Hot Topics
Infection Control headlines from 2009
By Nancy Andrews, RDH, BS
Infection Control is one of those issues that customers have to consider - it is always there, for every treatment, no matter how big or small. The topic simmers in the background of daily routine. Periodically, events focus everyone’s attention on office safety. This year the event was/is the H1N1 influenza pandemic, bringing respiratory, contact and droplet disease risk into the public eye - and lungs. Here is a review of the topics we covered this year that will help you zero in on the health risks dentistry is facing now.
Hand hygiene
Hand Hygiene is one of the most important infection control strategies to prevent cross contamination and personal exposure. Poor hand hygiene is emphasized by the CDC as a key cause of sickness and death in healthcare. Perhaps this is because the ultimate success of hand asepsis depends on behavior. So how can dental reps impact this?
- Understand the way diseases are transmitted.
- Provide hand hygiene products that make compliance fast and easy.
- Promote products that are safe and effective.
- Be an informed resource that customers can rely on.
Healthcare providers are struggling to contain the outbreak of this flu by implementing rigorous hand-washing practices. Hand washing is vital to reduce disease transmission. However, the correct soaps, lotions and gloves need to be used in a professional and home setting to prevent skin cracking, which could lead to another avenue of exposure to pathogens. Intact skin is vital to personal safety. Breaks in the skin create a portal of entry for germs, irritants and allergens, including MRSA (Methicillin Resistant Staph Aureus) skin infections, which are becoming more and more common in the general population.
All hand care products should be effective, compatible with gloves, and protect skin. Every office should have a complete line of hand asepsis and care products designed for professional use.
Supermarkets as competitors
Dental offices may seek low cost alternatives to professional products. For infection control, this is especially unwise. Professional products are safer, more effective and more appropriate than consumer grade products - they are designed to meet clinical standards. Home-use products may appear to be adequate or the same as professional products, but they may not reliably meet the needs of patient care.
H1N1 basics
The media is inundated with true and false facts about H1N1 (previously called "swine flu") but it is helpful to understand what the true risks are and how you can protect yourself, your clients, and your family from exposure.
Flu is transmitted primarily through airborne large-particle (5 micron or larger) respiratory droplets from sneezing or coughing, in close contact (6 feet or closer), smaller aerosols traveling greater distances, or contact with respiratory-droplet contaminated surfaces. Inhalation, direct personal contact, and touching eyes, nose or mouth with contaminated objects or hands are the most likely ways the flu is transmitted. Like other respiratory viruses, influenza viruses attach to ciliated epithelial cells lining the respiratory tract where they penetrate and replicate. Common cold viruses (such as rhinovirus) are heat sensitive, so they infect only the upper respiratory tract. Influenza is able to infect respiratory tissue in warmer areas, so it can cause more severe infections deeper: in the trachea, bronchi and lungs. "Swine flu" has not been shown to be transmitted by ingestion of food, including pork. An infected person can transmit the virus one day before symptoms develop, and at least seven days after onset. Children may remain infectious for longer. During pandemics, asymptomatic people spread the infection, and exposure in public is likely.
The April 2009 outbreak of "swine flu" in Mexico, and the very rapid spread to other countries, shows how efficiently the virus can be transmitted. This organism is a "novel" virus because it is not similar to past human flu species, so people do not have immunity to it. Influenza Type A originates in birds. Most strains stay in birds, but some are able to jump to other species (pigs, cats, seals, whales and others). The new strain was created when four different viruses infected pigs at the same time and exchanged genetic material. This sharing of genetic material caused a dramatically different new strain of influenza with the important ability to spread between humans.
Based on past flu pandemics, scientists have been predicting a flu pandemic (world-wide crisis), fearing a highly lethal new strain. How does this affect your clients, and most importantly, how does this affect you?
- Office personnel need to understand and implement a complete program to prevent the spread of influenza and similar diseases.
- Reps can help by supplying products and resources.
- Some offices may want to proactively reach out to their community to help in possible pandemic preparedness.
H1N1 safety strategies
When patients, dental workers or reps are sick, they should stay home. If workers become sick at work, they should leave, and seek medical care if appropriate. Taking anti-flu medication immediately, when the flu strikes, can be very effective. Advise your clients that they are part of the first line of defense. Infection control starts at the front office. When appointment confirmation calls are made, and when patients enter the office, they should be screened for respiratory symptoms, especially febrile conditions such as the flu. Of course, patients’ privacy should be protected during screening. Ill patients should be rescheduled or referred for treatment at facilities set up to control airborne diseases, such as some hospitals.
- Dental facilities are advised NOT to treat patients with symptoms of influenza and other aerosol transmissible diseases.
- Patients should be screened for symptoms of aerosol transmissible diseases.
- Dental workers and industry representatives should stay home if they are sick.
- Isolation and separation protocol should be observed for seven days after onset of symptoms or longer if symptoms remain.
- Vaccinations are the best defense against the flu. All healthcare workers are advised to be vaccinated for both seasonal and H1N1 influenza and other vaccine-preventable diseases. Since a severe complication of influenza is bacterial pneumonia, consider getting vaccinated for bacterial pneumonia.
- In a serious pandemic, separation and isolation will be important strategies. People may need to stay away from public places, including the overwhelmed medical emergency centers. Now is the time to set your plan and build a readiness pack that can sustain you in isolation if needed.
Sidebar:
Products Customers Need
Now is the time to check infection control supplies of customers. During pandemics, special contact, droplet and airborne precautions may be expected. Additional infection control efforts will require a generous supply of these basic items:
- Gloves.
- Masks (especially ASTM High Barrier masks, and possibly NIOSH N-95 respirators in case of emergencies).
- Disposable gowns. Consider new products with antimicrobial capabilities.
- Face shields and eyewear.
- Gentle, foaming hand soap to lather rapidly and protect skin during frequent use.
- Waterless hand sanitizers with water-based emollients to protect skin during frequent use.
- Paper towels and facial tissue.
- Waste receptacles.
- Disposable barriers for room surfaces.
- Surface disinfectant sprays and/or wipes.
- Single-use patient eyewear, bib-clips or self-adhesive patient bibs; any items for cross-contamination control.
The dental industry has an important role to play in managing the flu pandemic - to help customers stay healthy and keep their business active, even at times when many people are ill. The H1N1 flu pandemic is a wake-up call to the dental industry to support customers now and to help them prepare for possible increased flu risks.
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