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During the course of seminars presented at professional meetings, I routinely mention to groups to contact me should they have questions later on the topic we discussed. While most inquiries can be answered with a brief phone call or via e–mail, an increasing percentage require a more detailed clarification of terms, infectious disease issues, and preventive strategies. I thought you might find the following examples, which are representative of these inquiries, to be interesting and beneficial to you and your practice:
1) Do my prescription glasses provide sufficient protection when treating patients?
While any form of eyewear will provide some level of protection against the splash/spray of blood or other body fluids, the styles of many of today's frames are quite small and do not afford appropriate ocular protection. Disposable side shields, which are designed to fit all types of frames, provide additional protection. Unfortunately, if they are not placed correctly on the arm of the prescription glasses or are not flush against the sides of the lenses, the opportunity increases for splash/spray to reach the eye. Therefore, specifically designed protective eyewear with side shields, a face shield worn in conjunction with prescription glasses, or a disposable mask with face shield will provide the greatest barrier against aerosols and macroscopic debris.
2) Why is the destruction of Mycobacterium tuberculosis required by the EPA as the benchmark for classification of a disinfectant as an “intermediate–level” disinfectant?
I sometimes get this question in conjunction with the statement: “I know we are not as concerned about tuberculosis being spread from countertops as we are about hepatitis B and C viruses.” This statement is correct because M. tuberculosis is not transmitted via contaminated inanimate surfaces, such as countertops. Its major mode of transmission is through the inhalation of infectious microdroplet nuclei created from infectious aerosols. This vegetative, acid–fast bacillus serves as the resistance standard for disinfectants, primarily because of its resistance to germicidal chemicals. According to the EPA classification, approved label claim of “hospital disinfectant” assures that the product has a demonstrated ability to kill Staphylococcus aureus, Pseudomonas aeruginosa, and Salmonella enterica. The additional claim of “tuberculocidal” activity provides the level of microbial inactivation appropriate for contaminated clinical contact environmental surfaces in health–care facilities — “intermediate–level” disinfection. The ability of a disinfectant to destroy the more resistant tubercle bacilli leads to the consistent inactivation of less resistant vegetative bacteria, fungi, and viruses.
3) What if I, as an employee, refuse the hepatitis B vaccination offered by my employer?
You do have a right to refuse the vaccination. But if you do, you should realize that — without the hepatitis B immunization 3–injection series or evidence of immunity from previous viral infection — you remain at risk for acquiring hepatitis B virus (HBV) infection. This DNA virus remains the major infection–control target for OSHA's Bloodborne Pathogens Standard since it is considered the most–infectious bloodborne virus. Because OSHA considers HBV infection one of the most important protections that a health–care worker can have, OSHA regulations require the employee to sign a waiver if vaccination is refused. Please keep in mind that signing the waiver does not mean that, if you change your mind in the future, the employer does not have to pay to vaccinate you then.
4) Does the CDC recommend booster injections for people who received the HBV vaccine and who have had a positive serologic test for the protective antibody, anti–HBs?
Currently, a booster inoculation is not recommended. The key is to get tested within a few months after the third vaccine injection to make sure you have responded and have produced sufficient levels of protective antibody. Should you have subsequent serologic tests later, even if the level of protective anti–HBs declines, immunological memory has been shown to last for more than 25 years. The CDC continues to examine early test vaccine groups for possible cases of hepatitis B. As of this writing, the CDC has not found such infections.
Dr. John A. Molinari is director of infection control for THE DENTAL ADVISOR. Previously, he was professor and chairman of the Department of Biomedical Sciences at the University of Detroit Mercy School of Dentistry. Contact him at [email protected].
