RIYADH, 28 April 2003 — Cross infection is of grave concern in health care settings and in the dental sector in particular. Advances in education and technology have led to improvements and innovations in infection control in many countries, and the Kingdom is no exception. Despite on-going changes, however, some health risks linger and are a cause for concern to both health care workers and patients.
Dr. Hassan Abdelwassie, chief dental officer and general director of dentistry at the Ministry of Health, told Arab News that the ministry was taking steps to ensure that proper infection control procedures were adopted. He said that the changes being made are part of a continuing process and that obstacles were par for the course.
According to a recent study at King Saud University, only 8.4 percent of more than 200 private dental clinics surveyed in Riyadh followed the complete list of infection control procedures or “universal precautions” established by the American Dental Association (ADA) and Centers for Disease Control and Prevention (CDC).
The study also indicated that at present there were no “standard protocols” on infection control procedures in the Kingdom’s private dental clinics.
Universal precautions require dentists to wear gloves and face masks during treatment, and both items must be changed after each patient. Face masks can help prevent infection from oral respiratory secretions which are a source of transmission for several diseases, including SARS. High-volume suction can also significantly help reduce contamination in treatment rooms.
Other requirements include proper storage and sterilization of all medical equipment as well as proper disposal of needles and blades. In the study, only 56 percent of respondents reported using special containers for disposing of needles and other contaminated waste. Such material can be a major hazard if not properly disposed because of the risk of coming into contact with dangerous microbes found in blood, saliva and other waste products.
Researchers made several recommendations for improvements, and according to Dr. Abdelwassie, many changes are already under way as part of a Kingdom-wide campaign. Dr. Abdelwassie said that the MOH made announcements about infection control courses open to dental personnel. He added that the ministry was cooperating with both King Saud University and King Abdul Aziz University to incorporate these courses into their dental studies programs.
Hepatitis B vaccinations are compulsory for all dental care professionals, he said. Studies show that dental personnel have a five to ten times greater chance of Hepatitis B infection than the general population.
Dr. Abdelwassie pointed out that over the last three years, 12 dentists in the Kingdom had been barred from clinical work when they tested positive for the disease. Researchers also suggested that a standard infection control manual incorporating all published guidelines and regulations should be distributed to all dental practices. Dr. Abdelwassie said that such a manual is under preparation.
Ryad Mansour, operations manager for Dr. Tarek Hamad Al-Kadi Dental Surgery Clinics, said that dental care professionals at the clinic took into account various measures for infection control but that he was not aware of any formal regulations. “I know for a fact that we are adopting such measures,” he told Arab News. “But there are no standard procedures.”
According to Dr. Abdelwassie, the MOH sends inspectors to conduct general inspections of dental facilities. “In spite of a lack of manpower, the MOH is doing its best to inspect all dental care facilities at least once yearly,” he said.
According to Mansour, however, the inspections do little to solve the problem. He said that there were no “professional inspectors” visiting the clinic to ensure that infection control guidelines were being properly enforced.
Mansour said that some “boys” were sent by the Ministry of Health from time to time, but that they themselves lacked adequate knowledge and experience which would enable them to make improvements in the system. Mansour went on to say that infection control procedures were not given adequate attention.
“The MOH has unfortunately not shown professionalism in such matters and part of the problem is the staff assigned to oversee these important issues,” he added.
Along with many others, Mansour feels that the MOH needs to take a tough stand to ensure that all health care personnel, including the inspectors, are doing their jobs and making use of infection control resources available to them. Without standard regulations, however, infection control procedures will vary from one clinic to the next.
In one clinic which Arab News visited, infection control procedures were deficient. In addition to poor general hygiene, the dentist did not wear a face mask during treatment and a medical history of the patient was not taken.
According to Dr. Abdelwassie, patients also need to be alert to ensure that health care professionals were following regulations and not doing anything to compromise the health and safety of themselves or their patients. He said that concerned patients could voice their complaints to the regional health directorate. “We consider such complaints an important tool for improvement,” he added.
One dental patient, however, observed that patients expect doctors and dentists to know what is right and so they do not normally question procedures. “We trust them to know what’s best for us,” she said.
