Health care-associated transmission of hepatitis B & C viruses in dental care (dentistry)

Hepatitis B and C infections among Japanese dental health workers: Insights from vaccination rates and screening results in the Oita prefecture

OBJECTIVE

This study examined the hepatitis B virus (HBV) and hepatitis C virus (HCV) infection rates and vaccination rates for hepatitis B (HB) among dental healthcare workers (DHCWs) in the Oita prefecture, Japan.

METHODS

Hepatitis virus testing was conducted on 1920 participants (486 dentists and 1434 dental staff). Anonymous data on age, gender, occupation, hepatitis B surface antigen (HBsAg), antibodies to hepatitis B surface antigen (anti-HBs), antibodies to HCV (anti-HCV), history of HB vaccination, and antiviral treatment for individuals with positive anti-HCV were collected.

RESULTS

The positivity rates for HBsAg, anti-HBs, and anti-HCV were 0.5%, 39.7%, and 0.6%, respectively. Dentists had significantly higher rates of anti-HBs positivity (53.9% vs. 34.9%; p < .0001) and anti-HCV positivity (1.4% vs. 0.3%; p = .0080) compared to dental staff. The vaccination and non-vaccination rates among 1395 with a known HB vaccination history were 59.1% and 40.9%, respectively. Dentists had a significantly higher HB vaccine vaccination rate than the dental staff (73.6% vs. 54.0%; p < .0001). Those in the vaccination group were younger (p < .0001), had a higher proportion of males (p = .0022) and dentists (p < .0001), a lower HBsAg positivity rate (p < .0097), and a higher anti-HBs positivity rate (p < .0001) compared to those in the non-vaccination group. The positivity rate of HBsAg and anti-HBs in the unvaccinated group increased with age, with HBsAg positivity reaching 3.8% in the 70s and anti-HBs positivity reaching 40.4% in the 70s and 66.7% in the 80s.

CONCLUSIONS

This study highlights the need to raise awareness about hepatitis prevention vaccination, particularly among dental staff, due to differences in HB vaccination rates across occupations. In particular, they indicated that elderly DHCWs may be more vulnerable to HBV infection. Regular monitoring of the vaccination rate and infection risk is crucial.

HBV in Italian Women's Jail: An Underestimated Problem?

BACKGROUND

There is little information regarding the hepatitis B virus (HBV), vaccination status, and hepatitis B exposure in Italian women's jails. We aimed to describe the HBV exposure and HBs antibody (anti-HBs) protection levels in female prisoners.

MATERIAL AND METHODS

A retrospective multicentric study was performed in Italian prisons from 2021 to 2023. Univariate and multivariate analyses were conducted to identify risk factors for HBc antibody (anti-HBc) seropositivity and non-protective anti-HBs titer.

RESULTS

We included 156 patients. The median age was 41.0 (IQR 34.0-48.0). Of the studied subjects, 31 (19.9%) had anti-HBc positive titer. Two women were HBsAg positive. In the multivariate analysis, older age [OR 1.06 (CI 1.01-1.11), p = 0.011], North-Eastern European [OR 11.67 (3.29-41.30), p < 0.001] and African origin [OR 6.92 (CI 1.51-31.60), p = 0.013], and drug use [OR 6.55 (CI 1.96-21.9), p = 0.002] were risk factors for HBV exposure. Thirty-seven (32%) women had no history of HBV vaccination. Forty-four (38%) had an anti-HBs non-protective titer. In the multivariate analysis, North-Eastern European origin [OR 4.55 (CI 1.19-17.50), p = 0.027] was associated with unprotective anti-HBs titer.

CONCLUSION

Our results show both the low prevalence of HBV and protection in female prisoners. Age, North-Eastern European and African origin, and drug use have a role in exposure risk to HBV.

Aerosol generated by dental procedures: A scoping review

BACKGROUND

The current pandemic has raised awareness of aerosol dispersion in dental offices. This scoping review was conducted to assess the amount and spread of aerosol generated by dental procedures.

METHODS

This scoping review followed the PRISMA-ScR protocol and was conducted by searching multiple databases adopting a core search structure for each database. Detailed eligibility criteria were applied. The authors placed no restrictions on study design, year of publication, and study location. The literature search was updated on September 15, 2021.

RESULTS

A total of 51 papers were included in this scoping review. The risk of bias assessment was not conducted as per guidelines. The majority of studies found microorganisms, bloodstains, splatters of aerosol, and particles in the air part of the search strategy. Publication dates ranged from 1969 to 2021. Data came from different dental settings locations. Several factors were identified that have an effect on the amount and spread of the aerosol and spatter.

CONCLUSION

Although it is clear that the microbial contamination occurred mainly during aerosol-generating dental procedures, our understanding of the contamination level, spread, and half-life are limited.

Hepatitis B Vaccination Status in Dental Practitioners: Local Horrifying Report, National Considerable Issue, and Global Health Impact

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Precautions and recommendations for orthodontic settings during the COVID-19 outbreak: A review

Introduction

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2). It emerged as a global pandemic in early 2020, affecting more than 200 countries and territories. The infection is highly contagious, with disease transmission reported from asymptomatic carriers, including children. It spreads through person-to-person contact via aerosol and droplets. The practice of social distancing—maintaining a distance of 1-2 m or 6 ft—between people has been recommended widely to slow or halt the spread. In orthodontics, this distance is difficult to maintain, which places orthodontists at a high risk of acquiring and transmitting the infection. The objective of this review is to report to orthodontists on the emergence, epidemiology, risks, and precautions during the disease crisis. This review should help increase awareness, reinforce infection control, and prevent cross-transmission within the orthodontic facility.

Methods

A comprehensive literature review of English and non-English articles was performed in March 2020 using COVID-19 Open Research Dataset (CORD-19 2020), PubMed, MEDLINE, Scopus, and Google Scholar to search for infection control and disease transmission in orthodontics.

Results

This review emphasizes minimizing aerosol production and reinforcing strict infection control measures. Compliance with the highest level of personal protection and restriction of treatment to emergency cases is recommended during the outbreak. Surface disinfection, adequate ventilation, and decontamination of instruments and supplies following the guidelines are required.

Conclusions

Reinforcing strict infection control measures and minimizing personal contact and aerosol production are keys to prevent contamination within orthodontic settings. Although no cases of COVID-19 cross-transmission within a dental facility have been reported, the risk exists, and the disease is still emerging. Further studies are required.

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Coronavirus disease 2019 is a highly contagious global pandemic.

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It could transmit by asymptomatic carriers via person-to-person contact, aerosol, and droplets.

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Strict infection control and aerosol containment are required in orthodontic settings.

Introducing career skills for dental students as an undergraduate course at the University of Szeged, Hungary

BACKGROUND

In the last three decades there is a growing recognition in the dental profession that dental education must go beyond teaching the technicalities of dentistry and include professionalism and communication skills that the future dentist may need. Such skills are best taught in a student-centered way. Literature suggests that student-centered elements are difficult to introduce in traditional, teacher-centered curricula. This is especially true in post-communist countries where higher education was under strict state control for decades. The aim of the piece of research presented here was to investigate how difficult it is to introduce a student-centered career skills course in a traditionally teacher-centered dental curriculum.

METHODS

Considering the needs of our final-year dental students and Super's model of career development, we created an undergraduate curricular career skills course running for two semesters in two languages (Hungarian and English). The primary aim of the course is to help students with their career expectations and develop their identity as a professional workforce. The secondary aim is to teach skills that students can use when applying for a job. At the end of the semesters, we assessed our students' satisfaction with various aspects of the course by using a questionnaire. Results were analyzed item-wise and according to the main aspects of the course (i.e., groups of items organized around a particular aspect).

RESULTS

General satisfaction with the course was high, and practical skills training (such as CV and motivation letter writing) got the highest scores. From the answers it appears that the students were the least comfortable with having to deal with their personal values and preferences.

CONCLUSIONS

While it is common for universities to offer various forms of career intervention, to our knowledge, no other university offers a curricular career skills course specifically for dental students. Our student-centered course designed in a problem-based learning framework worked even in a traditionally teacher-centered educational environment, where university students are rarely encouraged to be active participants in courses. By sharing our experience, we would like to encourage our fellow dental educators working in similar environments to devise and offer such courses.

Prevalence of hepatitis B, C, and HIV among patients attending a teaching dental hospital. A 7-year retrospective study from the United Arab Emirates

Objectives

To determine the seroprevalence and case characteristics of hepatitis B, C and human immunodeficiency virus (HIV), and their transmissibility from patients to dental personnel following percutaneous and mucocutaneous injuries.

Methods

All incidents of sharp and splash injuries reported between January 2010 and January 2017 were retrospectively reviewed and analyzed. Descriptive statistics were calculated using the Statistical Package for the Social Science (SPSS). Prevalence was calculated as percentages, and chi-square test was used to assess categorical variables where a p-value of ≤0.05 was considered significant.

Results

Among the 436 reported incidents, 372 patients underwent serological screening. Fourteen patients (3.8%) had antibodies against hepatitis C virus, and 8 patients (2.2%) were positive for hepatitis B surface antigens. All positive cases were clinically asymptomatic. There were no positive cases for HIV. Three of the 14 hepatitis C positive patients were actively infectious upon polymerase chain reaction (PCR) analysis, but none of the injured dental personnel seroconverted upon a 6-month follow up. Approximately 88% of dental personnel were vaccinated against hepatitis B. Female personnel showed better vaccination rate by comparison to male personnel (p=0.005). Among the 5 different categories of professional status, cleaners showed a significantly low hepatitis B vaccination rate (p<0.000).

Conclusion

The prevalence of hepatitis B and C is higher than that previously reported from the United Arab Emirates, but transmissibility of viral hepatitis seems to be negligible.

The Barber Pole Might Have Been an Early Sign for Patient-Centered Care: What Do Interprofessional Education and Interprofessional Collaborative Practice Look Like Now?

In 2009, the Interprofessional Education Collaborative (IPEC) was initiated. Its release of interprofessional collaborative practice (ICP) core competencies in 2011 was pivotal for the engagement of health care professionals, including dentistry; in patient-centered, collaborative efforts for interprofessional education (IPE); and ICP. Thereby, IPEC is helping to put into application, in North America, the 2010 World Health Organization (WHO) Framework for Action on Interprofessional Education and Collaborative Practice. This article introduces IPE/ICP in 5 phases of evolution, emphasizing dental influence and inclusion, from historical perspectives through current applications that are expanded on in the accompanying articles elsewhere in this issue.

Ergonomic risk and preventive measures of musculoskeletal disorders in the dentistry environment: an umbrella review

Introduction

Dental practitioners are exposed to different occupational hazards during the course of their professional activity, such as physical, chemical, biological, ergonomic factors. The ergonomic hazards, caused by strained posture and prolonged repetitive movements, can induce musculoskeletal disorders. It occurs in 54–93% of dental professionals and involve the spine, shoulder and hand-wrist tract. Through a systematic review of international literature, we analyzed specific ergonomic risk factors and preventive measures of musculoskeletal disorders in professional dental activity.

Methods

This systematic review is coherent with the PRISMA statement. The scientific research on the major online databases was based on the following keywords: dentist, prevention, ergonomic, dentistry, musculoskeletal, neck pain, posture, ergonomics, work and occupational. The studies included in this review focus on disorders related to ergonomics and on the most effective preventive measures to be adopted. No restrictions were applied for language or publication type. We excluded reports not related to ergonomic prevention in dentistry, reports of minor academic significance, editorial articles, individual contributions, and studies published in scientific conferences.

Results

Online research indicated 4188 references: PubMed (2919), Scopus (1257) e Cochrane Library (12). We excluded 3012 of these, because they were unrelated to ergonomics theme and 187 due to duplication. From the remaining 989 studies, 960 papers did not meet inclusion criteria and they were excluded. Therefore, we analyzed 29 articles, including 16 narrative reviews and 13 original article. The main risk factor for the development of musculoskeletal disorders found in our analysis is static posture adopted during work, highlighted in 87.5% of reviews and 84% of original articles. With regard to preventive measures, 75% of the reviews highlighted the importance of stretching after each working session and at the end of the working day, while 61.5% of the original articles emphasized the use of modern and ergonomic instruments.

Discussion

This review showed that static postures are strongly responsible in the etiology of musculoskeletal disorders. The awkward postures more frequently identified among dental professionals are: extreme forward-head and neck flexion; trunk inclination and rotation towards one side; lifting one or both shoulders; increased curvature of the thoracic vertebral column; incorrect positioning of the lower limbs with thigh-leg angle of less than 90°. It is really important to use of a modern workstation with appropriate ergonomic supports. Among the preventive ergonomic measures, literature has widely recognized the role of physical activity and of a neutral and balanced posture. The present review has some limits: a large part of the selected studies did not have a high methodological quality score and an inadequate statistical analysis.

Transmission of blood-borne pathogens in US dental health care settings: 2016 update

BACKGROUND

During the past decade, investigators have reported transmissions of blood-borne pathogens (BBPs) in dental settings. In this article, the authors describe these transmissions and examine the lapses in infection prevention on the basis of available information.

METHODS

The authors reviewed the literature from 2003 through 2015 to identify reports of the transmission of BBPs in dental settings and related lapses in infection prevention efforts, as well as to identify reports of known or suspected health care-associated BBP infections submitted by state health departments to the Centers for Disease Control and Prevention.

RESULTS

The authors identified 3 published reports whose investigators described the transmission of hepatitis B virus and hepatitis C virus. In 2 of these reports, the investigators described single-transmission events (from 1 patient to another) in outpatient oral surgery practices. The authors of the third report described the possible transmission of hepatitis B virus to 3 patients and 2 dental health care personnel in a large temporary dental clinic. The authors identified lapses in infection prevention practices that occurred during 2 of the investigations; however, the investigators were not always able to link a specific lapse to a transmission event. Examples of lapses included the failure to heat-sterilize handpieces between patients, a lack of training for volunteers on BBPs, and the use of a combination of unsafe injection practices.

CONCLUSIONS

The authors found that reports describing the transmission of BBPs in dental settings since 2003 were rare. Failure to adhere to Centers for Disease Control and Prevention recommendations for infection control in dental settings likely led to disease transmission in these cases.

PRACTICAL IMPLICATIONS

The existence of these reports emphasizes the need to improve dental health care personnel's understanding of the basic principles and implementation of standard precautions through the use of checklists, policies, and practices.

Health care-associated hepatitis C virus infection

Hepatitis C virus (HCV) is a blood-borne pathogen that has a worldwide distribution and infects millions of people. Care-associated HCV infections represented a huge part of hepatitis C burden in the past via contaminated blood and unsafe injections and continue to be a serious problem of public health. The present review proposes a panorama of health care-associated HCV infections via the three mode of contamination that have been identified: (1) infected patient to non-infected patient; (2) infected patient to non-infected health care worker (HCW); and (3) infected HCW to non infected patient. For each condition, the circumstances of contamination are described together with the means to prevent them. As a whole, the more important risk is represented by unsafe practices regarding injections, notably with the improper use of multidose vials used for multiple patients. The questions of occupational exposures and infected HCWs are also discussed. In terms of prevention and surveillance, the main arm for combating care-associated HCV infections is the implementation of standard precautions in all the fields of cares, with training programs and audits to verify their good application. HCWs must be sensitized to the risk of blood-borne pathogens, notably by the use of safety devices for injections and good hygiene practices in the operating theatre and in all the invasive procedures. The providers performing exposed-prone procedures must monitor their HCV serology regularly in order to detect early any primary infection and to treat it without delay. With the need to stay vigilant because HCV infection is often a hidden risk, it can be hoped that the number of people infected by HCV via health care will decrease very significantly in the next years.

Management of an incident of failed sterilization of surgical instruments in a dental clinic in Hong Kong

BACKGROUND/PURPOSE

We describe an investigation of an incident of failed sterilization procedure in a dental clinic. We aim to illustrate the principles in performing such investigations and to highlight some of the important checkpoints in sterilization procedures.

METHODS

In response to this incident, proper sterilization of all equipment was performed immediately. On-site investigation was conducted by the investigation panel to identify the cause and risks, to coordinate post-exposure management in affected patients, and to make recommendations to prevent similar occurrence of such incidents in the future.

RESULTS

The incident was due to a rare lapse of monitoring during the autoclaving cycle. A total of 127 sources and 250 exposed patients were identified within 24 hours of the discovery of the incident for risk assessment and testing for blood-borne viruses, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). A protocol was devised to manage the exposed patients against HBV, HCV, and HIV. Immunization and hyperimmune globulin for hepatitis B, and tetanus toxoids were given to the exposed patients where indicated. Exposed patients were followed-up for 6 months. We came to the decision that dating of instrument packages and signed documentation of each autoclave printout, color change of chemical indicators of each load and daily autoclave performance should be made mandatory with immediate effect.

CONCLUSION

Rapid response is extremely crucial in minimizing the impact of this incident and relieving the anxiety of the affected patients. Proper recording and documentation of autoclave cycles and regular auditing should be enforced to prevent similar incidents.

Hepatitis B virus transmissions associated with a portable dental clinic, West Virginia, 2009

BACKGROUND

Although hepatitis B virus (HBV) transmission in dental settings is rare, in 2009 a cluster of acute HBV infections was reported among attendees of a two-day portable dental clinic in West Virginia.

METHODS

The authors conducted a retrospective investigation by using treatment records and volunteer logs, interviews of patients and volunteers with acute HBV infection as well as of other clinic volunteers, and molecular sequencing of the virus from those acutely infected.

RESULTS

The clinic was held under the auspices of a charitable organization in a gymnasium staffed by 750 volunteers, including dental care providers who treated 1,137 adults. Five acute HBV infections-involving three patients and two volunteers-were identified by the local and state health departments. Of four viral isolates available for testing, all were genotype D. Three case patients underwent extractions; one received restorations and one a dental prophylaxis. None shared a treatment provider with any of the others. One case volunteer worked in maintenance; the other directed patients from triage to the treatment waiting area. Case patients reported no behavioral risk factors for HBV infection. The investigation revealed numerous infection control breaches.

CONCLUSIONS

Transmission of HBV to three patients and two volunteers is likely to have occurred at a portable dental clinic. Specific breaches in infection control could not be linked to these HBV transmissions.

PRACTICAL IMPLICATIONS

All dental settings should adhere to recommended infection control practices, including oversight; training in prevention of bloodborne pathogens transmission; receipt of HBV vaccination for staff who may come into contact with blood or body fluids; use of appropriate personal protective equipment, sterilization and disinfection procedures; and use of measures, such as high-volume suction, to minimize the spread of blood.

Occupational hazards to dental staff

Dental professionals are predisposed to a number of occupational hazards. These include exposure to infections (including Human Immunodeficiency Virus and viral hepatitis); percutaneous exposure incidents, dental materials, radiation, and noise; musculoskeletal disorders; psychological problems and dermatitis; respiratory disorders; and eye insults. Percutaneous exposure incidents remain a main concern, as exposure to serious infectious agents is a virtual risk. Minimizing percutaneous exposure incidents and their consequences should continue to be considered, including sound infection control practices, continuing education, and hepatitis B vaccination. Basically, for any infection control strategies, dentists should be aware of individual protective measures and appropriate sterilization or other high-level disinfection utilities. Strained posture at work disturbs the musculoskeletal alignment and leads to stooped spine. The stooped posture also involved certain groups of muscles and joints. This may lead to diseases of the musculoskeletal system. Continuous educating and appropriate intervention studies are needed to reduce the complication of these hazards. So, it is important for dentists to remain constantly up-to-date about measures on how to deal with newer strategies and dental materials, and implicates the need for special medical care for this professional group.