You may be aware of the recent media and public interest in the standards of infection control in dentistry. Last month, an announcement was made by the NSW Health and Dental Council that infection control breaches had occurred at four dental surgeries; and warned of the potential of blood borne virus transmission. Over 11,000 patients have been advised to have blood testing for Hepatitis B & C and HIV status. So what are the risks for those patients who have had treatment at the practices named in Sydney? How are infection control guidelines and laws regulated in Australia and how could this happen?
What Has Happened?
A public health investigation of four dental practices in Sydney found instruments used in the Campsie and Sydney CBD practices of The Gentle Dentist, and Dr Robert Craige Starkenburg's clinics in Surry Hills and Bondi Junction, were not cleaned, sterilised or stored in accordance with guidelines set by the Dental Board of Australia. The Gentle Dentist clinics are owned by Dr Samson Chan, who had his registration suspended in mid-March following an investigation by the Dental Council, are still operating. Dr Starkenburg's practices have been closed.
The overall risk to individual patients of blood-borne virus transmission has been assessed as low by the NSW Health Council and no cases of blood-borne virus infection have been identified as associated with these dental practices. However, patients who have had an invasive procedure at either of The Gentle Dentist practices during the last ten years or any procedure at Dr Robert Starkenburg's practices are recommended to have testing for HIV, Hepatitis B and Hepatitis C.
The Dental Council have stated that since the suspension of Dr Chan's registration, an expert consultant has gone to the practice and provided further instruction and advice and the practices are now consistent with the relevant National Guidelines.
How are infection control standards controlled in Australia?
The Dental Board of Australia (National Board) takes breaches in infection control standards very seriously. Registered dental practitioners, by the law of the Dental Act, must comply with the National Board's Guidelines on infection control. As regulators of the profession, the Dental Board can permanently restrict or place conditions on the licence of dental practitioners who fail to comply.
Australia has some of the most strict infection control protocols in the world and registered practitioners are expected to continue to update their knowledge throughout their career across all areas of their practice, including infection control. The Dental Board recommend "taking a continuing professional development (CPD) course in infection control on a regular basis".
Dr Chan allegedly blamed the infection control breaches on inexperienced staff. By contrast, Dr Starkenburg allegedly told the same papers that his age (75) had made it difficult for him keeping up with the changing regulations around infection control.
What is the risk of blood borne virus transmission?
Although this is a very serious issue, it's important to maintain perspective. The actual risk for HIV infection after a needlestick or cut exposure to HlV-infected blood is 0.3% (about 1 in 300). Stated another way, 99.7% of needlestick/cut exposures to HIV-contaminated blood do not lead to infection. For Hepatitis B, those who have received a hepatitis B vaccine and have developed immunity to the virus are at virtually no risk for infection. For an unvaccinated person, the risk from a single needlestick or a cut exposure to HBV-infected blood ranges from 6%-30% and depends on the hepatitis B e antigen (HBeAg) status of the source individual. The estimated risk for infection after a needlestick or cut exposure to Hepatitis C-infected blood is approximately 1.8%. These statistics are only applicable for invasive procedures, that is; those that involve entry into the tissues during which bleeding occurs, such as surgery and tooth extractions.
The involvement of instruments during general dental procedures is the same as using kitchen cutlery; which is interesting—does the cutlery reused in restaurants go through a licenced autoclave steriliser? Infection control guidelines have changed immensely in the last 20 years and are continuing to do so. It wasn't until 1986 that wearing gloves became compulsory for healthcare professionals in Australia.
That's why at Bite Dental, all of our team members undergo annual refresher courses in infection control protocols to stay up-to-date. We are also in the process of AAAHC Accreditation, which is the gold standard of approval awarded to healthcare facilities that meet or exceed the national standards of practice. Currently this is not compulsory for dental practices in Australia. At the studio, our sterilisation room is clearly visible for patients to see the cleaning, disinfecting and sterilisation processes taking place. Take a look next time you are in the practice!
For those who would like more information on the incidences in Sydney, NSW Health has established a public information line staffed to assist patients of either practice who may have questions on 1800 610 344.