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[Survey of methods of cleaning, decontamination, disinfection and sterilization in dental health services in tropical areas].

The International Aid for Ontology (IAO) carried out this survey of hygiene in the dental health services of 5 French-speaking African countries in 1994, in association with the Faculty of Pharmaceutical and Biological Sciences of Paris. This study received support from the World Health Organization (WHO), the French Ministry for Cooperation and the European Community and the Ivory Coast Oral and Dental Hygiene and Health Committee (CIHSBD). Twenty-nine dental services from Benin (3), Burkina Faso (6), Ivory Coast (12), Mali (5), Niger (3) participated in this survey which gives an insight into the daily hygiene routines of these services. The cleaning, decontamination, disinfection and sterilization procedures for premises, dental equipment, instruments, hands and disposable items were investigated. No individual protocols are reported. Bench tops were cleaned or disinfected daily in 73% of centers and floors were cleaned or disinfected daily in 59% of centers. Walls were cleaned once per week in 44% of the centers. Hands were always washed between patients, with 68% of dental surgeons using only solid or liquid cleansing soaps and the others using antiseptic or disinfectant solutions. The dentist's chair was cleaned or disinfected daily in 68% of centers, mostly with soap (43%) or diluted bleach (23%). Vacuum equipment was cleaned with soap (50%) or diluted bleach (57%), with some surgeries using a combination of the two. Hand pieces and turbines were cleaned and disinfected after each use with alcohol (35%) or diluted bleach (26%) and were sterilized in 9% of centers. Instruments were sterilized with a Poupinel (63%), unspecified sterilizer (26%), autoclave (7%) or low temperature disinfection procedure (4%). Instruments were regularly sterilized in all centers. Single-use disposable items were often reused: 88% of centers reused gloves, 64% anesthetic cartridges and 32% disposable needles. This survey demonstrates that dentists do attempt to achieve appropriate hygiene standards despite difficult practice conditions, exacerbated by supply problems. In all applications, hygiene involves a succession of closely-related, logical steps, which form an asepsis chain aimed at preventing the transmission of infection. Our survey shows that fundamental elements of hygiene require attention to achieve this aim. The cleaning, disinfection and sterilizing of floor surfaces and equipment should be improved and more widespread use made of disposable items. It is important to define the hygiene level required for particular treatments, taking into account the oral and dental micro flora and whether the equipment has been decontaminated, disinfected or sterilized. A piece of equipment is decontaminated if it has been mechanically cleaned and decontaminated. It is disinfected if these steps are followed by rinsing with sterile water, drying and conditioning. An item is described as sterilized if it is cleaned, decontaminated, rinsed, dried, conditioned and then sterilized. We found that a wide variety of chemicals were used to clean hands, surfaces and equipment. The nature and appropriate methods of use of these chemicals were not widely known. Understanding the chemical composition of these chemicals makes it possible to classify them into cleaning agents, detergents, decontaminating agents and disinfectants. The definition, choice and use of antiseptics and disinfectants should be strictly controlled. It is also vital that single-use disposable items are used only once and are never reused. Hygiene in the dental surgery is a chain of processes aimed at protecting the patient and the medical staff. There are many links in the chain, involving floor and surface hygiene, hand washing by dentists and dental assistants, washing of surgery linen and treatment of equipment. Dental practitioners should continually focus on ensuring that the chain of hygiene procedures is not broken, in their own interests as well as in those of their patients.

Benin↗
PubMed2001

Implications of health care provision on acute lower respiratory infection mortality in Bangladeshi children.

This study uses a geographic information system to evaluate the effects of health care provision on acute lower respiratory infection (ALRI) mortality in very young children in rural Bangladesh. Since 1988, an ALRI control program has been operating in a rural area of Bangladesh in an effort to decrease morbidity and mortality of children suffering from ALRI. ALRI-specific mortality data for very young children (<2 years of age) were obtained from a surveillance system of the area from 1988 to 1993. The ALRI mortality data were aggregated by clusters of households called baris. In order to avoid bias in the population size of haris, spatial moving averages of ALRI-specific death rates were calculated. The relationships between ALRI death rates and several environmental and health service provision variables were measured using regression analysis. The results show that the ALRI mortality rate was 54% lower in the community-based ALRI control program area than in a comparison area where there was no intervention. Greater access to allopathic practitioners was related to lower ALRI mortality rates while access to indigenous practitioners was related to higher mortality. In conclusion, the benefit of the community-based ALRI control program, using a simple case management strategy and improved access to allopathic practitioners, should be replicated in other rural areas of Bangladesh in an effort to reduce child ALRI mortality.

Demography↗
PubMed1978

Johne's disease and the practitioner.

Mycobacterium paratuberculosis infections and the disease states resulting in cattle are defined as spectral in nature. There is a spectrum of immunological response which complicates tests based on this. It is recommended that initial diagnosis of suspicious clinical cases be confirmed by direct fecal smears and a serological test such as immunodiffusion. Herd evaluation requires the application of fecal cultures plus immunodiffusion. Control requires rigid management hygiene measures, surveillance of the herd status and post mortem confirmation of salvaged animals.

Animals↗
PubMed1991

Clinical and cost effectiveness of prophylactic parenteral penicillin in the care of simple wounds undergoing suture repair.

Physicians working in casualty and outpatient departments where adverse conditions prevail often prescribe antibiotic prophylaxis routinely at the time of suture repair of simple wounds. To evaluate this practice, we performed a randomized, controlled study of parenteral chemoprophylaxis of simple wounds undergoing suture repair. Uncomplicated wounds were randomized to either treatment with a combination of benzathine penicillin (2.4 million units) and procaine penicillin (2.0 million units) intramuscularly, or a control group. At the time of suture removal, seven days later, all wounds were reviewed for signs of infection. Of 320 patients enrolled in the study, 173 (54.1%) returned for review. Among treated wounds, 75 of 81 (92.6%) were healing, compared to 79 of 92 (85.9%) controls (p = 0.24). A significantly higher rate of healing was observed when wounds repaired nine or more hours after injury and involving the arms, legs, or trunk were treated (22 of 23, 95.7%) compared to those in whom prophylaxis was omitted (20 of 30, 66.7%) (p = 0.03). Wounds involving the head, and wounds repaired within nine hours after injury had a high rate of healing (greater than 90%), whether prophylaxed or not. Based on a 30% higher healing rate for the patients who benefited from treatment (arm, leg, trunk wounds repaired after nine or more hours), the drug cost of implementing prophylaxis for this group alone was more than five times that of an expectant, non-prophylactic strategy. These results serve to remind practitioners of the possibility that a clinically effective mode of therapy may not necessarily be cost-effective in the delivery of health care.

Cost-Benefit Analysis↗
PubMed2001

[Necessary multidisciplinary management of diabetic foot].

The pathogenesis of diabetic foot is multifactorial and optimal management requires a multidisciplinary team. In most cases, the diabetic foot complication is seen as a wound subsequent to trauma, less often as an acute neuroarthropathy or cellulitis without any apparent skin lesion. Patients look for medical care more or less rapidly, depending on the information received previously concerning foot problems. The patient may consult a general practitioner or sometimes directly attend a diabetic foot clinic. The efficiency of treatment depends on early diagnosis, a specific etiology-guided approach to wound care and management of diabetes mellitus. A multidisciplinary team is needed to provide optimal care for foot wounds and neurological, vascular and infections complications, and to control blood glucose in a global approach to management of the diabetic patient. The team must coordinate the actions of its different members, the goal for all being to obtain not only foot healing but also optimal foot function. This requires experience in surgery of the diabetic foot. Creation of special diabetic foot units has been proposed to manage diabetic patients with foot pathologies as outpatients or inpatients when necessary.

Algorithms↗
PubMed2003

Preventing central venous catheter-associated primary bloodstream infections: characteristics of practices among hospitals participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) study.

OBJECTIVES: To describe the conceptual framework and methodology of the Evaluation of Processes and Indicators in Infection Control (EPIC) study and present results of CVC insertion characteristics and organizational practices for preventing BSIs. The goal of the EPIC study was to evaluate relationships among processes of care, organizational characteristics, and the outcome of BSI. DESIGN: This was a multicenter prospective observational study of variation in hospital practices related to preventing CVC-associated BSIs. Process of care information (eg, barrier use during insertions and experience of the inserting practitioner) was collected for a random sample of approximately 5 CVC insertions per month per hospital during November 1998 to December 1999. Organization demographic and practice information (eg, surveillance activities and staff and ICU nurse staffing levels) was also collected. SETTING: Medical, surgical, or medical-surgical ICUs from 55 hospitals (41 U.S. and 14 international sites). PARTICIPANTS: Process information was obtained for 3,320 CVC insertions with an average of 58.2 (+/- 16.1) insertions per hospital. Fifty-four hospitals provided policy and practice information. RESULTS: Staff spent an average of 13 hours per week in study ICU surveillance. Most patients received nontunneled, multiple lumen CVCs, of which fewer than 25% were coated with antimicrobial material. Regarding barriers, most clinicians wore masks (81.5%) and gowns (76.8%); 58.1% used large drapes. Few hospitals (18.1%) used an intravenous team to manage ICU CVCs. CONCLUSIONS: Substantial variation exists in CVC insertion practice and BSI prevention activities. Understanding which practices have the greatest impact on BSI rates can help hospitals better target improvement interventions.

Catheterization, Central Venous↗
PubMed1991

Survey of veterinarians' recommendations for treatment and control of intestinal parasites in dogs: public health implications.

A systematic, random sample of 450 small and mixed-animal practitioners was selected from the client list of a prominent veterinary pharmaceutical and animal health company. A telephone survey was conducted, using a standard questionnaire, to assess whether current veterinary practices concerning prophylaxis and treatment of canine roundworm (Toxocara canis) and hookworm (Ancylostoma spp) infections are adequate to prevent transmission to human beings. Analysis of results focused on 3 questions related to prevention: practitioner's frequency of client education regarding zoonotic potential of roundworms and hookworms, pup age at which veterinarian recommends first anthelmintic treatments, and proportion of veterinarians recommending prophylactic drug administration for pups and nursing bitches. Despite the proven association of household pet dogs and human toxocariasis, only a third (148/450) of veterinarian respondents routinely discussed the potential zoonotic hazards of canine roundworms with their clients. A total of 29% (130/450) of veterinarians surveyed either never discussed these potential hazards or discussed them only when asked by their clients. With regard to anthelmintic treatment practices, 31% (140/450) of veterinarians surveyed recommended that pups first be examined and treated for intestinal parasites within 4 weeks of age. Thirty-three percent (163/450) recommended first examination and deworming at 5 to 6 weeks of age, and 36% (163/450) suggested that it be done at or after 7 weeks of age. Less than half (208/450) of veterinarians administered anthelmintics prophylactically to at least some pups and dogs. Sixty-four percent (287/450) of respondents recommended routine testing and treatment of nursing bitches.(ABSTRACT TRUNCATED AT 250 WORDS)

Ancylostomiasis↗
PubMed1989

Norwegian dentists' knowledge, attitudes, and behavior concerning the HIV.

Knowledge about routes of HIV transmission and attitudes to HIV antibody testing was studied in a group of Norwegian dentists. Personal protection by gloves was also recorded. Eighty-three of 120 (69%) dentists in Bergen (private practitioners) completed a postal questionnaire. More than half of these considered themselves to be in potentially infectious situations daily. Overall knowledge was good, although one fifth gave wrong answers about the relation between antibody status and infectivity. About half the respondents had attitudes to antibody testing not consistent with Centers for Disease Control (CDC) guidelines. These dentists scored significantly lower on the knowledge questions. Seventy-five (92%) reported consequent use of gloves. A low knowledge score was found among non-users. The present study indicates that lack of knowledge is related to non-recommended attitudes and behavior. The study underlines the need for continuous education and information about HIV.

Attitude of Health Personnel↗
PubMed1993

Influence of homelessness on acute admissions to hospital.

The aim of this study was to look at the influence of homelessness on acute medical admissions. A prospective case-controlled study was therefore performed on all homeless children admitted through the accident and emergency department over one year, comparing them with the next age matched admission from permanent housing. Assessments made were: whether homelessness or other social factors influenced the doctors' decision to admit; differences in severity of illness; length of stay; and use of primary care. The admitting doctors completed a semi-structured questionnaire during admission about social factors that influenced their decision to admit and graded the severity of the child's illness. The length of hospital stay was recorded. The family's social risk factors and accommodation were assessed at a home visit using a standardised questionnaire and by observation. Seventy homeless children were admitted. Social factors influenced the decision to admit in 77% of homeless children and 43% of controls. More of the homeless children were only mildly ill (33/70) than those from permanent housing (21/70), although three of the homeless children died of overwhelming infections compared with none of the controls. Among homeless families many were recent immigrants (44%). There was a marked increase in socioeconomic deprivation, in major life events in the previous year (median score 3 v 1), and in maternal depression (27% v 8%). Referral to the hospital was made by a general practitioner in only 5/50 (10%) of homeless compared with 18/50 (36%) of controls. Social factors were an important influence on the decision to admit in over three quarters of the homeless children and resulted in admission when less severely ill even when compared with admissions from an inner city population. Even though there was marked social deprivation among the homeless families, the decision to admit was based on vague criteria that need to be further refined.

Acute Disease↗
PubMed1999

Phage therapy: past history and future prospects.

Bacterial viruses (bacteriophages, also called "phages") can be robust antibacterial agents in vitro. However, their use as therapeutic agents, during a number of trials from the 1920s to the 1950s, was greatly handicapped by a number of factors. In part, there were certain limitations inherent in phage physiology (e. g. narrow host range, and rapid clearance from the body); in part there were technological limitations in the era (e.g. lysogeny not yet discovered); but the greatest limitation was the highly inadequate scientific methodologies used by practitioners at the time (e.g., their failure to conduct placebo-controlled studies, to remove endotoxins from the preparations, and to re-confirm phage viability after adding sterilizing agents to the preparations). In recent years, well-controlled animal models have demonstrated that phages can rescue animals from a variety of fatal infections, while non-controlled clinical reports published in Eastern Europe have shown that phages can be effective in treating drug-resistant infections in humans. This encouraging data, combined with the fact that drug-resistant bacteria have become a global crisis, have created a window of opportunity for phage therapy to be tested anew, this time using modem technologies and placebo-controlled designs. If successful, it can be used as a stand-alone therapy when bacteria are fully resistant to antibiotics, and as a valuable adjunct to antibiotics when the bacteria are still susceptible.

Administration, Oral↗
PubMed2002

Sexually transmitted infections in Bangladeshis resident in the UK: a case-control study.

OBJECTIVE: To evaluate the prevalence of sexually transmitted infections (STIs) and mode of presentation in patients originating from Bangladesh and resident in the United Kingdom in comparison with non-Bangladeshi patients attending an inner London genitourinary medicine (GUM) clinic. METHODS: A retrospective, cross sectional study with comparator group was carried out at an open access GUM clinic in east London. 104 consecutive newly attending Bangladeshi men were compared with 199 consecutive newly attending non-Bangladeshi men and 115 consecutive newly attending Bangladeshi women were compared with 218 consecutive newly attending non-Bangladeshi women. Any diagnosed sexually transmitted infections, sexual history characteristics, reasons for presentation, and referral patterns were noted. RESULTS: Bangladeshi men (28.8% compared with 7.5%; p<0.0001) and women (42.7% compared with 12.8%; p<0.0001) were more likely to be referred by their general practitioners or other medical services. Bangladeshi men were more likely to present with sexual dysfunction (12.5% compared with 2.5%; p=0.001). The prevalence of STIs was broadly similar across the study groups; however, syphilis was significantly more common in the Bangladeshi men (10.9% compared with 4%; p=0.04) and nongonococcal urethritis (NGU) in the control men (35% compared with 20.2%; p=0.02). Bacterial vaginosis was an infrequent diagnosis in the Bangladeshi women (3.5% compared with 22.4%; p<0.0001). CONCLUSIONS: STI prevalence in Bangladeshis attending GUM services is similar to other populations although patterns of presentation and referral do show variation. Bangladeshi men are more likely to access GUM clinics for psychosexual services. The presence of STIs in Bangladeshis particularly those imported from Bangladesh provides an opportunity for HIV transmission between the United Kingdom and Bangladesh.

Adolescent↗
PubMed1999

Extrusion of testosterone pellets: a randomized controlled clinical study.

BACKGROUND: It has previously been shown that testosterone implantation is an effective and well accepted form of androgen replacement therapy, but that pellet extrusion was the most frequent side-effect. The present study aimed to reduce the extrusion rate. OBJECTIVE: To determine whether the washing of testosterone pellets to remove potentially surface-adherent particles decreased the rate of extrusion of pellet implants. DESIGN: Prospective, randomized parallel group design in a single centre with consecutive procedures to be randomized (1 : 1) into a wash or control group. PATIENTS: The study included 251 testosterone implantation procedures in men with known androgen deficiency. MEASUREMENTS: The primary endpoint, extrusion rate per procedure, was evaluated prospectively by telephone contact at 1 week and then 3 and 6 month intervals. Secondary end-points included peri-procedure adverse events (bleeding, skin reaction, excessive discomfort) noted at the time of implant. Bruising, bleeding and infection were also evaluated as later adverse events by telephone and personal follow-up. Explanatory variables recorded as possible covariables included the number of implants used, production batch number of the implants, the operator, as well as other demographic and medical factors. RESULTS: In the wash group, the extrusion rate was 12% per procedure (19 pellets from 15 subjects) whereas in the control group, the extrusion rate was 11.1% per procedure (18 pellets from 14 subjects), indicating no evidence of any benefit of the wash procedure (OR = 1. 09 [95% CI 0.47-2.6] per procedure). There was no evidence of benefit in secondary endpoints including total adverse events (7.1%, OR 1.28 [0.44-3.9], bleeding/bruising (8.8%, 1.23 [0.47-3.3]) and infection (4.0%, 1.54 [0.35-7.6]) per procedure. Among men reporting an infection requiring antibiotic treatment according to their own general practitioners, six/ten (60%) subsequently experienced an extrusion. There were no significant differences in extrusion rate between four different operators (P = 0.24) nor among 12 different batches of pellets used during the course of the study (P = 0.77). CONCLUSIONS: The pellet washing procedure used during implantation does not reduce the subsequent extrusion rate. The higher rate of both primary and secondary adverse events in this prospective study compared with the previous retrospective survey may reflect either more rigorous follow-up or a secular trend.

Drug Implants↗
PubMed1988

Survey of general practitioners' attitudes to AIDS in the North West Thames and East Anglian regions.

As the numbers of people suffering from human immunodeficiency virus infection and the acquired immune deficiency syndrome (AIDS) increase, so will the contribution to care required from general practice. A postal questionnaire survey was therefore carried out among general practitioners in the North West Thames and East Anglian regions to determine their attitudes to AIDS and the issues it raises for them. One hundred and thirty seven questionnaires were returned (response rate 57%) and four factors underlying the doctors' attitudes identified; these concerned disease control, general practitioner care, patient support, and perception of seriousness. There were wide divergences of attitude among the general practitioners, younger doctors being more in line with specialist thinking on AIDS than older colleagues, and evidence of important gaps between policies advocated by AIDS specialists and bodies of opinion in general practice. Attitudes to AIDS in general practice may partly be a function of personal experience; further study is required.

Acquired Immunodeficiency Syndrome↗
PubMed2005

[Emerging or re-emerging infections that can be used for bioterrorism].

USED FOR WARFARE: Bioterrorism is a perfectly foreseeable eventuality. It is defined by the international use, or menace of use, of living organisms whatever their nature, or of substances derived from these organisms, aimed at provoking a disease or the death of human beings, animals or plants. UPDATED COUNTERACTING STRATEGIES: More than 180 infectious agents could be used for terrorist ends. The recent events in the dawn of this twenty-first century have reactivated and notably updated the strategies to counteract such an event. Clinical and therapeutic guidelines have been circulated in many countries. INFECTIONS THAT REQUIRE RECOGNITION: The role of practitioners in the rapid recognition of bioterrorism-related infections is crucial. Hence, updated knowledge on these potentially emerging or reemerging infections is required.

Anthrax↗
PubMed1978

Efficiency and cost of primary care by nurses and physician assistants.

We conducted a prospective study in a prepaid primary-care practice (health-maintenance organization) of a system in which nurses and physician assistants used protocols, and compared the efficiency and costs of this "new-health-practitioner" protocol system to a physician-only nonprotocol system. In five months, we studied 472 patients with any of four common acute complaints--respiratory infections, urinary and vaginal infections, headache, and abdominal pain; a subset of 203 patients was randomly allocated between the two systems. In the new-health-practitioner system physician time per patient was reduced by 92 per cent, from 11.8 to 0.9 minutes, and average visit costs--including practitioner time and charges for laboratory tests and medications--were 20 per cent less (P = 0.01). We conclude that this protocol system saves physician time and reduces costs.

Abdomen↗
PubMed2001

Is there a role for antibiotic cycling in the intensive care unit?

Antibiotic resistance of bacterial pathogens has emerged as one of the most important issues facing critical care practitioners. Resistance of many commonly encountered bacterial species is increasing and has been associated with greater administration of inadequate antimicrobial therapy to patients within intensive care units. This has resulted in greater patient morbidity, higher mortality rates, and increased healthcare costs. Methods to reduce antimicrobial resistance have focused on increasing adherence to infection control practices and improving antibiotic utilization. Antibiotic cycling is a strategy to reduce antimicrobial resistance by withdrawing an antibiotic or antibiotic class from use and subsequently reintroducing it at a later point in time. The main goal of cycling is to allow resistance rates for specific antibiotics to decrease, or at least remain stable, when their use is periodically eliminated from the intensive care unit.

Anti-Infective Agents↗
PubMed1995

Management of the clinical curriculum in which students direct rather than perform the laboratory stages of restorations.

At the University of Iowa, senior dental students direct rather than perform laboratory construction of clinical prosthodontic work. This report highlights the fundamentals of a successful curriculum based on this concept. One critical component of the curriculum involves teaching the process of self-evaluation of laboratory work as well as the evaluation of work received from a commercial laboratory. Instructors teach students how to evaluate a product in the sophomore preclinical curriculum. A computerized evaluation form, developed by the prosthodontic faculty, allows assessment of the students' laboratory work in addition to self-evaluation. To incorporate patient care into the appraisal process, a modified preclinical evaluation framework is used during the junior clinical clerkship. This expanded framework takes into consideration patient treatment factors such as degree of difficulty, diagnosis and treatment planning, use of infection control, and students' understanding of patients' comprehensive treatment plan. In the senior clinic, the students' ability to direct the construction of a prosthesis is enhanced by the unique diversity of faculty within the Department of Family Dentistry at the University of Iowa. This department unites private practice dentists with academicians and general practitioners with specialists.

Communication↗
PubMed2004

MFGDP(UK): the Key Skills Portfolio.

The purpose of this paper is to enable general dental practitioners to understand how to compile an evidence-based portfolio for the MFGDP(UK) examination. The principles of evidence-based portfolios are outlined. There are six key skills that a candidate needs to understand in order to complete this portfolio. The six Key Skills are: medical emergencies in general practice, infection control, record keeping, radiography, legislation as applied to general practice and staff training. Specific advice is given on each key skill in order to complete the Portfolio.

Clinical Competence↗