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      Italian multicenter study on infection hazards during dental practice: Control of environmental microbial contamination in public dental surgeries

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          Abstract

          Background

          The present study assessed microbial contamination in Italian dental surgeries.

          Methods

          An evaluation of water, air and surface microbial contamination in 102 dental units was carried out in eight Italian cities.

          Results

          The findings showed water microbial contamination in all the dental surgeries; the proportion of water samples with microbial levels above those recommended decreased during working. With regard to Legionella spp., the proportion of positive samples was 33.3%. During work activity, the index of microbial air contamination (IMA) increased. The level of microbial accumulation on examined surfaces did not change over time.

          Conclusion

          These findings confirm that some Italian dental surgeries show high biocontamination, as in other European Countries, which highlights the risk of occupational exposure and the need to apply effective measures to reduce microbial loads.

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          Most cited references33

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          The index of microbial air contamination.

          The standard index of microbial air contamination (IMA) for the measurement of microbial air contamination in environments at risk is described. The method quantifies the microbial flow directly related to the contamination of surfaces coming from microbes that reach critical points by falling on to them. The index of microbial air contamination is based on the count of the microbial fallout on to Petri dishes left open to the air according to the 1/1/1 scheme (for 1h, 1m from the floor, at least 1m away from walls or any obstacle). Classes of contamination and maximum acceptable levels have been established. The index of microbial air contamination has been tested in many different places: in hospitals, in food industries, in art galleries, aboard the MIR space station and also in the open air. It has proved to be a reliable and useful tool for monitoring the microbial surface contamination settling from the air in any environment. Copyright 2000 The Hospital Infection Society.
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            The dental unit waterline controversy: defusing the myths, defining the solutions.

            This article reviews the literature on the subject of dental unit waterline contamination. It has been expanded from the text of a lecture given at the Scientific Frontiers in Dentistry program sponsored by the National Institute for Dental and Craniofacial Research in Bethesda, Md., in July 1999. The author examines the underlying biological causes of waterline colonization by microorganisms, the evidence of potential health consequences and possible means of improving the quality of dental water. He also describes examples of devices currently marketed to improve and maintain the quality of dental treatment water. Microorganisms colonize dental units and contaminate dental treatment water. While documented instances of related illness are few, water that does not meet potable-water standards is inappropriate for use in dentistry. Exposure to water containing high numbers of bacteria violates basic principles of clinical infection control. Dentists should consider available options for improving the quality of water used in dental treatment.
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              Do contaminated dental unit waterlines pose a risk of infection?

              To review the evidence that the dental unit waterlines are a source of occupational and healthcare acquired infection in the dental surgery. Transmission of infection from contaminated dental unit waterlines (DUWL) is by aerosol droplet inhalation or rarely imbibing or wound contamination in susceptible individuals. Most of the organisms isolated from DUWL are of low pathogenicity. However, data from a small number of studies described infection or colonisation in susceptible hosts with Legionella spp., Pseudomonas spp. and environmental mycobacteria isolated from DUWL. The reported prevalence of legionellae in DUWL varies widely from 0 to 68%. The risk from prolonged occupational exposure to legionellae has been evaluated. Earlier studies measuring surrogate evidence of exposure to legionellae in dental personnel found a significant increase in legionella antibody levels but in recent multicentre studies undertaken in primary dental care legionellae were isolated at very low rate and the corresponding serological titres were not above background levels. Whereas, a case of fatal Legionellosis in a dental surgeon concluded that the DUWL was the likely source of the infection. The dominant species isolated from dental unit waterlines (DUWL) are Gram-negative bacteria, which are a potent source of cell wall endotoxin. A consequence of indoor endotoxin exposure is the triggering or exacerbation of asthma. Data from a single large practice-based cross-sectional study reported a temporal association between occupational exposure to contaminated DUWL with aerobic counts of >200cfu/mL at 37 degrees C and development of asthma in the sub-group of dentists in whom asthma arose following the commencement of dental training. Medline 1966 to February 2007 was used to identify studies for this paper. Design criteria included randomised control trials, cohort, and observational studies in English. Although the number of published cases of infection or respiratory symptoms resulting from exposure to water from contaminated DUWL is limited, there is a medico-legal requirement to comply with potable water standards and to conform to public perceptions on water safety.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BioMed Central
                1471-2458
                2008
                29 May 2008
                : 8
                : 187
                Affiliations
                [1 ]Istituto di Igiene e Medicina Preventiva, Università degli Studi di Sassari, Via P. Manzella 4, 07100 Sassari, Italy
                [2 ]Cattedra di Igiene ed Epidemiologia, Università degli Studi di Napoli "Parthenope", Via F. Acton, 38 – 80133 Napoli, Italy
                [3 ]Dip. di Scienze Biomediche ed Oncologia Umana – Sez. Igiene, Università degli Studi di Bari, Piazza G. Cesare 11, 70124 Bari, Italy
                [4 ]Dip di Sanità Pubblica, Università degli Studi di Parma, Via Volturno 39, 43100 Parma, Italy
                [5 ]Dip. di Scienze di Sanità Pubblica, Università di Modena e Reggio Emilia, Via Campi 287 – 41100 Modena, Italy
                [6 ]Dip. Di Medicina Interna e Sanità Pubblica – Cattedra di Igiene, Università degli Studi di L'Aquila, Via Vetoio 67010 Coppito di L'Aquila, L'Aquila, Italy
                [7 ]Dip. di Specialità Medico Chirurgiche e Sanita' Pubblica, Università degli Studi di Perugia, via Del Giochetto, 06100 Perugia, Italy
                [8 ]Dip. Scienze di Sanità Pubblica "G. Sanarelli", Università di Roma "La sapienza", Piazzale Aldo Moro 5, 00185 Roma, Italy
                Article
                1471-2458-8-187
                10.1186/1471-2458-8-187
                2430203
                18644099
                ba7f3bcc-340e-4bae-83ec-34cfb7656781
                Copyright © 2008 Castiglia et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 July 2007
                : 29 May 2008
                Categories
                Research Article

                Public health
                Public health

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