Richard Musgrave looks at dealing with superbugs.
After the huge advances made in the field of infection control during the 20th century, which resulted in the extinction of smallpox, tuberculosis and typhoid in western societies, it was assumed by many in the medical establishment that most strains of the microorganisms responsible for communicable diseases would eventually be rendered harmless to humans. Many optimists believed that it would only be a matter of decades before the common diseases were genetic or related to lifestyle or ageing.
Unfortunately the ability of pathogens to develop a resistance to antibiotics and sterile environments was underestimated. Worrying examples abound from the propensity of bacteria and viruses to survive in apparently clean surroundings.
The ability of bacteria and viruses to return in an even more virulent form, makes it crucial that dental professionals do not become complacent and remain vigilant about their hygiene protocols. Prevention is much better than cure in infection control. Full sterilisation of the dentist's hands and the surgery's surfaces and equipment is, of course, the best way to preclude the need for a course of antibiotic treatment.
The extremely fast reproduction rate of microscopic bacteria means they can evolve very quickly. Bacteria that survive a course of antibiotics are likely to possess attributes that help it to develop some resistance. When these microorganisms reproduce, they pass on their resistant DNA over time, therefore, the susceptibility of pathogens to medical antibiotics will inevitably decrease.
MRSA – that is, any strain of Staphylococcus aureus bacteria that has become resistant to beta-lactam antibiotics, is a prime illustration of the possible consequences if a thorough routine of handwashing and surface disinfection is not insisted upon.
MRSA is no more aggressive than older Staphylococcus strains, and generally causes mild infections such as impetigo when not given direct access to body tissues. However, open wounds such as those made during surgical procedures can potentially allow MRSA bacteria to enter through the skin. Once inside the body MRSA can cause cellulitis, sepsis, pneumonia or endocarditis. If left untreated, victims with weaker immune systems can suffer damage to vital organs or even die. The virus is also capable of surviving on a number of different surfaces, including fabrics and skin, making it very easy to transmit in medical facilities.
Nevertheless, the consistent practice of good hand hygiene and the correct anti-microbial products are usually all that is necessary to prevent patients being infected by this strain of bacteria and many others. A complete disinfection of a dentist's hands and arms is required to guard against any possibility of bacteria being transmitted from them to their patient.
As well as washing any visible contaminants off hands with a soap free liquid gel, dentists should never treat a patient without first disinfecting their hands with an alcohol-based hand rub. Alcohol rubs clear the hands and arms of bacterial flora that could contain harmful bacteria.
A painstaking routine of handwashing, using only the best disinfectant treatments and with constant cleaning of surfaces and instruments, is absolutely crucial to preventing communicable infections in surgery.