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BACKGROUND: Application of and compliance with infection prevention recommendations is crucial in all healthcare settings, including oral health. Reports of infection control breaches in the oral healthcare setting are increasing nationally, as demonstrated in recently published CDC and Safe Injection Practices Coalition blog postings as well as unpublished data. In April 2014, the New Hampshire (NH) Department of Health and Human Services Division of Public Health Services (DPHS) investigated an orthodontic practice in response to infection control concerns found during an unannounced inspection by the State of NH Board of Dental Examiners (BDE) and the NH Office of the Attorney General (AG). As a result of this investigation, the NH Healthcare-Associated Infections (HAI) Program initiated a quality improvement project focused on infection prevention in oral healthcare settings by engaging pertinent stakeholders and oral healthcare personnel (OHCP).
METHODS: In collaboration with the BDE and AG, DPHS conducted a comprehensive investigation of the orthodontic practice, including review of BDE records, site visits, and patient notification to assess whether the infection control concerns posed risk to patients. As part of the subsequent quality improvement project, NH professional societies distributed a survey to 2,387 OHCP to assess the educational needs and interests regarding infection prevention in the oral healthcare setting.
RESULTS: Findings of the investigation led to public notification and recommendations for patients to consult with their primary care physician regarding bloodborne pathogen testing. No associated infections were identified. The orthodontist’s license was temporarily suspended and later reinstated after all infection prevention deficiencies were corrected. As of January 5, 2015, 226 (9.5%) OHCP responded to the survey and 211 (93.4%) indicated interest in future educational opportunities, with particular interest in learning about guidelines, resources, outbreaks, and repercussions.
CONCLUSIONS: The knowledge gaps revealed by this investigation prompted a statewide effort to provide infection prevention education to NH OHCP. As noted in the investigation findings, regulatory oversight of most oral health care practices is less rigorous than that of acute-care facilities, and may influence the way infection prevention is approached in this setting. OHCP must understand all relevant infection prevention recommendations, as well as the potential consequences if these recommendations are not implemented appropriately. DPHS is encouraged that NH OHCP are motivated to acquire more knowledge and improve patient safety. DPHS plans to continue its quality improvement efforts by coordinating training opportunities and distributing educational materials with the goal of protecting dental patients from healthcare-associated infections.