Blood splashes to the eyes in oral and maxillofacial surgery, and the risks of HIV transmission

Blood and saliva contamination on protective eyewear during dental treatment

Objectives

Dental treatments are inherently associated with the appearance of potentially infective aerosols, blood and saliva splashes. The aim of the present study was to investigate the quantitative contamination of protective eyewear during different dental treatments and the efficacy of the subsequent disinfection.

Materials and methods

Fifty-three standardized protective eyewear shields worn by students, dentists and dental assistants during different aerosol-producing dental treatment modalities (supragingival cleaning, subgingival periodontal instrumentation, trepanation and root canal treatment and carious cavity preparation; within all treatments, dental evacuation systems were used) were analysed, using common forensic techniques. For detection of blood contamination, luminol solution was applied onto the surface of safety shields. A special forensic test paper was used to visualize saliva contamination. Further analysis was conducted after standardized disinfection using the same techniques. Statistical analysis was performed using SPSS.

Results

Macroscopically detectable contamination was found on 60.4% of protective eyewear surfaces. A contamination with blood (median 330 pixels, equivalent to 0.3% of the total surface) was detected on all shields after dental treatment. Between various dental treatments, the contamination with blood tend to be statistically significant (p = 0.054). Highest amount of blood was observed after professional tooth cleaning (median 1,087 pixels). Significant differences of saliva contamination were detected between the different measurements (p < 0.001) with contamination only after dental treatment. Due to the low variance and right-skewed distribution for saliva contamination, no statistical analysis between different treatments could be performed. After disinfection, 0.02% blood contamination and no saliva contamination were detected.

Conclusions

Disinfection is effective against blood and saliva contamination. Macroscopically, clean protective eyewear contains up to 12% surface contamination with blood. Based on the results, it may be concluded that protective eyewear is essential for each dental practitioner.

Clinical relevance

As standard for infection prevention in the dental practice, disinfection of protective eyewear after each patient is necessary.

Ocular injuries among oral and maxillofacial surgeons: Have high risk or not? An overview of a two-centered experience

BACKGROUND

Oral and maxillofacial surgeons are occupationally exposed to ocular injuries via bodily fluid (ie, blood or saliva), which can carry substantial latent risks, both bacterial and viral. The aim of this study was to determine the prevalence of ocular injury and infection among oral and maxillofacial surgeons during outpatient procedures.

METHODS

Data were collected from a consecutive series of 500 surgeries conducted by 26 resident surgeons via a questionnaire. Responses were categorized into two groups: Group I did not indicate an eye injury, and Group II did indicate an eye injury.

RESULTS

Of 500 procedures, 161 resulted in ocular injuries, a rate of 32.2 injuries per 100 person-procedures. Educated participants experienced eye injuries at a significantly higher rate than those who were uneducated (23.33% vs. 15.11%; P=0.022). Those not using eye protection experienced eye injuries at a significantly higher rate than those using eye protection (23.32% vs. 2.33%; P<0.001). Of all eye injuries, 14.28% required medical management. Incidents were reported at a rate of 10.56%, higher in those with multiple injuries.

CONCLUSION

These findings demonstrate major inadequacies and breaches of the present eye/face protection protocols. Because the number of clinical studies on ocular injuries during oral and maxillofacial surgerical procedures is limited in the literature, each additional study can be important for promoting awareness among professionals, so that serious morbidity can be prevented.

Eye-related trauma and infection in dentistry

Despite numerous technological and medical developments achieved in recent years, a significant amount of occupational health problems still exist in modern dentistry. The risk of eye injury is mostly attributed to the use of high-speed hand pieces and ultrasonic devices. A dental clinic may be the source of eye-related infection and injury because of mechanical, chemical, microbiological and electromagnetic irritants. Accidents may cause facial injuries that involve eyes of the clinicians, patients as well as dental assistants. Eye injuries can vary from mild irritation to blindness. The use of eye protection tools, such as protective goggles and visors, reduces the risk of eye damage or complete loss of vision while working with dangerous and floating materials. Therefore, all precautions should be taken, even when performing common procedures for which the risk expectancy is relatively low. Clinicians should be aware that they are also responsible for providing adequate protection for their assistants and patients, as well as themselves.

Work-related ocular events among Nigerian dental surgeons

Objective

Daily clinical activities in dental operatory expose dental surgeons to varied forms of ocular events. The purpose of the study was to determine the prevalence and pattern of ocular splashes and foreign bodies among dental surgeons in Nigeria.

Methods

This questionnaire-based cross-sectional of dental surgeons in Southern Nigeria was conducted between September 2010 and August 2011. The information elicited were demography, experience and type of ocular event, implicated dental procedure and action taken.

Results

Of the 185 studied, 148 of them responded. Of these 148 respondents, 56 (37.8%) reported foreign body, 18 (12.2%) splash, 33 (22.3%) both foreign body and splash while 41 (27.7%) reported no ocular event. It therefore means that the overall prevalence of ocular events among the respondents was 107 (72.3%). The prevalence of ocular events was significantly associated with age (p = 0.014), years of practice (p = 0.033) and safety eye goggle use (p = 0.023). The main dental procedures implicated in the ocular events among the respondents were scaling 77 (72.0%), tooth/cavity preparation 17 (15.9%), polishing 11 (10.3%) and forcep tooth extraction 10 (9.3%). The major implicated aetiological agents in the ocular events were calculus 74 (69.2%), saliva 29 (27.1%), mixed blood & saliva 19 (17.8%), tooth particles 15 (14.0%) and blood 9 (8.4%). The predominant action taken by the respondents was to rinse the eye under running water 89 (83.2%).

Conclusion

Ocular splash and foreign body events are high among dental surgeons in Nigeria. Age, years of practice and safety eye goggles wear were also found to be associated with ocular events. Eye safety awareness is therefore deemed a necessity for dental surgeon in Southern Nigeria.

Eye safety in operative dentistry — A study in general dental practice

AIM

In this safety conscious age all general dental practitioners should be promoting the use of eye protection. The aim of this study was to highlight the uptake of eye protection by all clinical staff and patients within the general dental practice setting, with regard to adequate protection and its use at appropriate times.

METHOD

Questionnaires were sent to 200 GDPs, chosen at random, to accumulate information on the use of protection, the preferred methods of eye protection and any experience of ocular injury.

FINDINGS

Eighty-seven per cent of GDPs wore eye protection routinely, but their choice of protection was not always adequate and not worn for all procedures. Forty-eight per cent of GDPs had experience of ocular trauma or infection which occurred during a variety of procedures; 75% of these injuries resulted from not wearing eye protection. In contrast less than half of the DNs and Hygienists use protection routinely, particularly when cleaning contaminated instruments. However, hygienists did wear eye protection for the majority of their patient work (96%).

CONCLUSION

Eye protection use by all staff and patients is currently suboptimal to conform to published guidelines. Risks encountered within the dental environment do cause harm to the unprotected eye, which can be reduced or even eliminated by improving the uptake of suitable eye protection; several choices for eye protection are available. Each individual dentist is responsible for the uptake of eye protection for all persons in their surgery environment.

Precautions against cross-infection during operations for maxillofacial trauma

One hundred oral and maxillofacial units in the UK were sent a postal questionnaire. Surgical staff of all grades were asked which infection-control measures were taken during the treatment of maxillofacial fractures. Two hundred and ninety-four questionnaires were completed, a response rate of 49%. If the patient was known to be infected by a blood-borne viral disease, significantly more surgeons used standard barrier precautions such as eye protection, fluid-resistant gowns, drapes, ball-ended clips, adhesive tapes and intermediate trays (P<0.0001). Bone-plating techniques were used in preference to wire osteosynthesis (P<0.0001). Only 31 (10.5%) of surgeons routinely used double gloves but 250 (85%) did so if the patient was an infection risk (P<0.0001). Universal precautions were not applied equally to all patients.

Should patients with facial fractures be regarded as high risk for HIV?

OBJECTIVE

To determine the prevalence of HIV seropositivity in patients with facial fractures in Edinburgh, UK.

DESIGN

A prospective study of 100 consecutive patients in 1994.

SETTING

Department of Maxillofacial Surgery, City Hospital, Edinburgh, UK.

SUBJECTS

100 patients with facial fractures who were willing to participate in the study.

MAIN OUTCOME MEASURES

Details of facial fractures. Assessment of risk factors for HIV. The seroprevalence of HIV based on unlinked anonymous testing of saliva.

RESULTS

None of the participants were HIV positive on saliva testing. Nine patients were found to have one or more risk factors for HIV. Eight patients had been tested for HIV previously.

CONCLUSION

Direct history taking appears to be effective in eliciting risk factors for HIV. A detailed risk factor history should be taken for all patients with facial fractures. Continuation of this study may establish whether or not there is a link between facial bone fractures and HIV seropositivity.