Hygiene risk for dental patients

DENTAL patients across Scotland are being put at risk of infection from blood diseases such as HIV and hepatitis because of poor standards of hygiene.

Dr Mac Armstrong, the Chief Medical Officer for Scotland, has written to all dentists calling for urgent action to improve basic sterilisation techniques. Dr Armstrong has also written to all GPs and health boards calling on them to ensure high standards are maintained.

The move follows a Scottish Executive study which found that dental surgeries routinely failed to meet basic hygiene standards.

According to the study, three quarters of practices do not change the water in their sterilisers on a daily basis.

Half do not have a dedicated sink for the cleaning of drills, probes and tweezers, while 70 per cent have no record of staff training for sterilisation techniques. A further 60 per cent have no instruction manuals for sterilising equipment.

Deadly viruses, including HIV, hepatitis C and vCJD, the human form of mad cow disease, can all be spread through contact with infected blood.

In September, a helpline was set up for 3,500 patients of an Inverness dentist after claims he failed to sterilise equipment.

Dr Armstrong said yesterday that standards had slipped due to a combination of ignorance and complacency.

And while he stressed that there was no evidence that any hepatitis infections had taken place as a result of poor hygiene, he said that without higher standards there was always a risk of such cross-contamination.

"We have written to all dentists, GPs and health boards in Scotland to highlight the concerns identified in this study and to make clear that we expect action on ten priority areas as a matter of urgency," he said.

"It is the legal and professional responsibility of all dentists, doctors and nurses working with re-usable instruments in primary care to ensure that this happens."

The Chief Dental Officer, Ray Watkins, echoed the concerns and highlighted a 150,000 training programme which has been set up for the profession.

"We have now set up an expert group to take this forward," Mr Watkins said.

"As well as providing training for staff in their practices, it will provide clear and consistent information and help them systematically audit their decontamination practices.

"We have asked NHS Boards to provide us with action plans detailing how they plan to address any shortcomings identified through this process."

The British Dental Association said: "Infection control is a core element of dental practice and the BDA fully supports its members in achieving excellence in this area.

"We provide both written and one-to-one guidance on infection-control issues and work closely with the relevant government departments to ensure the profession has the most appropriate and up-to-date advice."

A spokeswoman for the British Medical Association added: "We support the aims of the chief medical officer in highlighting this issue to all GPs."

The Executive report was carried out by the Glennie Group, chaired by John Glennie, chief executive of NHS Borders. The report was commissioned after concern in the 1990s that CJD could be transmitted via surgical instruments.

While dental procedures are categorised as low risk for such transmissions, there remains a risk for HIV, hepatitis B and C and other bacterial and viral infections.

"The survey has highlighted that the cleaning of instruments has several shortcomings and is poorly controlled," states the report. "The problem is compounded by the lack of clear instructions from manufacturers on the use of dental devices."

That could lead to disposable instruments being used more than once, the report added.