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Summary of Infection Control in the Dental Office: A Global Prospective

During the delivery of dental care, there is the potential for the dissemination and/or exposure to blood and other body fluids as well as numerous microorganisms that colonize the mouth and/or oral, nasal, and respiratory fluids/secretions. Dentists, dental staff, and patients can be exposed to a variety of pathogenic microorganisms from these sources within the dental office. Contamination from any of these organisms may result in disease transmission which may occur from direct contact with infected body fluids and tissues, or indirectly by contacting surfaces and/or devices that have been contaminated. This phenomenon can occur anywhere in the world where dental care is provided. The principles of infection control must be employed to ensure that dental care is delivered in as safe a manner as possible for both the dental providers and the patients.


The Importance of Infection Control
What happens when we ignore the principles of microbiology and infection control? Diseases are transmitted, people get sick, and some may die. Careers can be ruined. The importance of infection control simply cannot be overstated. The microbial threats facing us today are significant, and the situation is not likely to improve.
Highly resistant organisms are now commonplace and are the cause of health-careassociated infections (HAIs) throughout the world. In the USA, an estimated 1.7 million HAIs occur each year contributing to the death of almost 100,000 patients, and HAIs have emerged to become the fourth leading cause of death in the USA and kill more people each year than AIDS, breast cancer and auto accidents combined [6,7]. Approximately 5-10% of hospitalized patients in the developed world acquire such infections [8]. The rates of HAIs is much higher in underdeveloped countries [8]. A great majority of these infections are preventable. Proper use of hand hygiene is critical to the prevention of many of these infections [8]. However, compliance among HCWs is poor; usually below 40% [8,9]. Regardless of the country where dental care is rendered, the dentist has the moral, legal, and ethical responsibility to practice dentistry in as safe a manner as possible.
As explained throughout this publication, almost everything in a health-care setting can serve as a reservoir and a vector for opportunistic pathogenic organisms. This includes but is not limited to: surfaces, hands of HCWs, and medical/dental equipment and/or devices [1,2,10]. Factors that increase the acquisition of infections in any health-care setting, inclusive of dental, include: • The persistence of some bacteria and viruses on inanimate objects and surfaces for days, weeks, and months. • The lack of compliance with hand hygiene recommendations. Surfaces have been shown to play a significant role in the acquisition, persistence, and spread of infections. Clinically important microorganisms that can cause HAIs have been shown to persist in the environment for considerable periods of time [11]. This facilitates the spread of the organism throughout a health-care (dental) facility, especially when compliance with hand hygiene is poor. Contaminated hands have been shown to be the vector for the contamination of viruses to multiple surfaces or patients and can also be the source of recontaminating the surface that has been previously disinfected [11]. Across the globe, evidence documents low compliance with hand hygiene making the risk from contaminated surfaces a significant factor in disease transmission in medical and dental facilities. Figure 15.1 clearly illustrates how a contaminated surface with low hand hygiene compliance can put a patient a risk for the transmission of pathogenic viruses, bacteria, fungi, and other microorganisms [11]. Proper cleaning and disinfection of surfaces is essential to prevent the contamination and spread of infectious organisms in all dental settings.
Another factor that increases the risk of disease transmission in medical/dental setting is the persistence of many pathogens in the health-care environment. Viruses from the respiratory tract (coronavirus, coxsackievirus, influenzavirus, SARS virus, and rhinovirus) can persist on surfaces for a several days. Blood-borne viruses (HBV or HIV) can persist for more than 1 week [11]. Herpes viruses such as CMV or HSV type 1 and 2, commonly encountered in the dental office, persist on surfaces for a few hours up to 7 days [11]. However, viruses from the gastrointestinal tract (astrovirus, HAV, poliovirus, and rotavirus) can persist for approximately 2 months [11]. Bacteria can persist for much longer periods of time. Most Gram-positive bacteria can survive for months on dry surfaces and many Gram-negative species can also survive for weeks to months [11].

Disease Transmission in the Dental Office
Although the transmission of infectious diseases in all health-care settings, including dental, has been well documented, many dental offices DO NOT follow recommended infection control standards. Patients are put at risk for disease transmission in the dental office because of: • Cross contamination. • Unsafe injection practices. • Lack of personal protective equipment and hand hygiene. • Incomplete or total lack of instrument cleaning. • Improper biological monitoring of sterilizers. • Inability to perform and/or verify sterilization [1,2,10].  In order to prevent the transmission of infectious disease in the dental office, infection control recommendations have been formulated. While there is no universal global guideline, most countries as explained in the eleven chapters in this publication have clear-cut guidelines that dentists can follow to prevent the spread of infectious diseases during the delivery of dental care. It is the hope of all of the authors of this publication that their contributions can help the dental practitioners around the globe to understand the importance of infection control in the dental office and incorporate the principles of infection control/disease prevention presented in Chaps. 1-14 into their dental practices.