|
Detection of hepatitis C virus-RNA by polymerase
chain reaction in dental surgeries.
Piazza M; Borgia G; Picciotto L; Nappa S; Cicciarello S;
Orlando R Institute of Infectious Diseases, University of Naples
Federico II, Italy. J Med Virol 45: 40-2 (1995)
Abstract
The mean prevalence of anti-hepatitis C virus (HCV) in Italy is 0.87%. It
reaches 2% in Campania, Southern Italy. Approximately 50% of community
acquired non-A, non-B (NANB) hepatitis cannot be associated with known
parenteral exposure. A recent Italian study has shown that the only
demonstrable risk factor in 9% of acute C/NANB hepatitis is dental
treatment. There are no data on direct contamination by HCV of dental
surgeries. Possible environmental contamination by HCV-RNA was
investigated in dental surgeries after treatment of anti-HCV and HCV-RNA
positive patients. Thirty-five anti-HCV and HCV-RNA positive patients
with chronic hepatitis underwent dental treatment and were enrolled in
this study. Eight had chronic persistent hepatitis (CPH), 23 chronic
active hepatitis (CAH), and 4 cirrhosis. A total of 328 samples
collected from instruments and surfaces were tested after dental
treatment of 35 anti-HCV positive patients. The presence of HCV-RNA was
determined by polymerase chain reaction (PCR) to evaluate contamination
of instruments and surfaces in dental surgeries. Twenty (6.1%) out of
328 collected samples were positive for HCV-RNA. The positive samples
were from work benches (two), air turbine handpieces (one), holders
(four), suction units (one), forceps (four), dental mirrors (two), and
burs (six). Our data indicate that there is extensive contamination by
HCV of dental surgeries after treatment of anti-HCV patients and that if
sterilization and disinfection are inadequate there is the possible risk
of transmission to susceptible individuals
Failure of gloves and other
protective devices to prevent transmission of hepatitis B virus to oral
surgeons.
JAMA 1988 May 6;259(17):2558-60 Reingold AL, Kane MA, Hightower
AW Department of Biomedical and Environmental Health Sciences,
School of Public Health, University of California, Berkeley.
A survey of 434 oral surgeons was conducted to examine risk
factors for hepatitis B virus (HBV) infection. Overall, 112 (26%)
of the participants demonstrated serologic evidence of past or
current infection with HBV. Seropositivity was significantly
associated with age, number of years in practice, and year of
graduation from dental school but not with other variables
examined, such as the number of patients seen annually or the
number of patients seen who were at high risk of HBV infection.
The strong correlation between years in practice and
seropositivity was unaffected by reported use of gloves, face
masks, or eye shields. The use of gloves and other protective
devices does not appear to offer substantial protection against
HBV exposure in oral surgeons, and all oral surgeons should
receive HBV vaccine. PMID: 3357229, UI: 88188297
OSHA Preambles -
Bloodborne Pathogens
(29 CFR 1910.1030)Revision
Date: Jul 30 1999
Most healthcare workers who have transmitted to patients have several
factors in common (Exs. 6-476; 6-471):
(1) The dentists and surgeons were chronic HBV carriers, had high
titers of virus in their blood (HBeAg positive), and were unaware
that they were infected.
(2) Transmission occurred most frequently during the most
traumatic procedures.
(3) The dental personnel who transmitted did not routinely wear
gloves. However, some infected HCWs continued to transmit HBV to
patients in spite of the use of gloves and additional precautions.
(4) The dentists and surgeons often had a personal medical problem
(such as exudative dermatitis on the hands), or used techniques that
made transmission more likely. Several of the gynecologists used their
index fingers to feel for the tip of the suture needle when they
were performing deep abdominal surgery. http://www.osha-slc.gov/Preamble/Blood_data/BLOOD4.html
Veterans Administration cooperative study
on hepatitis and dentistry.
Am Dent Assoc 1986 Sep;113(3):390-6 Schiff ER, de Medina MD,
Kline SN, Johnson GR, Chan YK, Shorey J, Calhoun N, Irish EF
Personnel in the VA dental facilities were screened for the
detection of viral hepatitis and identification of factors
implicating infectivity. A total of 963 personnel from 126
dental facilities throughout the United States voluntarily
participated in the study. The rate of seroconversion for any
hepatitis B markers was approximately 1% per year. Serial
positive tests for antibody to hepatitis B core antigen or
antibody to hepatitis B surface antigen (or both) were present
in 16.2% of dentists and 13.0% of dental auxiliary personnel.
Oral and maxillofacial surgeons composed
the highest prevalence occupation
(24.0%),
and clinical personnel composed the lowest prevalence occupation
(8.9%). There was a significant association between years in
dental environment and serological positivity for viral B
infection. The dentists and dental auxiliary personnel had
significant linear trends of increasing serological positivity
with years in the dental environment. Although a majority of
personnel reported wearing gloves while treating high-risk
patients or performing invasive procedures, inadequate
prophylactic measures were exercised for most patients
undergoing a variety of less invasive procedures. The results of
the study show the need for an active immunization program
against type B viral infection for dental and dental auxiliary
personnel, preferably before the initial exposure to the
professional environment. PMID: 3531282, UI: 87009463
PHILADELPHIA INQUIRER AIDS VIRUS SURVIVES DENTAL-TOOL WASH HEAT
STERILIZATION IS URGED. A STUDY FOUND WASHINGTHE TOOLS WITH
DISINFECTANT DIDN'T DO THE JOB.
Published on 11/21/1992,
TEXT: The viruses that cause AIDS and hepatitis B can survive
within dental tools that are washed with disinfectant but not
heat-sterilized, posing a potential risk of disease
transmission, according to a new study.
The recent case of a Florida dentist who transmitted the virus
to five patients ignited widespread fear about catching AIDS
from dental procedures. But the infected patients in Florida got
the virus from the dentist, not from contaminated equipment,
according to investigations
|
