Although patient-to-patient transmission of bloodborne
pathogens is well documented in a variety of healthcare settings, this type of
transmission is seen infrequently in the dental setting. Since 2001, only two
documented incidences of patient-to-patient hepatitis B virus (HBV)
transmission have occurred as a result of dental care; neither of which was
attributed to unsafe injection practices.1,2
Bloodborne pathogen transmission due to infection control
lapses in a medical or dental setting can be difficult to detect. Long
incubation periods and asymptomatic infections associated with HBV and HCV can
lead to challenges in both identifying an incident infection and in identifying
a single healthcare exposure that may have led to infection. For these reasons,
the number of known instances of transmission in medical, and presumably dental
settings, may underrepresent the true number of infections resulting from
unsafe practices.
Recent patient notifications due to infection control
breaches in dental settings have not only heightened awareness of the risks
associated with dental care, but have also reinforced the need for continuing
education for staff performing injections in
all patient care settings.
Recent Notifications. Over the last 12 months, two large-scales
patient notification events have been initiated due to the identification of unsafe
injection practices in dental clinics. In July 2012, the Colorado Department of
Public Health and Environment became aware of infection control breaches at an
oral surgery practice.3 Needles and syringes were reportedly used
repeatedly, often for days at a time. These practices occurred for over a
decade, from September 1999 through June of 2011, when the breach was
discovered.
As a result, approximately 8,000 potentially exposed patients
were identified through patient records and notified that they should be tested
for HBV, HCV and HIV. Additional patients with unknown addresses were reached
via press release. As a result of this investigation, the oral surgeon
voluntarily relinquished his license and at least five patients tested positive
for a blood borne pathogen. It is important to note that the source of these
infections cannot be identified and may not have been a result of unsafe
practices at this office.
In late March of this year, a similar investigation and patient
notification occurred. The Oklahoma State Department of Health and the Tulsa
Health Department reported notification of approximately 7,000 patients of a
local dental practice due to the identification of unsafe practices. They
identified extensive breaches in infection control, including unsafe injection
practices such as reported needle and syringe reuse for drawing up and administering
medications from multidose medication vials and other mishandling of
medications.
As of May 2nd, the Oklahoma State Department of
Health indicated that their lab had completed testing of 3,740 persons: 69
individuals tested positive for HCV, four individuals tested positive for HBV,
and fewer than three tested positive for HIV. Further investigation will be
undertaken by the health departments to attempt to identify the sources of
these infections.
Resources Available for Dental Health Professionals. Safe
injection practices are essential in all healthcare settings where injections
are given, including dental offices. Although there have been no documented
cases of patient-to-patient transmission in a dental setting due to unsafe
injections, the potential exists and strict adherence to safe injection
practices is critical. Like all healthcare settings, continuing education and
monitoring of safe injection practices are imperative to patient
safety.
The Safe Injections Practice Coalition (SIPC), CDC and the One & Only Campaign have a variety
of resources available to help promote good practices and to educate providers surrounding
safe injection practices. They are listed below:
- CDC Guidelines for Infection Control in Dental Health-Care Settings - 2003 (MMWR)
- Slide presentation (CDC Division of Oral Health)
- Safe Injection Practices in Dentistry (CDC Division of Oral Health)
- Injection Safety is Every Provider's Responsibility (One & Only Campaign)
- Safe Injection Practices in Dentistry (CDC Division of Oral Health)
Wherever injections are given, injection safety is every provider’s responsibility!
References
1.
J Infect Dis. 2007 May 1;195(9):1311-4. Epub
2007 Mar 21. Patient-to-patient
transmission of hepatitis B virus associated with oral surgery. Redd JT,
Baumbach J, Kohn W, Nainan O, Khristova M, Williams I.
