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I have been covering the field of infection control long enough to have learned never to underestimate the miracle that is the human immune system. That said, the patients of a Tulsa, OK, dental practice that are currently being tested by the thousands face a risk of bloodborne infection that is highly concerning.
If accurate, the practices described in the dental office by state health investigators and licensing officials represent nothing less than a flagrant disregard of basic infection control measures. Suffice it to say, the now shuttered office could be reopened for business as usual on Halloween as a house of infectious horrors, with a different high-risk practice on view in every room.
The investigation into the dental and oral surgery practice of Wayne Scott Harrington, DMD, began after public health officials reported the kind of unusual case that typically triggers these patient look-back studies. According to a March 26, 2013 report by state health investigators, the index patient had recently tested positive for hepatitis C virus and had no known risk factors other than receiving dental care.
In inspections conducted while the office was still open, public health officials observed multiple sterilization and cross-contamination issues, dental assistants providing IV sedation procedures, and the drug cabinet unlocked and unattended.
Moreover, the dentist and staff told officials there was “a high population of known infectious disease carrier patients in the practice,” meaning cross transmission between patients was a possible source of transmission. In a particularly strange protocol, two separate sets of dental instruments were kept, one set for patients known to have infectious diseases and another set for patients “unknown or not believed to have an infectious disease,” investigators were told. The triumph of intuition over science in that policy is hard to exaggerate.
The two instrument kits had separate cleaning protocols, with the set for “infected” patients dipped in bleach as an extra step. As a possible result of this policy, the instruments designated for infected patients appeared to be rusted and could no longer be properly sterilized. Compounding the problem, the autoclave in the office had not been bio-tested for efficacy – generally recommended once monthly – in at least six years!
But perhaps most concerning – given the numerous blood-borne outbreaks caused over the years by improper use of multiple dose vials, syringes and needles -- were the office’s needle safety practices. Opened and unopened vials were found in drawers with needles in the patient care areas. Needles were being reinserted into multidose vials for use on mutiple patients, a practice that has been shown to contaminate the medication with blood from infected patients and create “a great risk of cross-contamination,” the report noted.
As of April 16th, 3,260 of some 7,000 notified patients of the practice have been tested for hepatitis B, hepatitis C and HIV. State health officials are not releasing any test results pending further investigation.