Ground zero


Infection-control-guidelinesAfter last year’s infection control scares, the Dental Board has streamlined the information process to help practitioners keep up with the continual evolution of infection control guidelines, writes John Burfitt.

With words like ‘hepatitis’ and ‘HIV’ alongside the title of ‘dentist’ in the headlines of July last year, there was little good news for the dental industry in the media stories about the hygiene breaches and fears of infection within a number of Sydney dental clinics.

The stories detailed the cases of breaches of infection control at the clinics, which resulted in the reported suspension of at least five dentists, while another three had conditions placed on their registrations.

The most revealing admission about the experience, however, came from one of the dentists involved—industry veteran, Dr Robert Starkenburg. He admitted he had difficulties keeping up with the ever-changing regulations about infection controls. Dr Starkenburg was quoted in The Sydney Morning Herald as saying, “In the last eight years, they have upgraded the protocols a lot.”

He was not the only dentist to have thought so, or indeed struggled to keep up with the continual evolution of dental infection control guidelines. Adelaide’s Dr Peter Alldritt, chair of the Australian Dental Association’s Oral Health Committee, states that monitoring the guidelines needs to be a constant part of a dentist’s job: “It is our responsibility as practitioners dealing with patients to check through all those details and always be [up to date] with the latest information coming through,” Dr Alldritt says. “But sometimes it can be challenging to follow what has stayed the same, what has changed and what the new recommendations are. One of the most important things is for the appropriate boards to offer simple, direct messages to follow.”

Getting up to speed

In October, only months after the infection scare, the Dental Board of Australia joined with the Australian Health Practitioner Regulation Agency to host a forum on effective infection prevention and control by dental practitioners. The forum reviewed the current guidelines and explored the expected standards of infection prevention and control practice, and the resources available to meet those standards.

As a result, the Dental Board has since issued further advice to registered dental practitioners, stressing the need to have a comprehensive infection control manual in their practice, and to adhere to three detailed documents so all practice staff meet the current standards.

“One of the most important things is for the appropriate boards to offer simple, direct messages to follow if they want them to be acted upon.”—Dr Peter Alldritt, Australian Dental Association Oral Health Committee

Those three core documents are the NHMRC Guideline for the Australian Guidelines for the Prevention and Control of Infection in Healthcare, the Australian and New Zealand Standard 4815, which covers office-based practice, and the current edition of the ADA Infection Control Guidelines. The Dental Board has also advised registrants that the Australian National Guidelines for the Management of Health Care Workers for workers known to be infected with blood-borne viruses are relevant to dentistry. Based on these core documents, each dental practice must prepare their own manual, outlining how the requirements in those core standards and guidelines are being implemented at that particular workplace.

With all these reference documents providing a wealth of information and presenting new inclusions, alterations and omissions, there is little surprise that the Dental Board’s website includes the telling admission. It states: “It was acknowledged at the forum that it is sometimes confusing for dental practitioners to understand how each of the different reference documents listed in the Board’s Guidelines apply to their practice. You should be familiar with each of these documents and think about how they apply to you and your workplace.”

What has been presented is not new information—but is now clearer, better presented and easier to follow, says Professor Laurence Walsh, editor of the ADA’s Infection Control Guidelines.

“That’s probably been the single biggest learning from the events of last year, that when it comes to infection controls, anyone working in a dental practice has a responsibility to follow the guidelines,” he says.

“By putting out this clear set of guidelines on the website, the Board is reminding dentists that these core documents do change and do get updated, and it is up to everyone to make sure they have the latest materials to refer to.”

The three core guidelines present a national approach to the topic, to be considered the definitive resource on the topic in the wake of the confusion between various state health departments on what were relevant practises and what were not.

Included with the latest advice are a fact sheet and a frequently asked questions section.

The latest guidelines, released in October 2015, have an accompanying self-assessment tool as an attempt to refine the volume of information to just the essential points.

“In dentistry, we have practitioners who are ‘lumpers’ and some who are ‘splitters’, and our approach is to appeal to both groups,” Professor Walsh explains. “The lumpers want things that have been worked out for them, with the message clear and simple for them to follow.

“For the splitters, we have produced the Practical Guide to Infection Control Guidelines, which is a mini textbook with 23 chapters, each of which covers a particular topic in great detail.”

Where it gets tricky

The main areas of confusion that have been presented as regular queries to both the ADA and the Dental Board
in recent years about infection control refer to sterilisation processes and
hand hygiene.

“We get a lot of questions about the quality of processes with sterilisation, and the suitability of steam sterilisers for certain things, and what the different cycles are suitable for,” Professor Walsh adds.

“We still get questions about hand hygiene and alcohol-based gels and whether they are scientifically good or not. On these issues, the dentists just want evidence and some direction.”

Two areas of confusion that Dr Peter Alldritt has noticed are batch-control identification—documenting which equipment has been used for which patients—and immunisation. “With the instruments, I know some people are unsure if they need to use batch codes for instruments for all patients or only some, such as those having oral surgery,” he says. “Some people are also questioning immunisation and choosing not to be tested for infections like hepatitis B, but the Board’s position recommends that everyone is.”

No delegation

Dr Sharon Liberali, chair of the ADA’s Infection Control Committee, believes the main misunderstanding is about just who is responsible for infection control procedures in a practice. She hopes the new guidelines resource will mark a turning point for the industry.

“The greatest confusion for many practitioners is they are not completely aware it is their personal responsibility to ensure correct infection control procedures are followed in the clinic environment, and they actually agree to this responsibility each time they re-register with the Dental Board of Australia,” she says. “This is the case whether you are an employee dentist or an employer dentist. This is a responsibility that we can’t delegate.”

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