Abstract
Effective sterilization of reusable instruments contaminated by Creutzfeldt–Jakob disease in dental care is a crucial issue for public health. The present cross-sectional study investigated how the recommended procedures for sterilization were implemented by French dental practices in real-world settings. A sample of dental practices was selected in the French Rhône-Alpes region. Data were collected by a self-questionnaire in 2016. Sterilization procedures (n = 33) were classified into 4 groups: (1) Pre-sterilization cleaning of reusable instruments; (2) Biological verification of sterilization cycles—Monitoring steam sterilization procedures; (3) Autoclave performance and practitioner knowledge of autoclave use; (4) Monitoring and documentation of sterilization procedures—Tracking and tracing the instrumentation. Answers were provided per procedure, along with the global implementation of procedures within a group (over 80% correctly performed). Then it was verified how adherence to procedure groups varied with the size of the dental practice and the proportion of dental assistants within the team. Among the 179 questionnaires available for the analyses, adherence to the recommended procedures of sterilization noticeably varied between practices, from 20.7% to 82.6%. The median percentages of procedures correctly implemented per practice were 58.1%, 50.9%, 69.2% and 58.2%, in Groups 1, 2, 3 and 4, respectively (corresponding percentages for performing over 80% of the procedures in the group: 23.4%, 6.6%, 46.6% and 38.6%). Dental practices ≥ 3 dental units performed significantly better (>80%) procedures of Groups 2 and 4 (p = 0.01 and p = 0.002, respectively), while no other significant associations emerged. As a rule, practices complied poorly with the recommended procedures, despite partially improved results in bigger practices. Specific training regarding sterilization procedures and a better understanding of the reasons leading to their non-compliance are needed.
Highlights
In addition to traditional infectious diseases from the human immunodeficiency virus (HIV), and from Gram-negative bacteria and Gram-positive bacteria, fungi, mycobacteria, tuberculosis and hepatitis B and C, preventing the risk of Creutzfeldt-Jakob disease (CJD) transmission is critical
Prions of CJD can be transmitted by various sources, including bovine spongiform encephalopathy, or iatrogenic routes such as growth hormones [4] or blood transfusions [5], or even dental care [6]
The Rhône-Alpes region comprises 6.3 million inhabitants—9.8% of the total French population—with 67% residing in urban areas. 3765 general dental practitioners (GDP) work in private practice, with very few working as employees (2%)
Summary
In addition to traditional infectious diseases from the human immunodeficiency virus (HIV), and from Gram-negative bacteria and Gram-positive bacteria, fungi, mycobacteria, tuberculosis and hepatitis B and C, preventing the risk of Creutzfeldt-Jakob disease (CJD) transmission is critical. The WHO regards human dental pulp as a “low-infectivity tissue” for prion diseases, given the presence of peripheral nerves [10], and the proximity of the nerves that make up the human dental pulp, with the central nervous system being a high-infectivity tissue [11,12]. These organisms can be transmitted in dental settings through direct contact with blood, oral fluids, or other patient materials, and indirect contact with contaminated objects (e.g., instruments, equipment, or environmental surfaces) [3]. Even if the risk is considered to be low, it is essential to observe good cleaning and sterilization practices as a means of preventing the iatrogenic transmission of prion proteins [13,14]
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