新型冠状病毒肺炎疫情期口腔专科感染防控的应急管理

本文根据国家有关新型冠状病毒感染防控要求和突发公共卫生事件应急条例,以及口腔专科的临床诊疗特点,参考国内外口腔诊疗中感染防控相关指南和文献,结合医院疫情期口腔诊疗中感染防控的应急管理工作举措,提出应对此次新型冠状病毒肺炎疫情期医院感染防控的建议,重点聚焦疫情期医务人员防护培训及医院感染防控落实等方面,旨在为口腔专科在疫情发生期快速应对新型冠状病毒感染防控的应急管理提供参考。     

新型冠状病毒肺炎疫情下提高口腔种植门诊诊疗工作的安全性

新型冠状病毒肺炎(Corona Virus Disease 2019,COVID-19)的爆发和传播,成为被世界卫生组织认定的“国际关注的突发公共卫生事件”[1],对口腔种植门诊的诊疗和护理带来巨大的挑战。口腔种植门诊诊疗操作的特殊性,新型冠状病毒肺炎的流行病学特点,使口腔医务人员成为新型冠状病毒肺炎感染的高危群体,疫情存在口腔操作中爆发的危险。本文根据对新型冠状病毒防控的总体要求,结合口腔种植门诊的专业特点,制定相关护理防控措施,保证护理工作有序进行,提高诊疗工作的安全性。本文内容涉及预检分诊、不同工作场景下的防护及提高口腔种植门诊诊疗环境安全性等,提出了疫情下的口腔护理防护策略,达到保护医护人员和患者健康的目的,以期为口腔种植门诊在疫情期的护理防控工作提供参考。     

新型冠状病毒肺炎疫情期间口腔急诊的管理与防控建议

新型冠状病毒肺炎(corona virus disease 2019,COVID-19)疫情发展迅速,防控形势严峻。在疫情防控期间,由于口腔诊疗操作的特殊性,如何处理各类口腔急诊,面临着巨大挑战。为了在严密防控疫情的同时,科学有序地做好口腔急诊的临床诊疗工作,本文从人员管理培训、流程及处理、防护和消毒等方面,就新型冠状病毒肺炎疫期口腔急诊处置提出建议,供口腔医疗机构和医务人员参考。     

从新型冠状病毒肺炎疫情防控看传染病流行期口腔门诊管理策略

新型冠状病毒肺炎爆发对口腔医疗机构管理和临床诊疗中的传染病防护提出了新课题。本文结合我国传染病防治法、国家卫生健康委员会颁发的相关规范标准,参考部分省份口腔医疗质量控制中心制定的口腔门、急诊医院感染控制规范和本次新型冠状病毒肺炎疫情情况,对口腔门、急诊在疫情控制期控制交叉感染和医务人员防护等方面进行了探讨,希望为疫情发生时口腔医疗机构的应对和相关的临床研究提供参考。     

新型冠状病毒肺炎疫情下口腔颌面外科的护理防控

新型冠状病毒肺炎的爆发对口腔颌面外科的诊疗和护理带来了巨大的挑战。为有效防止新型冠状病毒肺炎所致的疫情蔓延,最大限度减少新型冠状病毒肺炎在医疗机构内传播的风险,本文结合国家对新型冠状病毒防控的总体要求和颌面外科专业特点,制定口腔颌面外科护理管理相关防控措施,内容涉及预检分诊、分级防护、健康教育、相关科室防控关键点以及护理操作中的防控策略等,以保证颌面外科护理工作有序进行,同时提出了新型冠状病毒肺炎感染防控期间的口腔颌面外科护理管理建议,期望对疫情期口腔颌面外科的护理管理及今后的研究提供参考。     

口腔急诊医务工作者应对新型冠状病毒感染的防控管理规范

2019冠状病毒病(corona virus disease 2019,COVID-19)疫情期间,口腔医务人员因其诊疗操作的特殊性存在较大交叉感染的风险。目前多数地区的医院仅保留口腔急诊通道。本文依托本单位急性创伤急救中心,结合临床急救经验,从新型冠状病毒的流行病学特点、口腔科急诊诊疗感染的特点、医务人员的个人防护及诊室环境的防控管理等多个方面提出口腔急诊医务工作者的应急管理和防控规范,供口腔急诊医务人员参考。     

口腔诊疗中新型冠状病毒感染的防控

新型冠状病毒肺炎(COVID-19)疫情在短期内扩散至全球多个国家和地区,确诊和死亡病例数持续上升,成为被世界卫生组织认定的"国际关注的突发公共卫生事件"。正确的防控措施可以阻断新型冠状病毒在医院内的传播,降低感染风险,有效防止疫情进一步扩散。口腔专业因诊疗操作的特殊性,交叉感染的风险较高,严格的防控措施尤其重要。本文从新型冠状病毒的流行病学特点、口腔诊疗医院感染特点、患者评估以及诊疗操作和环境的防控等方面进行阐述,并提出相应的建议。     

新型冠状病毒感染疫情防控阶段口腔黏膜病诊疗的专家建议

2020年1月20日,国家卫生健康委员会公告(2020年第1号)将新型冠状病毒感染的肺炎纳入《中华人民共和国传染病防治法》规定的乙类传染病,按甲类传染病管理。各级人民政府、卫生健康行政部门高度重视,医疗卫生机构依法采取系列防控措施,共同预防控制新型冠状病毒感染的肺炎疫情的传播。在抗击疫情工作中,如何做好口腔黏膜病科医师防护规范、手部和环境的清洁消毒,对于口腔黏膜病伴发热的患者如何合理开展预检分诊,疫情防控期间口腔黏膜病患者的自我保健和自我管理等,是各级医疗机构、医务工作者和口腔黏膜病患者遇到的实际问题。针对这3个与口腔黏膜病科相关的问题,上海市口腔医学会口腔黏膜病专业委员会和上海第九人民医院集团口腔黏膜病专科联盟组织专家编写了相应的处置流程及专家建议,以满足当前口腔黏膜病医务工作者和患者更好地应对新型冠状病毒感染疫情工作的需要。本建议将根据国内疫情防控形势及新的相关诊疗方案而及时更新。     

新型冠状病毒肺炎防控期间口腔专科医院门急诊工作管理探讨

2019年12月我国发现新型冠状病毒感染的肺炎,它传染性强、人群普遍易感、无症状者也存在感染性[1]。该病毒的传播途径尚未完全明确,临床症状亦存在差异化,从目前新冠肺炎在全球流行特点看,其在医院内部传播及医务人员的感染是一个突出问题[2]。口腔诊疗产生喷溅及气溶胶的操作多,使口腔专业医务人员面临新型冠状病毒的风险加大[3,4]。     

新型冠状病毒肺炎疫情期口腔颌面外科全身麻醉管理

由于口腔治疗操作的特殊性,治疗过程中会不可避免地产生飞沫和气溶胶等漂浮颗粒,在新型冠状病毒肺炎疫情的防控关键时期内,口腔颌面外科的治疗工作受到很大影响;同时,口腔颌面外科全身麻醉在气道管理过程中极易造成病毒播散,这也为麻醉管理工作带来巨大挑战。本文从专科角度出发,对新型冠状病毒肺炎疫情期口腔颌面外科全身麻醉管理进行论述,以期为疫情期口腔颌面外科全身麻醉实施提供参考。     

蒸汽温热眼罩放松压力的效果评价

目的评价蒸汽温热眼罩放松压力的效果。方法选择日本某护士学校61名护士学生,其中31名为试验组,30名为对照组。试验组在施加计算式压力后安置蒸汽温热眼罩,对照组在施加计算式压力后安置不发热眼罩。2组施加压力前后进行问卷调查,对受试者的心理反应进行评分。在施加压力前、施加压力后、安置眼罩后分别对试验组与对照组进行鼻尖表面温度及左手拇指温度测量,比较温度变化值。结果试验组施加压力前为42.5分,施加压力后为59.5分,安置眼罩后为41.5分,安装眼罩后与施加压力后的心理反应评分差异有统计学意义(t=5.49,P=0.031)。对照组施加压力前为43.5分,施加压力后为57.5分,安置眼罩后为52.5分,安置置眼罩后与施加压力后的心理反应评分差异无统计学意义(t=0.32,P=1.654)。施加计算式压力后,安置蒸汽温热眼罩的试验组皮肤表面温度呈相对上升趋势。结论蒸汽温热眼罩的温热效应可提升闭眼放松效果。     

Compliance of Jordanian dentists with infection control strategies

Objectives : To assess whether dentists in Jordan are employing recommended infection techniques in their clinics and to identify the level of compliance of dentists with the recommended infection techniques commonly found in western countries. Participants : Dentists in Jordan (n=300). Methods : A questionnaire incorporating information regarding: infection control practices, vaccination, personal barrier protection, instrument sterilisation and disinfection, were distributed to 300 dentists in private and public practices. Results : A (93%) response rate (n=279) was available for analysis. Gloves were used by 73.3% of dentists; masks by 69.5%, protective eye wear by 43.8% and white coats worn by 75.9%. About 25% recorded patient medical histories. Offices in Jordan were found to be in compliance with respect to the use of disposable anaesthetic needles and carpules but only 27% use plastic containers for sharps; 72.6% of dentists had been vaccinated against hepatitis B viruses; approximately 70% use an autoclave for sterilisation but only 15% always use plastic bags for packing sterilised instruments. Conclusions : The majority of dental practitioners were found to be in compliance with most of the recommended infection control regulations. In this study the overall compliance with infection control procedures was 61.17% among dentists in Jordan. Further education may be appropriate in taking a medical history of each patient before treatment, wearing of masks and protective glasses and the use of plastic bags to wrap sterilised instruments.     

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目的    探讨运用正畸方法对乳牙牙合期上颌骨复合骨折患儿行非手术治疗的临床效果。方法    2005—2008年在中国医科大学口腔医学院正畸科进行治疗的上颌骨复合骨折患儿5例，于伤后1周内行正畸治疗，口内应用上颌薄牙合垫，口外戴前方牵引器配合弹性颅颌绷带联合牵引或用简单头帽颏兜垂直牵引。结果    通过正畸治疗，骨折部位得到良好的复位和固定，患者获得较好的咬合关系。结论    运用正畸方法治疗乳牙牙合期上颌骨复合骨折患儿，骨折愈合良好，咬合关系正常，软组织侧貌改善，是一种有效的治疗方法。     

Filtration efficiency of surgical and FFP3 masks against composite dust

The aim of this study was to investigate the protection efficiency of two types of face masks against composite dust and to characterize the particles that penetrated through the masks. Composite dust was created by grinding a commercial nano-filled composite in a plexiglass box without using water cooling or high vacuum evacuation, in order to obtain a worst-case exposure. Dust particles were collected using a personal inhalable aerosol sampler (IOM) fixed inside a custom-made phantom head. Surgical and filtering facepiece (FFP3) masks were tested, and the situation without a mask served as control. The IOM sampler contained a cassette with two filters to collect large inhalable (4–100 µm) and respirable dust particles (<4 µm). The amount of particles was determined gravimetrically by weighing filters before and after composite grinding, and further characterized by electron microscopy. Particle collection for both inhalable and respirable dust was the highest when no mask was used, and the lowest with the use of a FFP3 mask. Different sizes and shapes of particles were observed, with the largest particles (>1 µm) being seen when no mask was applied, whereas only nanoparticles could be detected when either type of face mask was applied. Even though FFP3 masks showed a higher filtration efficacy than surgical masks of the inhalable dust fraction, penetration of a small respirable particle fraction was inevitable for both masks.     

AIDS primer for stomatologists on the basis of a literature survey

On the basis of a literature survey, mainly of two American periodicals from 1987 the epidemiology, manifestations and treatment of AIDS patients are discussed with particular reference to the changes development on oral mucosa and to the treatment of these changes. The knowledge, attitudes and behaviour of stomatologists towards the risk-group patients and AIDS patients are discussed on the basis of the results of an inquiry with participation of 541 dentists from California. The degree of risk of infection of stomatologists and medical personnel with HIV during treatment of AIDS patients is discussed for protection of the dentists and auxiliary personnel the use is recommended of rubber gloves, masks and protective goggles during work. It is thought generally in the light of our knowledge up to now that the possibility of HIV infection during the work of dentists is low, lower than in the case of hepatitis virus B infection if the basic hygiene principles and caution are observed.     

Compliance of Saudi dental students with infection control guidelines

The aim of this study was to investigate compliance of dental students in a Saudi dental school with recommended infection control protocols. A pilot‐tested questionnaire concerning various aspects of infection control practices was distributed to 330 dental students. The response rate was 93.9% (n = 311). About 99% of students recorded the medical history of their patients and 80% were vaccinated against hepatitis B. The highest compliance (100%) with recommended guidelines was reported for wearing gloves and use of a new saliva ejector for each patient. Over 90% of the respondents changed gloves between patients, wore face masks, changed hand instruments, burs and handpieces between patients, used a rubber dam in restorative procedures and discarded sharp objects in special containers. A lower usage rate was reported for changing face masks between patients (81%), disinfecting impression materials (87%) and dental prosthesis (74%) and wearing gowns (57%). Eye glasses and face shield were used by less than one‐third of the sample. The majority of students were found to be in compliance with most of the investigated infection control measures. Nevertheless, further education is needed to improve some infection control measures including vaccination for Hepatitis B virus (HBV), wearing eye glasses, gowns and face shields and disinfecting impression materials and dental prostheses.     

正畸矫治器用于上颌骨LeFort Ⅰ、Ⅱ型骨折治疗21例

目的：运用正畸矫治器早期治疗复合外伤患者的上颌骨骨折,使上颌骨骨折片尽快复位并获得良好咬合关系。方法：对21例上颌骨骨折患者,于伤后1周内,口内运用正畸托槽和钢丝,口外运用前牵引弓和复合头帽,进行颌间和口外牵引,并进行制动和固定。结果：通过这种方法,20例患者能获得良好咬合关系,骨折片得到较好复位。结论：运用正畸矫治器治疗骨折端错位不明显,失牙少或无失牙的上颌骨骨折,能尽快开始骨折治疗,是一种有效的治疗方法。     

Aerosols and splatter in dentistry: a brief review of the literature and infection control implications

BACKGROUND: Aerosols and droplets are produced during many dental procedures. With the advent of the droplet-spread disease severe acute respiratory syndrome, or SARS, a review of the infection control procedures for aerosols is warranted. TYPES OF STUDIES REVIEWED: The authors reviewed representative medical and dental literature for studies and reports that documented the spread of disease through an airborne route. They also reviewed the dental literature for representative studies of contamination from various dental procedures and methods of reducing airborne contamination from those procedures. RESULTS: The airborne spread of measles, tuberculosis and SARS is well-documented in the medical literature. The dental literature shows that many dental procedures produce aerosols and droplets that are contaminated with bacteria and blood. These aerosols represent a potential route for disease transmission. The literature also documents that airborne contamination can be minimized easily and inexpensively by layering several infection control steps into the routine precautions used during all dental procedures. CLINICAL IMPLICATIONS: In addition to the routine use of standard barriers such as masks and gloves, the universal use of preprocedural rinses and high-volume evacuation is recommended.     

Custom-made 3D-printed face masks in case of pandemic crisis situations with a lack of commercially available FFP2/3 masks

In the case of pandemic crisis situations, a crucial lack of protective material such as protective face masks for healthcare professionals can occur. A proof of concept (PoC) and prototype are presented, demonstrating a reusable custom-made three-dimensionally (3D) printed face mask based on materials and techniques (3D imaging and 3D printing) with global availability. The individualized 3D protective face mask consists of two 3D-printed reusable polyamide composite components (a face mask and a filter membrane support) and two disposable components (a head fixation band and a filter membrane). Computer-aided design (CAD) was used to produce the reusable components of the 3D face mask based on individual facial scans, which were acquired using a new-generation smartphone with two cameras and a face scanning application. 3D modelling can easily be done by CAD designers worldwide with free download software. The disposable non-woven melt-blown filter membrane is globally available from industrial manufacturers producing FFP2/3 protective masks for painting, construction, agriculture, and the textile industry. Easily available Velcro fasteners were used as a disposable head fixation band. A cleaning and disinfection protocol is proposed. Leakage and virological testing of the reusable components of the 3D face mask, following one or several disinfection cycles, has not yet been performed and is essential prior to its use in real-life situations. This PoC should allow the reader to consider making and/or virologically testing the described custom-made 3D-printed face masks worldwide. The surface tessellation language (STL) format of the original virtual templates of the two reusable components described in this paper can be downloaded free of charge using the hyperlink (Supplementary Material online).     

Infection control practices and compliance to national recommendations among dentists in Romania

The aim of this study was to measure dental office compliance with current Romanian infection control regulations. A questionnaire was completed and returned from 61 randomly selected offices (32 private and 29 public with 94 dentists), where the sterilizers were also biologically monitored. Results indicated that with few exceptions, infection control practices in public and private offices were the same, with compliance on sterilising reusable instruments. Private offices monitored their sterilizers more frequently and had much newer equipment. Gowns were universally worn, but use of gloves, masks and protective eye-wear showed non-compliance with less than 10 per cent of the offices using personal protective equipment for all patients. Cost was the deciding factor. Predominant environmental disinfectants were alcohol and bleach. Offices were in compliance as to the use of disposable anaesthetic needles and carpules. Dentists reported reluctance to be vaccinated against hepatitis B even when offered free immunizations (6.4 per cent) and only 18.1 per cent of dentists had received any infection control training in the last three years. Results indicate that offices were in compliance for most national regulations. However, there are no recently published standards for dentistry in Romania concerning disinfectants or continuing education. Comparison with the literature indicates comparable compliance with recommended national infection control procedures for Romanian dentists as for dentists in other countries.