Where's the science?

By Mary Govoni, CDA, RDA, RDH, MBA

Many of you, the readers of Dental Economics, contact me with questions and comments regarding my monthly column. I look forward to the dialogue. But I am concerned that the number of queries and comments continue to question why certain procedures have to be done in dental settings with respect to infection prevention. Many recent comments have questioned the science behind the regulations and guidelines. Perhaps this is an indicator that there is still a lack of understanding of the "hows and whys" of infection prevention.

It has been nearly a year now since the stories about the infection control breaches in Oklahoma and several other states hit news media. In the time that followed, media referenced the Centers for Disease Control and Prevention numerous times in their stories. Most of those references were regarding the lack of weekly spore testing of sterilizers and improper sterilization of instruments as recommended in the CDC's "Guidelines for Infection Control in Dental Health Care Settings -- 2003."

As I have noted in previous columns, the CDC guidelines are those recognized (by dental boards) standards of care for patient safety in matters of infection prevention. These guidelines are frequently dismissed by dental team members. I believe this is because they are viewed as "recommendations" -- therefore not mandatory -- and also because we have become accustomed to following (or not following) OSHA rules in the Bloodborne Pathogens Standard.

There is an important distinction between OSHA and the CDC. OSHA is charged with promulgating and enforcing rules for the protection of employees -- occupational safety. The CDC and dental boards also are charged with the protection of the public (aka patients). I cringe when I hear statements such as "OSHA doesn't care about patient safety." This is not true. It's just not their responsibility. I also cringe when I hear statements such as "Those are just guidelines (regarding the CDC), so we really don't have to follow them."

Whether considering OSHA rules or CDC guidelines, be assured that both OSHA and the CDC rely on scientific studies, epidemiology, statistics on workplace injuries, and more related data than we can possibly imagine. In other words, they do not just make this stuff up.

The CDC Guidelines have 12 pages of references, which cite statistics and studies that have influenced the recommendations in the document. The National Institute for Occupational Safety and Health (NIOSH) has a multitude of research data on the risks of occupational injury and disease, which are referenced by OSHA as well as the CDC.

What I fail to understand is why some team members think that there have to be large or numerous outbreaks of disease to justify the preventive measures that are mandated. Dentistry touts itself as a preventive-oriented profession. Why is it that some of us cannot seem to make the leap from the importance of preventing caries and periodontal disease to preventing infectious disease during the delivery of dental health care?

The truth is that we do have proof that infectious diseases can be transmitted in dentistry when appropriate precautions are not taken.

The CDC confirmed last fall that a case of hepatitis C from a patient-to-patient transmission was discovered during the investigation of the Tulsa, Okla., incident. A patient in Albuquerque, N.M., was infected with hepatitis B in 2001, and there were several cases of hepatitis B and C from improperly sterilized instruments in Veterans Administration facilities in Dayton, Ohio, and in 2010-11 in St. Louis, Mo. In 2012, three patients were confirmed to have acquired unspecified infections from a Colorado oral surgeon who was reportedly reusing needles.

The question is: Where is the tipping point at which everyone in the dental profession stops saying "where's the science?" and does the right thing?

The science is there, my friends, staring us right in the face.

Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Mary Govoni & Associates, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at [email protected] or www.marygovoni.com.