C. diff -- Is it a concern for dentistry?

by Mary Govoni, CDA, RDA, RDH, MBA

The media is buzzing about Clostridium difficile infections, also referred to as C. diff. These infections are occurring at an alarming rate in hospitals, and result in 14,000 deaths annually in the U.S.

I’ve had many inquiries recently about C. diff infections and their link to dentistry. There are many stories and blogs on this possible link. The reality is that dentistry may play a small role in contributing to this high infection rate, but it is not related to our infection prevention procedures. To better understand this issue, let’s look at what C. diff is, why it is such a serious problem, how it is transmitted, and what surface disinfectants are effective against it.

Clostridium difficile is a spore-forming, gram-positive, anaerobic bacillus bacteria that causes irritation of the colon and severe diarrhea. According to the CDC, it is the cause of 15% to 25% of cases of antibiotic-associated diarrhea due to the exotoxins that the bacteria produce.

When patients take antibiotics, the C. diff that reside in the intestinal tract as part of the normal bacterial flora can overgrow, causing a C. diff infection. These patients experience abdominal pain, fever, severe diarrhea, and ulcerative colitis. Antibiotics most likely to cause C. diff infections are clindamycin, amoxicillin, ampicillin, and cephalosporins, and to a lesser extent, penicillin, erythromycin, and quinolones.

Since some of these drugs are frequently prescribed for antibiotic prophylaxis or treatment of infections in dentistry, the CDC urges dentists to use caution when prescribing these drugs for patients. Antibiotic prophylaxis is typically used in dentistry for patients at risk for infective endocarditis and those who have had total joint replacements.

The current guidelines for antibiotic prophylaxis are available at http://jada.ada.org/content/139/suppl_1/3S.abstract for infective endocarditis and http://www.aaos.org/about/papers/advistmt/1033.asp for patients with total joint replacements.

The American Dental Association recommends that dentists review these guidelines and use caution when prescribing antibiotics. Patients who are most susceptible to C. diff infections are the elderly, those taking proton-pump inhibitors and/or antibiotics, and those with chronic illnesses who are immunocompromised.

It is important to note that C. diff is transmitted through contact with feces, which is not a typical exposure risk in dental health-care settings. The spread of C. diff happens primarily in hospitals and long-term care facilities. So while dentists can help decrease the risk of C. diff infections by more judicious prescribing of antibiotics, this epidemic infection does not warrant changes in the infection control protocols in dental facilities.

This means that there is no need to make changes in the surface disinfectants that we use in treatment areas in dentistry. Most EPA-registered surface disinfectants do not claim to be effective against C. diff, but are appropriate for use in the treatment rooms because they are tuberculocidal and effective against hepatitis B, HIV, MRSA, and other microorganisms likely to be present on contaminated environmental surfaces.

Hypochlorite-based products have been shown to be effective against C. diff, such as Dispatch Hospital Cleaner Disinfectant with bleach, which may be appropriate for use in cleaning bathroom facilities where possible exposure to feces may occur.

Educating dental teams and patients about the risks of C. diff infections is an important step in controlling these outbreaks. The CDC has numerous resources available for patients and clinicians at www.cdc.gov/vitalsigns, which includes fact sheets for patients and posters that can be printed and posted in dental facilities. Vital Signs can also be accessed through the new CDC iPad app, downloadable from iTunes at http://itunes.apple.com/us/app/cdc/id487847188?s_cid=bb-oadc-ipadapp-001.

C. diff is a concern for dentistry. Make sure that you and your team are knowledgeable about these infections so you can possibly save the lives of your patients.

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.