Hepatitis cases highlight infection control for temporary dental clinics

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Image by Neon Tommy via flickr
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It is likely that three patients and two volunteers contracted hepatitis B at a large free dental clinic held in 2009 in Berkeley County, W.V., according to investigators.

Investigators documented problems with infection control at the large Mission of Mercy clinic, held at a school gymnasium. But they were unable to definitively link those breaches with the five infections, or to determine exactly how the patients and volunteers were infected. They have shared their conclusions in the October issue of the Journal of the American Dental Association.

The news of the cluster of hepatitis B infections among attendees at the West Virginia clinic attracted wide attention in 2010, after health officials sent out letters notifying hundreds of clinic patients and volunteers that they might have been exposed. The highly infectious hepatitis B virus can lead to serious liver damage.

Veronica Nett of the West Virginia Gazette reported on the case as it unfolded.

“The Berkeley County Health Department has sent out notification letters to 1,137 patients and 826 volunteers who worked at or received care from the Mission of Mercy Dental Clinic in Hedgesville on June 26 and 27, 2009,” she wrote. “The state Bureau for Public Health was notified in November that three patients and two volunteers at the clinic had developed acute hepatitis B, said Dr. Dee Bixler, director of the state Infectious Disease Epidemiology program.”

At the time, health officials said they suspected the five had been infected at the clinic. But their efforts to pin down exactly how and why the infections occurred ultimately failed, the team of investigators, which included Bixler, wrote in their JADA report.

Their investigation revealed “numerous infection control breaches,” they said.

“We identified opportunities for potential exposure of patients to HBV (hepatitis B) and other blood-borne pathogens such as reusing unsterilized handpieces, leaving sterilized instruments unwrapped and allowing patients to transport their own partially used anesthetic carpules.”

But they added, “specific breaches in infection control could not be linked to these (hepatitis B) transmissions.”

They wrote that their retrospective investigation of the temporary clinic was “subject to severe limitations” due to the fact that much of the information about infection control procedures was gleaned in interviews with supervisors conducted months after the two-day clinic was held.

They were also limited by a lack of specific information contained in treatment records kept at the clinic and the inability to obtain a biological specimen from one of the patients.

They noted that no one had been designated to oversee infection control practices at the clinic and recommended that every such clinic designate an infection control coordinator to “plan and oversee infection control and volunteer safety during clinic operation.”

“Temporary dental clinics can and do provide needed dental care to many patients,” they concluded. “However, because of the types of settings and volume of patients treated, consistently maintaining recommended infection control practices in these clinics can be challenging.”

When reached by telephone, Richard Stevens, executive director of the West Virginia Dental Association said he had not yet seen the JADA article. But he noted that the 2009 Berkeley County clinic was the last Mission of Mercy clinic to be held in the state, due to the health concerns and lawsuits that resulted.

“We haven’t had a project since,” Stevens said.

Transmissions of hepatitis B in dental settings have been extremely rare since the 1980s when universal precautions for the handling of potentially infectious materials were adopted and the hepatitis B vaccination of dental workers became routine.

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