Implementation of Recent Infection Prevention Procedures Published by Centers for Disease Control and Prevention: Difficulties and Problems in Orthodontic Offices

Abstract

Context: The Centers for Disease Control and Prevention has recently published its "Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care", but information concerning compliance, occupational hazards, and specific recommendations for orthodontic facilities is less widely available. Evidence Acquisition: We searched electronic English articles published in PubMed and Google Scholar databases (2010-May 2016) using various combinations of the key indexing terms. Results: 95 articles were selected for comprehensive reading according to the inclusion criteria. Problems and difficulties for orthodontic offices in applying the recommendations have been divided into nine focus areas concerning the quality of supplies, the procedures necessary to adhere to the standard precautions of hand hygiene, the use of personal protective equipment (PPE), respiratory hygiene/cough etiquette, sharps safety, orthodontic instrument reconditioning, cleaning and disinfecting clinical contact surfaces and dental unit water lines, and impression disinfection. Conclusions: On the basis of our experience in a university department of orthodontics and private orthodontic offices, we believe that innovative thinking based on better knowledge, education and training, ergonomics, and task-specific, evidence-based guidelines and resources are required to improve compliance with infection control recommendations.

Infection Control in Dentistry and Drug-Resistant Infectious Agents: A Burning Issue. Part 2

“…The insufficient compliance of guidelines during infection prevention in dentistry depends on the limited awareness of the infective risk and mainly the fact that the dentist will not share the same fate of the patient in the case of an adverse event (AE), but the financial-occupational consequences can be just as serious as that of an airplane crash [5-8, 56, 58, 59]. Here, we confirm the current significant extent of violations and main noncompliance in IC observed in dental settings ( Table 1), sadly not different from those previously reported [12][13][14][15][60][61][62][63][64][65][66][67][68].…”

“…Glove perforation was 17% in maxillofacial surgery, and occurred significantly more frequently in procedures that exceeded 90 minutes than in those taking less time or during surgical procedure with a high risk of percutaneous injury rate (long procedures: intermaxillary fixation, sinus lift), in surgeon and first assistants. In addition, endodontia and orthognathic surgery are at high risk of glove perforation [13,73]. Needlestick and sharp injuries occur as a consequence of poor visibility, unexpected patient movements, and during the clearing up of dental instruments at the end of treatments and manual cleaning [27][28][29]74].…”

“…We underline the numerous violations and noncompliance concerning two aspects: (a) the use of standard surgical masks, which is risky in relation to MRSA carriers among DHCP and (b) surface disinfection [1,21,65] (Table 1). Barenghi reviewed the microbial contamination of CCSs and analyzed the guidelines, products, and procedures (barrier protective coverings, disinfectants vs. cleaners, impregnated wipes, choice of surface disinfectant and wipes) for the management of CCSs [13][14][15]. Here, we report some updated data focused on ARIAs.…”

“…It has been shown that the presence of a significant total coliform contamination, as markers of the presence of feces, before surface disinfection or on some dental materials "received from manufacturer" and/or "clinically exposed" (see in Ref. [13]). MRSA contamination has been detected on 2.8% of fomites [99].…”

“…The use of disposable barrier protective coverings (DBPCs) (transparent food barriers, purpose and medical-grade barriers, adhesive barriers) is recommended in particular for more contaminated zones of instruments (curing lights, intraoral radiographic equipment, computer keyboards, multiple-use dental dispenser devices, etc. ), dental chair parts (dental suction units, light arms), buttons, switches, and other materials and accessories [13][14][15]107]. In the future, it will be ergonomic to increase the use of the no-touch procedures (vaporization with hydrogen peroxide, HEPA filters, etc.)…”