Coronavirus antibody positive tests and continued use of personal protective equipment throughout the pandemic

The COVID-19 pandemic has thrust not only a novel virus onto the world, but new challenges resulting in novel approaches. Governments have reduced regulation in order to facilitate timely advances to combat the disease. Antibody testing has rapidly been deployed but it is creating challenges for staff and patients. Mask use has come to the forefront and human factor (HF) strategies must be examined to reduce risk associated with lack of engagement from both healthcare staff and patients. In this we explore these issues and suggest some solutions.     

Surgical specimen handover from the operating theatre to laboratory—Can we improve patient safety by learning from aviation and other high‐risk organisations?

Essential communication between healthcare staff is considered one of the key requirements for both safety and quality care when patients are handed over from one clinical area to other. This is particularly important in environments such as the operating theatre and intensive care where mistakes can be devastating. Health care has learned from other high‐risk organisations (HRO) such as aviation where the use of checklists and human factors awareness has virtually eliminated human error and mistakes. To our knowledge, little has been published around ways to improve pathology specimen handover following surgery, with pathology request forms often conveying the bare minimum of information to assist the laboratory staff. Furthermore, the request form might not warn staff about potential hazards. In this article, we provide a brief summary of the factors involved in human error and introduce a novel checklist that can be readily completed at the same time as the routine pathology request form. This additional measure enhances safety, can help to reduce processing and mislabelling errors and provides essential information in a structured way assisting both laboratory staff and pathologists when handling head and neck surgical specimens.     

Quality assurance guidelines for surgical outreach programs: a 20-year experience.

Numerous American volunteer organizations travel throughout the developing world, providing surgical services to those in need. Medical staff who undertake such missions must contend with the realities inherent to providing healthcare abroad. Inadequate medical facilities and equipment, coupled with a short mission duration and the lack of substantial integration with the local medical community, greatly increase the risk of unnecessary medical complications. At present, there is no definitive set of quality assurance guidelines for the surgical outreach community. This report draws on 20 years of outreach experience to recommend a set of quality assurance guidelines for surgical outreach missions.     

Management in oral and maxillofacial surgery during the COVID-19 pandemic: Our experience

A novel β-coronavirus (2019-nCOV), identified in Wuhan City in late December 2019, is generating a rapid and tragic health emergency in Italy due to the need to provide assistance to an uncontrollable number of infected patients and, at the same time, treat all the non-deferrable oncological and traumatic maxillofacial conditions. This article summarises the clinical and surgical experience of Maxillofacial Surgery Unit of “Magna Graecia” University (Catanzaro -Italy) during the COVID-19 pandemic and would like to provide a number of recommendations that should facilitate the scheduling process of surgical activities during the COVID-19 pandemic and reduce the risk of infection among healthcare professionals.     

2019-nCoV重症患者气管切开防喷溅装置的设计与初步应用

目的 对2019-nCoV高传染性重症患者进行气管插管、气管切开等高危程序操作,是一线医务人员发生感染的重要危险因素,急需降低操作者的感染风险。方法 本团队发明一种手术防喷溅隔离装置,在操作者与患者之间建立可视化防喷溅隔离区域,术者可将手伸进隔离装置的操作口进行手术操作,在不影响正常手术程序的同时,降低了自身感染风险。结果 本装置经申请专利后已初步试用于临床,在7例重症新型冠状病毒肺炎患者的气管切开术中得以成功应用,目前已批量生产,发往武汉抗疫一线。结论 本隔离装置在救治2019-nCoV患者的临床应用中得到良好反馈,为抗击疫情的一线医务工作者提供了有效防护措施,降低了感染风险。     

Challenges with healthcare workers’ protection during the COVID-19 pandemic in Iran

During the COVID-19 pandemic, healthcare workers stand in the frontline of the fight against the disease. This study aimed to assess the challenges with personal protection during the pandemic in Tehran, Iran. Seven-hundred healthcare workers were surveyed between April and May 2020, and the study was performed in surgical care wards. Questionnaires, which were sent to 1000 workers via online platforms, social networks, and emails to different associations, were used to assess the use of personal protective equipment (PPE) and the reasons for not using it. A total of 700 replied. Face masks and face shields had the highest and lowest use, respectively. Equipment shortage, time constraint, low supervision, and lack of information were the reasons for personnel not using PPE. To reduce the burden of COVID-19 and accelerate the process of patient care, it is important to protect and maintain the well-being of staff. Organised national and international arrangements to protect them are critical.     

Viral hepatitis: a review of clinical, laboratory and research aspects

The nature and the diagnosis and prognosis of the two forms of viral hepatitis is discussed. The possibility of transmission of these diseases during dental treatment to other patients or to dentists or their staff is considered and measures to reduce this risk are suggested.     

Risk factors for oral postoperative infection in patients with diabetes

The prevalence of diabetes mellitus in the general population has been increasing sharply. Currently, much is feared but little is known about postoperative complications of oral surgery among persons with diabetes. Existing dental education and practice guidelines cite excess infectious risk among patients with diabetes; however, empiric evidence to support such concerns is lacking. In fact, dentists commonly prescribe antibiotics when dental surgical procedures involve bone. This practice may contribute to the rising problem of microbial resistance and may increase overall healthcare costs. The growing number of dental patients with diabetes warrants strengthening the evidence base to guide their dental care and prevent possible morbid complications.     

Prevention and detection of prosthetic temporomandibular joint infections—update

Prosthetic joint infections are not only distressing complications for patients and surgeons, but also have an enormous financial impact on healthcare systems. The reported incidence of prosthetic joint infection is likely underestimated due to difficulties in their diagnosis. This unfortunate complication has challenged joint replacement surgeons for years, despite all the advances made in this surgical discipline. Since eradication of these infections can be very difficult, prevention remains the primary objective. Identifying recipient risk factors, adopting a proper surgical technique, appropriate wound care, optimizing the operating room environment, and appropriate postoperative care have become some of the core elements that can help to minimize the overall incidence of this complication. The purpose of this article is to provide the temporomandibular joint replacement surgeon with an update on the prevention and detection of prosthetic joint infections based on a review of the most recent information published in the orthopedic and surgical literature.     

Evaluation of medical and dental visits in New York City: Opportunities to identify persons with and at risk for diabetes mellitus in dental settings

Objective

The identification of persons with or at risk for chronic diseases is a new practice paradigm for oral healthcare. Diabetes mellitus (DM) is a chronic disease of particular importance to oral health providers. This study sought to understand healthcare utilization patterns that would support the introduction of this new practice paradigm.

Methods

The primary and oral healthcare utilization patterns of New York City (NYC) adults were assessed using data collected from the 2013 NYC Community Health Survey. We stratified healthcare utilization patterns by type of provider, insurance, DM diagnosis and DM modifiable risk factors.

Results

Of 6.4 million NYC adults, an estimated 676 000 (10.5%) reported a previous diagnosis of DM, and 3.9 million (69.5%) were identified with one or more modifiable risk factor for DM. Of these at risk individuals, 2.2 million (58.9%) received dental services in the past 12 months, and 545 000 (14.3%) did not see a primary care provider during the same period. Of the approximately 1.16 million adults without health insurance, an estimated 338 000 (26.2%) had a dental visit only.

Conclusion

Healthcare utilization patterns in this urban setting suggest that oral healthcare providers can support the identification of patients with and at risk for DM who may otherwise not have the opportunity for screening.     

Dentistry: risks for addictive disease

Chemical dependence is chronic disease with genetic, psychosocial, and environmental contributing factors and neurological characteristics. Dentists may be at an increased risk for addiction because they are in a helping profession, work in a stressful environment in which drugs are readily available, often exhibit perfectionist personality traits, and function in isolation. Treatment can be effective, especially when provided by staff skilled in working with healthcare professionals, using the Twelve-Step approach, involving families, and addressing related dysfunctional behavior patterns and psychological issues.     

Tuberculosis: infection control/exposure control issues for oral healthcare workers

AIM: The aim is to present the essential elements of an infection control/exposure control plan for the oral healthcare setting with emphasis on tuberculosis (TB). METHODS AND MATERIALS: A comprehensive review of the literature was conducted with special emphasis on TB infection-control issues in the oral healthcare setting. RESULTS: Currently available knowledge related to TB infection-control issues is supported by data derived from well-conducted trials or extensive controlled observations. In the absence of supportive data the information is supported with the best-informed, most authoritative opinion available. CONCLUSION: Essential elements of an effective TB infection-control plan include a three-level hierarchy of administrative, environmental, and respiratory-protection controls. CLINICAL SIGNIFICANCE: Standard precautions provide the fabric for strategies to prevent or reduce the risk of exposure to bloodborne pathogens and other potentially infectious material. However, standard precautions are inadequate to prevent the spread of organisms through droplet nuclei 1-5 micron in diameter and additional measures are necessary to prevent the spread of Mycobacterium tuberculosis. Oral healthcare settings have been identified as outpatient settings in which patients with suspected or confirmed infectious TB disease are expected to be encountered. Therefore, oral healthcare settings must have a written TB infection-control program.     

Peer-to-peer learning/teaching: An effective strategy for changing practice and preventing pressure ulcers in the surgical patient

Hospitals are increasingly focused on finding cost effective ways to ensure patient safety and enhance quality outcomes. Hospitalized patients are at increased risk for a variety of complications, one of the most common is the development of pressure ulcers. In 2008, the Center for Medicare and Medicaid services, the largest payer source for older adults in the US, began to withhold reimbursement to care facilities for pressure ulcers (Stage 3 or 4) that develop as a result of hospitalization. Staff nurses are ideally positioned to prevent the development of hospital acquired pressure ulcers (HAPUs); however, studies reveal several barriers including a knowledge deficit of causative factors, incorrect identification and staging of wounds, inaccurate use of risk assessment tools and an under utilization of evidence-supported prevention intervention strategies (Ilesanmi et al., 2012; Sievers et al., 2012). This paper examines a cost effective, innovate approach to address these barriers and reduce hospital acquired pressure ulcers using peer-to-peer learning/teaching with staff nurses.     

Preventing and Treating Peri‐Implantitis: A Cost‐Effectiveness Analysis

Background: A large number of treatments for peri‐implantitis are available, but their cost‐effectiveness remains uncertain. This study evaluates the cost‐effectiveness of preventing and treating peri‐implantitis. Methods: A Markov model was constructed that followed each implant over 20 years. Supportive implant therapy (SIT) for managing peri‐implant mucositis and preventing development of peri‐implantitis was either provided or not. Risk of peri‐implantitis was assumed to be affected by SIT and the patient's risk profile. If peri‐implantitis occurred, 11 treatment strategies (non‐surgical or surgical debridement alone or combined with adjunct therapies) were compared. Treatments and risk profiles determined disease progression. Modeling was performed based on systematically collected data. Primary outcomes were costs and proportion of lost implants, as assessed via Monte Carlo microsimulations. Results: Not providing SIT and performing only non‐surgical debridement was both least costly and least effective. The next best (more costly and effective) option was to provide SIT and perform surgical debridement (additional 0.89 euros per 1% fewer implants lost). The most effective option included bone grafts, membranes, and laser treatment (56 euros per 1%). For patients at high risk, the cost‐effectiveness of SIT increased, whereas in low‐risk groups, a cost‐optimized strategy was cost‐effective. Conclusions: Although clinical decision‐making will be guided mainly by clinical condition, cost‐effectiveness analyses might add another perspective. Based on these findings, an unambiguous comparative effectiveness ranking was not established. However, cost‐effectiveness was predominantly determined by provision of SIT and initial treatment costs. Transferability of these findings to other healthcare systems needs further confirmation.     

Infection control in the dental office

The risk of infectious disease transmission is an inherent part of dental practice. Fortunately, such risks can be greatly reduced through modern infection control practices. Such practices include the use of various measures, including administrative, engineering, and work practice controls. Such measures should be codified in an office infection control plan, which should form the basis for the daily infection control activities of the staff. This article discusses some of the measures that should be taken to safeguard the health of dental healthcare workers and patients.     

Development of squamous cell carcinoma from pre-existent oral leukoplakia: with respect to treatment modality

The present study was undertaken in order to determine whether surgical treatment of oral leukoplakia reduces the risk of the subsequent development of carcinoma. This study included 142 patients with oral leukoplakia who received or did not receive surgical treatment. All subjects were followed-up for more than 6 months with a mean follow-up period of 4 years. Malignant transformation rate was lower among patients who received surgical excision (1/75) than among those who did not receive surgical treatments (4/51). However, the malignant transformation rates were high in patients who received cryosurgery (3/12) or cryosurgery plus surgical excision (1/4). There was no obvious relation between the grade of epithelial dysplasia and the rate of malignant transformation. Our results suggest that surgical excision of oral leukoplakia may reduce the risk of the subsequent development of carcinoma.     

Reducing postoperative pain by changing the process

Untreated postoperative pain is an important ethical and financial issue that can lead to unnecessary suffering and prolonged stays in hospital. Despite the availability of effective analgesics and a growing body of published material that supports their use, postoperative pain remains a problem worldwide. To reduce acute postoperative pain, we introduced an intervention combining evidence-based analgesic protocols with the education of staff and patients on a surgical ward. The experiences of 68 patients before and 80 patients after the intervention were compared (worst pain scores, duration of pain, and satisfaction). Inadequately controlled pain was significantly reduced after the intervention, which suggests that the introduction of analgesic protocols supported by the education of staff and patients can be beneficial. Despite this, severe pain remained relatively common, indicating room for improvement. Duration of pain and patient satisfaction were not affected by the intervention, and patient satisfaction remained high throughout the study.     

Instrument cassettes for office safety and infection control

The goal of a dental infection control program is to provide a safe working environment that will reduce the risk of health care-associated infections among patients and occupational exposures among staff members. Minimizing the potential for percutaneous sharps injuries is a primary focus for a comprehensive infection control program. This article will review the advantages of using instrument cassettes, as well as provide an overview of engineering and work practice controls and instrument processing, to emphasize how appropriate use of instrument cassettes can improve office safety and infection control.     

An outline of appropriate risk management in the use of temporary dental nursing staff in practice

It'll never happen, it might not happen, it shouldn't happen, it happened!The risk of human error represents the greater threat to complex systems such as the delivery of healthcare rather than technical failure. Much of the legislation recently introduced in UK healthcare services, Building a Safer NHS; An Organisation with a Memory and A First Class Service evolved from a growing awareness of adverse incidents occurring in the healthcare setting. In general dental practice the absence of a trained skilled dental nurse with local knowledge of the working environment constitutes a risk to patient safety. Be this through the lack of appropriate selection, training, induction or clinical supervision of an appropriate stand in. Be it due to poor governance, audit or quality control the cost to the practitioner, practice, profession and patient can be high. To mitigate this risk a comprehensive risk management system will be needed in practice. Planning to prevent such risks requires understanding, analysing, managing and costing the risk. Success depends on robust systems for screening, contracting and training of staff within an educated team of safety orientated personnel supported by suitable frameworks for standards, resources, policies, protocols, processes and checks within a clearly identifiable chain of command.     

口腔医务人员职业暴露分析

目的：了解口腔医务人员职业暴露的状况,分析其发生的危险因素并探讨防范措施,为降低职业暴露的风险提供参考。方法回顾2013年1月—2015年12月44例口腔医务人员发生职业暴露的登记数据,对其职业、暴露源、暴露种类、暴露环节等进行分析。结果44例职业暴露者以医生和护士为主,分别占54.5％和34.1％;其中发生锐器伤39例,黏膜暴露3例;暴露环节前两位是诊疗后整理器械或清洗器械、操作或手术时锐器刺伤,分别为19例（占43.2%）、15例（34.1%）;所有职业暴露者均及时进行妥当处理,随访暂未发现因职业暴露而导致医务人员感染。结论医生护士在诊疗中使用器械及诊疗后处理器械是发生职业暴露的高危环节。