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Infections during care – protecting the vulnerable

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  Posted by: The Probe      8th March 2020

Healthcare-associated infections (HCAIs) remain a prevalent problem. Not only do HCAIs pose a direct risk to patients, but they also increase the levels of antibiotics prescribed, contributing substantially to the development of antibiotic resistance. While often thought of as a problem affecting large hospitals, any primary care setting can present a risk of infection to patients, if cleaning and disinfection protocols are not adequately followed and maintained.

A recent study found that more than one in twenty patients are affected by preventable harm, with around one in eight among them subsequently dying or rendered permanently disabled.[i] Preventable harm is a broad category, and mistakes are an inevitability, but one area where these are inexcusable is where infection occurs due to simply not following standard safety and infection practises. This includes ensuring all staff properly and regularly wash their hands, and that equipment is adequately decontaminated and sanitized.

Within a healthcare environment, the risk of infection is generally more serious than in the wider community for two main reasons. Firstly, patients are more likely to be in a weakened, vulnerable or exposed state, where they may be more likely to contract an infection, and/or an infection may increase the risk posed by the illness they are being treated for. Secondly, infections within a healthcare setting are more likely to be drug-resistant – though drug-resistant bacterial infections are increasingly common among the general population.[ii] Around 10% of all antibiotic prescriptions in the UK originate from dental care, and as many as half of these may be unnecessary or inappropriate.[iii] By preventing cross-infections during treatment through strong adherence to disinfection and sanitization protocols, we can directly and indirectly protect patients – both from immediate infection, and by reducing the quantity of antibiotics used, thereby slowing the development of antibiotic resistance.

Compromised health

Health statuses and behaviours that can predispose patients towards conditions requiring dental treatment often leave them more susceptible to infection generally. Failure to maintain personal hygiene (especially handwashing), depression, alcohol consumption, smoking, night-shift work, diabetes, and a host of other conditions can increase vulnerability, especially when more than one of these is a factor.[iv], [v], [vi], [vii], [viii], [ix], [x]

All due care should be taken to follow disinfection and sanitization protocols before and after every surgery. It is important not to let the basics slip. A study of dental students observed improper mask use in 24% of student encounters, improper glove use 35% of the time, and a failure to wash hands after removing gloves 37% of the time.[xi] While these were students, it is always important to observe proper infection control practice throughout the entire chain.

Sources of infection

A patient’s apparent health does not mean that they pose any less of a risk than others. Many infections are asymptomatic at times, or carriers may remain asymptomatic yet still be infectious to others.[xii] Patients’ skin and clothing can also shed harmful microbes, potentially contaminating surfaces. A study of clinically asymptomatic patients visiting a hospital dental clinic found that after each patient visited, MRSA prevalence in the environment increased dramatically. Surfaces, particularly those most in contact with the patient – such as the arm rest of the dental chair – were found to be substantially more contaminated with MRSA than other areas. Paper dental records were found to harbour the most extensive colonies.[xiii]

Around two-thirds of HCAIs are associated with wet biofilms, however, biofilm present on dry surfaces may also pose a potential danger. A recent study looking at items from several UK hospitals found dry biofilms were present on 95% of the items submitted. While the items had been cleaned (usually with bleach), they still contained possibly harmful dry biofilms including staphylococci (with MRSA strains being present across many of the samples) and Bacillus spp. (which helps protect biofilms from disinfection). Exactly what risk dry biofilms pose to patients is not currently well understood.[xiv]

The aforementioned are relatively indirect means of transmission. Within a dental clinic, the primary means of transmission are bodily fluids, air droplets and contaminated surgical instruments. While everything should be kept as sanitary as possible, surgical tools are directly exposed to patient saliva and blood, necessitating that they be suitably sterilized and reprocessed before reuse.

The Lisa type B vacuum sterilizer from W&H is a highly advanced, yet straight forward and easy-to-use machine that can ensure your instruments are thoroughly sterilized in cycle times from just 13 minutes. With integrated traceability and risk-free cycle selection, Lisa handles your practice’s sterilization needs reliably and with great efficiency. W&H also provides ECPD training, helping clinicians obtain a thorough understanding of the theory and practice of handpiece maintenance and decontamination, and ensuring you are confident in reprocessing handpieces in accordance with HTM 01-05.

Protecting patients from cross-infection is a key duty of care. While some patients may be at greater risk than others, it is critically important to maintain high standards at all times. By using a quality sterilizer and following suitable infection control protocols, you can help ensure that your patients are safe from cross-infection.


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[i] Panagioti M., Khan K., Keers R., Abuzour A., Phipps D., Kontopantelis E., Bower P., Campbell S., Haneef R., Avery A., Ashcroft D. Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic and meta-analysis. BMJ. 2019; 366: I4185. July 18, 2019.

[ii] Ventola C. The antibiotic resistance crisis: part 1: causes and threats. Pharmacy and Therapeutics. 2015; 40(4): 277-283. July 18, 2019.

[iii] Montero M. Antimicrobial resistance: what should dentists be doing? Odovtos International Journal of Dental Sciences. 2016; 18: 10-14. July 18, 2019.

[iv] Allegranzi B., Pittet D. Role of hand hygiene in healthcare – assoiciated infection prevention. Journal of Hospital Infection. 2009; 73(4): 305-315. July 18, 2019.

[v] Andersson N., Goodwin R., Okkels N, Gustafsson L., Taha F., Cole S., Munk-Jørgensen P. Depression and the risk of severe infections: prospective analyses on a nationwide representative sample. International Journal of Epidemiology. 2016; 45(1): 131-139. July 18, 2019.

[vi] Trevejo-Nunez G., Kolls J., de Wit M. Alcohol use as a risk factor in infections and healing.  Alcohol Research. 2015; 37(2): 177-184. July 18, 2019.

[vii] Qui F., Liang C., Dai Z. Impacts of cigarette smoking on immune responsiveness: up and down or upside down? Oncotarget. 2017; 8(1): 268-284. July 18, 2019.

[viii] Loef B., Van Baarle D., Van der Beek A., Van Kerkhof, van de Langenberg D., Proper K., Klokwerk+ study protocol: an observational study to the effects of night-shift work on body weight and infection susceptibility and the mechanisms underlying these health effects. BMC Public Health.  2016; 16; 692. July 18, 2019.

[ix] Ibrahim N., Alwafi H., Sangoof S., Turkistani A., Alattas B. Cross-infection and infection control in dentistry: knowledge, attitude and practice of patients attended dental clinics in King Abdulaziz University Hospital, Jeddah, Suadi Arabia.  Journal of Infection and Public Health. 2017; 10(4): 438-445. July 18, 2019.

[x] Cooke F. Infections in people with diabetes. Medicine. 2015; 43(1): 41-43. July 18, 2019.

[xi] Anders P., Townsend N., Davis E., McCall Jr. W. Observed infection control compliance in a dental school: a natural experiment.  American Journal of Infection Control. 2016; 44(9): 153-156. July 18, 2019.

[xii] Chisholm R., Campbell P., Wu Y., Tong S., McVernon J., Geard N. Implications of asymptomatic carriers for infectious disease transmission and control. Royal Society Open Science. 2018; 5(2): 172341. July 18, 2019.

[xiii] Faden A. Methicillin-resistant Staphylococcus aureus (MRSA) screening of hospital dental clinic surfaces.  Saudi Journal of Biological Sciences. 2018.

[xiv] Ledwoch K., Dancer S., Otter J., Kerr K., Roposte D., Rushton L., Weiser R., Mahenthiralingam E., Muir D., Maillard J. Beware biofilm! Dry biofilms containing bacterial pathogens on multiple healthcare surfaces; a multi-centre study. Journal of Hospital Infection. 2018; 100(3): 47-56. July 18, 2019.

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