Infection control in the dental practice with emphasis on the orthodontic practice

Infections present a significant hazard in the orthodontic office because they can be transmitted by blood or saliva through direct or indirect contact, droplets, aerosols, or contaminated instruments and equipment. Because the incidence of certain microbial cross-infections in the dental environment has not been well documented, orthodontic personnel may not take the problem of cross-infection as seriously as they should, and they may transmit or contract more infections than they realize. The use of effective infection-control procedures in the orthodontic office and laboratory will prevent cross-contamination that may extend to the orthodontist, office staff, assistants, and patients. The goal of this article is to present infection control in a simple, yet comprehensive, manner, and to encourage all orthodontic practitioners to implement essential infection-control procedures in their practices.     

Cross-infection control in Malaysian dental practice

STUDY OBJECTIVE: The aim was to study the spectrum of clinical problems and outcomes in infants born at an urban academic hospital. In consequence, as part of the overall study, the incidence of congenital anomalies and the outcomes of affected infants were recorded. DESIGN: This was a prospective, hospital-based study, undertaken on liveborn infants born over a 3-year period, 1 May 1986 to 30 April 1989. SETTING: Kalafong Hospital, Pretoria. MAIN RESULTS: A total of 17,351 liveborn infants was examined and the total congenital anomalies incidence was 11.87 per 1,000 livebirths. The central nervous system was the system most frequently involved (2.30 per 1,000 livebirths), followed by the musculoskeletal system (2.13 per 1,000 livebirths). The commonest individual congenital anomaly was Down syndrome (1.33 per 1,000 livebirths), followed by neural tube defects (0.99 per 1,000 livebirths) and ventricular septal defects (0.69 per 1,000 livebirths). In 11% (2.25 per 1,000 livebirths) of neonatal deaths, infant loss was attributable to congenital anomalies. CONCLUSIONS: The incidence of congenital anomalies in black South African neonates, born in an urban setting, is as high as in other First- and Third-World countries, and the incidence of some individual congenital anomalies is higher. This study indicates the need for further research and the establishment of prenatal, genetics and paediatric facilities to manage these problems.     

Infection control challenges in child-care centers

This article reviews the various disorders that result in abnormal iron and fat within the liver. MR techniques that detect and characterize fat and iron are discussed. Chemical shift images are useful in detecting intracellular lipid and can characterize diffuse hepatic steatosis as well as focal areas of fatty sparing and fatty infiltration. T2*-weighted gradient-echo sequences are useful in detecting hepatic iron. Typical imaging features of genetic hemochromatosis and hepatic iron from blood transfusions are described.     

Rationalizing infection control in the dental office

We performed a prospective study in 17 consecutive patients following Autologous bone marrow (BM) or rhG-CSF primed peripheral blood item cell (PBSC) transplantation, with the objective of comparing immune recovery between both procedures and to evaluate results in rhG-CSF mobilized peripheral blood stem cell transplantation (PBSCT). Kinetics of immune reconstitution showed differences, with a faster recovery of CD3+ and CD8+ T cells, and a more rapid and sustained recovery of CD8+/-/CD56+ natural killer (NK) cells in the PBCSCT group. Autologous bone marrow transplantation (ABMT) was associated with a improved reconstitution of the CD19+/CD5+/-subpopulation. Moreover, rhG-CSF mobilized PBSCT generated a greater recovery of CD8+/-/CD56+ cells than previous data concerning transplantation with peripheral blood (PB) progenitors collected after myelosuppressive chemotherapy or myelosuppressive therapy plus rhG-CSF. Our results show differences in the rate and pattern of B and T lymphocytes reconstitution after ABMT and PBSCT. Additionally, we state an enhancement of CD56+ cells in patients undergoing PBSCT mobilized solely using rhG-CSF.     

感染控制制度在CT室中的应用

近年来,随着新的医疗环境的改变及环境气候等多因素的变化,感染性疾病日益流行,潜在的医院感染现象越来越普遍,如果沿袭过去的管理模式,很难发现潜在的感染问题,而制度化管理更多的关注感染控制过程而不是结果,是通过对感染过程的控制来进行管理,具备及时的可测量性和评估性,可以及时发现实施过程中存在的缺陷,及时加以改进,从而进一步保证实施结果最大限度的达到管理目标.我们CT室在医院感染控制制度的基础上,结合CT室的工作特点,制定了一系列的相关感染控制制度并在临床工作中加以应用,取得了满意的效果.     

The location and tracking of swallowed dental appliances: the role of radiology

BACKGROUND: The effects of beta 2 adrenergic agonists on chemoreceptors remain controversial. This study was designed to examine whether fenoterol, a beta 2 adrenergic agonist, increases the ventilatory responses to hypercapnia (HCVR) and hypoxia (HVR) in normal subjects. METHODS: HCVR was tested with a rebreathing method and HVR was examined with a progressive isocapnic hypoxic method in 11 normal subjects. Both HCVR and HVR were assessed by the slope of occlusion pressure (P0.1) or ventilation (VE) plotted against end tidal carbon dioxide pressure and arterial oxygen saturation, respectively. Respiratory muscle strength, spirometric values and lung volume were measured. After a single oral administration of 5 mg fenoterol or placebo HCVR and HVR were evaluated. RESULTS: Fenoterol treatment did not change the specific airway conductance or forced expiratory volume in one second. Respiratory muscle strength did not change. Fenoterol increased the slope of the HCVR of both P0.1 (from 0.251 (0.116) to 0.386 (0.206) kPa/kPa, average increase 71%) and VE (from 10.7 (3.4) to 15.1 (4.2) l/min/kPa, average increase 52%), and shifted the response curves to higher values. For the HVR fenoterol increased the slopes of both P0.1 and VE (from -4.06 (2.00) x 10(-3) to -7.99 (4.29) x 10(-3) kPa/%, an average increase of 83%, and from -0.221 (0.070) to -0.313 (0.112) l/min/%, a 44.5% increase, respectively), and shifted the response curves to higher values. CONCLUSION: Acute administration of fenoterol increases the ventilatory responses to both hypercapnia and hypoxia in normal subjects.     

Infection control for the dying

The data on 36 patients who had undergone coronary angiography (CAG) and/or transluminal balloon angioplasty (TBAP) again after successful TBAP were analyzed. Twenty four patients were found to develop restenosis (n = 26), 80 and 92% of patients having them within the first 6 and 12 months after successful TBAP, respectively. Restenosis were demonstrated to be of almost the same degree and extent as the baseline stenoses; however, after repeated TBAP there was a slight reduction in the extent of residual stenosis as compared with the first TBAP (15.9 +/- 16.1% and 30.8 +/- 16.6%, respectively), though this difference was insignificant. At baseline, 42% of dilated stenoses were complicated and/or eccentric, while restenosis were eccentric in 16% of cases (p < 0.05) and complicated in 21% (p < 0.05). Thus, restenoses are X-ray morphologically more favourable for TBAP.     

Infection control and related issues in intravascular therapy

The use of Intravascular (i.v.) catheters has become an increasingly common practice in today's healthcare setting. This increase, however, brings associated problems. An overview of the current literature surrounding i.v. devices and infection control issues was undertaken. This included: the pathogenesis of infection with reference to local and systemic complications; the importance of handwashing; the influence of catheter material and type on infection rates; the controversy over skin preparation and whether it is best to use povidone-iodine, chlorhexidine or an antibiotic ointment; insertion techniques; the duration of line placement; the dilemma over the choice of dressing, i.e. gauze vs transparent; nurses' responsibilities in relation to the UKCC standards and professional accountability; safety issues; and the main principles surrounding the safe disposal of sharps. To conclude, this overview finds that all healthcare professionals must be held accountable for every aspect of i.v. therapy, including the control of infection.     

Infection control issues and intraoperative care

The incidence of congenital dislocation of the hip (CDH) in Singapore and Malaysia has been reported as being lower than in the West. In our hospital, we have seen an increasing number of congenital hip dislocation as well as dysplastic hips. We undertook a prospective study from December 1989 to December 1994 of 20,000 live births. The neonates were all screened by a consultant neonatologist and the findings were confirmed by a consultant paediatric orthopaedic surgeon. All babies had plain X-rays at 3 months and an acetabular index (AI) of 30 degrees or more was considered dysplastic. All babies with positive signs were followed up for 1 year and again had radiographs taken at 1 year. Comparison of plain X-rays and ultrasound assessment in a subgroup of 130 neonates showed that 64% of patients with AI > 20 degrees had hip dysplasia by ultrasonographic (alpha angle < 60 degrees) The incidence of dysplastic hips was 16.8 per 1000 live births. The overall incidence of neonates with dislocated hips was 4.7 per 1000 live births. The Malays were most affected with an incidence of 5.4 per 1000 live births. The incidence of developmental dysplasia of the hip in Singapore is higher than previously reported, with the Malays having the highest incidence. A significant number of babies with clicking hips have radiological evidence of acetabular dysplasia (AI > 30 degrees). One-third of the babies' hips were still dysplastic at 1 year of age. A well-organised screening programme with experienced examiners has proved to be useful in making early and accurate clinical diagnosis.     

Infection control: principles for practice

This article discusses the general principles of infection control and outlines the role nurses can play in maintaining a safe environment. This article is the third and final part of our 1998 series on infection control.     

Infection control of hepatitis C in Dutch dialysis centres

BACKGROUND: In dialysis patients, blood transfusions and long-term dialysis are well-known risk factors for transmission of hepatitis C virus (HCV). Transmission of HCV by transfusions has become extremely rare since the introduction of antibody screening. However, nosocomial transmission of HCV within dialysis units still occurs. We performed a survey of current infection control measures against HCV in Dutch dialysis centres that had participated in a national HCV prevalence study. METHODS: All twenty-seven Dutch dialysis centres where HCV-positive patients had been identified (HCV prevalence 1-8%), participated. With the use of a questionnaire we evaluated screening procedures for resident patients and guest patients, routine hygienic measures in HCV-positive and -negative patients, and cleaning procedures of dialysis equipment. RESULTS: All centres except one screened new patients for HCV antibodies, but the frequency of periodic follow-up screening varied. Most centres requested HCV antibody screening of guest patients in advance, but in daily practice 55% of the centres dialysed guest patients even when HCV antibody status was not available. The majority of centres had not implemented special precautions for patients with unknown HCV antibody status. In most centres the use of protective glasses, masks and aprons depended on the HCV antibody status of the patients. Surprisingly, 85% of the centres allowed their nurses to operate dialysis machines with gloves possibly blood contaminated. All centres sterilized their machines at the end of the day, but only 77% sterilized their machines between all dialysis sessions. Traces of blood were removed with alcohol in 63% of the centres. CONCLUSION: Dutch dialysis centres have not yet implemented an optimal policy for prevention of HCV. Especially, operating dialysis machines with gloves might be a potential source for nosocomial transmission of HCV, not yet covered by the issued guidelines. Because dialysis patients probably have a prolonged serological window phase after a recent HCV infection, it does not suffice to implement a preventive strategy against nosocomial transmission based on the results of HCV antibody screening. Universal, rigorous implementation of adequate infection control measures irrespective of HCV antibody status should be the cornerstone for prevention of nosocomial transmission of HCV and other blood borne pathogens.