Key Points
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Demonstrates that the hepatitis C virus was not transmitted from a dental healthcare worker to patients despite suboptimal infection control practice.
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Provides evidence which contributes to the debate on the need to restrict the practice of health professionals infected with blood-borne viruses.
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Suggests that patient notification or 'look back' exercises may be unnecessary in similar situations.
Abstract
Objectives To investigate the association between treatment by a dental healthcare worker (HCW) and patient infection with a blood-borne virus (BBV).
Design Nested case control study.
Setting A patient notification exercise (PNE) arising from a hepatitis C virus positive HCW that was undertaken because of deficiencies in infection control practice.
Methods Cases were individuals with a BBV infection identified as a result of the PNE. Controls were randomly selected individuals with negative tests for BBVs. Detailed information on dental treatment was obtained from patient notes. Information on risk factors for BBV infection was obtained using a structured questionnaire administered by telephone interview.
Results Thirty patients had evidence of infection with a BBV. The mean number of visits for treatment was 20.5 in cases and 18.6 in controls; the difference 1.8 (95% CI -5.4 to 9.1) was not statistically significant (p = 0.62). Transmission of hepatitis C in the dental setting was excluded by sequencing of the viral genome or establishing alternative risk factors.
Conclusion There was no evidence of transmission of hepatitis C virus from the HCW to patients, or transmission of a BBV from patient to patient. To ensure consistent practice within the UK the National Institute for Health and Clinical Excellence should produce guidance on PNEs for the NHS.
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Acknowledgements
We would like to thank: staff at the NPHS laboratories in Cardiff and Bangor, and the Centre for Infection London, who processed samples; staff from Gwynedd Local Health Board who administered the PNE and located records for the case control study; and members of the North Wales Health Protection Team who interviewed patients.
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Mason, B., Cartwright, J., Sandham, S. et al. A patient notification exercise following infection control failures in a dental surgery. Br Dent J 205, E8 (2008). https://doi.org/10.1038/sj.bdj.2008.656
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DOI: https://doi.org/10.1038/sj.bdj.2008.656
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