The realm of dental and oral surgery clinics are often considered peripheral to the conventional spectrum of infection prevention programs, potentially leading to dire repercussions if non-compliance or neglect of protocols occurs. It’s imperative, therefore, to step up infection surveillance, diligently maintain sterilization procedures, and enforce patient safety practices to drastically reduce surgical site infections (SSIs). Nonetheless, historically, such clinics have not been under the routine jurisdiction of infection preventionists (IPs).
Evidence of infection prevention and control (IPC) lapses in dental settings offer a stark testimony to their severe repercussions on patient health. Ever since 2003, the Centers for Disease Control and Prevention (CDC) has issued regular recommendations, the latest edition being in 2016. Elementary IPC practices bear a universal application; the standard precautions that apply in acute care facilities, apply to dental clinics with an equal need. Across settings, hand hygiene, the deployment of personal protective equipment (PPE), environmental disinfection, safe injection measures, instrument cleaning, and sterilization stand as the pillars of IPC practices.
Cleaning mechanically versus manually, particularly for implementing safe dental care, is preferred due to effectiveness and efficiency. Interventions in oral surgery can directly impact patient outcomes. Microbes from the oral cavity, if not contained, could infiltrate normally sterile sites, triggering secondary infections. SSIs linked to oral and dental procedures arise from risk factors which can be classified into two categories – patient-related or procedure-related. Aspects such as the patient’s age, diabetic status, smoking habits, and other comorbidities play a pivotal role. On the other hand, procedure-related factors encompass sterilization of instruments, surgical site preparation, antibiotic prophylaxis, and the procedure’s duration.
SSIs remain a concern in outpatient settings for less complex issues like tooth extractions or dental implants. However, understanding the SSI rate following oral surgeries is constrained due to limited availability of data. A Saudi Arabian study reported a SSI rate of 10.3% after oral or maxillofacial surgeries, underscoring an urgent need to understand and address risk factors for SSIs better.
Prophylactic antimicrobial usage in dental surgeries to prevent SSIs varies. Dentists treating outpatient setups may be more inclined to prescribe them for patients with a history of joint replacement or possessing risk factors for avoiding secondary site seeding. However, the threat of antimicrobial resistance poses a considerable challenge.
SSIs pertaining to dental procedures do not fall within the reporting mandate for acute care facilities, either at the federal or state level. As such, surveillance remains limited to published research. This lack of a uniform surveillance system hinders the detection, understanding, and management of the problem. As a result, patient and procedure-related factors wedded to risk should be factored into a comprehensive dental SSI prevention strategy. Achieving Diabetes control in the preoperative setting, emphasizing good oral hygiene, and advocating for the preoperative use of a chlorhexidine mouthwash could potentially prove effective in mitigating SSIs. Prescription of prophylactic antibiotics to only high-risk cases can help tackle antimicrobial resistance.
Patient safety in dental clinics also necessitates environmental hygiene and disinfection using Environmental Protection Agency registered products. Reliable cleaning schedules, increased focus on high-touch surfaces, and comprehensive terminal cleanups should be protocol. Furthermore, checklists and standard operating procedures can facilitate staff training and promote adherence.
Infection preventionists striving to contribute to dental clinic safety must acquaint themselves with the risk factors of water quality issues concerning dental care. This learning coupled with their understanding of disinfection, sterilization, and patient safety practices empowers them to guide dental health professionals, fostering a more robust IPC environment in these clinics.