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Flagrant infection control breach in Tulsa: Will it spark more oversight for dentistry?

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Last month the news broke that Tulsa oral surgeon Scott Harrington, DDS, had treated patients under unsanitary and unsafe conditions for as long as six years.  As a result, letters were sent to 7,000 patients who had been treated by Dr. Harrington during the past six years, warning of the health hazard and advising them to seek testing.

Some of the multiple violations cited by the Oklahoma State Department of Health included:

  • Unsanitary conditions
  • Incomplete drug logs
  • Disorganized and unlocked drug cabinet that contained expired medication
  • Equipment that was rusted and not properly sterilized
  • Failure to display his dental license

Susan Rogers, executive director of the Oklahoma Board of Dentistry, informed the press that dental offices are inspected after complaints, but the Board does not have enough personnel to regularly inspect the more than 10,000 licensees in the state.  “We have a pretty good process,” she said. “This isn’t something we would have detected through our current methods of doing what we do in the inspections.”

Since 2010, several dental offices and clinics have been found to be practicing below acceptable infection control standards.  High profile cases included the VA dental clinic in St. Louis, MO (2010); the VA dental clinic in Dayton, OH (2011); and a Colorado oral surgeon (2012).

In the St. Louis case, four of the veterans tested positive for hepatitis, although it remains unknown whether their exposure was linked to the dental clinic; while in Ohio, nine patients tested positive for hepatitis B and C.  The Colorado Department of Public Health and Environment identified three former patients with infections, but, due to patient confidentiality, would not specify which diseases they found.

Is this the tip of the iceberg?  What does this trend mean for dentistry?

For decades, medical facilities have been held accountable to a high level of infection control practices through stringent oversight by multiple regulatory agencies.  These agencies perform unannounced inspections and dole out harsh penalties if it is felt patient safety is in jeopardy.  In addition to following Centers for Disease Control guidelines for medical facilities, the medical facilities follow the Association for Professionals in Infection Control and Epidemiology (APIC), Association of Perioperative Registered Nurses (AORN) as well as OSHA and any other applicable state or federal guidelines.

Increasing regulations, expectations of quality from payers and patient demands may draw dentistry into the same high level of accountability as our medical counterparts.  Safe and trusted care provided in a quality-driven environment should be everyone’s goal.  To establish a threshold for this goal, the federal government and payers alike require healthcare facilities to be accredited by a nationally recognized accreditation body such as The Joint Commission (hospitals), Accreditation Association for Ambulatory Healthcare (outpatient facilities including dental offices) and others.  Having accreditation certification from one of these recognized organizations is a sign that the quality of the practice’s care and performance meet or exceed nationally-recognized Standards.

Considering the rise in public sentiment along with concerns from payers and state licensing agencies, could this be where dentistry is heading?  We invite you to weigh on that thought (anonymously if you prefer).  Post your thoughts here.

Maintaining high standards in your practice

To maintain high infection control protocols in your practice, consider purchasing CDC Guidelines: From Policy to Practice by OSAP. This 170-page workbook helps you put into practice the infection control recommendations from the Centers for Disease Control and Prevention (CDC).

Following are some tips provided by the Organization for Safety, Asepsis and Prevention (OSAP) that may help reassure patients concerned about infection control protocols:

  • Assure patients that your office uses evidence-based infection control precautions as recommended by the Centers for Disease Control and Prevention.  The latest recommendations and other resources can be downloaded from the CDC at http://www.cdc.gov/oralhealth/infectioncontrol/index.htm.
  • Inform patients that all dental anesthetics are sold as sterile single-use needles and cartridges, and that your office properly disposes of these items.
  • Explain the sterilization process and that it includes thorough cleaning, examination and then sterilization of all instruments, including handpieces.
  • Reassure patients that instruments are maintained in sterile pouches or wrap until they are needed for patient care. It may be particularly useful to open pouches only after patients have entered the treatment area, so they may see for themselves that the instruments are properly packaged.
  • Discuss the processes you use for assuring sterility, such as chemical indicators on and/or in packs of instruments and regular monitoring of the sterilization process through the use of a biological indicator (spore test).
  • Reassure the patients that all procedures requiring licensure or certification are provided only by professionals licensed to provide those services.  Refer to your state licensing board and the American Dental Association (www.ada.org) for additional information.

Read more about these incidents:

Dr. Harrington, Tulsa: http://www.tulsaworld.com/news/article.aspx?subjectid=17&articleid=20130329_17_A1_ULNSrm458141

Ohio VA clinic: http://www.flapsblog.net/2012/03/dayton-ohio-veterans-administration.html

St. Louis VA clinic: http://www.stltoday.com/lifestyles/health-med-fit/fitness/issues-go-unsolved-at-st-louis-va-medical-center/article_dbe77c8f-495b-51b8-aa9e-f276f5224ec3.html

Colorado oral surgeon: http://www.cbsnews.com/8301-504763_162-57485244-10391704/three-infections-linked-to-colorado-dentist-accused-or-reusing-needles-for-over-11-years/

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