Catching the bug

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Infection control practices have changed dramatically in recent years. Largely as a spin-off from the AIDS epidemic, protocols have been built into every area of clinical practice. Surgeries that slip on these precautions can play host to a spread of infections. Bloodborne diseases such as hepatitis B and HIV, airborne viruses such as SARS and avian flu, and respiratory infections all rank highly on the risk list. So how can dentists best protect both their patients and staff?

Safeguarding staff

Patients can often be economical with the truth when it comes to their true medical history, explains Dr Martin Fulford, scientific adviser to the British Dental Association, so defensive practice is the cornerstone of infection control.

"Treat every patient as though they're potentially infectious," he advises. "It's very difficult to identify who is infectious. Many may not know it themselves or may be reluctant to disclose that they're infected because of the stigma attached to some conditions.

Statistics suggests, for example, that up to 90% of hepatitis C infections are asymptomatic. "It's not an insignificant problem," Fulford says, "Up to 75% [of sufferers] go to develop chronic infection, and 20 to 50% go on to develop cancer or sclerosis.

Dentists often forget that they, and their staff, are at the greatest risk of acquiring infection. With potentially daily exposure to pathogens, team members must all adhere to best practice to maintain a safe clinic. Team-wide immunisation is a proactive way to minimise the spread of infection. Dr Charles Palenik, director of the infection control research and services department at the Indiana University School of Dentistry, suggests appointing a safety coordinator, from within the current staff, to keep tabs on vaccinations.

Is everyone in the practice immunised against hepatitis B, influenza and tetanus? These are things that protect the staff that the practitioner must address.

For infection control measures that are consistent throughout the practice, ensure that staff are all on the same page. Policies and protocols should be laid down in writing, and adherence to these procedures must be included as a condition of employment.

You give them an induction, you train them on their additional duties and then you reinforce the training at every given opportunity," recommends Fulford. "Always make it a subject to them at practice meetings, so it becomes a second nature to them. Whenever I give a lecture I always point out that it's them that's most at risk, which of course concentrates their minds more."

Palenik advocates a ‘zero tolerance' approach to staff that are sloppy on rules. "We cannot tolerate unsafe people, because they will hurt themselves, patients and you," he argues, "So people who do not buy in to the programme and do not get with what's going on, out they go; no tolerance.

Lather, rinse, repeat

Routine use of precautions such as gloves, masks and protective eyewear has been a cornerstone of infection control for several years. More up-to-date research suggests that cotton clinical coats, however, are for superficial purposes only.

Dr Caroline Pankhurst is a clinical lecturer in oral medicine at King's College London Dental Institute (KCLDI). "Often the uniforms that people wear in the practices don't necessarily provide protection," she explains. "The uniform itself is usually made of cotton, and bacteria and viruses can get through that. The uniform is really only there to look professional, it's what the patient expects to see; but it isn't actually protecting the dentist or the nurse at all.

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