Battle of the bugs

By Maria Perno Goldie, RDH, MS

With increased visits to the dental office, as well as more international travel and a growing need for access to care, there is a real risk of disease transmission from patient to care provider, from care provider to patient and from patient to patient. Recent reports of actual and potential cross contamination in dental healthcare settings suggest that the risk of disease transmission is universal.(1) There is no region of the world that could not benefit from improvements in infection prevention and safety education, research, or policy development.The Center for Disease Control (CDC) recommends practicing good hand hygiene by washing with soap and water or using an alcohol-based hand sanitizer.(2) The Hand Hygiene Guidelines were developed in 2002 by the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC), in collaboration with the Society for Healthcare Epidemiology of America (SHEA), the Association of Professionals in Infection Control and Epidemiology (APIC) and the Infectious Disease Society of America (IDSA).(3) The hand hygiene guidelines are part of an overall CDC strategy to reduce infections in health care and other settings to promote patient safety.(4) The guidelines outline handwashing, the use of gloves, alcohol-based handrub, finger nail care, efficacy of antiseptic agents, systems for measuring improvements in adherence to these hand hygiene recommendations, and contact dermatitis.To maintain a clean environment, they also recommend establishing cleaning procedures incorporating the use of EPA approved surface disinfectants for frequently touched surfaces that come into direct contact with people’s skin.(5)

Can you imagine a world without antimicrobials? We would be defenseless against infections, and common problems like food poisoning would kill us. This state of affairs seems inconceivable, but the World Health Organization (WHO) thinks it is a possibility if action is not taken at this time. This message was clear and distinctly heard in the WHO director-general’s statement on World Health Day last year, which was dedicated to creating global awareness of the need to combat antimicrobial resistance (AMR). (World Health Day 2011, Director-General Statement.(6)

In essence, the microbes are getting smarter at evading the drugs we use against them, and researchers and companies are not making new drugs quickly enough to outpace the microbes. When the first antibiotics were introduced in the 1940s, they were hailed as "wonder drugs," the miracles of modern medicine. It was a phenomenon, but the world may be on the brink of losing these miracle cures.

“The emergence and spread of drug-resistant pathogens has accelerated. More and more essential medicines are failing. The therapeutic arsenal is shrinking. The speed in which these drugs are being lost far outpaces the development of replacement drugs. In fact, the R&D pipeline for new antimicrobials has practically run dry.”(6) Why is this? The bugs have become smarter than us! The WHO has been concerned about Antimicrobial Resistance (AMR) since year 2000, when it released a report on infectious diseases series--Overcoming Antimicrobial Resistance.(7) However, it was October 2011 when AMR once again made global headlines, as a new type of “superbug” had been detected. Malaysian researchers at the Institute of Medical Research (IMR) first found bacteria that can produce the New Delhi metallo-beta-lactamase-1 (NDM-1) enzymes.

These bacteria are informally called “superbugs” because they have developed the ability to inactivate a group of powerful antibiotics called carbapanems with the NDM-1 enzymes they produce. They are “super” because many of our antibiotics cannot kill them. Bacteria are not the only types of microorganisms that can develop resistance against the drugs we have to kill them. Other harmful microbes, like parasites, fungi, and viruses, can also develop mechanisms to survive. While often found in hospitals and long term care facilities, they are also found in drinking water, such as in India.

This highlights some of the major issues with antimicrobial resistance, that is, infection prevention and the way waste is disposed. According to a 2009 report titled Bad Bugs, No Drugs: No ESKAPE! published by the Infectious Diseases Society of America (IDSA), in between 2003 and 2008, there were only six antibacterials (antibiotics that kill bacteria) that were approved to be used in the United States.(8) Only two large pharmaceutical companies, GlaxoSmithKline and Astra Zeneca, have strong and active antibiotic R&D programs.

Hepatitis B
Until new drugs are developed, there are measures we can take to reduce and slow down the resistance of bacteria to our antibiotics. One of the many is that we can actively prevent and control infections in health services and beyond. You and I, as health care professionals, can make a difference. Vaccines, practicing proper hand hygiene, adhering to hospital, state, and national antibiotic guidelines, and practicing proper infection control in the office are all things that we can do to help combat this problem. We await further improvements in infection prevention and safety education, research, or policy development.