DT News - Latin America - Dentists should be aware of swine flu, says top Mexican infection control expert

Javier Martínez de Pisón, DT Latin America

jue. 30 abril 2009

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MEXICO CITY, Mexico: The head of infection control at the School of Dentistry of the National University of Mexico (UNAM), Dr Enrique Acosta-Gio, said in an interview with Dental Tribune Latin America that the outbreak of the swine flu pandemic came as a total surprise. “You talk to dentists about global health risks, about a biological event of worldwide significance and they look at you and wonder, ‘how does this relate to me?’ People thought that this sounded like a doomsday scenario. Even I was not prepared for an outbreak originating in Mexico,” said Dr Acosta-Gio, who has been head of dental infection control at UNAM since 1992.

UNAM, one of the largest universities in the world with a campus twice the size of New York’s Central Park, has research facilities and highly trained human resources who have studied influenza in animals and humans, and its president is a permanent advisor to Mexico’s Health Secretary. Mexico’s Health Department has shut down the campus as well as schools from kindergarten to the university level until reliable data on the evolution of the pandemic is available.

It came as a surprise
The top expert added that the potential scenario of a pandemic case study involved a virus originating in Asia or other distant country, which eventually would reach Mexico. Dr Acosta-Gio emphasized that this outbreak should make dentists aware of infection procedures to protect themselves and their patients.

“Back in 2006 Dr José Naro, now president of the National University of Mexico, was the Dean of the Medical School, and called for a meeting on pandemic preparedness. We talked different scenarios –first that it would come from South East Asia and that we would be reacting to something outside of Mexico,” explained Acosta-Gio. “We were considering what the University would do in case of an outbreak. We believed the University would stay open and respond as the outbreak evolved. Now, it shows up first in Mexico, and the authorities closed the University. It has taken us one week to understand and re-accommodate all the university components. Dr Naro has formed committees; I am a member of the science and technology committee providing and structuring the institutional response to this outbreak.”

Since the outbreak, the Deans of Health Sciences and the university’s president meet every morning at 8 am. The dental school has a well-structured program in infectious control on UNAM’s web page, which has been linked to all its infection control resources. “We are providing concise information from UNAM, WHO, CDC and OSAP in Spanish and in English so that people who want to find the sources can see where it came from. At this stage I am editing this information into three concise paragraphs of information,” the doctor said.

“People are not really interested in understanding the biological behavior of the virus; they only want to know what to do, explains Acosta-Gio. “We are trying to formulate all the frequently asked questions to a ‘yes, no and information is not available at this time’ so we can respond briefly to the questions and provide some advice on what to do, how to act.”

What is UNAM doing
Thousands of UNAM nursing and medical students are working in the hospitals of Mexico City to fight the outbreak. The University is providing them with information on safe clinical behavior and safe clinical practices.

“These outbreaks have a series of peaks, so we cannot just loosen our control of the situation,” continues Dr Acosta-Gio. “We will have to be in continuous vigilance after the outbreak subsides and the university reopens. We want to make sure that we can interview the patients and provide elective dental treatment for patients with infectious communicable diseases. We won’t be seeing patients that have an active case of flu-like symptoms, a cold, or influenza. And, we want to make sure that patients who had it have shown no symptoms for at least seven days in the past.”

Dr Acosta-Gio said they want to make sure “our students have these procedures well integrated into their practice, and we want to make sure the faculty watch these events. We want to make sure that we can guarantee all the safety we can provide for our patients with sterilization, disinfection and the use of personal protective equipment, and the right kind of personal protective equipment according to the activities.”

Asked about the infection control procedures dentists should follow for this and other outbreaks, Dr Acosta-Gio said “the dental profession should has access to all the correct information on the flu outbreak. We also want to know that they have access to all the right supplies, and we have been training people in infection control. It is a matter of scenarios. The first part is a public health measure, a state of health care emergency where people are advised to avoid crowds, wear a face mask, to wash their hands, and avoid the splash and splatter exposure to other people’s coughing and sneezing.”

“In the dental office you don’t want to have a waiting room full of people. You have to have a good patient flow and a good airflow for ventilation. The infectious control issues are basically the same with this outbreak as with any other, except for elective dental procedures for people with suspicious flu-like disease,” he added.

Basic rules of infection control
The Mexican researcher said that Infection Control has four main principals. The first is to act to be safe, which means that before seeing patients, you have to get your immunization shots. “A seasonal flu shot is recommended for every health care professional, including dentists and their staff, as well as tetanus and Hepatitis B,” he explained. “We don’t want sick dentists and staff handling patients and instruments. Work restrictions should be applied to workers who may have flu-like symptoms.”

“The second principle is to avoid contact with blood and body fluids. This is standard precaution as well as cough and sneeze etiquette. Wash your hands. The third principle of infection control is to keep the instruments safe, which means sterilization and high-level disinfection in a sporicidal solution of the instruments. And the fourth principle has to do with the disinfection of surfaces and the use of protective barriers to avoid the dissemination of the contamination after or during the patient treatment.”

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