December 1, 2019 is the 32nd World AIDS Day. The theme of this year's publicity campaign in my country is "Communities mobilize together to prevent HIV/AIDS, and I will act in a healthy China" (the English theme is "Communities make the difference").

According to the latest data on the global AIDS epidemic released by the World Health Organization (WHO). As of 2018, there were approximately 37.9 million people living with HIV worldwide, including 36.2 million adults and 1.7 million children (<15 years old). Although the morbidity and mortality have been decreasing year by year, the number of HIV-infected people in the world is still not to be underestimated. In 2018, the incidence rate was 1.7 million, and the case fatality rate was 800,000. ).

Blood transmission is one of the three main routes of HIV transmission. A survey and study jointly released by the World Health Organization (WHO) and the US Centers for Disease Control (CDC) shows that although the vast majority of HIV-infected people may not develop special symptoms during the 2-10-year incubation period from HIV infection to onset. Systemic symptoms are not easy to detect, but 80% of infected people will first develop oral diseases and seek medical treatment during the incubation period.

Frequent dental infections

If the disinfection and sterilization of the dental clinic does not meet the hygienic standards, the risk of exposure of doctors and patients to blood-borne infectious diseases such as AIDS will be very high, and the dental clinic may also become a high-risk place for AIDS infection. Let's review this year's reports of infections in dental offices around the world.

According to a report by USA Today on March 26, 2019, three "Trieu Family Dental Clinics" in Philadelphia, USA, were closed by the local health department. Because its equipment is not properly sterilized and medical devices such as needles are reused, there is a serious risk of HIV infection in patients who seek medical treatment. It is estimated that the potential impact range may be as high as 1,500 people!

The British "Daily Mirror" reported an equally sensational news on May 19, 2019: a dental clinic in London called "Dentality Hoddesdon" even cleaned the scaler only twice a day due to improper disinfection of medical equipment. , resulting in nearly 600 patients at risk of contracting various infectious diseases such as HIV.

Pay attention to oral sensory control and prevent blood-borne infectious diseases

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According to the public data from 2008 to 2017 (Table 1), the number and treatment rate of oral patients in my country have steadily increased, and the number of patients with blood-borne diseases such as HIV, HBV, and HCV is large. In order to prevent the occurrence of oral blood-borne infectious diseases, what problems should we focus on?

1

Oral instruments

In the process of oral diagnosis and treatment, the saliva and blood of patients who are most likely to transmit HIV and other blood-borne infectious diseases will directly contaminate various instruments such as dental handpieces, burs, root canal treatment instruments, tooth extraction forceps, mouth mirrors, and medical staff. Especially during cleaning and denture preparation, the blood mist formed can pollute the face, eyes, oral mucosa and respiratory tract of the stomatologist. Although the oral epithelium has a good protective effect against HIV infection, when suffering from gingivitis, periodontitis, and oral ulcers, the natural barrier of the oral cavity is destroyed, providing a good channel for HIV virus invasion ( 2).

In addition, the study found that doctors in the process of work, HIV-contaminated needles and needle tips, a simple one-time piercing the skin and the probability of HIV infection is 0.3%. If physicians exposed mucous membranes, including the conjunctiva, oral cavity, and nasal mucosa, exposed to HIV-contaminated bodily fluids, the chance of HIV infection was 0.09% (3). Because of the diagnosis and treatment of infected people, dentists are more likely to come into contact with and be exposed to the source of HIV infection, and the probability of being stabbed by sharp objects during operation is also relatively high.

In addition to attaching great importance to occupational exposure, do personal protection and strengthen prevention. In order to prevent cross-infection between doctors and patients and between patients, to prevent the spread of AIDS during oral operations. Oral medical institutions should strictly abide by the procedures for handling oral instruments in WS506-2016 "Technical Operational Specifications for Sterilization and Sterilization of Oral Instruments", and all used instruments must be thoroughly cleaned and then disinfected and/or sterilized. In the instrument cleaning step, select appropriate cleaning agents such as enzyme cleaning agents for soaking and brushing operations; follow the basic principles of oral instrument treatment - one person, one use, one disinfection and/or sterilization.

But in fact, the disinfection and sterilization status of dental medical instruments urgently needs to be further improved. Taking Baoshan District, Shanghai as an example, the Health Supervision Institute of Shanghai Baoshan District Health Bureau conducted a special investigation on the disinfection and sterilization of dental instruments in 51 medical institutions in Baoshan District from July to September 2013. The test results show that (Table 2), a total of 102 sterilized dental diagnosis and treatment instruments were tested, 96 of which were qualified, and the total pass rate of sterilization was 94.12%. Although the general condition of the public medical institutions in the district is good, the sterilization pass rate is 100.00%; but 6 private and individual dental clinics in the district (3 dental handpieces, 1 tooth collar, 1 extraction forceps and 1 scaler) have been destroyed. Bacteria oral diagnosis and treatment equipment failed to pass the test, and the sterilization pass rate was 91.67% (4).

2

oral impression

Oral impressions will come into direct contact with the patient's saliva, dental plaque, and even blood during the preparation process, and a large number of pathogenic microorganisms may be adsorbed on the surface. Cross-infection and transmission among nurses, technicians, patients.

When selecting an impression disinfectant, in addition to ensuring good disinfection and bacteriostatic effect, it should also be noted that the selection of common clinical impression materials such as alginate, silicone rubber, polyether rubber, etc. has little effect on the stability and will not affect the size. and precision disinfectants (5).

Merris surface disinfectant Kava liquid can kill MRSA, VRE, HIV, hepatitis B virus and hepatitis C virus in 2 minutes, and kill Mycobacterium tuberculosis, Pseudomonas aeruginosa, Klebsiella pneumoniae, etc. in 3 minutes (The kill rate reaches 99.999% and above). Kava solution has excellent effect on sterilizing oral impressions/models, has no effect on accuracy, and is significantly better than glutaraldehyde, chlorine-containing disinfectants, ultraviolet rays, etc.

Remarks: The above data comes from MicroBiotest Inc. (a third-party laboratory certified by the US EPA)

3

Oral comprehensive treatment table waterway

The dental unit water lines (DUWLs) provide general medical water for the auxiliary equipment of the dental chair unit (DCU) such as dental handpieces, ultrasonic scalers, and water guns. Due to the small diameter and smooth material of the DCU water pipeline, and even if the dental drill has been strictly sterilized, due to the high-speed operation of the turbine during use, viruses and bacteria such as hepatitis B and AIDS that may exist in the oral cavity of the patient being treated will be removed. It is "sucked back" into the entire water system of the dental treatment, so the inner wall is prone to form a microbial film, resulting in widespread microbial contamination of the output water. The risk of nosocomial infection is created by the introduction of microorganism-laden water into the mouths of doctors and patients (6).

According to the Shanghai Center for Disease Control and Prevention and Shanghai Fengxian District Center for Disease Control and Prevention, 6168 water samples were tested on the treatment water of stomatology comprehensive treatment benches in 187 medical institutions in Shanghai, and the average overall pass rate of hygiene quality was 62.89 %. 57%。 The qualified rate of primary, secondary and tertiary hospitals were 59. 95%, 68. 79% and 50. 23%, and the qualified rate of primary dental clinics was 64. 57%. The pass rates of water source water, pipe water, mouthwash, rinse water and mobile phone outlet water for dental treatment water were 84. 21%, 83. 42%, 67. 24%, 65. 75% and 52. 97%, respectively. The qualified rate of water storage tank was 57.05%. Among the five water sources, the sterile water supply system has the worst sanitary quality, with a pass rate of only 34.78% (Table 3).

To sum up, the water pollution of the comprehensive treatment table in dental medical institutions is serious, and the sanitation quality of the dental department in the tertiary hospital is the lowest among different types of hospitals, and there is a hidden danger of nosocomial infection (7).

At present, the total amount of bacteria in the output water of the international DCU can refer to the drinking water standard. Medical institutions can use chemical treatment methods as the preferred physical method as a supplement, such as selecting slip liquid for waterway disinfection, and at the same time considering factors such as effectiveness, safety, and corrosion of waterway system materials, and strengthen the management of DUWLs.

4

Environmental disinfection

Cleaning and disinfection of the medical environment is the basis of medical safety. The splash of blood and saliva in the process of oral diagnosis and treatment will cause serious pollution to the environment of the clinic. For example, due to the frequent operation of the dental handpiece and the connection of the saliva suction device and the three-way gun, the public contact surface of the dental treatment center is relatively close to the patient's mouth, and there is a great chance of being contaminated by the patient's saliva and blood. Studies by Japanese scholars on the surface of objects in the oral operating environment with blood contamination show that the positive rate of blood tests such as lamp handles, dental chair seats, and operation panels is 25.0%-46.0% (8).

However, in the face of serious environmental pollution, the importance of dental clinics needs to be strengthened urgently. In September 2015, an on-site inspection of the current situation of nosocomial infection management in 72 dental clinics in Suzhou found that there were widespread unqualified situations in the treatment of reused instruments, environmental management and occupational protection.

In particular, the environmental management pass rates of public and private institutions are only 43.48% and 34.69% (Table 4): disinfection and isolation measures for treatment units between each patient have not been implemented, the light source handle is not covered, terminal disinfection is not in place, and environmental disinfection methods Irregular, poor ventilation in the consultation room, but no effective air purification measures have been taken, there are potential safety hazards (9).

Surface cleaning and disinfection can effectively cut off the transmission route. Broad-spectrum, fast, safe and mild disinfectant wipes can be used for disinfection operations.

For example, CaviWipes is used to clean and sterilize the surface of the lighting handle and pipeline connection of the dental treatment table, and the TPC semi-quantitative bacterial culture slide and ATP fluorescence detector are used to clean and sterilize the surface of the object before and after disinfection. Bacterial counts were determined with relative light units (RLU). It can be found (Table 5, Table 6): the differences in the number of colonies and ATP values ​​before and after disinfection on the surfaces of the two objects were statistically significant (P<0.01); CaviWipes cleans and disinfects the public contact surface of the comprehensive dental treatment table The effect is obvious (such as Table 5, Table 6) (8).

Merris Oral Sensory Control Solution

references:

1. https://www.who.int/hiv/data/en/

2. Lu Yang, Li Qiang. J Diseases Monitor & Control Apr2016, Vol.10 No.4

3. Yan Zhigang, HIV Transmission and Protection in Stomatology. Chinese Journal of Misdiagnosis Nov. 2007 Vol 7 No. 25 Chin J Misdiagn, Nov 2007 Vol 7 No.25

4. Qin Zhihong, Liu Xiangyang, Xu Guo (Sanitation Supervision Institute of Shanghai Baoshan District Health Bureau, Shanghai 201901). Investigation on the current situation of disinfection and sterilization of dental instruments in medical institutions in Baoshan District, Shanghai, Shanghai Preventive Medicine, 2014, Vol. 26, No. 8

5. Peng Jia, Shi Weiwei, Xu Baohua. Effects of disinfection methods on dimensional stability and surface accuracy of oral impressions [J]. Journal of China-Japan Friendship Hospital. 2018.32(5):301-303

6. Su Jing. Preliminary study on infection risk and prevention and control of oral treatment water

7. Jiang Ning, Xu Chunhua, Tian Liang, Chen Yuehuo, Zhu Qiuli, Fan Junhua, Zhu Renyi. Investigation on water pollution of dental comprehensive treatment benches in medical institutions in Shanghai, Chinese Journal of Disinfection, Vol. 31, No. 7, 2014

8. Liu Cuimei, Hu Kai, Ban Haiqun, Ding Jianfen, Cai Zhigang. Observation on the disinfection effect of public contact surfaces of comprehensive dental treatment table. Chinese Journal of Hospital Infectious Diseases, Vol.22, No.23, 2012 Chin J Nosocomiol Vol.22 No.23 2012

9. Wang Xiuzhen, Yan Xiangming, Zhao Naxing, Ni Xiaoyan, Zhao Xu. Investigation on the current situation of hospital infection management in dental clinics in Suzhou. Chinese Journal of Disinfection, Vol. 35, No. 5, 2018