Relationships among and demographic predictors of dentists' self-reported adherence to national guidelines

Outbreak of bacterial endocarditis associated with an oral surgery practice: New Jersey public health surveillance, 2013 to 2014

BACKGROUND

In October and November 2014, the New Jersey Department of Health received reports of 3 patients who developed Enterococcus faecalis endocarditis after undergoing surgical procedures at the same oral surgery practice in New Jersey. Bacterial endocarditis is an uncommon but life-threatening condition; 3 patients with enterococcal endocarditis associated with a single oral surgery practice is unusual. An investigation was initiated because of the potential ongoing public health risk.

METHODS

Public health officials conducted retrospective surveillance to identify additional patients with endocarditis associated with the practice. They interviewed patients using a standardized questionnaire. An investigative public health team inspected the office environment, interviewed staff, and reviewed medical records.

RESULTS

Public health officials identified 15 confirmed patients with enterococcal endocarditis of those patients who underwent procedures from December 2012 through August 2014. Among these patients, 12 (80%) underwent cardiac surgery. One (7%) patient died from complications of endocarditis and subsequent cardiac surgery. Breaches of recommended infection prevention practices were identified that might have resulted in transmission of enterococci during the administration of intravenous sedation, including failure to perform hand hygiene and failure to maintain aseptic technique when performing procedures and handling medications.

CONCLUSIONS

This investigation highlights the importance of adhering to infection prevention recommendations in dental care settings. No additional patients with endocarditis were identified after infection prevention and control recommendations were implemented.

PRACTICAL IMPLICATIONS

Infection prevention training should be emphasized at all levels of professional dental training. All dental health care personnel establishing intravenous treatment and administering intravenous medications should be trained in safe injection practices.

Advancing infection control in dental care settings: factors associated with dentists' implementation of guidelines from the Centers for Disease Control and Prevention

BACKGROUND AND OVERVIEW

The authors set out to identify factors associated with implementation by U.S. dentists of four practices first recommended in the Centers for Disease Control and Prevention's Guidelines for Infection Control in Dental Health-Care Settings-2003.

METHODS

In 2008, the authors surveyed a stratified random sample of 6,825 U.S. dentists. The response rate was 49 percent. The authors gathered data regarding dentists' demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the guidelines and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of those factors on the implementation of four recommendations: having an infection control coordinator, maintaining dental unit water quality, documenting percutaneous injuries and using safer medical devices, such as safer syringes and scalpels. The authors conducted bivariate analyses and proportional odds modeling.

RESULTS

Responding dentists in 34 percent of practices had implemented none or one of the four recommendations, 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations. The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices and had at least three sources of instruction regarding the guidelines. Dentists with practices in the South Atlantic, Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied.

CONCLUSIONS

Implementation of the four recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control, increasing continuing education requirements and developing multiple modes of instruction may increase implementation of current and future Centers for Disease Control and Prevention guidelines.

Correlates of infection control practices in dentistry

BACKGROUND

Studies conducted in the first decade of the AIDS epidemic indicated that, in general, dentists had suboptimal levels of compliance with standard infection control practices, including work practices designed to reduce exposure to bloodborne pathogens. This study was designed to assess current rates of compliance with these practices in a population of Maryland dentists and to identify correlates of safe work practices.

METHODS

We surveyed 648 Maryland dentists using a confidential, self-administered questionnaire.

RESULTS

Three hundred and ninety-two questionnaires were returned (60% response rate). We found that infection control practices were variable as reported by responding dentists. In addition, several potentially modifiable factors were found to be significantly correlated with these practices, including (1) attitudes toward patients infected with HIV and (2) safety program management within the practice.

CONCLUSION

These data are encouraging in that recommended infection control practices are being adopted, at least among a sample of Maryland dentists. Strategies for further improvement are identified.

Clinical practice and the perceived importance of identifying high risk patients

The Royal Free NHS Trust is implementing a Universal Precautions policy for blood and body fluids. Anticipating the introduction of this policy, a questionnaire was sent to a sample of staff and students who work with patients or clinical specimens. The questionnaire covered: views about identifying 'high risk' patients and specimens; perceived risks of human immunodeficiency virus (HIV) and hepatitis B infection from blood exposures; and current practices to avoid exposure to blood. Over half the respondents thought it important to identify high risk patients and specimens. Such respondents were more likely to overestimate the risks of HIV and hepatitis B virus transmission after blood exposures, they were less likely to wear gloves and more likely to resheathe needles. Although two-thirds of respondents thought Universal Precautions would reduce their risk of blood-borne infections, they identified a number of reasons why it would be difficult for them to practice it. Those who thought it important to identify high risk patients gave more reasons than other respondents. This survey indicates that many staff believe it is important to identify high risk patients and this belief seems to influence clinical practice. In order to implement a policy of Universal Precautions successfully, it is necessary to address underlying beliefs as well as giving staff information and training.

Early childhood tooth decay. Pediatric interventions

Pediatricians in the greater Chicago area were surveyed to probe their awareness and approaches to management of dental caries in early childhood. A total of 298 pediatricians (21% of those surveyed) responded to the questionnaire. Ninety-five percent of the respondents stated they examined their patients' teeth; 85% considered dental examinations part of their responsibility for children under 3 years of age. However, our data suggest that many pediatricians are unaware of the decay and the dietary patterns associated with tooth decay in early childhood. Although 96% of the respondents referred patients to a dentist when decay was diagnosed, analysis of diet and dietary counseling were performed by only 61% and 65% of the respondents, respectively. Recommendations for preventive measures that can be adopted by pediatricians are offered.