Dental offices inconsistent in infection-control compliance

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A new study that looked at dental office compliance with infection-control guidelines from the U.S. Centers for Disease Control and Prevention (CDC) found that implementation was neither complete nor uniform across all practices (Journal of the American Dental Association, October 2012, Vol. 143:10, pp. 1127-1138).

The authors wanted to identify the factors associated with implementation of four infection-control practices first recommended in the CDC's Guidelines for Infection Control in Dental Health-Care Settings, 2003.

CDC published the 2003 guidelines in collaboration with infection-control experts from other federal agencies, academia, and private and professional organizations, and mailed more than 200,000 copies to actively practicing dental healthcare providers, dental education program directors, state boards of dental examiners, and dental laboratories, according to the JADA authors.

The document updated and consolidated previous dental infection-control recommendations and those from other relevant CDC guidelines, such as those regarding hand hygiene, and added new evidence-based recommendations.

Little information is available on private practice dentists' attitudes toward, knowledge of, and implementation of the 2003 guidelines, noted the study authors. They wanted to test compliance rates with four recommendations that would serve as indicators of guideline adherence.

4 new recommendations

For this study, researchers from the CDC collaborated with an independent research organization (RTI International) to develop a questionnaire, collect and analyze the data, and submit final reports. RTI subcontracted data collection to the ADA's Survey Center. The sample was selected from a pool of 115,437 dentists practicing in the U.S. who owned or co-owned a private dental practice.

The survey was sent to 6,825 dental practices; a total of 3,042 dentists responded, for a response rate of about 49%. The authors considered owners of dental practices the most appropriate people to complete the survey because of their responsibility for oversight of a practice's infection-control program.

The survey gathered data regarding dentists' demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the guidelines, and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of these factors on the implementation of four new preventive recommendations in the CDC Guidelines for Infection Control in Dental Health-Care Settings, 2003:

  • Designating an infection-control coordinator to monitor all infection-control activities
  • Using a separate water system for each dental unit that had been monitored at least once in the preceding 12 months to determine dental water quality
  • Routinely documenting percutaneous injuries
  • Using safer medical devices, such as safer syringes and safer scalpels

The authors conducted bivariate analyses and proportional odds modeling.

Here are some of the key findings:

  • Responding dentists in 34% of practices had implemented none or one of the four recommendations.
  • 40% had implemented two of the recommendations, and 26% had implemented three or four of the recommendations.
  • Almost 80% of dentists reported having a designated infection-control coordinator in the practice.
  • Approximately 62% of practices reported using separate dental unit water line systems, and 40.2% reported monitoring dental unit water quality at least annually.
  • The two most frequently cited recommendations implemented were designating an infection control coordinator and always documenting percutaneous injuries.
  • The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices, and had at least three sources of instruction regarding the guidelines.
  • Dentists with practices in the South Atlantic, Middle Atlantic, or East South Central U.S. Census divisions were less likely to have complied.

Better communication needed

These are the first population-based estimates evaluating U.S. dentists' compliance with recommendations in the 2003 guidelines, study author Jennifer Cleveland, DDS, dental officer/epidemiologist at the CDC, told

The study results indicate a need to focus additional efforts on communicating the importance of adopting a strong infection-control focus within dental clinical practices, she noted.

"These findings should encourage dentists to develop policy and procedures to comply with these recommendations, and especially to have one person who has the oversight of ensuring that these policies and procedures are carried out in everyday dental practice," Dr. Cleveland said.

Strategies targeted at raising awareness of the importance of infection control, increasing continuing education requirements, and developing multiple modes of instruction may increase implementation of future CDC guidelines, she added.

"Working with state licensing boards to require continuing education credits for infection control for relicensure could provide additional sources of instruction and continued dissemination of the guidelines," the authors concluded.

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