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| 2010-22 |
| 22-1 |
ISSN (Print) 1013-9052
EISSN 1658-3558
The Saudi Dental Journal,
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia
| Tel. |
966-1-467-7328 |
| Fax. |
933-1-467-7308 / 966-1-467-7534 |
| Email |
saudidj@ksu.edu.sa |
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Infection control practice in private dental laboratories in Riyadh
Abdulaziz A. Al-Kheraif, BSc, MPhil, PhD, Fahmy A. Mobarak, BDS, MS, PhD Department of Dental Hygiene Faculty of Applied Medical Sciences King Saud University
BACKGROUND: In view of the risk of infection of dental health care workers and patients, interruption of possible chains of infection is to be demanded. OBJECTIVE: The objective of this study was to assess infection control practice in private dental laboratories in Riyadh City, Kingdom of Saudi Arabia. METHODS: The study was conducted on thirty-two private dental laboratories in Riyadh City regarding infection control practiced by these laboratories. The instrument of the study consisted of ten open-ended questions that were asked from the laboratories directors. RESULTS: A large percentage of the surveyed laboratories (87.5 %) did not implement any infection control protocol during their practice. The mean number of impressions received per week was 16. Most of the surveyed laboratories (90.6 %) had no way of communication with the clinics regarding the disinfection procedures. The results indicated that 62.5 % of the laboratories reported that they were aware that they may get infection from non-disinfected items. Only a small percentage (6.2%) of the laboratories added disinfecting agent to pumice slurry. Wearing laboratory coats was reported by 75% of the laboratory workers. The use of gloves during work was reported by 59.3% of the laboratories while 56.2% reported the use protective eyewear. Only 21.8% of the laboratories use face masks during work. CONCLUSIONS: Construction of infection control manuals that contain updated and recommended guidelines to ensure aseptic practice in private dental laboratories is highly recommended. Also, a way of communication between dentists and dental technicians regarding disinfection of laboratory items should be strongly encouraged.
The past two decades have produced more professional interest in the spread of infectious diseases in dental practice than perhaps any other period.1,2 However, the emergence of acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV), the re-emergence of resistant strains of tuberculosis and the world wide spread of hepatitis B and C viral infections have revived wide spread public fear and consensus about incurable and fatal infectious diseases.3-6
Public pressure has led inevitably to governmental intervention to require protective measures against disease transmission by health-care providing facilities, including dental settings.7 The reemphasis of infection control policy in dentistry that occurred during the last two decades has now resulted in impressive approaches to prevention of disease spread in the dental office.8 These approaches are directed toward patient protection and protection of the dental staff. However, in contrast to the dental treatment rooms and surgical operatories where infection control measures are rigidly recommended and regulated, the dental laboratories are often overlooked when planning effective infection control and exposure control measures.9 This constitutes threats to the safety of dental technicians, who may acquire pathogenic microorganisms from impressions and other items contaminated with patient blood or saliva.10,11 Cross infection may occur among dental staff and patients from contaminated items sent from the dental laboratories to dental clinics.12 The dental health care personnel (DHCP) refers to all personnel in the dental health care settings who might be occupationally exposed to infectious materials including body substances and contaminated supplies.13 The DHCP include dentists, dental hygienists, dental assistants and dental laboratory technicians.13 Dental patients and DHCP can be exposed to multiple pathogenic microorganisms including cytomegalovirus (CMV), hepatitis B virus (HBV), hepatitis C virus, herpes simplex virus, (HIV), Mycobacterium tuberculosis, staphylococci, streptococci and other viruses and bacteria that colonize or infect the oral cavity and respiratory tract.13 These organisms can be transmitted in dental settings through (1) direct contact with blood, oral fluids or other patient materials and (2) indirect contact with contaminated objects.14 Dental prostheses and appliances, as well as items used in their fabrication (impressions, occlusal rims and bite registrations), are potential sources for cross-contamination and should be handled in a manner that prevents exposure of DHCP, patients, or the office environment to infectious agents.15, 16 Effective communication and coordination between the dental laboratory and dental clinic will ensure that appropriate cleaning and disinfection procedures are performed either in the dental office or laboratory so that disinfection is guaranteed but duplication of procedures is avoided.17 Infection control practice must therefore cover all aspects of dental activities. In Saudi Arabia, no data is available regarding infection control practice in dental laboratories in Riyadh. However, such data would be needed in evaluation of infection control procedures in the dental settings. Therefore, the objectives of the present study were: (1) To survey infection control practice performed by private dental laboratories in Riyadh City and (2) To evaluate communication between dentists and dental technicians regarding disinfection of laboratory items.
A list of 50 privately owned dental laboratories in Riyadh City, Saudi Arabia was obtained from the Ministry of Health. Only 32 (64%) laboratories were located, while the rest, because of improper information regarding addresses could not be located and therefore were not included in the survey. The instrument of the study consisted of ten open-ended questions that were asked of laboratories directors through direct personal interviews. All directors stated that they were quite familiar with infection control regimen performed in their laboratories.
The survey questions were pilot-tested via ten-minute interviews with ten consecutive students in their final year from the Dental Technology Department, College of Applied Medical Sciences, King Saud University. Responses from the pilot tests were analyzed to assess the clarity and relevance of the questions. Consequently, necessary modifications were carried out based on the feed-back from pilot-test participants. The study was carried out between January and May 2007. The survey requested respondents to provide data regarding the number and types of impressions received by the laboratory each week, the manner in which the impressions were received from the clinic, the infection control protocol (ICP) implemented by the laboratory, awareness of the possibility of getting infection from contaminated impressions, communication between the laboratory and the clinic about disinfection procedure, addition of disinfectant to pumice slurry and types of personal protective equipments used in the laboratory.
The mean number of impressions received per laboratory was 16 (range 10¬30). The results showed that 47 % of the received impressions were of the rubber type, while 40 % were alginate and 13 % were made of other materials. The results indicated that 31 % of the impressions were received from the clinics in plastic box, 28% in sealed plastic bag and 41% were received wrapped in tissue papers or unwrapped.
Infection control forms an important part of practice for all health care professions and remains one of the most cost-beneficial interventions available.18 The British Dental Association (BDA) stated that "infection control is a core element of dental practice" and the BDA fully supports its members in achieving excellence in this area.19 We studied infection control practice in private dental laboratories because they often lack rigid supervision regarding occupational safety rules that are commonly practiced in universities and hospitals. Today, the formally trained and certified dental technician is recognized as a broadly educated and highly skilled artisan who candemonstrate the ability, understanding and credentials as a key member of the modern restorative dental health care team. Nevertheless, optimization of this health care team is sometimes hampered by a lack of understanding and communication about infection control.
The aim of this investigation was to highlight the area of infection control procedures in private laboratories in Riyadh to assure proper safety for DHCP and patients as well. This study showed that 87.5% of the surveyed laboratories did not implement any ICP and this percentage is relatively high compared to developed countries such as United Kingdom.20 The other important finding in the study was that only 9.4% of the laboratories received known disinfected impressions. This finding is similar to that obtained by other reported studies.20-24 This study supports previous studies which showed that few dentists working in private dental sector in Riyadh were conversant with proper infection control measures in dental practice.25 Disinfection of impressions is now considered a routine procedure in dental settings in countries like USA and UK.26-32 The results of the present study showed that the lack of communication between the dental offices and commercial dental laboratories regarding handling and decontamination of dental items was high at 90.6%. The results are in agreement with the study by Kugel et al.21 about communication practice between dental laboratories and dental clinics regarding disinfection procedures. Anil et al. 33 recommended that communication between the dental laboratory and the dental staff regarding disinfection procedures performed for both items sent to or received from the laboratories should be in a written form. Previous microbiological reports found that non-disinfected impressions are capable of transmitting microorganisms to dental laboratory technicians and alginate material transmits more bacteria than silicon impressions.34-37 Results of the present study indicated that 62.5% of the laboratories were aware of the possibility of getting infection from non-disinfected items while 37.5% were not aware of that. Although, the awareness about cross infection was high, this study showed a lack of general attitude in using the personal protective equipments (coat, glove, eye wear, masks) during work. These findings are in agreement with previous studies which documented that 44% of dental technicians in England wore protective gloves when working on materials delivered from offices, 15% wore gloves for about 50% of their working time and 26% of them did not use protective gloves at all.20 The lack of use of these personal protective equipments explained the high prevalence of ocular injury and foreign bodies in the eyes of dental technicians during practice.38-43 Only 6.2 % of the surveyed laboratories added disinfecting solution to the pumice slurry. The results are in agreement with the study by Jagger et al.20 who reported that about 61% of dental laboratories used no disinfectant in the pumice and 93% did not disinfect the polishing instruments, e.g., wheels and mops. Verran et al.44 in their 1997 study documented that both clinical and non-clinical (teaching) laboratories are not immune from the presence of potentially pathogenic microorganisms in pumice slurry and stated that disinfection reduced contamination by oral microorganisms. Williams et al.45 documented the presence of fungi in used dental laboratory pumice which presented an unhygienic condition in the dental laboratory and which could place dental laboratory technicians and denture patients at increased risk of fungal sensitization and disease. On the other hand, Witt and Hart46 proved that pumice slurry freshly made up using disinfectant was reported to be free from contamination. Literature indicated that pathogen of tuberculosis (Mycobacterium tuberculosis] remains dangerous for several weeks.13,39 Other studies showed that HBV could survive in dried blood at room temperature on environmental surfaces up to one week.47 So infection can take place through skin abrasions or scratches of bare hands. Moreover, HBV is known to be present in saliva of patients with viral hepatitis infection and could be transmitted to health care workers.48 Several serological studies have shown that DHCP have a significantly higher prevalence of HBV infection than the general population.49-58 Moreover, occupational infection of dental laboratory technicians with HBV infection has been reported.59 In addition, in a survey reported by McCarthy and Britton,60 dental students showed the highest rate of occupational injuries among dental, medical and nursing students. Previous reports confirmed that all members of the dental profession are at a risk at least three times greater than the general population of contracting HBV infection and developing the carrier state.61 The risk is even greater than the risk of acquiring HIV infection from practice.62 This study's finding and other studies suggest that all health care workers who work in dental laboratories or handle laboratory cases on regular basis should be vaccinated against hepatitis B.63-66 In addition, post-vaccination serological test is mandatory to asses the effectiveness of immunization.67
The present study showed that there was a lack of commitment to the standards of infection control practice in private dental laboratories in Riyadh. Also, communication between dental clinics and dental laboratories regarding disinfection of laboratory items was found deficient. Formal supervision of private dental laboratories through official channels to assure proper adherence to infection control measures is demanded. Continuing education through infection control courses and infection control manuals that contain updated and recommended guidelines to ensure aseptic practice in private dental laboratories is highly needed.
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