Oral Hygiene Jan/Feb 2024

Infection Control

Presented by Emeritus Professor Laurence Walsh AO BDSc, PhD, DDSc, GCEd, FRACDS, FFOP (RCPA), FDTFEd

All the changes to Infection Control for 2024

A vital update on recent changes to infection control following the release of the new AS 5369 Standard in December 2023

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On the cover...

Emer. Prof. Laurie Walsh is presenting two in-person lectures in Melbourne and Sydney in June detailing all the Infection Control changes in 2024 following the release of AS 5369

14

4 BRIEFS

6 NEWS & EVENTS

16 CPD CENTRE

20 ABSTRACTS

Tabitha Acret explores the world of oral probiotics

22 CHANGING TO MORE SUSTAINABLE DENTAL PRACTICE IN THE POST-PANDEMIC ERA

Across the years of the COVID-19 pandemic, many dental clinics have found that their use of disposable items has increased dramatically.

In this article, Prof. Laurie Walsh challenges that mindset

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INFECTION CONTROL CHALLENGES FOR 2024

As we begin a new year, it’s useful to flag a number of the issues that will emerge during the coming 12 months, to prompt thought, reflection and discussion explains Prof. Laurie Walsh

32 PREVENTING NEEDLE STICK INJURY

Sharps injuries in dental practice remain a concern today even though dentistry adopted preventive practices in the 1980s details Dr Greg Mahoney

New Cervitec Gel with optimized care formula

The new Cervitec Gel is recommended especially for the care of at-risk areas. The oral care gel with optimized care formula contains chlorhexidine, fluoride, xylitol and provitamin D-panthenol. With the new formula, Cervitec Gel protects the teeth, gums, peri-implant tissue and mucuous membrane with even more efficiency. Cervitec Gel supports the treatment of gingivitis, mucositis, denture stomatitis, periodontitis and peri-implantitis and helps combat elevated bacterial counts. It prevents inflammation and freshens breadth. Provitamin D-panthenol and xylitol moisturize and protect the gums and mucous membrane. Depending on the situation, the gel is applied either directly on the oral mucous membrane or removable restoration and distributed with an interdental brush or used to brush teeth. Given its smooth consistency, the clear gel can be optimally distributed on complex surfaces, e.g. implant restorations. Cervitec Gel can be applied in the dental office or at home. Cervitec Gel is widely accepted due to its mild taste. The soothing ingredients leave a pleasant feeling in the mouth. Available from Ivoclar on 1300-486-252 or visit www.ivoclar.com

3 ways to get the most out of www.dentist.com.au

When people want to find a dentist, they mostly use the internet and Google “Dentist in...”. That’s what the research shows. Word of mouth is no longer king! Google only shows 3 or 4 individual dental practices on the first page of its search results. The other results returned are for, among other things, the website www.dentist.com.au. This directory lists all practices and practitioners and is searched a million times a year.

Get Listed! If you’re listed on dentist.com.au, your phone will ring! So just do it!

Upgrade your listing: Just like in Google, where your practice sits in the dentist.com.au search results list determines how often your phone rings. If you’re at the top of the list, then your phone will ring more often and if there is more detailed information listed about your practice, then this helps too. Unlike Google, you can increase your priority in searches for an annual fee. This increases your prominence in searches for your home suburb and often also in the surrounding suburbs. Plus you can add heaps of detailed information about your practice and practitioners.

Add your link for online bookings. If you accept online bookings, then once you’ve upgraded your listing, you can add the link to accept online bookings through your preferred booking engine and this will appear directly in the search results list. For details on how to upgrade, visit: dentist.com.au/information-for-dentists

COVID-19 vaccinations significantly reduce disease severity, hospitalisations and deaths, but in 2023, uptake of vaccines including booster doses was relatively low. Perceptions about the benefit and safety of COVID-19 vaccines are important determinants of vaccine uptake. This remains particularly important given that research evidence regarding the protection against COVID-19 offered via different types of immunity (e.g. infection-induced/vaccine-induced/hybrid) is ever-changing. However, public perceptions of this changing body of evidence and the extent to which they may influence vaccination perceptions and intentions have not been studied in detail. In this study, whether people in the USA think COVID-19 vaccination is less beneficial or safe for someone who has already had COVID-19 was we examined, compared to someone who has not. Whether COVID-19 vaccine benefits and safety perceptions and intentions (for primary and booster doses) vary was also examined. An online survey of 1,733 US adults was undertaken (mean age 41 years, 66.4% were non-Hispanic White and 66.0% were female). Half (53.1%) had received ≥1 dose of a COVID-19 vaccine and 27.6% reported prior COVID-19 infection. Overall, respondents believed COVID-19 vaccines are less beneficial and less safe for someone who had already had COVID-19. Those who experienced COVID-19 after being vaccinated believed that the vaccines are less beneficial and less safe than those who had not. Over 40% of the respondents felt that a COVID-19 vaccine did not even offer a moderate benefit for someone else with prior history of COVID-19 infection and 30% felt that a COVID-19 vaccine was unsafe. Benefit and safety perceptions of COVID-19 vaccination varied according to COVID-19 infection history. Vaccinated respondents who had personally experienced COVID-19 post-vaccination perceived COVID-19 vaccines as less beneficial and less safe for someone else compared to vaccinated respondents who had not personally experienced COVID-19 post-vaccination.

Thorpe A, et al. Impact of prior COVID-19 infection on perceptions about the benefit and safety of COVID-19 vaccines. American Journal of Infection Control 2024;52(1):125-128.

Excitement builds as IDEM 2024 emerges as the pinnacle event in dental innovation for Asia Pacific

IDEM 2024, the International Dental Exhibition and Meeting and the leading dental exhibition and conference in the Asia Pacific, is poised to captivate and inspire dental professionals from around the region with its highly anticipated event happening in April at Marina Bay Sands, Singapore’

The exhibition is set to present a wellrounded experience for all participants, with over 500 exhibitors from 33 countries showcasing their latest products and innovations together alongside a comprehensive 3-stream scientific conference featuring more than 30 speakers from around the world.

“We are delighted to collaborate again with our esteemed partners to present IDEM 2024 to the dental community. Following the resounding success of IDEM as an inperson event in 2022, we eagerly anticipate the amalgamation of innovation and expertise that will undoubtedly mould the future landscape of dentistry,” said Mathias Kuepper, the Managing Director and Vice President Asia-Pacific of Koelnmesse Pte Ltd.

Over 30 conference sessions

Anticipated by professionals and enthusiasts alike, the 13th edition of IDEM stands as a cornerstone in the dental community where attendees can learn from an impressive line-up of renowned experts. The SDA Masterclass by the father-andson duo, Dr David S. Alleman and Dr Davey Alleman, will kick off the confer-

ence programme, offering a half-day conference session and half-day workshop on biomimetic dentistry.

Over 30 conference sessions and workshops will feature a wide range of topics by notable speakers such as Dr Alberto Miselli covering the “Umbrella Concept” and Dr Andrea Bazzucchi sharing the latest advances in digital workflow synergy. Other conference sessions and workshops include global expert Dr Roberto Sorrentino’s “Restorative Materials and Luting Agents in Prosthodontics” and Dr Paulo Monteiro’s insights and expertise in “Anterior Indirect Restorations”.

Oral Health Therapy forum

The 5th edition of the Dental Hygienist and Therapist Forum (DHTF) will take place from 20-21 April 2024, providing a dedicated platform for hygienists and ther-

apists to engage in meaningful discussions and knowledge-sharing, with an interesting variety of topics such as oral ulcers, paediatric patient management, digital workflows and oral care for older adults.

Dr Lawrence Yong, President of the Singapore Dental Association, shared, “I am thrilled to welcome dental professionals from around the world to IDEM 2024. This conference is a powerful testament to Singapore’s unwavering commitment to advancing dental science and education. I am particularly enthusiastic about the conference sessions, which will delve into burning topics within our field—offering valuable insights that attendees can readily apply in their practices the next day.”

Asian Speaker Series

Attendees can also look forward to the inaugural “Asian Speaker Series”, an innovative platform designed to spotlight diverse talents from within the region. A collaborative effort between the regional and national dental associations to offer a more diverse take on the latest developments in dentistry, explore riveting industry topics such as “Treating the Paediatric Patient”, “Oral Care for the Dependent Older Adult” and delve into complex topics such as “The Systoles and Diastoles of Implant Dentistry” and “Prognosticating Periodontal Treatment Outcomes Using Artificial Intelligence”.

Expansive trade exhibition

The heart of IDEM 2024 lies within its exhibition, spanning a fully booked 17,000 square meters and hosting over 500 exhibitors who will present a diverse range of products and services, showcasing the latest industry innovations. It will host 11 pavilions (China, France, Germany, Italy, Japan, Singapore, South Korea, Spain, Switzerland, Taiwan and the USA), underscoring the wide scope of the dental industry showcased at the event.

Economic

Spanish Embassy in Singapore, representing the Spain Pavilion, expressed, “We are thrilled to be part of this dynamic and highly acclaimed event. Newly supported by ICEX Spain Trade and Investment, our pavilion is a testament to the innovation and excellence within the Spanish dental industry. We look forward to engaging with the international community, sharing our expertise and contributing to the vibrant exchange of ideas that IDEM 2024 represents.”

Antonio Garcia Rebollar, Trade and

Counsellor,

This unprecedented gathering of industry leaders and innovators such as GC Asia, Straumann, 3M, imesicore GmbH and many more, creates an immersive experience designed to inspire and inform dental professionals. Attendees can expect to engage with the latest industry offerings, witness live demonstrations and explore groundbreaking solutions that have the potential to reshape the landscape of dentistry.

3M, one of IDEM 2024’s sponsors, expressed, “IDEM provides a unique platform for industry leaders to connect, share knowledge and contribute to advancing dental science. We eagerly anticipate the exciting interactions and collaborations that will unfold. Attendees can look forward to scientific education, new products and hands-on demonstrations” – said Kae Moe Wong, Asia Area Marketing Leader.

In addition to the established players, IDEM 2024 welcomes more than 40 firsttime exhibitors this edition. These new companies bring forth a diverse array of products, ranging from orthodontics and endodontics to prosthodontics and paediatric dentistry. The inclusion of these innovative companies reflects IDEM’s commitment to staying at the forefront of emerging trends and technologies in the dental field.

imes-icore GmbH, an innovator in digital and dental CAD/CAM production systems, shares their excitement in their first participation as an exhibitor. “IDEM 2024 is the epitome of international collaboration and innovation. As a first-time exhibitor, we are thrilled to be part of this gathering, showcasing our solutions of

“The exhibition includes over 500 exhibitors from 33 countries alongside a comprehensive 3-stream scientific conference featuring more than 30 speakers from around the world...”

the best possible automated and validated workflows to a diverse audience.”

Unparalleled networking

IDEM 2024 provides an unparalleled platform for networking, fostering connections and gaining exclusive opportunities for meaningful business discussions and relationship-building. The event will be complemented with IDEM360+, an all-in-one digital platform

and app that enables participants to do business matching, find networking opportunities, schedule meetings, navigate around the event and more. Visitor badges will also be made digital from this edition and accessed via the IDEM360+ app.

Register now

Online registration is ongoing. Trade visitor registration is free and conference delegate tickets are available at a discounted price before 12 April 2024. Visit www.idem-singapore.com for more information and to register.

About IDEM Singapore

The award-winning trade fair, IDEM, is a biennially-held three-day B2B trade fair and convention for the dental industry. Styled as the Leading Dental Exhibition and Conference in the Asia Pacific Region, the conference brings in world-class speakers in general dentistry, while the exhibition is the largest dental B2B trade fair in the Asia Pacific. Riding on its continuous success since 2000, IDEM will enter its 13th edition in 2024 and maintain its position as a leading dental trade and continuing education platform in the Asia Pacific.

Rise above the challenges – Elevate your dental practice! The ultimate DIY dental marketing pack – Save 88%!

In today’s competitive landscape, dentists in Australia and New Zealand are navigating through increasingly challenging times. With growing competition and tighter economic circumstances, the need to stretch every marketing dollar further has never been more crucial.

That’s where The Ultimate DIY Dental Marketing Pack comes in – your comprehensive solution to not just survive, but thrive in these testing times.

Meticulously crafted for dental practice owners and managers in Australia and New Zealand, this pack isn’t just another marketing toolkit; it’s a strategic partner in your journey towards attracting new patients and securing your practice’s future.

Why choose this?

n Unprecedented Comprehensive Pack: Everything you need in one easy-to-use DIY package.

n Significant Savings: $8,080 value for just $997! Act quickly and save 88%!

n Prepared by experts: Heavily curated content based on more than 10,000 hours of 1 on 1 consulting with dentists in A/NZ by Angus Pryor and his team.

What’s Inside?

Perpetual DIY Marketing Pack

n 12-Month Marketing Calendar: plan and execute your marketing efforts with precision. Includes monthly marketing themes, promotional activities, list of key international days, and more. $500 value.

n 24 x Social Media Posts: engage and grow your audience all year. Includes caption library of over 100 customisable social media captions, professional image library, 24 professionally designed Canva templates to level up your practice’s social media image. $2400 value.

n 24 x Professionally-Written Patient Emails: Keep your patients informed, interested and thinking about you! Send just one of these emails to your patients and you could reap thousands in additional business. $2400 value.

n 12-Month Dentist.com.au Upgrade: Enjoy thousands of additional views of your practice listing. Elevate your online presence and appear strongly in surrounding suburbs. $795 value.

n Automated Reminder System: Dental life gets busy, so this system helps you always know where you’re up to, allowing you to stay on track effortlessly. $360 value.

One-off bonuses

n Google Business Profile Checklist: Appearing strongly in Google is Marketing 101 for dentists and an essential part of your online presence is your Google Business Profile (formerly Google My Business). This checklist gives you the clear steps for success. $200 value.

n 12-Point Website Self-Audit: Your website is a virtual calling card for your entire business. What does it say about you? This 5-minute check will give you everything you need to independently assess whether you practice comes across as a hero or a zero. $500 value.

n Competitor Assessment: Looking for answers about the competition in your local area? This 5-minute assessment will help you gauge your competition and suggest next steps. $995 value.

n The Dental Practice Profit System book: No.1 Amazon bestselling book from Australia’s no.1 Google-ranked dental marketer, Angus Pryor. $30 value.

Take advantage of this Limited Time Offer! This incredible offer is only available for a limited time. Seize the opportunity to elevate your dental practice!

every dentist in australia every dentist in new zealand and every dental practice...

n Australia and New Zealand have over 25,000 dental practitioners

n dentist.com.au and dentist.co.nz lists every practitioner free of charge

n For 20 years, the Australian public has relied on www.dentist.com.au to find and connect with you. Now we have introduced the service to New Zealand

n Over 1 million searches are made every year

n Visit dentist.com.au or dentist.co.nz to check your details are correct

n Visit www.dentalcommunity.com.au and login to update your details any time without cost

9929 1900 or email info@dentist.com.au

THE ULTIMATE DIY DENTAL MARKETING PACK – SAVE 88%!

Rise Above the Challenges – Elevate Your Dental Practice!

In today’s competitive landscape, dentists in Australia and New Zealand are navigating through increasingly challenging times. With growing competition and tighter economic circumstances, the need to stretch every marketing dollar further has never been more crucial.

That’s where The Ultimate DIY Dental Marketing Pack comes in – your comprehensive solution to not just survive, but thrive in these testing times.

Meticulously crafted for dental practice owners and managers in Australia and New Zealand, this pack isn’t just another marketing toolkit; it’s a strategic partner in your journey towards attracting new patients and securing your practice’s future.

WHY CHOOSE THIS?

Unprecedented Comprehensive Pack: Everything you need in one easy-to-use DIY package.

Significant Savings: A $8,080 value for just $997! Act quickly and save over 90%!

Prepared by experts: Heavily curated content based on more than 10,000 hours of 1 on 1 consulting with dentists in Australia and New Zealand by Angus Pryor and his team

WHAT’S INSIDE? PERPETUAL DIY MARKETING PACK

12-Month Marketing Calendar: plan and execute your marketing efforts with precision. Includes monthly marketing themes, promotional activities, list of key international days, and more. $500 value

24 Social Media Posts: engage and grow your audience all year. Includes caption library of over 100 customisable social media captions, professional image library, 24 professionally designed Canva templates to level up your practice's social media image. $2400 value

24 Professionally-Written Patient Emails: Keep your patients informed, interested, and thinking about you! Send just one of these emails to your patients and you could reap thousands in additional business. $2400 value

12-Month Dentist.com.au Upgrade: Enjoy thousands of additional views of your practice listing. Elevate your online presence and appear strongly in surrounding suburbs. $795 value

Automated Reminder System: Dental life gets busy, so this system helps you always know where you’re up to, allowing you to stay on track effortlessly. $360 value

ONE-OFF BONUSES

Google Business Profile Checklist: Appearing strongly in Google is Marketing 101 for dentists, and an essential part of your online presence is your Google Business Profile (formerly Google My Business). This checklist gives you the clear steps for success. $200 value

12-Point Website Self-Audit: Your website is a virtual calling card for your entire business. What does it say about you? This 5-minute check will give you everything you need to independently assess whether you practice comes across as a hero or a zero. $500 value

Competitor Assessment: Looking for answers about the competition in your local area? This 5-minute assessment will help you gauge your competition and suggest next steps. $995 value

The Dental Practice Profit System book: no.1 Amazon bestselling book from Australia’s no.1 Google-ranked dental marketer, Angus Pryor. $30 value

LIMITED TIME OFFER!

This incredible offer is only available for a limited time. Seize the opportunity to elevate your dental practice!

“Definitely Angus has a great organisation. You will get value for money.”

Dr Claire Wilson, VIC

“My experience with Angus and the team has been really excellent. They’ve helped my business grow.”

Dr Brian Chen, NSW

“Honestly, it’s the best money I’ve ever spent. Because it’s all about return on investment. And this is the best return on investment I’ve ever done.”

Dr Geoff Hall, VIC

Nurturing balance: Exploring the oral microbiome and the role of oral probiotics

By Tabitha Acret, BOH, Grad.Cert (Public Health), current

master’s student

The oral cavity, often considered a gateway to overall health, harbours a diverse and dynamic ecosystem known as the oral microbiome.

Comprising a vast array of microorganisms, this microscopic community plays a crucial role in maintaining oral health and influencing broader systemic well-being.

In recent years, the spotlight has turned to oral probiotics as potential allies in fostering an harmonious oral microbiome.

TThe oral microbiome: A complex community

he oral microbiome is a complex ecosystem comprising bacteria, viruses, fungi and other microorganisms that coexist within the mouth. This dynamic community interacts in a delicate balance, contributing to various physiological functions, including digestion, immune response modulation and defence against pathogens.

Microbial diversity and stability

Research has unveiled the incredible diversity within this microbiome, with hundreds of different species cohabiting in a relatively small space.

The stability of this ecosystem is essential for oral health, as disturbances in microbial balance can lead to a range of issues, including decay, periodontal disease and halitosis.

Wade, W. G. (2013)

Oral microbiome and health implications

The oral microbiome’s influence extends beyond the confines of the mouth, impacting overall health. Imbalances in the oral microbiome have been linked to systemic conditions such as cardiovascular diseases, diabetes, and respiratory infections. This highlights the interconnectedness of oral health with the broader well-being of the body.

Sanz, M., Jepsen, S. (2020)

Oral probiotics: Guardians of oral health

Recognising the significance of a balanced oral microbiome, researchers have turned their attention to the potential benefits of oral probiotics.

Probiotics, defined as live microorganisms conferring health benefits to the host, offer a promising avenue for promoting oral health by modulating the composition and activity of the oral microbiome.

Promoting beneficial bacteria

Oral probiotics, often containing strains of Lactobacillus and Bifidobacterium, work by introducing beneficial bacteria into the oral cavity. These friendly microbes contribute to the suppression of harmful bacteria helping prevent oral imbalances.

Teughels et al (2013)

Balancing the microbial landscape

Oral probiotics play a role in rebalancing the oral microbiome, particularly after disruptions caused by factors like antibiotics, stress, or poor oral hygiene. By fostering a healthier microbial environment, these probiotics contribute to the prevention and management of oral conditions.

Meurman, J. H., Stamatova, I. (2007)

Oral probiotics and periodontal disease

Probiotics exert their effects on the periodontal health through various mechanisms. These include the inhibition of pathogenic bacteria associated with periodontitis, modulation of the immune response and promotion of a balanced microbial environment within the oral cavity.

Teuhhels, et al (2013)

tance of maintaining a balanced oral microbiome, oral probiotics emerge as promising agents for supporting oral health and potentially influencing overall well-being. As research continues to unravel the complexities of these microscopic communities, the integration of oral probiotics into oral care routines may become a cornerstone in fostering a healthier and more resilient oral environment.

Studies have demonstrated that specific strains of probiotic possess the ability to inhibit growth of harmful bacteria implicated in periodontal disease.

This inhabitation contributes to the reduction of inflammation and may slow progression.

Several studies have explored the efficacy of probiotics in managing periodontal disease. While more research is needed to establish definitive conclusions, existing evidence does suggest a potential role for probiotics in improving periodontal parameters, such as reduced pocket depth and improved tissue attachment levels.

Conclusion

In conclusion, the oral microbiome stands as a testament to the intricate interplay between microorganisms and human health. Recognising the impor-

About the author

Tabitha Acret is a dedicated and passionate award-winning Dental Hygienist. She studied a Bachelor or Oral Health at Newcastle University , Graduate Certificate in Public Health and is a current Masters student. Tabitha has become one of the most sought-after Hygienists and Educators in Australia and internationally with a fast-growing and loyal customer base of patients, dental professionals and media. Tabitha was previously the National Vice-President for the Dental Hygienists Association of Australia and has volunteered in many roles since graduation for the Association. She also has a passion for educating with students, working as a Clinical Educator at Sydney University and Newcastle University as well as working in private clinical practice and as a Clinical Educator within the dental industry.

Question 1. Imbalances in the oral microbiome have been linked to...

a. Cardiovascular disease

b. Diabetes

c. Respiratory infection

d. All of the above

Question 2. Oral probiotics often contain...

a. Bacillus

b. Streptococcus thermophilus

c. Bifidobacterium

d. Saccharomyces boulardii

e. Enterococcus

Question 3. The effects of oral probiotics include...

a. Inhibiting pathogenic bacteria

b. Modulating the immune response

c. Promotion of a balanced microbial environment

d. All of the above

Question 4. The oral microbiome is a complex ecosystem comprising...

a. Bacteria

b. Viruses

c. Fungi

d. Varios microorganisms

e. All of the above

Question 5. The oral microbiome can become unbalanced due to...

a. Antibiotic use

b. Stress

c. Poor oral hygiene

d. All of the above

Question 6. A change from disposable gowns to reusable gowns has been estimated to reduce...

a. Energy consumption by 64%

b. Greenhouse gas emissions by 66%

c. Solid waste generation by 84%

d. All of the above

Question 7. Low-temperature vaporised hydrogen peroxide (VHP) sterilisation is better for the environment because...

a. The chamber only needs to be heated to around 40°C.

b. Packaging used for instruments processed using VHP can be recycled.

c. Water used in the process does not need to be distilled.

d. All of the above.

Question 8. The big contributor to environmental impact of disposable over reusable instruments occurs...

a. From transport and disposal costs.

b. Due to greenhouse gas emissions in the manufacturing process.

c. From electricity consumption during the manufacturing process.

d. Due to the raw materials consumed.

e. All of the above.

Question 9. A single disposable gown has an estimated carbon footprint of carbon dioxide gas equivalents of almost...

a. 100 grams

b. 500 grams

c. 1 kg

d. 2 kg

Question 10. The everything disposable mindset that dominated during the height of the pandemic is sustainable going into the future...

a. True

b. False

READ THE ARTICLES BELOW AND ANSWER THE QUESTIONS ONLINE AT WWW.DENTALCOMMUNITY.COM.AU - 2 HOURS OF CPD

Question 11. Every dental clinic is now required to have a washer disinfector...

a. True

b. False

Question 12. Ultrasonic cleaners are being phased out for dental practice....

a. True

b. False

Question 13. A Class 2 or PCD must be included in every steam steriliser cycle...

a. True

b. False

Question 14. There are no major changes between AS 5369 and AS/NZS 4815...

a. True

b. False

Question 15. Using a particular device in the steriliser to test its performance protects the practice from all possible prosecutions relating to infection control...

a. True

b. False

Question 16. How effective is post-exposure prophylaxis in preventing HIV from needle stick injuries?

a. 20%

b. 40%

c. 60%

d. 80%

Question 17. The new version of the Ultra Safety Plus is called the...

a. Ultra Safety Plus Snap

b. Ultra Safety Plus Twist

c. Ultra Safety Plus Pro

d. Ultra Safety Plus Lock

Question 18. The risk of transmission following a skin puncture injury is dependent on:

a. The level of virus in their blood.

b. The amount of blood involved.

c. The type of needle or syringe in question.

d. The time that has elapsed since the needle was used.

e. All of the above.

Question 19. The risks of acquiring HIV from a contaminated needle are:

a. 0.23%

b. 0.56%

c. 1.8%

d. 6-30%

Question 20. Following the implementation of Ultra Safety Plus, a study found that the number of avoidable needle stick injuries reduced to an average of:

a. 14.8 per 1 million hours worked.

b. 8.3 per 1 million hours worked.

c. 11.8 per 1 million hours worked.

d. 7.3 per 1 million hours worked.

e. 0 per 1 million hours worked.

Infection Control UPDATE 2024

4.5 hr FACE-TO-FACE LECTURE + 1.5 hr VIDEO

Presented by Emeritus Professor Laurence Walsh AO

BDSc, PhD, DDSc, GCEd, FRACDS, FFOP (RCPA), FDTFEd

This course will discuss recent developments in infection control, with the major focus being on instrument reprocessing, following the release of the AS 5369 Standard in December 2023. The online video component (90 mins) covers New infection control terminology used in 2024; Online resources to support implementing modern infection prevention and control; The journey leading to AS 5369; and an explanation of how the standards system works in Australia, including the interactions between ISO, EN and Australian standards and the concepts that underline the standards landscape. The latter video also summarises the normative ISO and EN standards for AS 5369. As a bonus feature, there is another video on the history of infection prevention and control over the past 150 years.

TOPICS for the 4.5 hour face-to-face session include:

n The importance of precleaning at the chairside.

n What happens when instrument reprocessing is delayed.

n Key requirements for the proper use of ultrasonic cleaners and washer disinfectors.

n How to assess the outcomes of the cleaning process.

n Workflow, PPE and hand hygiene for the reprocessing area.

n Design elements of the reprocessing area and the concepts of physical and spatial segregation of work areas.

n The requirements for sterilising handpieces.

n Proper use of bespoke sterilisers running S cycles.

6 HOURS CPD

n Protocols for using air-removal and steam penetration tests.

n Correct use of chemical indicators.

n Tests for the integrity of packaging systems.

n Implementation of low temperature sterilisation.

n Criteria for load release from sterilisation.

n Definitions of non-conforming items.

n Environmental conditions for instrument storage.

n Record keeping requirements.

n Batch control information, including for high level disinfection.

Laurie Walsh is a specialist in special needs dentistry who is based at the University of Queensland in Brisbane, where he is an emeritus professor. He has been working in clinical microbiology for over 27 years, with more than 200 publications in this field and has been teaching microbiology and infection control at postgraduate level for the more than 25 years, including for the ADA and RACDS. Laurie has contributed to the development of national standards since 1992, including standards for masks, gloves, faceshields, ultrasonic cleaners and most recently, for instrument reprocessing (the AS 5369 standard). He was also involved in the development of

CDNA BBV guidelines, the second edition of the Australian Commission on Safety and Quality in Health Care standards and the ADA IC guidelines.

Oral Hygiene Abstracts 2024

By Emer. Prof. Laurence Walsh AO

Surgical respirators in clinical settings

One of the main infection prevention and control measures introduced during the COVID-19 pandemic was the focused application of respiratory protection to ensure health worker safety and the effective use of personal protective equipment. However, user acceptance of these strategies is paramount in sustainable compliance. During the periods of very high transmission of SARS-CoV-2, most health workers in NSW wore P2/N95 respirators. The effectiveness of any respirator is dependent on achieving and maintaining an adequate seal for the duration of its use. If respirators do not meet acceptable standards for comfort and compliance with donning, the ability to maintain an appropriate seal may be reduced, potentially leading to respirator leak and patient and health worker infection. This study explored various aspects of respirator use in NSW. The aim of the study was to understand the relationship between respirator comfort and user experience. A cross-sectional study was conducted in NSW (Nov-Dec 2022) using an anonymous self-administered online questionnaire. Of 2,514 respondents, 65% reported to have used a respirator every working day, with only a few using a respirator once weekly or less (9%). Almost all respondents had completed at least one fit test (96%) prior to the survey. Some 59% experienced discomfort from wearing a respirator. The most reported adverse effect was difficulty communicating (64%), followed by skin irritation or acne (62%) and headache (56%). Despite somewhat less favourable ratings on comfort and communication, NSW health care workers were in favour of respiratory protection. However, a focus on tolerance of respirators and strategies to address adverse effects from prolonged respirator use must be considered when implementing policies and procedures. The NSW Health respiratory protection program provides strategies such as frequent breaks, increased hydration, avoidance of makeup while wearing a respirator and skin protection with regular moisturising to reduce pressure injuries. Moreover, resources must be allocated to improve the design, breathability and sustainability of a respirator along with education and training on how to use respiratory protection safely and effectively.

Jain S, et al. Evaluation of health worker acceptance and tolerance of respirators in clinical practice—An Australian perspective. American Journal of Infection Control 2024;52(1):46-53.

Air treatment systems: State of the evidence

The COVID-19 pandemic increased the focus on preventing contamination with airborne pathogens (e.g. viruses, bacteria and fungi) by reducing their concentration. Filtration, UV or ionisation technologies could contribute to air purification of the indoor environment and inactivation of micro-organisms. The aim of this study was to identify relevant literature and review the scientific evidence presented on the efficacy of filter and germicidal technologies in air purification devices used to capture and inactivate micro-organisms and airborne viruses in practice. A scoping review was per formed; after applying exclusion criteria, 75 studies were included. Data support the inactivation efficiencies of ultraviolet germicidal irradiation (UVGI) and ionisation applications in laboratory studies. Based on the results of these laboratory studies, it may be concluded that filtration, UVGI and ionisation technologies have an effect on various micro-organisms under different environmental conditions and these can inactivate microorganisms and viruses. However, these studies are not representative of a practical situation. For example, no continuous aerosol emitting source in a room is used to investigate inactivation of microbiological contaminants. Studies that do work with aerosolised micro-organisms often study the decrease in a room which explains filtration, however, not inactivation of these pollutants. Overall, the laboratory studies do not adequately represent the practical situation in which the purifier systems are used. As well, the number of studies performed in practical situations is limited. Hence, based on the literature, no unambiguous conclusions can be drawn regarding the effectiveness of air purification technologies in clinical practice. Demonstrating the effectiveness of these air purifiers in practice will prove to be very challenging. As well, studies into the effect of by-products on human health of UVGI systems and ionisation systems are needed.

Kompatscher K, et al. Scoping review on the efficacy of filter and germicidal technologies for capture and inactivation of microorganisms and viruses. Journal of Hospital Infection 2023;12:39-48.

Changing to more sustainable dental practice in the post-pandemic era

By Emeritus Professor Laurence J. Walsh AO

Across the years of the COVID-19 pandemic, many dental clinics have found that their use of disposable items has increased dramatically. This article challenges that mindset, prompting a rethink of decisions on two key elements that can lower the environmental impacts of dental practice: disposable gowns and disposable instruments.

PReusable gowns

rior to the pandemic, reusable linen gowns were the norm in many dental schools and in private and public dental clinics for many years. Hence, it is relevant to ask the question as to why clinics cannot return to this as a normal practice for non-surgical dental procedures.

Modern reusable gowns are typically made of cotton, polyester or blends of cotton and polyester. It is important to know the composition of the gown because this influences how it is machine dried. Gowns with more cotton can tolerate a higher temperature in the dryer and will take longer to dry than those with more polyester and vice versa.

Even without including any presoaking in sodium hypochlorite, the processes that are used for machine washing and machine drying exert antimicrobial actions, but do not lower the splash resistance of the gown to any measurable extent. Modern reusable fabrics typically have superior resistance to fluid splashes when compared to disposable gowns, albeit at the cost of greater weight and also less breathability. Of interest, a majority of clinicians (over 80%) have reported feeling comfortable and safe when wearing reusable gowns.1,2

From a life cycle analysis (LCA) point of view, a reusable gown incurs costs for acquisition, laundering and eventual replacement. One can expect gowns to be laundered and reused 75 times before being replaced.3

There are also impacts from water use for washing and the release of water containing detergents into the waste stream and on the use of mains electrical power for operating the washer and dryer. The latter can be offset if electricity is generated by photovoltaic cells, hydro, wind or other zero-emission methods.

Disposable gowns represent a significant component of the waste generated by dental and other healthcare facilities over the past 5 years. Environmental impacts occur from the manufacture of the gowns, their transport to the point of use and disposal. Little has been done to attempt to recycle the polypropylene of disposable gowns, because of the risks that would pose to those working in recycling due to potentially infectious material being present on the gown caused by splashes of patient fluids.4

Overall, across different items of PPE used in dentistry, greenhouse gas emissions are greater for disposable gowns than for disposable gloves or surgical masks. A change from disposable gowns to reusable gowns has been estimated to reduce energy consumption by 64%, greenhouse gas emissions by 66% and solid waste generation by 84%.5 If fabrics in reusable gowns are designed for even longer use than the nominal 75 use cycles, the benefits of the change to them would be even larger.5,6 This is why further research into the degradation of the fabrics used in gowns and their splash resistant properties, with repeated laundering, is needed.

clinical | EXCELLENCE

The polypropylene used in disposable gowns is derived from fossil fuels and this polymer generates during its production around 3 kg of carbon dioxide equivalent per kilogram of polypropylene manufactured.7 Most polypropylene production is undertaken in China, with the raw material then being exported to manufacturers who produce the disposable gowns. Thus, there is shipping of

based on the assumption that the gown when disposed goes to landfill rather than for incineration. Incineration increases greenhouse gas emissions.8-10

Disposable instruments

Another trend which emerged during the COVID-19 pandemic was for more dental clinics to use kits of dispos-

“Disposable gowns represent a significant component of the waste generated by dental and other healthcare facilities over the past 5 years. Environmental impacts occur from the manufacture of the gowns, their transport to the point of use and disposal...”

the polypropylene raw material and then subsequently shipping of the disposable gowns from the gown manufacturer (typically in Asia) to Australia. It has been estimated that a single disposable gown has a carbon footprint of almost 1 kg of carbon dioxide gas equivalents. That is

able dental instruments, ranging from simple kits containing a dental mirror and some probes, through to single use sterile extraction forceps, to single use implant surgical kits. From a purely manufacturing point of view, when considering the processes involved in casting, finishing and polishing metal alloys, the differences between disposable and reusable dental instruments are quite small, in terms of greenhouse gas emissions. Similar raw materials and amounts of electricity will be used.

The big contributors to environmental impact with disposable instruments occur because of transport and disposal costs, whether that is into landfill or by incineration. On the other hand, a normal reusable instrument, when properly cared for, should give a long period of clinical use, after which it is discarded and replaced.

Most estimates place the use life of regular non-surgical and surgical instruments at around 10 years.11

As with reusable gowns, there are reprocessing costs associated with reusable instruments. Costs for staff time figure large in such calculations, however the use of mechanical cleaning systems and better instrument management approaches (such as instrument cassettes) can considerably reduce these staff time costs by improving the efficiency of reprocessing by as much as 5 times.

One must factor in the electrical energy used for steam sterilisers, heat sealers, washer disinfectors and other equipment, as well as the electrical energy required for air-conditioning the reprocessing area and for providing relevant heating and lighting. There are additional considerations for water usage, including the cost of specially treated deionised water for steam sterilisers and for the

“Using alternative methods of sterilisation may further reduce the direct costs and environmental impacts of reprocessing reusable dental instruments...”

usage of various chemicals as part of the cleaning process. To date, there have not been detailed calculations of all these individual environmental impacts for reprocessing reusable instruments in dentistry. Having said that, calculations of this type have been undertaken for medical instruments and these show very large costs savings when instruments are reused, compared to the single use alternative.12

Using alternative methods of sterilisation may further reduce the direct costs and environmental impacts of reprocessing reusable instruments in the dental setting. As an example of this, one can compare low-temperature vaporised hydrogen peroxide (VHP) sterilisation to steam sterilisation. VHP does not require water to be free of ions and hence there are no costs for distillation, deionisation or reverse osmosis. Total electrical energy consumption is very low for several reasons. The first of these is that the chamber does not need to be heated to 134°C, but rather only to around 40°C, which is necessary to keep the hydrogen peroxide in the vapour form, to stop it condensing.

Secondly, the only direct heating that is required is for the small nozzle where the hydrogen peroxide is converted from the liquid phase to the vapour phase. This nozzle tip is heated to just 55°C. On the other hand, with a steam steriliser, a sizeable volume of water must be heated to convert the water into steam and both the chamber and the load items within the chamber must also be heated to reach the 145°C operating temperature of the holding cycle.

A second consideration is that the packages used for VHP are made of a material (DuPont Tyvek™) that can be recycled. Unlike used disposable surgical gowns, used sterilisation packages made of Tyvek are not contaminated and so these do not pose a risk to those involved in recycling processes. At the present

time, such recycling is only available in North America, but it is possible that it will extend to Australia in the future.

Conclusions

Staff working in practices make decisions about where and when to use disposable gowns and disposable instruments. When making those decisions, they should consider both the direct costs to the practice (the financial expense for purchase and shipping), as well as the environmental impact those decisions have. The “everything disposable” mindset that dominated many dental clinics during the height of the pandemic is not a situation that is sustainable going into the future. Now is the time to think “back to the future”.

About the author

Emeritus Professor Laurence J. Walsh AO is a specialist in special needs dentistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years. His published research work includes over 400 journal papers, with a citation count of over 20,000 citations in the literature. Laurie holds patents in 8 families of dental technologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his contributions to dentistry.

References

1. McQuerry M, et al. Disposable versus reusable medical gowns: a performance comparison. Am J Infect Control 2021;49:563-70. doi: 10.1016/j.ajic.2020.10.013.

2. Belkin NL. Reusable personal protective equipment refutes savings claims of disposable counterparts. Hosp Mater Manage 1992;17(10):14-7.

3. Rizan C, et al. Environmental impact of personal protective equipment distributed for use by health and social care services in England in the first six months of the COVID-19 pandemic. J R Soc Med 2021;114:250-63.

4. Singh N, et al. Environmentally sustainable management of used personal protective equipment. Environ Sci Technol 2020;54:8500-8502.

5. Varangu L, et al. Reusable personal protective equipment in Canadian healthcare: Safe, secure, and sustainable. Healthc Manage Forum 2023;36(4):207-16.

6. Vozzola E, et al. An environmental analysis of reusable and disposable surgical gowns. AORN J. 2020;111:315-25.

7. Kutralam-Muniasamy G, et al. A critical synthesis of current peer-reviewed literature on the environmental and human health impacts of COVID-19 PPE Litter: new findings and next steps. J Hazard Mater 2022;422:126945.

8. De-la-Torre GE, Aragaw TA. What we need to know about PPE associated with the COVID-19 pandemic in the marine environment. Marine Pollut Bull 2021;163:111879.

9. Kumar H, et al. COVID-19 creating another problem? Sustainable solution for PPE disposal through LCA approach. Environ Dev Sustain 2020;23:9418-32.

10. Zhao W, et al. Comparative life cycle assessments of incineration and non-incineration treatments for medical waste. Int J Life Cycle Assess 2009;14:114-121.

11. Spry CN. Care and handling of basic surgical instruments. AORN J 2007;86(Suppl 1):S77-81.

12. Donahue LM, et al. A comparative carbon footprint analysis of disposable and reusable vaginal specula. Am J Obstet Gynecol 2020;223:225.e1-7. https://doi.org/10.1016/j.ajog.2020.02.007.

Infection control challenges for 2024

By Emeritus Professor Laurence J. Walsh AO

As we begin a new year, it’s useful to flag a number of the issues that will emerge during the coming 12 months, to prompt thought, reflection and discussion.

Washer-disinfectors

Automated mechanical cleaning of reusable medical devices (RMDs) is a mainstay of modern instrument reprocessing practices, with ultrasonic cleaners and washer disinfectors (WD) being the two most commonly used technologies in dental practice reprocessing areas. Both of these

approaches are included and discussed in the new December 2023 Australian standard on reprocessing of RMDs that will be discussed below. The Australian standard that applies to ultrasonic cleaners used in healthcare facilities (AS 2773) was updated in late 2019. This reinforces the point that ultrasonic cleaners will continue to be used in reprocessing (Figure 1).

A key consideration when considering which of these two methods to use with a particular device is the manufacturer’s instructions for reprocessing. Under the Essential Principles requirements when devices are approved by the Therapeutics Goods Administration (TGA), RMDs that are designed by the manufacturer for reuse on multiple patients must have comprehensive documentation on reprocessing.

This will indicate whether the device can be cleaned in an ultrasonic cleaner, or whether a washer disinfector is needed. As an example of this, several modern air turbine high speed handpieces have been designed to be compatible with cleaning in a washer disinfector, as they are able to tolerate the highly alkaline detergents that are used, without undergoing corrosion. A separate device will be needed for lubrication of these handpieces once they have been cleaned. Washer disinfectors will be fitted with couplings onto which the handpieces will be attached. These couplings will ensure that the range of liquids that are dosed into the chamber are delivered to the internal aspects of the handpieces.

International standards that relate to WD are found within the ISO 15883 series. Some of these have been updated in recent years, particularly those relating to the use of performance assessment using soil tests. An example is part 5 of the series from 2021 which focuses on performance requirements and test method criteria for demonstrating cleaning efficacy. This type of testing can occur in 2 different contexts: type testing, under simulated use conditions, with defined test soils, soiling methods and RMDs that are representative; and performance qualification (PQ) testing under everyday clinical conditions with loads that are soiled from clinical use. In type testing, various synthetic soils can be applied onto dental RMDs, while in PQ, a range of different soil test devices are available commercially. Test strips can be placed in parts of the chamber that are more difficult for the spray jets to reach, so that the effectiveness of cleaning can be assessed. While there is a minimum requirement in the ISO 15883 series for daily assessment of performance, it is best practice to use soil tests in every WD cycle. The test strips should be visibly free of any soil at the completion of the cycle.

Motors and scalers

In addition to the point made above regarding the compatibility of certain models of handpieces with a WD cycle, another key consideration is what happens to the electric motor that is driving the handpieces. Many clinics now use red band handpieces on electric motors, rather than air turbine handpieces, since the former provide higher and more

consistent torque and generate less noise during operation. A number of companies now make electric motors that are designed for steam sterilisation and the instructions for these dictate that steam sterilisation is to be undertaken between individual patient use. This means that the clinic needs to have a sufficient inventory of electric motors as well as handpieces.

Similar comments apply to modern piezoelectric ultrasonic scalers. Many common brands of these scalers have barrels that are designed for steam sterilisation. This is stated in the user instructions and is also, like dental handpieces, indicated by a symbol that is printed on the side. Clinics need to ensure that they have a sufficient inventory of barrels as well as scaler tips to meet their usage requirements. Adding to this, most brands of ultrasonic scaler provide specific advice around the types of materials that are suitable for wiping over the barrel before it is packaged for sterilisation. Products give specific advice around the correct method of packaging the tip (often located within the mandrel), barrel and O-rings to ensure proper steam sterilisation.

Navigating the selection and use of chemical indicators

The ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies, of which Standards Australia is a member. ISO standards are used extensively as normative references for Australian Standards, and in many cases, full-text adoption of ISO standards is undertaken in Australia and in other countries to achieve uniformity. When new ISO standards that relate to infection control are published, a key consideration is whether their target audience is manufacturers of products, or end users. This point of the intended readership is often made in the ISO standard in its introduction section.

Like Australian standards, when a new ISO standard is published, that cancels and replaces earlier editions. Typically, the introduction to the new standard will state the documents that have been superseded, to remove any doubt around this point. In the case of ISO 11140 Part 6, Sterilisation of healthcare productschemical indicators - Type 2 indicators

Figure 1. A benchtop ultrasonic cleaner used for mechanical cleaning of dental instruments. Note the glass partition that separates the reprocessing area from the adjacent dental operatory.

Every dental clinic is now required to have a washer disinfector.

Ultrasonic cleaners have been outlawed for dental practice.

A Class 2 or PCD must be included in every steam steriliser cycle.

There are no major changes between AS 5369 and AS/NZS 4815.

Using a particular device in the steriliser to test its performance protects the practice from all possible prosecutions relating to infection control.

and process challenge devices for use in performance testing of small steam sterilisers, which was published in November 2022, the previous standard which is superseded is EN 867 Part 5. This is an essential point since any marketing of chemical indicators for small steam sterilisers that continues to refer to EN 867 Part 5 is outdated and irrelevant.

The fact that a manufacturer would still indicate EN 867 Part 5 on their marketing materials reveals that they are unaware of the new ISO standard, and raises the question that their products may not conform to the requirements of the new 2022 standard. It is also important to clarify that the scope of ISO 11140 Part 6, as indicated by its name, relates only to small steam sterilisers. This classification

includes those with chamber volumes of less than 60 litres (This definition comes from EN 13060). Large sterilisers use tests that are described under EN 285. Another key point regarding ISO 11140 Part 6 is that its application is for steam sterilisers running B cycles (i.e. prevacuum types).

ISO 11140 Part 6 introduces some changes in terminology in its Annexe D and these changes should also be reflected in information provided to market air removal and steam penetration tests. The new terminology includes “reference porous load” and “reference hollow device”.

The latter term replaces the previous terminology of “hollow load type A”. The standard also points out that

when a test for air removal and steam penetration uses tubing that is made out of plastic polymer rather than metal, the polymer system will have a restricted number of uses and must not be used beyond that point as its performance and reliability will be affected.

Implementing the new reprocessing standard

On 15 December 2023, Australian Standard AS:5369:2023 Reprocessing of reusable medical devices and other devices in health and non-health related facilities was published. This document has a history that dates back to the two families of ancestor standards of instrument reprocessing, the hospital based series (AS 2014:1994 which became AS/NZS 4187:2003 and then AS 4187:2014) and the office-based practice series (AS/NZS 4815:2001 which became AS/NZS 4815:2006). The new AS 5369 supersedes the previous 4187 and 485 series, and unified both, being built on the platform of the 4187 series with modern ISO layout, definitions and nomenclature. The new standard was the result of over 3 years of work, involving 2 public consultation rounds and the committee addressing over 700 public comments on 2 versions.

One of the key changes in the document is the scope, which has extended beyond health care facilities, to include the effective and safe reprocessing, storage, handling and transportation of reusable medical devices and other devices used in skin penetration and skin aesthetic procedures and other treatments. This provides a uniform thinking approach across different settings, which will simplify assessment by public health regulators in the future.

The new standard has a strong emphasis on local facility level risk assessments to inform procedures, since the standard is not written as a step-bystep procedural document. Examples of topics for these local risk assessments include ergonomic considerations in the reprocessing area, physical and operational segregation of work areas within instrument reprocessing (Figure 2), air movement and air exchange in the

Table 1. Common myths and falsehoods

Instrument reprocessing solutions

Instrument reprocessing solutions

Instrument reprocessing solutions

has revolutionised sterilisation by offering a compact, dedicated line that provides unparalleled performance!

Mocom has revolutionised sterilisation by offering a compact, fully dedicated line that provides unparalleled performance!

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Washing

Disinfection

Washing

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Decontamination

Decontamination

Disinfection

Drying

Disinfection

Drying

Drying

Sterilisation

Sterilisation

Following appropriate advice

Freprocessing area, water used for instrument cleaning and water used for the final rinsing of instruments. The information on water quality requirements is based on the second amendment of AS/ NZS 4187:2014, which was specifically around that topic.

A number of topics have transferred directly from the 2014 4187 standard to the 2023 5369 standard. These include following the Spaulding classification, how the performance of steam steriliser cycles is assessed and the correct sequence for start of day tests for a prevacuum steriliser (a door seal air leak test followed by a daily Bowie-Dick test, with the later use of a process challenge device being completely optional). Each practice will need to undertake a gap analysis between their current processes and what is described in the new 5369 standard and then progress through implementation.

inally, the Dental Board of Australia expects all registered dental practitioners to follow current advice and high-level evidence. Clinicians should be alert to any advertising materials or courses that continue to cite ISO or Australian standards that have been superseded, since these are clearly outdated and inaccurate. People also need to be cautious about incorrect advertising claims. Some of the most common myths that the author has debunked on multiple occasions are in Table 1. People need to be particularly careful about statements that are made by anonymous people on social media including Facebook and LinkedIn. Some people making such posts are not qualified or informed on the topics that they are posting on and the information can be misleading. Sadly, we live in the age of misinformation and disinformation and this is why the onus on finding the best quality information sits with each registrant.

About the author

Emeritus Professor Laurence J. Walsh AO is a specialist in special needs dentistry who is based in Brisbane, where he served for 36 years on the academic staff of the University of Queensland School of Dentistry, including 21 years as Professor of Dental Science and 10 years as the Head of School. Since retiring in December 2020, Laurie has remained active in hands-on bench research work, as well as in supervising over 15 research students at UQ who work in advanced technologies and biomaterials and in clinical microbiology. Laurie has served as Chief Examiner in Microbiology for the RACDS for 21 years and as the Editor of the ADA Infection Control Guidelines for 12 years. His published research work includes over 400 journal papers, with a citation count of over 20,000 citations in the literature. Laurie holds patents in 8 families of dental technologies. He is currently ranked in the top 0.25% of world scientists. Laurie was made an Officer of the Order of Australia in January 2018 and a life member of ADAQ in 2020 in recognition of his contributions to dentistry.

Figure 2. Another view of the same glass partition that establishes physical segregation between the dental operatory and the instrument cleaning section of the adjoining reprocessing area.

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Preventing needle stick injury

By Dr Greg Mahoney, BDSc, PhD, MSc (Dent), GradDipClinDent, FADI, FPFA

Sharps injuries in dental practice remain a concern today even though dentistry adopted preventive practices in the 1980s.

An Australian study found 27.7% of dentists had experienced at least one sharps injury in the previous 12 months and 16.1% of these involved a contaminated instrument that had been previously used on a patient. Furthermore, the most common devices to cause sharps injury in the previous 12 months were needles (14.4%).1 Hollow-bore needle injuries are of particular concern, since they are likely

to contain residual blood and are associated with an increased risk for blood-borne virus transmission. Of the 57 documented cases of occupational HIV transmission to healthcare personnel reported to CDC from June 1995 to December 2002, 50 (88%) involved percutaneous exposure. Of these, 45 (90%) were caused by hollow-bore needles and half of these needles were used in a vein or an artery.2

The risk

Blood-borne viruses that could potentially be transmitted by a sharps injury include hepatitis B and C, as well as HIV. The risk of transmission following a skin puncture injury is dependent on:

• Whether the person who previously used the object had an infection;

• The level of virus in their blood;

• The amount of blood involved;

• The type of needle or syringe in question;

• The time that has elapsed since it was used; and

• The nature of the injury.

So in dentistry, the most likely source of a blood-borne virus transmission is the local anaesthetic needle, being hollow and injected into a vascular rich area. It is estimated that up to 14% of inferior dental nerve blocks result in an intravascular injection and with an infiltration may too puncture a blood vessel.3

Protects you and your staff from needle stick injuries

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A study demonstrated that when introduced in a dental school, Ultra Safety Plus was a the key success factor for avoiding needle stick injuries.

The risks of acquiring other bloodborne viruses from a contaminated needle are considerably higher than the 0.23% for HIV with 6-30% for hepatitis B and 1.8% for hepatitis C.4 Acquired hepatitis B and C cases have been reported in Australia.5,6 Following known exposure to blood borne virus, post-exposure prophylaxis (PEP) should be considered. PEP is known to be over 80% effective in preventing HIV from needle stick injuries and while oral health care workers are vaccinated against hepatitis B, there is no vaccination for Hepatitis C. Post exposure prophylaxis protocols are an essential part of everyday practice although are an expensive and time consuming process with a considerable emotional toll.7 It makes eminent sense for all dental operatories to adopt effective needle stick injury prevention protocols and safety equipment. The criteria for local anaesthetic delivery should be:

FREQUENCY OF NEEDLE STICK INJURIES

ULTRA SAFETY PLUS INTRODUCTION

With Ultra Safety Plus, needle stick injuries decreased from an average of 11.8 to 0 injuries per 1,000,000 hours worked(1)

from an average 11.8 per 1,000,000 hours

to zero in UK dental schools. Consequently it has been adopted by most dental school across the UK.8-10

• Compatible with the existing local anaesthetic cartridge;

• Able to be used for all techniques for local anaesthesia;

• Single use or autoclavable;

• Proven to be effective in reducing or eliminating needle stick injury; and

• Cost effective.

Prevention

Areview of the availability of safety systems, including needleless systems, found that one system met the above criteria - the Ultra Safety Plus from Septodont. The Ultra Safety Plus™ and now the new Ultra Safety Plus Twist (also from Septodont) system – which does not require the re-sheathing or removal of a needle from its syringe – has been in my private practice for over 10 years and in that time there has been no cases of local anaesthetic needle stick injury.

Evaluating the system against the desirable criteria

Compatibility: The system uses the existing 2.2ml cartridges.

Technique: The system comes with preloaded a 27 or 30 gauge needle in short and extra short and looks, feels and acts like the traditional dental injection.

Autoclavable: It comes in single use and if desired, an autoclavable plunger.

Effectiveness at reducing needle sticks: Zakrzewska found that the number of avoidable needle stick injuries reduced from an average 11.8 per 1 million hours worked to zero in UK dental schools (Figure 3). Consequently it has been adopted by most dental school across the UK.8-10

Cost effectiveness. The University of Queensland found the cost of safety syringes was comparable to non-disposable syringes, however the reduction in the cost of managing sharps injuries was substantial.11

Figure 3. Zakrzewska found that the number of avoidable needle stick injuries reduced

worked

Figure 1. The new Ultra Safety Plus Twist from Septodont.

Figure 2. The Ultra Safety Plus from Septodont.

1.

2.

The system works by sliding down a captive rigid sheath over the needle when loading up a new cartridge, exposing the needle and cap. After injection, the sheath is moved up to the first click so that the needle can be uncovered for a second injection if required. At the end of the injection, the sheath is slid up till the second click which is a one way lock to permanently lock the sheath in place over the needle, preventing sharps injuries during changeover between patients.

Adopting sharp safe methods is essential in all dental practices. The Ultra Safety Plus and Ultra Safety Plus Twist provides the dental team with the necessary tool to provide safe practice. If sharp safe habits are not expected of each team member, the risk of a sharp injury increases.

References

1. Leggat PA, Smith DR. Prevalence of percutaneous exposure incidents amongst dentists in Queensland. Aust Dent J. 2006;51(2):158-61.

2. CDC. Workbook for Designing, Implementing and Evaluating a Sharps Injury Prevention Program 14 Dec 2019]. Available from: https://www.cdc.gov/ sharpssafety/part1TEXTONLY.htm.

3. Taghavi Zenouz A, Ebrahimi H, Mahdipour M, Pourshahidi S, Amini P, Vatankhah M. The Incidence of Intravascular Needle Entrance during Inferior Alveolar Nerve Block Injection. J Dent Res Dent Clin Dent Prospects. 2008;2(1):38-41.

4. CDC. Exposure to Blood :s What healthcare personnel need to know. National Center for Infectious Diseases Divison of Healthcare Quality Promotion and Division of Viral Hepatiti. 2003.

5. Haber PS, Young MM, Dorrington L, Jones A, Kaldor J, De Kanzow S, et al. Transmission of hepatitis C virus by needle-stick injury in community settings. J Gastroenterol Hepatol. 2007;22(11):1882-5.

“The system works by sliding down a captive rigid sheath over the needle when loading up a new cartridge, exposing the needle and cap. After injection, the sheath is moved up to the first click so that the needle can be uncovered for a second injection if required. At the end of the injection, the sheath is slid up till the second click which is a one way lock to permanently lock the sheath in place over the needle, preventing sharps injuries during changeover between patients...”

6. Res S, Bowden FJ. Acute hepatitis B infection following a community-acquired needlestick injury. J Infect. 2011;62(6):487-9.

7. McAllister J. Literature review for the national guidelines for post-exposure prophylaxis after nonoccupational and occupational exposure to HIV (revised). National PEP Guidelines Expert Reference Group 2016;Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine.

8. Zakrzewska JM GIaJJ. Introducing safety syringes into a UK dental school – a controlled study. BrDent J 2001(190):188-92.

9. Zakrzewska JM BE. Use of dental safety syringes in British and Irishdental schools. . Br Dent J. 2003(195):207-9.

10. Oliver G, David DA, Bell C, Robb N. An Investigation into Dental Local Anaesthesia Teaching in United Kingdom Dental Schools. SAAD Dig. 2016;32:7-13.

11. Walsh L. Sharps injuries during patient changeover: Are you getting the point. Australasian Dental Practice January/February 2018:64-6.

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With Ultra Safety Plus, needle stick injuries decreased from an average of 11.8 to 0 injuries per 1,000,000 hours worked(1) YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5

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(1) J.M Zakrzewska et al. Introducing safety syringes into a UK dental school – a controlled study. Brit Dent J 2001 ; 190; 88-92.

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