Kate Scheer: Infections during care – protecting the vulnerable
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 . Preventable harm is a broad category, and mistakes are an inevitability, but one area where these are inexcusable is where infection occurs due to 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 becoming increasingly common among the general population . 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.
Health status and behaviour that can predispose patients towards conditions requiring dental treatment might leave them more susceptible to infection. 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 [3,4,5,6,7,8,].
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 .
Sources of infection
A patient’s apparent health does not mean that they pose any less of a risk. Many infections are asymptomatic at times, or carriers may remain asymptomatic yet still be infectious to others . 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 more contaminated with MRSA than other areas. Paper dental records were found to harbour the most extensive colonies . 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 .
These 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 and must be suitably sterilized and reprocessed before reuse.
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 following correct infection control protocols, you can help ensure your patients are safe from cross-infection, at least in the practice.
Kate Scheer is a Marketing Executive with W&H. She advises: “The Lisa type B vacuum sterilizer from W&H is a highly advanced, yet straight forward and easy-to-use machine that ensures 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.” For more information, go to www.wh.com/en_uk
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