Background
Many dental procedures produce aerosols (droplets, droplet nuclei and splatter) that harbour various pathogenic micro‐organisms and may pose a risk for the spread of infections between ...dentist and patient. The COVID‐19 pandemic has led to greater concern about this risk.
Objectives
To assess the effectiveness of methods used during dental treatment procedures to minimize aerosol production and reduce or neutralize contamination in aerosols.
Search methods
Cochrane Oral Health’s Information Specialist searched the following databases on 17 September 2020: Cochrane Oral Health’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library, 2020, Issue 8), MEDLINE Ovid (from 1946); Embase Ovid (from 1980); the WHO COVID‐19 Global literature on coronavirus disease; the US National Institutes of Health Trials Registry (ClinicalTrials.gov); and the Cochrane COVID‐19 Study Register. We placed no restrictions on the language or date of publication.
Selection criteria
We included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on aerosol‐generating procedures (AGPs) performed by dental healthcare providers that evaluated methods to reduce contaminated aerosols in dental clinics (excluding preprocedural mouthrinses). The primary outcomes were incidence of infection in dental staff or patients, and reduction in volume and level of contaminated aerosols in the operative environment. The secondary outcomes were cost, accessibility and feasibility.
Data collection and analysis
Two review authors screened search results, extracted data from the included studies, assessed the risk of bias in the studies, and judged the certainty of the available evidence. We used mean differences (MDs) and 95% confidence intervals (CIs) as the effect estimate for continuous outcomes, and random‐effects meta‐analysis to combine data. We assessed heterogeneity.
Main results
We included 16 studies with 425 participants aged 5 to 69 years. Eight studies had high risk of bias; eight had unclear risk of bias. No studies measured infection. All studies measured bacterial contamination using the surrogate outcome of colony‐forming units (CFU). Two studies measured contamination per volume of air sampled at different distances from the patient's mouth, and 14 studies sampled particles on agar plates at specific distances from the patient's mouth.
The results presented below should be interpreted with caution as the evidence is very low certainty due to heterogeneity, risk of bias, small sample sizes and wide confidence intervals. Moreover, we do not know the 'minimal clinically important difference' in CFU.
High‐volume evacuator
Use of a high‐volume evacuator (HVE) may reduce bacterial contamination in aerosols less than one foot (~ 30 cm) from a patient's mouth (MD −47.41, 95% CI −92.76 to −2.06; 3 split‐mouth RCTs, 122 participants; very high heterogeneity I² = 95%), but not at longer distances (MD −1.00, −2.56 to 0.56; 1 RCT, 80 participants).
One split‐mouth RCT (six participants) found that HVE may not be more effective than conventional dental suction (saliva ejector or low‐volume evacuator) at 40 cm (MD CFU −2.30, 95% CI −5.32 to 0.72) or 150 cm (MD −2.20, 95% CI −14.01 to 9.61).
Dental isolation combination system
One RCT (50 participants) found that there may be no difference in CFU between a combination system (Isolite) and a saliva ejector (low‐volume evacuator) during AGPs (MD −0.31, 95% CI −0.82 to 0.20) or after AGPs (MD −0.35, −0.99 to 0.29). However, an 'n of 1' design study showed that the combination system may reduce CFU compared with rubber dam plus HVE (MD −125.20, 95% CI −174.02 to −76.38) or HVE (MD −109.30, 95% CI −153.01 to −65.59).
Rubber dam
One split‐mouth RCT (10 participants) receiving dental treatment, found that there may be a reduction in CFU with rubber dam at one‐metre (MD −16.20, 95% CI −19.36 to −13.04) and two‐metre distance (MD −11.70, 95% CI −15.82 to −7.58). One RCT of 47 dental students found use of rubber dam may make no difference in CFU at the forehead (MD 0.98, 95% CI −0.73 to 2.70) and occipital region of the operator (MD 0.77, 95% CI −0.46 to 2.00).
One split‐mouth RCT (21 participants) found that rubber dam plus HVE may reduce CFU more than cotton roll plus HVE on the patient's chest (MD −251.00, 95% CI −267.95 to −234.05) and dental unit light (MD −12.70, 95% CI −12.85 to −12.55).
Air cleaning systems
One split‐mouth CCT (two participants) used a local stand‐alone air cleaning system (ACS), which may reduce aerosol contamination during cavity preparation (MD −66.70 CFU, 95% CI −120.15 to −13.25 per cubic metre) or ultrasonic scaling (MD −32.40, 95% CI ‐ 51.55 to −13.25).
Another CCT (50 participants) found that laminar flow in the dental clinic combined with a HEPA filter may reduce contamination approximately 76 cm from the floor (MD −483.56 CFU, 95% CI −550.02 to −417.10 per cubic feet per minute per patient) and 20 cm to 30 cm from the patient's mouth (MD −319.14 CFU, 95% CI ‐ 385.60 to −252.68).
Disinfectants ‒ antimicrobial coolants
Two RCTs evaluated use of antimicrobial coolants during ultrasonic scaling. Compared with distilled water, coolant containing chlorhexidine (CHX), cinnamon extract coolant or povidone iodine may reduce CFU: CHX (MD −124.00, 95% CI −135.78 to −112.22; 20 participants), povidone iodine (MD −656.45, 95% CI −672.74 to −640.16; 40 participants), cinnamon (MD −644.55, 95% CI −668.70 to −620.40; 40 participants). CHX coolant may reduce CFU more than povidone iodine (MD −59.30, 95% CI −64.16 to −54.44; 20 participants), but not more than cinnamon extract (MD −11.90, 95% CI −35.88 to 12.08; 40 participants).
Authors' conclusions
We found no studies that evaluated disease transmission via aerosols in a dental setting; and no evidence about viral contamination in aerosols.
All of the included studies measured bacterial contamination using colony‐forming units. There appeared to be some benefit from the interventions evaluated but the available evidence is very low certainty so we are unable to draw reliable conclusions.
We did not find any studies on methods such as ventilation, ionization, ozonisation, UV light and fogging.
Studies are needed that measure contamination in aerosols, size distribution of aerosols and infection transmission risk for respiratory diseases such as COVID‐19 in dental patients and staff.
APIC MegaSurvey: Methodology and overview Landers, Timothy, PhD, RN, CNP, CIC; Davis, James, MSN, RN, CCRN, HEM, CIC, FAPIC; Crist, Katrina, MBA, CAE ...
American journal of infection control,
06/2017, Letnik:
45, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Highlights • The APIC MegaSurvey was completed by 4,078 infection preventionists (IPs) in 2015. • MegaSurvey methods and study design are reviewed. • 37.7% were considering certification. • ...Surveillance and investigation accounted for a mean of 25.4% of IP practice. • 66.2% of IPs practiced in acute care, with a wide variety of other practice settings.
Chlorine and solar disinfection are widely used disinfectants in water treatment. However, certain potential pathogens can resist these methods, posing a public health risk. One such case is ...Acanthamoeba, a resistant free-living amoeba that protects pathogens inside from disinfection, thus endangering the health of water users. This work is the first evaluation of the inactivation efficiency achieved by combining NaClO (Clsub.2) and solar radiation (SR) against two Acanthamoeba strains from different sources (freshwater and pool water) and their endosymbiont bacteria (EB). Amoebae were exposed to different Clsub.2 doses (0–500 mg/L), SR wavelength ranges (280–800 nm and 320–800 nm), used as gold standards, and their combinations. The EB exhibited resistance to conventional Clsub.2 and SR treatments, requiring up to 20 times higher disinfectant doses than those needed to inactivate their protective Acanthamoeba. The pool strain and its EB demonstrated greater resistance to all treatments compared to the freshwater strain. Treatments with Clsub.2 (5 mg/L)/SRsub.280–800nm completely inactivated both Acanthamoeba and EB of the freshwater strain, reducing up to 100 times the necessary Clsub.2 doses, suggesting that chlorine photolysis is an attractive treatment for disinfecting freshwater and preventing waterborne diseases associated with Acanthamoebae and its EB.
Recently, the coronavirus disease 2019 (COVID-19) epidemic has greatly threatened global public health. The responsibility of healthcare-associated infection control professionals (ICPs) is to ...prevent and control the nosocomial infections. The mental health status of ICPs deserves more attention, however, the correlational research is still lacking. This study aims to investigate the incidence and risk factors of mental health status among ICPs in China during the outbreak of COVID-19.A national cross-sectional survey was performed. The online questionnaire was completed by 9228 ICPs from 3776 hospitals throughout China. Data collection tools were used, including demographics data questionnaire, the Chinese version of the 12-item general health questionnaire (GHQ-12) and the Chinese version of the psychological capital questionnaire (PCQ) for medical staff. Univariate and multivariable analyses were conducted.The total score of mental health of Chinese ICPs was 3.45 ± 2.57. 5608 (60.77%) ICPs might have mental health problems. The psychological capital was in the upper-middle level with an average score of 3.72 ± 0.38. An increased mental health problem risk was associated with the greater self-efficacy and working in the public hospital; a significantly lower risk was obtained by working in the second-class hospital rather than in the third-class hospitals. Besides, mental health problem risk of ICPs working in hospitals of the western economic region or northeast economic region was more significant than that in hospitals of the central economic region. However, a lower risk was caused by the unmarried than married, and working years in department ≤1 year contributed to the lower risk than that >20 years. Moreover, fewer working hours per week, higher values of hope, and optimism each were contributed to a lower risk.Chinese healthcare-associated ICPs were under different levels of mental health problems in fighting against COVID-19. More importantly, we should actively deal with the mental health problem of ICPs and help them get rid of psychological disorders.
The aim of this review is to describe variation in standards and guidelines on 'heating, ventilation and air-conditioning (HVAC)' system maintenance in the intensive care units, across the world, ...which is required to maintain good 'indoor air quality' as an important non-pharmacological strategy in preventing hospital-acquired infections. An online search and review of standards and guidelines published by various societies including American Institute of Architects (AIA), American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), Centers for Disease Control and Prevention (CDC), Department of Health Estates and Facilities Division, Health Technical Memorandum 2025 (HTM) and Healthcare Infection Control Practices Advisory Committee (HICPAC) along with various national expert committee consensus statements, regional and hospital-based protocols available in a public domain were retrieved. Selected publications and textbooks describing HVAC structural aspects were also reviewed, and we described the basic structural details of HVAC system as well as variations in the practised standards of HVAC system in the ICU, worldwide. In summary, there is a need of universal standards for HVAC system with a specific mention on the type of ICU, which should be incorporated into existing infection control practice guidelines.
Coronavirus disease 2019 (COVID-19) was first reported in Wuhan in December 2019 and has rapidly spread across different cities within and outside China. Hong Kong started to prepare for COVID-19 on ...31st December 2019 and infection control measures in public hospitals were tightened to limit nosocomial transmission within healthcare facilities. However, the recommendations on the transmission-based precautions required for COVID-19 in hospital settings vary from droplet and contact precautions, to contact and airborne precautions with placement of patients in airborne infection isolation rooms.
To describe an outbreak investigation of a patient with COVID-19 who was nursed in an open cubicle of a general ward before the diagnosis was made.
Contacts were identified and risk categorized as ‘close’ or ‘casual’ for decisions on quarantine and/or medical surveillance. Respiratory specimens were collected from contacts who developed fever, and/or respiratory symptoms during the surveillance period and were tested for SARS-CoV-2.
A total of 71 staff and 49 patients were identified from contact tracing, seven staff and 10 patients fulfilled the criteria of ‘close contact’. At the end of 28-day surveillance, 76 tests were performed on 52 contacts and all were negative, including all patient close contacts and six of the seven staff close contacts. The remaining contacts were asymptomatic throughout the surveillance period.
Our findings suggest that SARS-CoV-2 is not spread by an airborne route, and nosocomial transmissions can be prevented through vigilant basic infection control measures, including wearing of surgical masks, hand and environmental hygiene.
The recent COVID-19 pandemic has made everyone aware of the threat of viruses and the growing number of antibiotic-resistant bacteria. It has become necessary to find new methods to combat these ...hazards. One tool that could be used is UVC radiation, i.e., 100–280 nm. Currently, the available sources of this light are mercury vapor lamps. However, the modern world requires more compact, mercury-free, and less energy-consuming light sources. This work presents the results of our research on a new material in which efficient UVC radiation was obtained. Here, we present the results of research on Casub.9Y(POsub.4)sub.7 polycrystals doped with Prsup.3+ ions prepared using the solid-state method. The absorption, excitation, emission, and emission decay profiles of praseodymium(III) ions were measured and analyzed. The upconversion emission in the UVC region excited by blue light was observed. Parameters such as energy bandgap, refractive index, and thermal stability of luminescence were determined. The studied phosphate-based phosphor possesses promising characteristics that show its potential in luminescent applications in future use in medicine or for surface disinfection.
Repeat department-wide surveys are commonly employed for infection control. There remains debate concerning their cost-effectivess. The aim of the study was to measure the impact of repeat ...department-wide surveys in major in-patient departments (IPDs) and ambulatory facilities (AFs) in a tertiary care hospital. This was a retrospective study of 138 surveys condcuted in 96 departments over a 5-year period.
Two itemized questionnaires were designed to assess the most frequently inadequately adhered to infection control measures: one for IPD (with 21 items) and the other for AF (with 17 items).
A total of 72 surveys were conducted in 49 IPDs, of which 39 (54%) were repeat surveys, and 66 surveys in 47 AFs, of which 33 (50%) were repeat surveys. The baseline rate of adherence/department was 71% ± 14 for the IPD, with an increase from the first to the last survey to 82% ± 13 (P = .037). In 15/21 measured infection control items, adherence improved.
Adherence to infection control items was lower at baseline in the AFs than in the IPDs (63 ± 27), with an increase to 76 ± 20 (non significant). Although adherence improved for 9 items, it deteriorated in another 8, producing an overall statistically unchanged outcome.
Repeat whole-department surveys contribute moderately to increased adherence to infection control guidelines. AFs demonstrate lower rates of adherence to infection control guidelines and are less receptive to educational measures.
•Department-wide surveys (DWS) are labor intensive; are they cost-effective?•We reviewed 138 surveys in 49 in-patient departments (IPD) and 47 ambulatory units (AU).•Adherence with guidelines was 71% ± 14 per IPD and increased to 82% ± 13 (P < .05).•Adherence was lower in the AU, with an increase from 63% ± 27 per AU to 76% ± 20 (NS).•Repeat DWS contribute moderately to adherence to infection control guidelines.
There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus ...aureus (MRSA), multiresistant Gram-negative bacilli, norovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the value of physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence on the role of antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens.
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