Global Roundtable-From Guidelines to Compliance. Fiona Collins, JeannéOosthuysenand Annabel Fossey, Liliana Donatelli

Transcription

1 Global Roundtable-From Guidelines to Compliance Fiona Collins, JeannéOosthuysenand Annabel Fossey, Liliana Donatelli

2 Disclosures The presenters have no conflict of interest regarding the content of this presentation

3 Objectives Recognize international partners to exchange information on infection control in dentistry. Discuss common principles and key differences of various international guidelines. Identify resources, references and regulations from the countries represented in facilitated discussion. Identify at least one action step to enhance infection control compliance and advance dental safety in their country.

4 Vision Every visit is a safe dental visit Mission To be the world s leading provider of education that supports safe dental visits

5 Introduction to Topic Previous In Global Roundtables 2013-San Diego: Mexico, Panamá and Brazil Dental Community, Guidelines 2014-South Africa, India, Mexico, Scotland and Brazil (Missions) Guidelines and Compliance 2015 Scotland, Netherlands, Mexico, Canada, Brazil Comparing Guideline Topics 2016 Summary from Previous Years, South African Experience, Ideas to improve compliance Brazilian Experience

6 OSAP Symposium 2015 Brazil, Canada, Mexico, Scotland and The Netherlands Selected specific area of infection control Developed understanding of similarities and differences Discussed these differences Objective was to expand understanding Develop forward actions and global database

7 Instrument Decontamination (Processing) PPE Sharps treatment Transport and Processing Area Categorization of Instruments Cleaning (+/- presoaking) Packaging and Sterilization Handpieces Storage Type of monitoring recommended/required Documentation

8 Mostly minor differences Findings Sharps disposal and transportation PPE Cleaning Sterilization Handpieces Sterilization monitoring A few unique outliers

9 Conclusions General guidelines were substantially similar Develop global understanding Areas developing guidelines Explore other areas Compliance to guidelines

10 Infection Prevention and Control in Dental Practices: A South African Perspective Dr Jeanné Oosthuysen and Prof Annabel Fossey Department of Life Sciences Faculty of Health and Environmental Sciences

11 Declaration The authors declare that they have no competing interests. This investigation was partially financed by the National Research Foundation, South Africa, the Central University of Technology, Free State and the Dentistry Development Foundation of the South African Dental Association. Funding from the National Research Foundation, South Africa, the Central University of Technology, Free State and OSAP to attend OSAP 2016 conference.

12 Issue 1 st World or 3 rd world standards? Establishment of a safe working environment to control risks

13 Issue High incidence human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) Hepatitis B and C infections Tuberculosis infections Violent society leading to trauma with open wounds as a regular feature in many patients

14 Issue In South Africa: No oral health care specifications / guidelines exist No way of measuring compliance to best practice Audit-feedback is commonly used in health practices to improve compliance to best practice Inconsistencies can be identified Practices can be modified

15 Issue In South Africa: Variety of oral health care facilities Rural and urban facilities on the one hand Public and private on the other hand Low- or limited resource country

16 Issue In South Africa: Diversity of personnel training levels: From cleaners, without any formal qualification to practitioners at post graduate level Dental practitioners Dental therapists Dental assistants Dental hygienists Dental technicians Dental students Practice managers, employers, executive managers

17 Project Aim of this project: To develop an audit and feedback instrument (AFI) to measure compliance to infection prevention and control standards To test the AFI in dental practices in South Africa

18 Project Objectives: To compile guidelines that can be used to develop the AFI To develop the AFI according to the guidelines To test the AFI in 50 dental practices

19 Project Criteria for the development of the AFI: Self-administered instrument Electronic calculation instrument Used by: - Dental practitioners - Employers - Managers - Personnel Provide electronic feedback Feedback about compliance status with specifications

20 Results Focus areas - logical order CDC guidelines: Focus area 1: Administrative Controls Focus area 2: Personnel Protection Controls Focus area 3: Environmental- and Work Controls Focus area 4: Surface Contamination Management Focus area 5: Equipment Maintenance Focus area 6: Air- and Waterline Management Focus area 7: Personal Protective Equipment Usage Focus area 8: Personal- and Hand Hygiene Practices Focus area 9: Sterilisation Practices Focus area 10: Safe Sharps Handling Focus area 11: Waste Management

21 Results Issue

22 Results Issue

23 Results Issue

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25 Results Issue

26 Results Category classification Compliance categories (%) Category description Colour code Target 100 Target Close to target >80 - <100 Compliance Poor >50 - <80 Poor compliance Unacceptable <50 Unacceptable compliance Every oral health care facility should aim for 100% compliance. Developed from colour categories assessment of drinking water safety in SA Source: WRC, DWAF, DoH. Quality of domestic water supplies Volume 1: Assessment Guide. 2 ed. Pretoria: Water Research Commission, Department of Water Affairs and Forestry, and Department of Health South Africa; 1998

27 Sector Years Since Qualified Institution Qualified > 25: 22.4% Results UP 40.8% 21-25: 22.4% Private Sector 81.6% 16-20: 6.1% 11-15: 6.1% UWC 20.4% 6-10: 18.4% Medunsa 12.2% Public Sector (State Clinic) 18.4% < 5: 25.5% UKZN 12.2% Witwatersrand 8.2% Other 6.1%

28 Gender Home Language Respondent Age Respondent Position > 65: 4.1% 52-65: 22.4% Results Afrikaans 55.1% Male 69.4% 42-50: 22.4% Dental Practitioner 85.7% S-Sotho 16.3% 32-40: 34.7% English 8.2% Female 30.6% Other 6.1% N-Sotho 6.1% Oral Hygienist 4.1% Zulu 4.1% Xhosa 2% 22-30: 16.3% Dental Therapist 4.1% Dental Assistant (In Office Trained) 4.1% Tswana 2% Other 2%

29 Results Focus area Questions per focus area Number of facilities - Blue compliance category* Number of facilities - Green compliance category* Number of facilities - Yellow compliance category* Number of facilities - Red compliance category * Mean % score Administrative Controls Personnel Protection Controls Environmental- and Work Controls Surface Contamination Management Equipment Maintenance Air- and Waterline Management Personal Protective Equipment Usage Personal- and Hand Hygiene Practices Sterilisation Practices Safe Sharps Handling Waste Management Number of facilities per categories (%) (Total = 49 facilities 11 focus areas = 539) *= Number of facilities counted in the compliance category 12 (2.2%) 50 (9.3%) 235 (43.6%) 242 (44.9%) 51.1

30 Results

31 Results

32 Results Section Range (%) Mean (%) No of practices complying Personal- & hand hygiene practices Waste management Compliance is questionable

33 Results Section Range (%) Mean (%) No of practices complying Surface controls Safe sharps handling Compliance is a concern

34 Results Section Range (%) Mean (%) No of practices complying Sterilisation practices Personnel protection controls PPE usage Poor compliance

35 Results Section Range (%) Mean (%) No of practices complying Equipment maintenance Environmental- & work controls Air- & waterline management Administrative controls Compliance is a huge problem

36 Conclusions Data indicate that compliance in this practice sample was poor. Systems are necessary to improve infection prevention and control in South African OHC facilities. AFI is an effective system to measure compliance and suggest remediation.

37 Acknowledgement Dr Elsa Potgieter, Chief Microbiologist Mangaung Metropolitan Municipality, Bloemfontein South Africa Sr Laura Ziady, Nurse Educator / IPC Assessor from Mediclinic SA Participating oral health care practitioners and workers OSAP, NRF, CUT and the South African Dental Association

38 CIOSP -Brazil Dental Schools Chuck Hughes January, 29 th ANVISA, CRO-DF, Universities UNESP (Araraquara, Araçatuba), USP (SP, Bauru), UFPE, São Leopoldo Mandic, UNIFRAN, epidemiologists, clinicians. 25 attendees

39 Brazilian Experts New Initiative [ Group to improve Infection Control in Dentistry Representatives from Universities (São Public Health, Dental Association Clinicians Epidemiologists, Infection Control consultants 1st Zoom Call April 27 th -Monthly

40 Proposal -OSAP International Meetings Would you like to attend? Topics Frequency How to manage Proposal to OSAP

41 References CDC_2003 CDC_2016 ANVISA_2006 Oosthuysen J, Fossey A (2015) Assessment of the audit-feedback instrument for oral health care facilities in South Africa. South African Dental Journal, 2015 August;70(7): Available from

42 Takeaways General guidelines were substantially similar Develop global understanding Areas developing guidelines Explore other areas Compliance to guidelines Improve Infection Control Everywhere s: Fiona Collins: Jeanné Oosthuysen: Annabel Fossey: Liliana Donatelli: