CDC Division of Oral Health 2018 Update

Transcription

1 CDC Division of Oral Health 2018 Update Organization for Safety, Sepsis and Prevention (OSAP) Annual Meeting Friday, June 1, 2018 Michele Junger, DDS, MPH Dental Officer Objectives Discuss a recent report of a cluster of idiopathic pulmonary fibrosis (IPF) among dental health care personnel (DHCP) Review CDC Dental Handpiece Statement Review new resources for infection prevention and control in dental health care settings Slide 2 Idiopathic Pulmonary Fibrosis (IPF) 1

2 Report of Dental Personnel Treated for IPF at a Virginia Tertiary Care Clinic, Nett RJ, Cummings KJ, Cannon B, Cox Ganser J, Nathan SD. Dental Personnel Treated for Idiopathic Pulmonary Fibrosis at a Tertiary Care Center Virginia, MMWR Morb Mortal Wkly Rep 2018;67: Slide 4 Idiopathic Pulmonary Fibrosis (IPF) A form of chronic, progressive fibrosing interstitial pneumonia of unknown cause Estimated median survival after diagnosis is 3 5 years Exposures that are suggested contributing factors Viral infections Cigarette smoking Occupations with exposure to dust, wood dust, and metal dust Slide 5 IPF Epidemiology, United States Estimated annual incidence: 6.8 to 17.4 per 100,000 Estimated prevalence: 14.0 to 63.0 per 100,000 Increased with increasing age No published data regarding DHCP and IPF Spagnolo P, Sverzellati N, Rossi G, et al. Idiopathic pulmonary fibrosis: an update. Ann Med 2015;47: Nalysnyk L, Cid Ruzafa J, Rotella P, Esser D. Incidence and prevalence of idiopathic pulmonary fibrosis: review of the literature. Eur Respir Rev2012;21: Slide 6 2

3 Cluster Found Among Dental Personnel in VA From September 1996 June (1%) of 894 patients treated for IPF were identified as DHCP 7 patients died During 2016 Dentists accounted for 0.038% of US residents Represented 0.893% of patients treated for IPF at this clinic 23 fold difference Slide 7 DHCP Exposures Infectious agents Chemicals Airborne particles Ionizing radiation Other potentially hazardous materials Inhalation exposures likely increase risk for certain workrelated respiratory diseases Slide 8 Summary No published data exist regarding IPF in DHCP No clear etiology has been identified for this unique cluster, but occupational exposures are possible Reinforces the need to further understand occupational exposures of DHCP and associated risks so that prevention strategies can be developed Slide 9 3

4 CDC Personal Protective Equipment (PPE) Recommendations CDC PPE Recommendations PPE protects against Skin and mucous membrane exposures to bloodborne pathogens Exposures during cleaning procedures Wear surgical mask and eye protection with solid side shields or face shield to protect mucous membranes Change masks between patients or during patient treatment if mask becomes wet Slide 11 Respirators Used when treating patients with diseases requiring airborne transmissions precautions (e.g., Tuberculosis) Used in the context of a complete respiratory protection program Most surgical masks are not NIOSH certified as respirators and do not satisfy OSHA requirements for respiratory protection Slide 12 4

5 Respiratory Protection No CDC recommendation to use a respirator during standard patient care DHCP who perform tasks resulting in occupational exposures to known respiratory hazards should wear adequate respiratory protection if other controls (e.g., improved ventilation) are not practical or effective Further research needed to explore occupational exposures and associated risks to develop prevention strategies Slide 13 Resources National Institute for Occupational Safety and Health (NIOSH), Dentistry Occupational Safety and Health Administration, Respiratory Protection ml Slide 14 CDC Statement on Reprocessing Dental Handpieces 5

6 CDC Statement on Reprocessing Dental Handpieces Released April 11, 2018 Provides updated information regarding reprocessing of dental handpiece devices, particularly those that do not attach to air and waterlines on reprocessing dental handpieces.htm Slide 16 Dental Handpiece Summary 1. Clean and heat sterilize handpieces and other intraoral instruments that can be removed from the air lines and waterlines of dental units. 2. For handpieces that do not attach to air lines and waterlines, use FDA cleared devices and follow the validated manufacturer s instructions for reprocessing these devices. 3. If a dental handpiece cannot be heat sterilized and does not have FDA clearance with validated instructions for reprocessing, do not use that device. Slide 17 Slide 18 6

7 news/2018 archive/february/ada persuades cdc to revisehandpiece infection control recommendations Slide 19 New CDC Resources Basic Expectations for Safe Care (BESC) Training Modules 10 training modules, each has a slide deck and speaker notes Covers the basic principles of infection prevention and control Complements CDC s Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care Can be used for education and training care modules.htm Slide 21 7

8 Slide 22 Slide 23 Slide 24 8

9 CDC DentalCheck Now available for ios and Android mobile devices As of April ,658 downloads 94% ios 6% Android Slide 25 Conclusions More research needs to be done on occupational exposures in DHCP New guidance is available on dental handpiece devices New infection prevention and control training tools are available Slide 26 All dental settings, regardless of the level of care provided, must make infection prevention a priority. For more information, contact Centers for Disease Control and Prevention (CDC) CDC INFO ( ) TTY: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. CS