Advancing infection control in dental care settings: Factors associated with dentists' implementation of guidelines from the Centers for Disease Control and Prevention

Background and OverviewThe authors set out to identify factors associated with implementation by U.S. dentists of four practices first recommended in the Centers for Disease Control and Prevention's Guidelines for Infection Control in Dental Health-Care Settings—2003.MethodsIn 2008, the authors surveyed a stratified random sample of 6,825 U.S. dentists. The response rate was 49 percent. The authors gathered data regarding dentists' demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the guidelines and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of those factors on the implementation of four recommendations: having an infection control coordinator, maintaining dental unit water quality, documenting percutaneous injuries and using safer medical devices, such as safer syringes and scalpels. The authors conducted bivariate analyses and proportional odds modeling.ResultsResponding dentists in 34 percent of practices had implemented none or one of the four recommendations, 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations. The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices and had at least three sources of instruction regarding the guidelines. Dentists with practices in the South Atlantic, Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied.ConclusionsImplementation of the four recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control, increasing continuing education requirements and developing multiple modes of instruction may increase implementation of current and future Centers for Disease Control and Prevention guidelines.The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, Atlanta.The authors thank Jon Ruesch, who when this study was conducted was the director, Survey Center, American Dental Association, Chicago, for his effort in the collection of the data for this research project. Mr. Ruesch is now retired.     

Effect of gallium on bone mineral properties

Summary Gallium nitrate is biologically active in blocking bone rsorptionin vitro as well asin vivo. Administration of gallium nitrate to growing rats results in a dose-dependent accumulation of low levels of gallium in bone that is associated with specific changes in the mineral properties of bone. To elucidate in greater detail the changes induced by gallium, the properties of whole and density-fractionated bone samples from control and galliumtreated rats were examined. These studies showed that short-term treatment with gallium nitrate caused an increase in bone calcium and phosphate content. Devitalized bone powder from the gallium-treated rats was less soluble in acetate buffer and less readily resorbed by monocytes. Density fractionation analyses demonstrated that the largest proportion (76% by weight) of powdered metaphyseal bone particles from rats had a density of <2.15 g/cc. Following short-term treatment (14 days) with gallium nitrate (45 mg/kg body weight), a significant increase in the relative proportion of more dense bone (≥2.15 g/cc) was observed (24% for the control vs. 39% for the gallium-treated rats,P<0.01). In the diaphyseal samples, the largest proportion (88% by weight) of the bone powder had a density of ≥2.15 g/cc. After short-term treatment with gallium, a slight decrease in mean diaphyseal particle density was observed. Measurement of calcium accretion with⁴⁵Ca in the gallium-treated rats demonstrated increased specific activity in the metaphyseal bone samples, densities=2.0, 2.1, 2.15, and 2.25 g/cc; the difference was significant only for the 2.25 g/cc fraction. Therefore, short-term treatment with gallium nitrate leads to an increase in the calcium content of mature bone with more dense (more mineralized) bone particles accumulating in the metabolically more active metaphyseal bone. The data provide greater insight into the changes in bone properties induced afterin vivo treatment with gallium nitrate. However, the physiologic mechanisms by which these changes are effected are not known.     

Type IIB Tampa: a variant of von Willebrand disease with chronic thrombocytopenia, circulating platelet aggregates, and spontaneous platelet aggregation

Type IIB von Willebrand disease is characterized by enhanced ristocetin- induced platelet aggregation and absence of large von Willebrand factor multimers from plasma. An alteration of the von Willebrand factor molecule resulting in increased reactivity with platelets appears to be the basis for these abnormalities. We have now identified a new variant of type IIB von Willebrand disease in a family in which the four affected members also have chronic thrombocytopenia, in vivo platelet aggregate formation, and spontaneous platelet aggregation in vitro. In spite of repeatedly prolonged bleeding times and persistent thrombocytopenia, their bleeding diathesis is only moderate.     

Audit of extracapsular cataract extraction and posterior chamber lens implantation as a routine treatment for age related cataract in east Africa

AIMS: To evaluate the outcome of extracapsular cataract extraction (ECCE) and posterior chamber intraocular lens implantation (PC-IOL) in an African eye clinic during the transition from intracapsular cataract extraction to ECCE and PC-IOL. METHODS: A retrospective survey of 461 consecutive operations for age related cataract with a mean follow up of 52.9 weeks (range 0-275) and a minimum follow up of 4 weeks in 87.9% of eyes. RESULTS: A best corrected vision of 6/18 or better was obtained in 94.3% of eyes, and an uncorrected vision of 6/18 or better in 78.2% of eyes. Six eyes (1.5%) had a best corrected vision of less than 6/60. The visual acuity at 2 months was strongly predictive of the vision at 1 year or more after surgery. Preoperative biometry and IOL power calculation increased the proportion of eyes obtaining an uncorrected vision of 6/18 or better from 73.8% to 81.3%. Four eyes developed visually significant posterior capsule opacity. CONCLUSION: ECCE and PC-IOL can give very good results in an African setting. A better visual outcome should lead to increased demand for cataract surgery, which will eventually reduce the number of cataract blind people in Africa.     

Conjunctival marginal zone B-cell lymphoma (MALT lymphoma) with amyloid and relapse in the stomach

The authors report a localized (primary) conjunctival marginal zone B-cell lymphoma (mucosa-associated lymphoid tissue (MALT)-type), with amyloid deposition with relapse in the stomach, 14 months after the initial diagnosis. Ocular adnexal marginal zone B-cell MALT lymphoma is often localized at diagnosis; some relapse in typical MALT sites. There are few reports of localized conjunctival lymphoma with a relapse in the stomach. The authors suggest that all patients with localized ocular adnexal lymphoma be followed for an extended period.     

Urrets-Zavalia syndrome as a complication of argon laser peripheral iridoplasty

OBJECTIVE: To report on 8 patients who developed prolonged mydriasis after argon laser peripheral iridoplasty (ALPI). DESIGN: Retrospective case series. METHODS: A review of the charts of 8 patients with persistent occludable angles after laser iridotomy who developed mydriasis after undergoing ALPI. RESULTS: 12 eyes of 8 patients (mean age 50.2, standard deviation 6.9, range 40-61 years) developed persistent dilatation. 7 of 8 patients had plateau iris syndrome. Only one patient had a decrease in visual acuity. Intraocular pressure increased only in 1 eye and remained stable or decreased in the others. Of the 8 patients, 7 had blurred vision, 2 had photophobia, 4 had glare and 1 had discomfort. The pupillary response to pilocarpine instillation was minimal or absent. Mydriasis eventually resolved in all eyes without treatment. CONCLUSION: ALPI can be complicated by mydriasis unresponsive to pilocarpine. Mydriasis and accompanying symptoms resolved spontaneously within 1 year in most patients.     

Anterior segment optical coherence tomography imaging of trabeculectomy blebs before and after laser suture lysis

PURPOSE: To image trabeculectomy blebs before and after laser suture lysis (LSL) using anterior segment optical coherence tomography (AS-OCT). DESIGN: Prospective observational study. METHODS: Blebs were imaged with a prototype of the AS-OCT (Carl Zeiss Meditec, Inc, Dublin, California, USA) before and after LSL. Blebs were assessed for bleb height, bleb wall thickness, apposition of the scleral flap to sclera, and patency of the internal ostium. RESULTS: Seven blebs in eyes of seven patients were imaged. Pre-LSL, five blebs were low and two were of moderate height. After LSL, six of seven eyes (85.7%) showed an increase in total bleb height, with increased bleb wall thickness and separation of the scleral flap from sclera. In one eye, there was no discernible change in bleb height, cavity height, or wall thickness. CONCLUSIONS: AS-OCT was able to demonstrate features of bleb morphology that changed after LSL.     

Primary appendectomy. The effect of prophylatic cephaloridine on postoperative wound infection.

A prospective, randomized, double-blind study on the effect of cephaloridine prophylaxis in the surgical management of appendicitis was performed. Of the 139 patients studied, 70 received cephaloridine and 69 received placebo prophylaxis. Both groups of patients were well matched with regard to age, sex, operative findings, and bacteria isolated at operation. Postoperative wound infections were detected in 11.6% of placebo-treated patients and in 1.4% of cephaloridine-treated patients (P less than .02). Prophylactic treatment with cephaloridine of patients undergoing surgery for uncomplicated appendicitis resulted in a perceptible reduction in the rate of postoperative wound infection.     

The influence of premenstrual syndrome on ratings of anxiety in women with generalized anxiety disorder

During the premenstrual and follicular phases of the menstrual cycle, 41 women who had generalized anxiety disorder (GAD) plus premenstrual syndrome (PMS) were assessed with psychiatric rating scales and compared with 21 GAD patients without PMS and 19 controls. The latter two groups were rated only once, in the typical open-ended manner. Symptoms during both phases of the menstrual cycle were more severe in the GAD + PMS patients than in the controls and were more severe during the premenstruum. For the GAD + PMS patients, ratings obtained in the typical open-ended manner were influenced by how patients felt during the premenstruum. Thus, the assessment of women with GAD + PMS may be complicated by cyclical fluctuations in symptom severity, and ratings obtained in the typical manner may be influenced disproportionately by how these patients feel premenstrually.