Challenges

Dental offices are places constantly exposed to contaminations. This is due to the fact of high human exchange during the day and excessive volume of aerosols which come directly from patients mouth and respiratory tract. Therefore, dental practitioners continuously expose themselves and patients to pathogens and should pay attention to the risk of possible cross-contamination. One of the most common disinfection chemistry used in dental offices is quaternary ammonia compounds, which are used for surface and instruments disinfection as well as for aspiration system decontamination. However, only a limited number of dentists are aware of their drawbacks.

It has been 18 months since the World Health Organisation announced the pandemic state caused by COVID-19. By this time situation began to be serious and we were surrounded by dreadful news, the closing of the borders between the countries, and chaos. The pandemic took almost 5 million lives, vastly impacted our lifestyles, and created a burden on economical development.

While with low incidence, endoscopes are significant vectors for the transmission of microorganisms. Notably, they have caused more outbreaks than any other reusable medical device. Reprocessing failures have led to more than 100 endoscope-related outbreaks in the US. These failures can occur at different steps of the reprocessing and can be for example due to the inadequate cleaning of endoscopes channels, ineffective disinfection, use of contaminated water for flushing, and inefficient drying.

Infection prevention and control plays a crucial role in avoidance of an outbreak of MDROs. While institutions are careful with managing the budget covering for this risk we would like to point out why its economically worth to prevent the epidemic based on the calculations published in the Clinical Microbiology and Infection. In 2016 Dr Jon Otter and colleagues published a comprehensive economic evaluation of a carbapenemase-producing Enterobacteriaceae (CPE) outbreak across five hospitals in London. 

In the era of the COVID-19 pandemic hand hygiene became something we got used to living with on a daily basis. From one day to another we found ourselves equipped with an alcohol-based hand-rub (ABHR). Today, hand-rubbing for 30 seconds grew into an unmistakable gesture. However, we should not omit the fact that ABHR is essential not exclusively during the virus epidemic. It’s a solution to get rid of the pathogens or simply clean your hands when far from the source of water.

2019-nCoV is an enveloped virus that belongs to the Coronaviruses group. Coronaviruses can cause respiratory infections in mammals and birds, going from common colds to pneumonia and bronchitis. Coronaviruses have the particularity to cause both upper (nasal cavity, pharynx, larynx) and lower (lungs) respiratory tract infections. They can be transmitted from human to human when there is close contact via droplets when sneezing and coughing. Those droplets can reach the nasal cavity, the mouth or directly the lungs at a distance of 1.8 m. Infected people can be contagious during the viral incubation period, even if they are asymptomatic, and they become more contagious when symptoms start to appear.

The situation is getting worse every year, causing countless MDROs outbreaks worldwide, and tens of thousands of victims. It is estimated that by the year 2050, more people will die because of MDRO infections than because of cancer. MDROs infections also have an « economic burden » in healthcare institutions, due to expensive treatments that sometimes do not work, longer hospital stays, etc. 

There is now evidence that several pathogenous microorganisms such as Clostridioides Difficile and Vancomycin-resistant Enterococcus (VRE) can persist on contaminated surfaces for several months, therefore, they can be spread by patients or healthcare workers to other surfaces or directly to other patients, potentially causing cross infections or at a higher scale, outbreaks.

Similarly to hand hygiene, environmental hygiene is a real challenge, which can be overcome by playing on different elements: the choice of the right surface disinfection product, understanding better the human factor, and how to facilitate the implementation of such changes.