Monday, October 20, 2014

Ebola transmission and how our dental office prevents the spread of all infectious diseases

The College of Dental Surgeons of BC recently released a Health advisory update regarding the Ebola virus and how it may influence dental treatment. What they have asked is for us to identify patients whom:
  • Have travelled to any West African country: Liberia, Guinea, Sierra Leone, Nigeria (Lagos), or the Democratic Republic of Congo AND
  • Are experiencing fever or other symptoms related to Ebola (e.g. headache, weakness, muscle pain, or hemorrhage)?
And if a patient answers yes to both questions then they should isolate themselves and phone their local emergency department.
As I was reading it two thoughts came into my head. The first being was that I’m sure if a person was hemorrhaging and had been to one of those countries I suspect they would call the hospital before booking a dental appointment.

The second was what is the exact mode of transmission. I already know everything we do for infection control but I think it is a mystery to some as to what’s involved in sterilization and infection control in a properly operating dental office.

First I'll go through the facts for Ebola and then I'll let you know our sterilization protocols.

When listening on the news you will always hear the journalist reference that a bodily fluid must be transferred for Ebola transmission. But HIV is another virus that requires bodily fluid transfer – is Ebola easier or more difficult to contract than the former?

You cannot get Ebola through air, water or food transfer, or casual contact. You can get it from:
  1. Touching the blood or body fluids of someone who has died or is sick with Ebola
  2. Touching contaminated objects like syringes
  3. Touching infected animals, or their blood, or eating their meat
So with regards to the first point, what is considered “touching”?

Ebola is transferred through direct contact of the eyes, nose, mouth, broken skin (a cut or abrasion) – the “fluid” would have to directly touch one of these areas.

What bodily “fluids” spread Ebola?

The virus can be contracted through an infected person’s saliva, mucous, vomit, feces, sweat, urine, breast milk or semen.

Can you get Ebola through a sneeze or a cough?

Yes. A person who is symptomatic would have to sneeze directly on the person and then the mucous or saliva would have to contact the eyes, nose, mouth or broken area of the skin for an individual to be at risk. Sneezing and coughing are obviously not indicative that you have Ebola but they are symptoms.

Can you get Ebola from kissing or intercourse?

Yes if the individual is symptomatic.

Can you get Ebola from shaking hands?

Yes if the persons hand is contaminated with fluids but this is a lower risk.

How long before you start showing symptoms?

The incubation period can be from 2 to 21 days from exposure with most individuals showing symptoms between 8-10 days.

What are the symptoms of Ebola (EVD)?

Ebola is a virus that can result in fevers of 101.6F/38.6C or above, headaches, joint and muscle aches, weakness diarrhea, vomiting, stomach pain, lack of appetite, abnormal bleeding and possible red eyes, hiccups, sore throat, chest and rash are all symptoms.

As you can see because of the ease that this disease is transmitted in contrast to HIV the reason why it has become a major concern world wide.

What precautions do we use to combat the transmission of every known pathogen in the world?

(i) Every patient has there own personal set of individually wrapped and sterilized instruments. This is not a requirement with respect to Canadian and US guidelines but if it was me this is what I would want which is why we’ve chosen to do this.

(ii) Every caregiver uses a new set of gloves and mask between patients. Even when moving out the room in between procedures the gloves are mandated by us to be removed and left in the room.

(iii) Instruments are washed in a machine called a Hydrim. Again this is not required by the Canadian or American Dental Association but we feel it’s much more effective than using the alternative: a cold sterilizing ultrasonic solution where multiple patients instruments are placed in a giant tub throughout the course of the day. The Hydrim washer will remove 99.9% of protein. You cannot sterilize if you can’t remove loose debris.

(iv) The instruments are then packaged and wrapped and sealed with sterilized indicator tape or packages and run through a sterilizer. If the sterilization process fails at any point the tape will not change color.

(v) We also conduct weekly spore tests as a double check the whole process is working correctly.

(vi) The rooms are wiped down with a bactericidal, sporicidal and tuberculocidal soak that will eliminate any residual bacteria, spores or viruses on any counter surfaces.

The last place you should get an infection from is the dental office which is why we incorporate all these important safeguards into treatment.


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