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Are dentists making the grade on infection-control policies?
A recent poll on infection control published in the Journal of the American Dental Association raised eyebrows for the wrong reasons. The survey of 352 New York dentists revealed almost a quarter didn't wear gloves, while 19% admitted to not washing or disinfecting their hands between patients.
The results, while startling, tap into a dirty truth about dentistry; infection-control procedures are rarely seen as a positive addition to daily practice.
Although there's little data on infection-control practices in the Middle East, anecdotal evidence suggests dentists find it similarly tedious in terms of time and money. But, as regional cases of avian flu and drug-resistant tuberculosis show, dentists can't afford to let standards lapse.
MED asks: is the dental community doing enough to keep infection control at the top of its agenda?
Law and enforcement
Dr Iyad Hijjawi is the general manager of the Middle East Centre for Infection Control Technologies. With a few exceptions, he notes, the region has strong infection control laws. But these are undermined by poor enforcement.
"Most government authorities in the region adhere to the American Centres for Disease Control and Prevention guidelines," reveals the Jordan-based dentist. "They are usually pretty stringent. But there are inconsistencies in the policing of infection control."
Regulation is tighter for dental surgeries located in hospitals, polyclinics and large primary care centres, Hijjawi claims. But many governments, including those in Jordan and Syria, struggle to find the manpower to police their bustling private dental sectors.
"There are often thousands of dentists in solo practice, spread over a wide area, and providing varying degrees of infection control.
"Because of the widespread nature of the dentists in these countries, it becomes very expensive and logistically difficult for the health authorities to carry out regular inspections and enforcement of infection-control policies."
While a certain amount of responsibility for enforcing controls lies on the shoulders of government departments, the dental industry has always prided itself on being largely self-regulated. So what leads dentists to flout policy and risk patient safety?
According to Dr Wassim Slim, dentist at the British Dental Clinic in Dubai, the overriding reason is time. "I have worked in dental surgeries before where it is the dentist's nurse that is expected to clean all of the instruments. So she is rushing to get everything ready before the next patient," he says. "Invariably, there will be times when things will get missed."
For single-dentist clinics, the pressure is even greater.
"It's very easy to let things slip and take shortcuts when you are under pressure," Hijjawi agrees. "Probably the biggest faux-pas that a dentist can make is to not sterilise instruments in between patients."
The cost conundrum
The second major cause behind lax cross infection control is cost.
The estimated cost to clinics maintaining a watertight infection control policy can be upwards of US$25,000 per year. This roughly equates to between $5 and $20 per patient per procedure, depending on the treatment. Topping the price list are disposable instruments and tools, consumables such as gloves and clinical waste removal, among others.
Infection control is also equipment-based, meaning the costs increase year-on-year. Adding to this, admits Hijjawi, is the general push by local health authorities towards more international standards.
"The cost of infection control is forever spiralling. Two things push the costs up - increased regulations and increased standards. Because we now have to dispose of so many things, the percentage of our turnover each month that is spent of infection control has gone up significantly."
For dentists struggling to meet overheads, this can be the tipping point, claims Hijjawi.
"Dentists are notoriously bad businessmen and they are always looking to make savings. Unfortunately these tend to be in the wrong places. That is just a fact of dental business.
"It is sadly quite a common practice for items that are meant to be disposed of after first use, to be reused again to save money."
Start-up practices are among the worst offenders. The massive investment required to fund the business means there is not always enough left in the pot for disposables. "Often, certain instruments have to be bought second-hand," Slim says.
With the use of more disposable tools and instruments comes another problem that can impact good practice. The Middle East is notorious for its difficulties in maintaining a stable supply of dental equipment. It is not uncommon for dentists to have several different suppliers for the same disposable instruments and materials.
"It is an absolute nightmare," laments Slim. "Suppliers are always running out; shipments from America and Europe are sporadic and unreliable and you do not always get the same things."
