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Cross-infection in dentistry
Journal of Dentistry, 8, No. 1, 1980, pp. 1--2
Printed in Great Britain'
Cross-infection in dentistry* Cross infection in dental practice is a matter that concerns everyone associated with t h e delivery of dental care. Although the problem has always been present, there has not always been sufficient awareness of it or sufficient willingness to take the necessary steps to deal with it and minimize risks to patients and operators alike. In recent years, however, there has been an upsurge of interest all over the world, much of this sparked off by the particular problems associated with patients and dentists who suffer from or are carriers of infectious hepatitis. The problem is, of course, much greater than solely one of hepatitis, but it is perhaps thanks to this particular disease and our awareness of it that the question is now being considered with due care by responsible bodies in so many areas. For example, the Department of Health and Social Security, the British Dental Association, the Commission on Dental Practice of the F6d6ration Dentalre Intemationale, as well as the protection societies, have all been involved in the production of guidelines in recent years. However, not infrequently the guidance given varies, which is understandable considering the complexity of the situation. The most recent report is that of the expert group set up to advise. the Chief Medical and Dental Officers of the Health Departments of Great Britain on whether patients known to have a positive reaction to hepatitis B surface antigen may be given treatment in general dental practice and on the forms of treatment that may be undertaken and the precautions necessary to avoid the risk of infection of staff and other patients. Their recommendations are not agreed by any means by all who come into contact with the problem but a recent review of the report commented that 'where a known risk exists it would be foolish in the extreme not to take precautions but the greatest danger seems to lie in the transmission of infection from patient to patient by inadequate instrument sterilization, and such poor standards are surely inexcusable these days' (Sykes P. [1979] D~ntal
Practice 17, 31). All members of the dental profession are involved in the prevention of the transmission of infection between one patient and another, and between patients and dental staff, but dental schools are particularly important since they influence the attitudes of their new graduates and also of established members of the profession in their locality. It was for this reason that when a symposium was held in 1979 to discuss the problem of cross-infection in dentistry, most of the participants were drawn from dental schools, but representatives from the Department of Health and Social Security, the British Dental Association and the dental industry were also present and took part in the programme. As forecast in an earlier issue of Journal of Dentistry, four of the papers given at the symposium, each devoted to a particular aspect of the prevention of cross-infection in dental practice, now appear together in this issue. There were also three other contributions that reinforced and expanded some of the points made in these four papers. Mr D. H. Norman, Area Dental Officer of the Ealing, Hammersmith and Hounslow AHA, drew attention to the constant need to review precautions taken to avoid cross-infection in the Community Dental Service and to monitor the effectiveness of measures advocated. He emphasized that particular attention should be given to ensuring that working methods * Introduction by Professor D. S. Shovelton.
2
Journal of Dentistry, Vol. 8/No. 1
in the dental surgery are those appropriate to present conditions, not simply a continuation of previous practices. He then discussed the problems in community services of the proper study of the distribution of resources to ensure that funds are deployed in the most effective way, thus ensuring that implementation of some aspects of improved procedures does not necessitate a cutback in other parts of the service. These points were illustrated by examples of the problems encountered during school inspections, in the care of children in residential homes and during busy general anaesthetic sessions. One of the continuing problems in the prevention of cross-infection is the design of rotary cutting instruments, particularly handpieces, that can be sterilized easily and regularly under the conditions of general dental practice. That this can be done was stressed by Mr P. Kiess of Kaltenbach and Voigt, Biberach, West Germany, who drew attention to the essential difference between external wiping dean and sterilization p e r se. He concluded that autoclaving or hot air sterilization provides the only sure way of disinfecting handpieces but pointed out that even with these methods, problems can arise from the protection afforded to micro-organisms by the oil used in lubrication. Experiments in the use of additives to improve the killing of organisms during sterilization while maintaining the lubricating properties of oil were described and improvements in the reliability of sterilization and in the shortening of sterilization cycles were discussed. Dr K. J. Dombrowsky, of the International Institute of Dental Practice Administration in Koblenz, examined the problems of cross-infection as seen from a West German standpoint. As would be expected, these problems are broadly similar to those in the United Kingdom. He underlined the problems that arise because of the mobility of patients in present society. This, together with the varying incubation periods of infectious diseases, makes documentation very difficult when investigating the transmission of diseases to and from patients in dental practice. He emphasized that hygiene measures, in addition to preventing contamination and transmission of infection, must also provide a proper working environment and support the wellbeing of all those in dental practice. The need for a rational system of hygiene practicable in daily dental practice was stressed and the speaker concluded that this can only be achieved ff all members of the dental team are conscious of the need to prevent cross infection and the means of doing so. A retrospective view of the symposium would suggest that the principal achievement of this type of gathering is to focus attention of a group of interested and involved people on a particular problem--in this case, that of cross-infection in dentistry. The awareness of shortcomings in present methods of sterilization and in the prevention of contamination is important and should encourage the re-examination of these shortcomings in all areas of dentistry, with the objective of raising the level of cleanliness and sterilization practised in our surgeries and clinics in the 1980s.
Printed in Great Britain'
Cross-infection in dentistry* Cross infection in dental practice is a matter that concerns everyone associated with t h e delivery of dental care. Although the problem has always been present, there has not always been sufficient awareness of it or sufficient willingness to take the necessary steps to deal with it and minimize risks to patients and operators alike. In recent years, however, there has been an upsurge of interest all over the world, much of this sparked off by the particular problems associated with patients and dentists who suffer from or are carriers of infectious hepatitis. The problem is, of course, much greater than solely one of hepatitis, but it is perhaps thanks to this particular disease and our awareness of it that the question is now being considered with due care by responsible bodies in so many areas. For example, the Department of Health and Social Security, the British Dental Association, the Commission on Dental Practice of the F6d6ration Dentalre Intemationale, as well as the protection societies, have all been involved in the production of guidelines in recent years. However, not infrequently the guidance given varies, which is understandable considering the complexity of the situation. The most recent report is that of the expert group set up to advise. the Chief Medical and Dental Officers of the Health Departments of Great Britain on whether patients known to have a positive reaction to hepatitis B surface antigen may be given treatment in general dental practice and on the forms of treatment that may be undertaken and the precautions necessary to avoid the risk of infection of staff and other patients. Their recommendations are not agreed by any means by all who come into contact with the problem but a recent review of the report commented that 'where a known risk exists it would be foolish in the extreme not to take precautions but the greatest danger seems to lie in the transmission of infection from patient to patient by inadequate instrument sterilization, and such poor standards are surely inexcusable these days' (Sykes P. [1979] D~ntal
Practice 17, 31). All members of the dental profession are involved in the prevention of the transmission of infection between one patient and another, and between patients and dental staff, but dental schools are particularly important since they influence the attitudes of their new graduates and also of established members of the profession in their locality. It was for this reason that when a symposium was held in 1979 to discuss the problem of cross-infection in dentistry, most of the participants were drawn from dental schools, but representatives from the Department of Health and Social Security, the British Dental Association and the dental industry were also present and took part in the programme. As forecast in an earlier issue of Journal of Dentistry, four of the papers given at the symposium, each devoted to a particular aspect of the prevention of cross-infection in dental practice, now appear together in this issue. There were also three other contributions that reinforced and expanded some of the points made in these four papers. Mr D. H. Norman, Area Dental Officer of the Ealing, Hammersmith and Hounslow AHA, drew attention to the constant need to review precautions taken to avoid cross-infection in the Community Dental Service and to monitor the effectiveness of measures advocated. He emphasized that particular attention should be given to ensuring that working methods * Introduction by Professor D. S. Shovelton.
2
Journal of Dentistry, Vol. 8/No. 1
in the dental surgery are those appropriate to present conditions, not simply a continuation of previous practices. He then discussed the problems in community services of the proper study of the distribution of resources to ensure that funds are deployed in the most effective way, thus ensuring that implementation of some aspects of improved procedures does not necessitate a cutback in other parts of the service. These points were illustrated by examples of the problems encountered during school inspections, in the care of children in residential homes and during busy general anaesthetic sessions. One of the continuing problems in the prevention of cross-infection is the design of rotary cutting instruments, particularly handpieces, that can be sterilized easily and regularly under the conditions of general dental practice. That this can be done was stressed by Mr P. Kiess of Kaltenbach and Voigt, Biberach, West Germany, who drew attention to the essential difference between external wiping dean and sterilization p e r se. He concluded that autoclaving or hot air sterilization provides the only sure way of disinfecting handpieces but pointed out that even with these methods, problems can arise from the protection afforded to micro-organisms by the oil used in lubrication. Experiments in the use of additives to improve the killing of organisms during sterilization while maintaining the lubricating properties of oil were described and improvements in the reliability of sterilization and in the shortening of sterilization cycles were discussed. Dr K. J. Dombrowsky, of the International Institute of Dental Practice Administration in Koblenz, examined the problems of cross-infection as seen from a West German standpoint. As would be expected, these problems are broadly similar to those in the United Kingdom. He underlined the problems that arise because of the mobility of patients in present society. This, together with the varying incubation periods of infectious diseases, makes documentation very difficult when investigating the transmission of diseases to and from patients in dental practice. He emphasized that hygiene measures, in addition to preventing contamination and transmission of infection, must also provide a proper working environment and support the wellbeing of all those in dental practice. The need for a rational system of hygiene practicable in daily dental practice was stressed and the speaker concluded that this can only be achieved ff all members of the dental team are conscious of the need to prevent cross infection and the means of doing so. A retrospective view of the symposium would suggest that the principal achievement of this type of gathering is to focus attention of a group of interested and involved people on a particular problem--in this case, that of cross-infection in dentistry. The awareness of shortcomings in present methods of sterilization and in the prevention of contamination is important and should encourage the re-examination of these shortcomings in all areas of dentistry, with the objective of raising the level of cleanliness and sterilization practised in our surgeries and clinics in the 1980s.