made sterilization process protocols. Very common are three failures of instruments disinfections: multiple use of disinfectant, adding of disinfectant, adding new instruments. There is still need for improvement in disinfection and sterilization in dental practice, especially including: monitoring and documentation of sterilization process, proper use of disinfectants according to manufactures instructions, frequent disinfection of surfaces which contact with patients. Dental stuff should take part in advanced training courses about disinfection and sterilization.

Attitudes and behavior of dental students concerning infection control rules: a study with a10-year interval

The study compared the attitudes and behavior of 4th-year dental students regarding infection control rules in 1995 and 2005. Self-administrated questionnaires were applied to 592 students at 5 different dental schools in 1995 (n=350) and in 2005 (n=242). The chi-square and Fisher's exact tests were used for statistical analysis of data. Significance level was set at p<0.05. The response rate was 90.3 percent in 1995 and 81.0 percent in 2005. There was no improvement in the use of rubber gloves (p=0.316), face masks (p=0.572) or gowns (p=0.862) between 1995 and 2005. There was a lesser frequency of the use of protective eyewear in 2005 (p<0.001). No student used the individual protection equipment correctly. There was a decrease in the sterilization of burs in 2005 when compared to 1995 (p<0.001). No student could describe the correct use of the autoclave. Disinfection and use of a dental chair barrier were done correctly by a minority of students in 1995 (2.8 percent) and 2005 (6.1 percent) (p=0.069). Most students correctly discarded perforating/cutting instruments in both years (p=0.749). The attitudes and behavior of dental students concerning infection control are worrisome. There was no improvement and, for some parameters, there was a worsening in the procedures over the time period evaluated.

Este estudo comparou as atitudes e comportamento de estudantes de odontologia do quarto ano em relação às medidas de controle de infecção em 1995 e 2005. Questionários foram aplicados a 592 estudantes em cinco diferentes faculdades de odontologia em 1995 (n=350) e 2005 (n=242). Testes de qui-quadrado e testes exatos de Fisher foram utilizados. O nível de significância estatística utilizado foi p<0,05. As taxas de respostas foram iguais a 90,3 por cento em 1995 e 81,0 por cento em 2005. Não houve melhora no uso de luvas (p=0,316), máscaras (p=0,572) ou gorros (p=0,862) entre 1995 e 2005. Houve uma diminuição na frequência do uso de óculos de proteção em 2005 (p<0,001). Nenhum estudante utilizou o equipamento de proteção individual corretamente. Houve uma diminuição no relato de esterilização de brocas em 2005 comparado com 1995 (p<0,001). Nenhum estudante foi capaz de descrever o uso correto da autoclave. Desinfecção e uso de barreira na cadeira odontológica foi corretamente realizado por uma minoria de estudantes em 1995 (2,8 por cento) e 2005 (6,1 por cento) (p=0,069). A maioria dos estudantes descartava corretamente os instrumentais pérfuro-cortantes em ambos os anos (p=0,749). As atitudes e comportamentos desses estudantes de odontologia em relação ao controle de infecção são preocupantes. Não houve melhora, e para alguns parâmetros, houve uma piora na realização desses procedimentos no período avaliado.

The impact of clinical information systems in dental schools.

Although Clinical Information Systems (CIS) are gaining widespread acceptance in dental schools, their impact on users is not well understood. We conducted separate qualitative studies of the impact of CIS on users in two dental schools and then compared our results. We found five themes in common. By understanding the factors that impact CIS implementation we believe that dental schools will be better prepared to manage them.

Compliance of Jordanian dentists with infection control strategies.

OBJECTIVES: To assess whether dentists in Jordan are employing recommended infection techniques in their clinics and to identify the level of compliance of dentists with the recommended infection techniques commonly found in western countries. PARTICIPANTS: Dentists in Jordan (n = 300). METHODS: Aquestionnaire incorporating information regarding: infection control practices, vaccination, personal barrier protection, instrument sterilisation and disinfection, were distributed to 300 dentists in private and public practices. RESULTS: A (93%) response rate (n = 279) was available for analysis. Gloves were used by 73.3% of dentists; masks by 69.5%, protective eye wear by 43.8% and white coats worn by 75.9%. About 25% recorded patient medical histories. Offices in Jordan were found to be in compliance with respect to the use of disposable anaesthetic needles and carpules but only 27% use plastic containers for sharps; 72.6% of dentists had been vaccinated against hepatitis B viruses; approximately 70% use an autoclave for sterilisation but only 15% always use plastic bags for packing sterilised instruments. CONCLUSIONS: The majority of dental practitioners were found to be in compliance with most of the recommended infection control regulations. In this study the overall compliance with infection control procedures was 61.17% among dentists in Jordan. Further education may be appropriate in taking a medical history of each patient before treatment, wearing of masks and protective glasses and the use of plastic bags to wrap sterilised instruments.

Influence of clinicians' socio-demographic, professional and educational variables on their compliance with preventive measures against hepatitis B and C.

PURPOSE: To investigate the influence of a number of variables regarding clinicians' gender, social class, length of time since graduation and the level of knowledge on their use of available preventive measures against hepatitis B and C. MATERIALS AND METHODS: A cross-sectional questionnaire-based survey was carried out involving a random and representative sample (n = 319) of the clinicians working in Recife, Pernambuco, North-East Brazil. The participants were interviewed by means of a questionnaire, prepared and pretested by the researchers. Pearson's chi-square and Fisher's exact tests were used in the statistical analyses (significance level: 5%). RESULTS: Female clinicians were found to make more frequent use of equipment such as lab coats, scrub caps and masks (P = 0.0357). With regard to lab coat use in relation to social class, it was seen that clinicians from social class B used it less (P = 0.0077). The length of time since graduation was seen to be connected with the use of scrub caps (P = 0.0003), coating of equipment with polyvinyl chloride plastic film (P = 0.037), use of alcohol for cleaning equipment (P = 0.0012), two-handed recapping of needles (P < 0.0001) and immunisation (P = 0.003), showing that those who graduated most recently were more likely to take adequate infection control steps. The fact that clinicians had been informed about hepatitis B and C, and also their knowledge about its contagion, was positively associated with their levels of vaccination against HBV (P = 0.0313 and 0.0108, respectively). CONCLUSIONS: The adherence to preventive practices against hepatitis B and C was shown to be connected with the clinicians' socio-demographic, professional and educational variables.