Percutaneous exposures to HIV-infected blood. Among dental workers enrolled in the CDC Needlestick Study

Exposure to Biological Fluids in Dental Practice-Narrative Review on Appropriate Risk Assessment to Guide Post-Exposure Management

Accidental exposure to blood or other biological fluids is a common occurrence in dentistry, and its post-exposure management is a key component of infection prevention and control programs designed to prevent the transmission of blood-borne pathogens such as hepatitis B and C viruses (HBV, HCV) and human immunodeficiency virus (HIV). This narrative review aims to comprehensively review the risk assessment process for each of these pathogens at all steps of the epidemiological process, i.e., source-exposure route-receptive person, in order to provide a better understanding of the delicate differences that influence the transmission risk and that drive the individualized post-exposure management.

Human Immunodeficiency Virus (HIV) Transmission in Dentistry

HIV transmission in the health-care setting is of concern. To assess the current position in dentistry, we have reviewed the evidence to November 1, 2005. Transmission is evidently rare in the industrialized nations and can be significantly reduced or prevented by the use of standard infection control measures, appropriate clinical and instrument-handling procedures, and the use of safety equipment and safety needles. We hope that breaches in standard infection control will become vanishingly small. When occupational exposure to HIV is suspected, the application of post-exposure protocols for investigating the incident and protecting those involved from possible HIV infection further reduces the likelihood of HIV disease, and also stress and anxiety.

Dental practice, human immunodeficiency virus transmission and occupational risks: views from a teaching hospital in Nigeria

Background:

More than 40 oral manifestations of human immunodeficiency virus (HIV) infection have been recorded and between 70% and 90% of persons with HIV infection will have at least one oral manifestation at some time during the course of their disease. Oral health-care workers (OHCWs) are therefore, key players in the prevention and management of HIV-infection.

Aim:

The aim of this study was toassess the perceptions of the OHCWs from a Teaching Hospital in Nigeria toward HIV transmission in dental practice and occupational risk.

Subjects and Methods:

A cross-sectional study. A self-administered questionnaire was used for data collection. A total of 113 OHCWs comprising students, house officers, resident doctors, dental nurses and consultants participated. Analysis was by Statistical Package for the Social Sciences version 17 (SPSS Inc., Chicago, IL, USA). Data analysis included descriptive statistics (frequency distribution and cross tabulation).

Results:

More than half 64/113 (56%) of the respondents were in the age group 20-30 years and females 68/113 (60%). Though 88% (100/113) of the respondents demonstrated a good knowledge about HIV transmission, 82/113 respondents (72%) disagreed that the risk of HIV transmission in the dental clinic was very low. 82.4% (93/113) did not know that saliva contains anti-HIV activity while 46% (52/113) agreed that pure saliva does not contain the virus except when contaminated by blood. 86.7% (98/113) of the OHCWs disagreed that dental professionals have a lower risk of being infected with HIV compared with other health-care providers.

Conclusion:

The OHCWs studied manifested some inaccurate perception of occupational risks as regards HIV transmission in dental practice. This could lead to potential stigma and discrimination of people living with HIV/acquired immune deficiency syndrome and thus hindering efforts geared at curtailing the spread of the virus.

HIV transmission in the dental setting and the HIV-infected oral health care professional: workshop 1C

This workshop addressed two important issues: first, the global evidence of HIV transmission from health care provider to patient and from patient to health care provider in the general health care environment and the dental practice setting; second, in the era of highly active antiretroviral therapy, whether oral health care professionals living with HIV pose a risk of transmission to their patients and whether standard infection control is adequate to protect both the patient and the oral health care professional in dental practice. The workshop culminated in a general discussion and the formulation of a consensus statement from the participating delegates, representing more than 30 countries, on the criteria under which an HIV-infected oral health care professional might practice dentistry without putting patients at risk. This consensus statement, the Beijing Declaration, was agreed nem con.

[Assessing knowledge, attitude, and practice on occupational blood exposure in caregiving facilities, in Morocco]

OBJECTIVE

This study had for aim to evaluate practices and knowledge of infectious hazards, to determine the prevalence of viral infections related to occupational blood exposure among health care workers, and to propose a preventive policy.

DESIGN

This descriptive multicentric and transversal epidemiological survey was carried out from 2003 to 2004 in 10 Moroccan cities. Two thousand eight hundred and forty four persons were contacted and 2086 accepted to answer the questionnaire (73.3 %).

RESULTS

The mean age was 40.8+/-7.8 years and seniority 15.6+/-7.4 years. Blood was the most incriminated product (96.1%), followed by dirty linen and hospital waste. Instruments most often mentioned as dangerous were hollow needles (80.3%). The most feared infections were viral hepatitis (77.5%) and HIV (89.3%). Only 40.6% of the personnel were adequately vaccinated against hepatitis B. Post-vaccine serology was performed on only 1.8% of the vaccinated staff. During the last 12 months, 58.9% of the personnel underwent at least one occupational blood exposure 5.8% of which was reported. Universal precautions appeared poorly used as only 65.6% wore gloves for invasive acts and 61.5% correctly disinfected their hands. Re-sheathing used needles was frequent (51.2%).

CONCLUSIONS

Infectious hazards in healthcare facilities are not sufficiently taken into account: the recent creation of occupational health services in hospital facilities should contribute to improve working conditions, make hepatitis B vaccination available and mandatory, and lead to more information and education on hazards related to occupational blood exposure for healthcare personnel.

Percutaneous injuries of dental personnel at the University of the West Indies, School of Dentistry

AIM

To report the results of a survey of all percutaneous injuries occurring in 2003-2004 to staff and students at the dental school in Trinidad.

METHOD

Data were collected via 163 questionnaires administered to all dental surgery assistants, the current clinical students (years 3, 4 & 5), the interns, part-time and full-time academic staff.

RESULTS

A 71% response rate was obtained. The number of persons reporting one or more sharps injuries at the dental school was 42 (37%). Of these, 17 (40%) were percutaneous. Needlesticks and periodontal scaler injuries were the most common. There was no significant correlation (p>0.05) between injury and gender, age group, dominant hand or needle recapping technique. 75% of respondents described their concern of contracting a blood-borne disease from a sharps injury as "high" and 59% of the respondents followed the school's recommended protocol following the injury. 50% of the injuries among the students and interns were not reported.

CONCLUSIONS

A more rigorous programme of risk management with respect to sharps injuries needs to be designed and implemented at the school. There is also a need to improve surveillance of and reduce the underreporting of these injuries.

Occupational exposures to human immunodeficiency virus, hepatitis B virus, and hepatitis C virus: risk, prevention, and management

Current data indicate that the risk for transmitting bloodborne pathogens in dental health care settings is low. Pre-exposure hepatitis B vaccination and the use of standard precautions to prevent exposure to blood are the most effective strategies for preventing DHCP from occupational infection with HIV, HBV or HCV. Each dental health care facility should develop a comprehensive written program for preventing and managing occupational exposures to blood that: (1) describes the types of blood exposures that may place DHCP at risk for infection; (2) outlines procedures for promptly reporting and evaluating such exposures; and (3) identifies a health care professional who is qualified to provide counseling and perform all medical evaluations and procedures in accordance with the most current USPHS recommendations. Finally, resources should be available that permit rapid access to clinical care, testing, counseling, and PEP for exposed DHCP and the testing and counseling of source patients.

Transmission of HIV in the dental clinic and elsewhere

This review focuses on the risk of transmission of HIV in dental practice in developed and developing countries; and as a result of oral sex, perinatal transmission and breast feeding. Postexposure prophylaxis (PEP) and practical measures to control cross-infection with TB are also discussed. There are few data from resource-poor countries where prevalence of HIV and risk of infection are higher--issues that deserve priority. Available information indicates that the risk of HIV transmission in the dental office is very low. Transmission of HIV from three healthcare workers to patients has been confirmed, including a dentist who infected six patients. There are >300 reports (102 confirmed) of occupational transmission to healthcare workers, including nine dental workers (unconfirmed). Exposure to HIV has been reported by 0.5% dentists/year. The risk of HIV infection after percutaneous exposure (0.3%) can be reduced by 81% with zidovudine PEP. However, risk assessment is required to assess the need and appropriate regimen. The risk of HIV transmission associated with orogenital sex exists, but is considered extremely low: barrier protection is recommended. Conversely, the proportion of babies who acquire HIV from untreated HIV-seropositive mothers is 15-25% in developed countries and 25-45% in developing countries. The frequency of HIV transmission attributable to breastfeeding is 16%. Airborne transmission of TB can be avoided by the prompt referral of known/suspected cases of active TB for chemotherapy, deferral of elective procedures until patients are not infectious, and the use of appropriate standard/isolation precautions including adequate ventilation of treatment areas.

Prospective survey of percutaneous injuries in orthodontic assistants

This prospective diary survey provides documentation concerning the occurrence of percutaneous injury among orthodontic chairside assistants in the United States and Canada. A 20-day period was used to collect data regarding exposure to injuries; 693 valid responses were received from orthodontic assistants. Most chairside assistants in this sample work in a solo practice and average 33 hours per week treating patients for 49 weeks per year. The study identified a percutaneous injury rate of 0.11 for chairside assistants during this period, a rate than can be extrapolated to 1.4 episodes of percutaneous injury per year per chairside assistant. The majority of these injuries occurred outside the mouth. Those assistants with longer orthodontic experience had a lower injury rate than those with less experience. The rate of percutaneous injury to dental assistants was slightly higher than the annual rate (0.99) for orthodontists monitored by means of a companion survey and slightly lower than the rate (1.9) for a smaller sample of orthodontists from the American Dental Association survey of 1995. The annual rate of percutaneous injury for orthodontic chairside assistants is less than half of that observed for dentists in general practice.

A prospective survey of percutaneous injuries in orthodontists

This national survey provides documentation regarding typical orthodontic practice patterns in the United States, including the prevalence of percutaneous injuries. The sample reflects a similar geographic distribution of the population as a whole, with more practitioners located in areas with higher populations. Most practitioners in this sample were in solo full-time practice, averaging 35 hours per week, and treating patients for 47 weeks per year. A 20-day prospective period was used to collect data regarding exposure to percutaneous injuries. The study identified a mean percutaneous injury rate of 0.085 during a 20-day period for practicing orthodontists, a value that can be extrapolated to slightly less than one (0.99) percutaneous injury per orthodontist per year. The majority of these injuries (84%) occurred outside the mouth. This rate is approximately one third the rate reported for dentists in general practice.

National survey of endodontists and selected patient samples: infectious diseases and attitudes toward infection control

A survey was conducted of 591 patients from endodontic practices located in six large municipalities in the United States. A comparison was made between the self-reported incidence of transmissible diseases from patients medical histories to national statistics for the incidence of hepatitis B, herpes, tuberculosis, and HIV/AIDS. A national survey of 422 endodontists was also conducted. This survey was used to determine the beliefs and attitudes of practicing endodontists toward infection control techniques and infectious diseases. Compared with previous surveys, a trend toward increasing use of the hepatitis B vaccine, gloves, and greater acceptance of medically compromised patients was found.