Appendix 2 Syllabus for Infection Control Training for Members of the Dental Team

Quintessentials of Dental Practice – 39
Clinical Practice – 3

Infection Control for the Dental Team

Authors:

Michael V Martin

Martin R Fulford

Antony J Preston

Editor:

Nairn H F Wilson

Quintessence Publishing Co. Ltd.

London, Berlin, Chicago, Paris, Milan, Barcelona, Istanbul, São Paulo, Tokyo, New Delhi, Moscow, Prague, Warsaw

British Library Cataloguing in Publication Data
Martin, Michael (Michael V.)
Infection control for the dental team
1. Dentistry, Operative - Complications 2. Infection - Prevention
I. Title II. Fulford, Martin R. III. Preston, Antony J.
617.6'05

ISBN: 1850973229

All rights reserved. This book or any part thereof may not be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, or otherwise, without the written permission of the publisher.

ISBN: 1-85097-322-9

Foreword

Infection control is central to the clinical practice of dentistry. It is a responsibility of all members of the dental team, individually and collectively. Failures in standards of infection control may be the subject of legal actions, let alone actions in respect of professional conduct. Patients and the public at large must be protected from the unnecessary spread of infection and all members of the dental team must be safe in their working environment.

Infection Control for the Dental Team, a most important addition to the now near-complete Quintessentials of Dental Practice series, deals with infection control risk, medical histories and personal protection, surgery design and equipment, instrument decontamination, disinfection and ethical and legal responsibilities in infection control. In addition, this excellent volume concludes with most helpful models, policies, protocols and checklists for robust infection control arrangements. If you have any uncertainties about any aspect of infection control or wish to ensure compliance with legal requirements, let alone national and international guidance on infection control, this Quintessentials volume will address your needs.

In keeping with all the other volumes in the Quintessentials series, Infection Control for the Dental Team is succinct, engaging and capable of being read through in a few hours. It is anticipated, however, that this book will not just be read through, but will become a valuable training resource, important source of reference and highly regarded guidance on infection control for the dental practitioner and the dental team. And if that is not exceptional value for money, implementation of the guidance provided in this book will be good insurance in terms of being able to refute any allegations of failure in infection control.

All in all, another outstanding addition to the Quintessentials series. Congratulations to the authors on an important job well done, and to a very high standard.

Preface

Infection control is part of every dental professional’s daily practice. In this book we have attempted to offer the busy professional simple and effective guidance based on an accurate risk assessment. We have used this guidance to set working methods in a variety of different settings, from dental hospitals to practices, and found it to work without loss of clinical time. We have also included an extensive set of generic protocols that can be easily modified according to the needs of each particular clinical setting. Our hope is that this book will ensure that dental professionals have a safe and practical working environment that is free from the risk of transmitted infection.

Chapter 1

The Risks

Aim

The aim of this chapter is to describe the risks of contracting an infectious disease in the dental surgery environment.

Outcome

After reading this chapter, you should have a basic understanding of how infectious disease could potentially be transmitted in dentistry.

Terminology

Infection control in dentistry is all the methods we use to prevent the transmission of potentially pathogenic micro-organisms. The transmission of micro-organisms does not always result in infection. To cause an infection, the micro-organisms have to be transferred in sufficient numbers and then multiply to cause infectious disease. The number of bacteria, viruses, fungi or prions that are necessary to infect is called the minimum infective dose, as can be measured in experimental animals. The minimum infective dose can be decreased if a person’s defence mechanisms are impaired, for example, by chronic longstanding debilitating disease, medical interventions (immunosuppressive drugs, cytotoxic therapy) or very rarely by congenital disease; such patients are described as being medically compromised or immunocompromised.

Potential Routes of Transmission of Infection

When dentistry was practised without the use of any protective barriers or effective decontamination, there was an increased potential for the transmission of infection by direct contact. The routine use of barrier methods has reduced this potential to almost nil. With the growth in world travel and the increase in hepatitis, HIV and tuberculosis, infection control in dentistry is all the more important.

The risk from the inhalation of aerosols by patients or dental personnel has never been completely or reliably assessed. The highest risk of transmission of infection is by direct blood-to-blood contact. This contact can occur through injuries by “sharps” that penetrate the epithelium or by direct inoculation of wounds by contaminated instruments. Another potential route of transmission is through the conjunctiva of the eye.

Potential Pathogens in Dentistry

Although potentially any micro-organism could cause infection in dentistry, in practice only a selected few have been proven to be involved. These are shown in Table 1-1. This is because the oral cavity and saliva are selective in the number and type of micro-organisms that are usually present. In addition, while blood could contain many pathogens, it is usually sterile. Nevertheless, it is wise to routinely presume that every patient is potentially infectious. The presumption that every patient is potentially infectious logically leads to use of a standard set of infection control methods; these are often called universal or standard precautions. The use of standard precautions for every patient has not been adopted by all dentists. In some countries different types of infection control precautions are used for different procedures; this is problematical as it presumes that patients can be accurately assessed as potential carriers of disease but this is often not possible.

Table 1-1 **Micro-organisms implicated in infection from dental treatment**
Micro-organism	Probable route of transmission
Herpes simplex type 1	Hands, record cards, splatter from oral cavity
Hepatitis B	Sharps injuries, trans-conjunctival
HIV	Possibly contaminated needles or local anaesthetic
Hand, foot and mouth disease	Direct contact with infected skin
Methicillin-resistant
Staphylococcus aureus	Hands
Tuberculosis	Aerosols
Pseudomonas aeruginosa	Infected water lines, aerosols
Legionella pneumophila	Infected water lines, aerosols

Viruses

Potentially any virus could be transmitted by dental procedures, but those of greatest concern are the herpes and hepatitis viruses.

Hepatitis B was transmitted by dental procedures before the introduction of vaccines against this virus. Some of the transmissions of hepatitis B have resulted in the deaths of dental personnel. Most transmissions have been by blood-to-blood contact, usually following sharps injuries. Saliva could potentially transmit hepatitis as the concentration of the virus in saliva can be very high at certain stages of the illness. Transmission of hepatitis B has also been described through the conjunctiva of the eye.

Hepatitis C has been suspected to be transmitted in dentistry, but there is little evidence to support this contention. The virus has been found in the saliva of infected persons, but in concentrations well below the minimum infective dose. Recent research has also shown that even sharps injuries suffered by dental personnel with instruments used on carriers of hepatitis C have not resulted in transmission of this virus.

Human immunodeficiency virus (HIV) can be found in saliva but usually in low numbers. There have been extensive studies to determine if this virus could be transmitted by dental procedures. With one exception, no transmission has been proven. The exception is the curious case of Dr Acer, a practitioner in Florida, who was infected with HIV and who is thought to have transmitted the virus during dental procedures on five patients. This is an exceptional case.

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