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Wed 21 May 2008 04:00 AM

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In sickness and in health

The infection control in your clinic may be right, but can you say the same for its staff?

The infection control practices in your clinic may be right on the money, but can you say the same for its staff? MED reviews the routine jabs that every hygienist should have.

In a patient-focused profession, it's easy to lose sight of your own health in the workplace. Infection control guidelines emphasis the importance of protecting the patient - but it's equally important for hygienists to protect themselves.

A first rule of healthcare is that prevention is better than cure, and routine vaccinations should be high on any clinic's list of priorities. MED discusses how to stay ahead of the game on occupational exposures.

Dental hygienists are at increased risk of influenza because they work in such close contact with people who might.

Mass medication

Most countries have lists of recommended vaccinations for healthcare workers, targeting diseases that flag up specific occupational risks. There are two major reasons for this; firstly, it protects employees from diseases that can develop serious complications when adult infections occur; and secondly, it stops them serving as a source of cross-infection to patients.

As the most infectious bloodborne hazard, immunisation against hepatitis B virus (HBV) should top the list of vaccinations in any dental surgery.

The three-injection vaccination schedule has contributed significantly to a drop in the incidence of workplace infection over the last 20 years and should be offered to any employee likely to have contact with blood/body fluids, clinical waste and sharps in the course of their duties.

In parts of the Middle East, routine childhood vaccination for HBV is still patchy and relatively new. In Saudi Arabia, for example, widespread vaccination only began in 1989 so many adult patients will not be immune.

Staying vigilant on HBV immunisation is thus doubly important for hygienists to help protect themselves against occupational infection.

Mumps, measles, rubella, and varicella (chickenpox) vaccinations are next.

Common childhood diseases can be significantly more severe in adult cases, with studies showing that between 1 and 2% of adults contracting varicella require hospitalisation.

Hygienists have regular contact with children, and a drop in the number of parents opting to immunise means vaccination coverage can be compromised.

By ensuring staff immunity against these diseases, dental surgeries can cut the risk of patient-worker transmissions, for healthier staff and clients.An often overlooked jab in immunisation schedules is the influenza vaccine. Influenza viruses can cause illness among people of any age, but infection rates are highest among children.

Dental hygienists are at increased risk of influenza because they work in such close contact with people who might be carriers.

An annual vaccination is your single best defence against infection from flu.

Paper-pushers

Good vaccination practices should be a standard part of clinic life. Each practice should have a nominated staff member to keep confidential vaccination records updated, and to ensure staff employees are immunised according to national guidelines.

A periodic checklist helps fight complacency and keep vaccinations at the forefront of each employee's mind. Office records can include:

• A copy of each employee's hepatitis B vaccination status, including dates of all of the hepatitis B vaccinations

• A record of all required vaccinations, in keeping with current recommended national guidelines

• Any additional immunisations, such as diphtheria and pneumococcal vaccines, that are not necessarily mandatory but remain an important component of fighting infection control

• Any signed vaccination refusal statement from the employee

Establishing an alerting system, or including markers in the records, can help keep accounts current and ensure that all members of the dental team stay up to date with booster vaccinations.

Herd immunity

The well-published MMR scare - reportedly linking the vaccine to an increased risk of autism - has seen many parents think twice about immunising their children. In both the UK and US, healthcare professionals have reported a rise in the documented outbreaks of measles and mumps.

This trend has serious consequences, both for unprotected children and for the rest of society.

Dental hygienists often take it for granted that their patients have had the full range of recommended vaccinations. Don't. By raising the issue of immunisations, you can help parents make sound decisions on the clinical benefits of vaccination.

Through boosting vaccination uptake among your patient base, and maintaining good immunisation practices in the dental clinic, you stand to win on all counts.

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