Dentist Infection Control

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American Veterinary Medical Association Targets Antimicrobial Resistance

The American Veterinary Medical Association (AVMA) has announced the release of a report designed to help veterinary practices combat the threat of antimicrobial resistance.

The report from the AVMA Task Force for Antimicrobial Stewardship in Companion Animal Practice is intended to provide a "framework for instituting a clinic-level approach for judicious antimicrobial use" and other educational resources.

AVMA notes that a significant focus of the task force was to assemble the following core elements of a companion animal antimicrobial stewardship program:
  • Each veterinary practice should commit to the reduction in antimicrobial resistance by creating and adopting a clinic-specific plan in which everyone contributes to effective antimicrobial stewardship.
  • Antimicrobial stewardship in a practice begins with the appointment of a principal person to lead the program and to support the practice stewardship goals with all available resources.
  • Practices should address issues of antimicrobial resistance by taking a proactive approach to antimicrobial use and veterinary infection control, using accepted guidelines, recommendations and expertise.           
  • Understanding what is working and what is not requires self-assessment and monitoring, with a goal of continual improvement.

The report, which was released November 2016, includes sections on the following:
  • Why should we promote antibiotic stewardship?
  • Understanding companion animal practitioners’ attitudes toward issues of antimicrobial resistance and stewardship
  • Survey of veterinary laboratories regarding antibiotic susceptibility
  • Practice guidelines
  • Core elements of companion animal antimicrobial stewardship programs

Through the task force, AVMA has made combating antimicrobial resistance a priority. As AVMA states, "Proper use of antimicrobials in companion animals is essential to optimize therapeutic efficacy, enhance treatment success and minimize resistance to antimicrobials; all of which contribute to protecting public health and animal health and well-being."

The task force has developed a wealth of valuable resources, including do's and don'ts of antimicrobial prescribing, and provides links to resources developed by the International Society for Companion Animal Infectious Diseases and the Federation of European Companion Animal Veterinary Associations. Access these resources here.


CDC Brings Attention to Dental Infection Control and Prevention Practices

The Centers for Disease Control and Prevention (CDC) Division of Oral Health has contributed an article to Medscape (free account required for access) discussing the prevention of disease transmission in dental settings.

The article notes that, while rare, transmission of infectious agents between patients and dental healthcare personnel (DHCP) in dental settings do occur. Specifically, CDC references published reports describing the transmission of hepatitis B and hepatitis C in dental settings and a report on a 2015 outbreak of Mycobacterium abscessus infection at a pediatric dentistry practice.

The column then provides tips and advice for dental disease transmission prevention on topics that include:
  • Administering of local anesthesia
  • Use of multi-dose vials
  • Cleaning and heat-sterilizing of handpieces
  • Sterilizer monitoring
  • Water standards

CDC references additional resources to aid in dental infection prevention, such as its "Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care" 2016 report. This is a summary guide of basic infection prevention recommendations for all dental healthcare settings, including traditional settings such as private dental practices, dental clinics, dental schools and educational programs (including dental assisting, dental hygiene, and laboratory). In addition, the recommendations include nontraditional settings that often use portable dental equipment such as clinics held in schools for sealant and fluoride placement and other sites for humanitarian dental missions.

CDC also references its "Infection Prevention Checklist for Dental Settings." CDC notes the checklist should be used to ensure the dental healthcare setting has appropriate infection prevention policies and practices in place, including appropriate training and education of DHCP on infection prevention practices. Systematic assessment of  personnel compliance with the expected infection prevention practices is a critical step in following guidelines. Feedback  to DHCP regarding performance as well as documentation of compliance is important.

As the CDC states in the Medscape report, "Infection prevention should be a priority in all clinical dental care settings. A survey of U.S. dentists looked into implementation of four recommended infection prevention recommendations (have an infection control coordinator in the dental practice, maintain dental unit water quality, document percutaneous injuries, and use safe medical devices such as safer syringes and scalpels). [The survey] found that only 25% of practices had routinely implemented three or four of these recommendations."

Need assistance with dental infection control program development, improvement and/or education? Contact ICCS, a leading national provider of infection control and prevention services for dental offices and oral surgery centers.


CDC Launches App for Dental Infection Prevention

The Centers for Disease Control and Prevention (CDC) has released a mobile application designed to assist facilities with monitoring their ongoing compliance with recommended dental infection prevention practices.

The CDC DentalCheck app is a tool dental practices can use to help evaluate dental healthcare personnel (DHCP) compliance with administrative policies and clinical practice infection prevention and control recommendations.

Note: While the app is a good resource, it is important that dental practices and oral surgery centers do not consider it as a replacement for a robust infection prevention and control program overseen by a trained infection preventionist.

The app is based on recommendations contained in CDC's "Guidelines for Infection Control in Dental Health-Care Settings – 2003" as well as other recommendations relevant to dentistry published by CDC since 2003.

It can be used to help ensure appropriate infection prevention policies and practices are in place, including appropriate training and education of DHCP, and assessment of compliance of personnel with infection prevention practices.

Within the app, users can navigate to references and resources for areas of focus including sterilization, safe injection practices and hand hygiene. They can also access a summary of basic infection prevention principles and recommendations for dental settings.

CDC DentalCheck can be downloaded through the iTunes App Store. It can be displayed on any iOS-enabled mobile device.

Dental practices and oral surgery centers are under increased infection prevention and control scrutiny following a number of high-profile infection outbreaks over the past few years, including a odontogenic infection outbreak related to pediatric patients undergoing a pulpotomy, or "child root canal." Infection Control Consulting Services (ICCS) works with dental practices and oral surgery centers to develop a comprehensive infection prevention plan and provides other services designed to help organizations maintain compliance and keep patients safe. Contact ICCS today to learn more.


CDC Issues Bird Flu Warning Following Reports of Human Infections in China

With Chinese health authorities confirming more than 100 new human cases of avian influenza, the Centers for Disease Control and Prevention (CDC) has issued a travel alert for visitors to China.

As of January 16, 120 new human cases of avian influenza A (H7N9) have been confirmed since September 2016. The H7N9 virus found in birds does not normally infect humans. However, in the spring of 2013, the first human cases of H7N9 virus infection were reported in China. Since then, more than 900 laboratory-confirmed cases of human infection with H7N9 virus have been reported. About one-third of cases have resulted in death.

While there are no recommendations against travel to China, CDC is advising people traveling to the country to avoid contact with poultry, birds and their droppings and to avoid eating undercooked poultry. CDC notes that evidence suggests that most people have been infected with the virus after having contact with infected poultry or contaminated environments. Infected birds appearing healthy may still be able to transmit the virus to people.

No ongoing person-to-person spread of this virus has been found, although the CDC states that it is possible and even likely that there will be some limited person-to-person spread with this virus. There is no vaccine available to prevent H7N9 infection at this time.

Hygiene guidance includes the following
  • Wash hands often.
  • If soap and water is not available, clean hands with hand sanitizer containing at least 60% alcohol.
  • Do not touch one's eyes, nose or mouth. If it is necessary to touch the face, ensure hands are clean.
  • Cover one's mouth and nose with a tissue or sleeve when coughing or sneezing.
  • Try to avoid close contact with people who are sick.

Symptoms generally start with high fever and cough. Many cases progressed to very serious illness, including severe pneumonia, acute respiratory distress syndrome, septic shock and multi-organ failure leading to death.

No cases of human or bird infection with this H7N9 virus have been detected in the United States, and the risk to people in the United States is considered low.


"Nightmare Superbugs" are Here: Drug-Resistant Bacteria Kills Nevada Woman

The Centers for Disease Control and Prevention (CDC) has reported that a woman has died after she contracted an incurable infection, resistant to all 26 antibiotics available in the United States.

The report was included in the January 13 Morbidity and Mortality Weekly Report (MMWR). As it noted, in August 2016, the Washoe County Health District in Reno, Nev., was notified of a patient at an acute-care hospital with carbapenem-resistant Enterobacteriaceae (CRE) that was resistant to all available FDA-approved antimicrobial drugs.

The specific CRE was Klebsiella pneumoniae, which NPR notes is described as a "nightmare superbug" (or "nightmare bacteria") because it was even resistant to antibiotics developed as a last resort against bacterial infection. The patient died in September.

While deaths from "superbug" infections are not uncommon, what is unusual in this case is that the bacteria was detected early in treatment but the infection still could not be stopped.

As the MMWR report notes, there are three important takeaways from this experience:
  • Although CRE isolates are commonly sent to CDC as part of surveillance programs or for reference testing, resistance to all antimicrobials is very uncommon.
  • To slow the spread of bacteria with resistance mechanisms of greatest concern or with pan-resistance to all drug classes, CDC recommends that when these bacteria are identified, facilities ensure that appropriate infection control contact precautions are instituted to prevent transmission and that healthcare contacts are evaluated for evidence of transmission
  • The patient in the report had inpatient healthcare exposure in India before receiving care in the United States. Healthcare facilities should obtain a history of healthcare exposures outside their region upon admission. Screening should be considered for CRE when patients report recent exposure outside the United States or in regions of the United States known to have a higher incidence of this organism.

What should be particularly concerning is such superbugs are likely spreading, and doing so in a manner that may prove challenging to detect.

As Bill Hanage, an infectious diseases epidemiologist at the Harvard T.H. Chan School of Public Health and senior author of the study, notes in a PBS report, "You know the phrase 'Shutting the stable door after the horse has bolted?' The horse has not only bolted, the horse has had a lot of ponies, and they're eating all our carrots."


Study Reveals Infection Control Challenges in Long-Term Care Facilities

Researchers have concluded that long-term care facilities (LTCFs) require infection control policies specific to their setting and should not mirror those used in acute care hospitals.

The study, titled "Paramyxovirus Outbreak in a Long-Term Care Facility: The Challenges of Implementing Infection Control Practices in a Congregate Setting," was published in Infection Control & Hospital Epidemiology, the journal for the Society for Healthcare Epidemiology of America (SHEA). It examined an 16-day outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) at a long-term dementia care facility in Tennessee.

Of the facility's 41 patients, 30 (73 percent) contracted at least one of the viruses, 15 had to be hospitalized and five died. Here are some of the challenges the facility faced in controlling the outbreak, as identified by the researchers:
  • Offsite testing of patients with suspected illness delayed results and response.
  • Separation of sick and healthy residents and staff proved difficult because of widespread illness among staff.
  • Due to their dementia, patients were unable to report symptoms and adhere to recommended restrictions.
  • Lack of alcohol-based hand rub limited success of infection control precautions.
  • The number of isolation carts needed quickly exceeded the number available.
  • Reduction in available staff due to illness hindered efforts.

Following the outbreak, the facility made a number of changes to its infection control protocols, including active screening; improved separation of ill and healthy residents and staff during cold and flu season; and renewed emphasis on the importance of hand hygiene and personal protective equipment. The facility also partnered with a private lab to provide faster respiratory viral testing.

LTCFs continue to face challenges as patients are discharged from hospitals far earlier than in past decades. Patient acuity has resulted in nursing homes and other LTCFs requiring additional human and fiscal resources in order to provide appropriate services, including those pertaining to long-term infection control and prevention, to the growing population of residents.


Compromised Vaccines Administered to 900 Children in New Jersey

The New Jersey Department of Health (NJDOH) is reporting that approximately 900 children received potentially compromised vaccines.

The vaccines were administered at a Manahawkin practice, which participates in the NJ Vaccines for Children Program. The practice was found to be out of compliance with the Centers for Disease Control and Prevention's (CDC) requirements for vaccine storage and management. Specifically, the vaccine, which were administered between November 1, 2014 through July 28, 2016, may not have been stored at proper temperatures.

An additional 38 children who received vaccines after July 28, 2016, received vaccines that were not stored properly.

On January 9, the State Division of Consumer Affairs in the Attorney General's Office filed a complaint with the State Board of Medical Examiners alleging gross negligence, professional misconduct and other violations by the practice. An investigation is ongoing.

As the NJDOH notes, "Exposure to temperatures outside the range recommended by vaccine manufacturers can make the vaccines less effective. Children who received these vaccines might not be fully protected against vaccine-preventable diseases."

Proper storage of vaccines often presents a challenge for practices and ambulatory surgery centers (ASC). Refrigerators in ASCs that house vaccine of any nature (e.g, flu vaccine during the in-season) must be monitored for temperature stability twice a day. Consultants with Infection Control Consulting Services (ICCS), a national provider of infection control and prevention consulting services, frequently discover during onsite visits that ASCs are mostly unaware of the need to monitor and record twice-daily when refrigerating vaccines.

ICCS guides its ASC clients not only on compliant practices related directly to the provision of surgery but other infection control- and epidemiology-related practices as well. Learn more about ICCS services for surgery center infection control.

Note: CDC offers a free vaccine storage and handling toolkit, which was published in June 2016. It is a comprehensive resource for healthcare providers on vaccine storage and handling recommendations and best practice strategies. The Toolkit includes guidance on managing and storing vaccine inventory, using and maintaining storage unit and temperature monitoring equipment, preparing for emergency situations and training staff.