Guideline in historical perspective - Orientation on the Infection Prevention guideline in oral care practices
Guideline in historical perspective
It had long been known that all kinds of diseases could be transferred from patient to patient in healthcare. Cleaning, disinfecting and sterilizing instruments had been in use for a long time. Since 1861, the role of antiseptic working and the use of antiseptics has gained increasing emphasis. Clean clothing became a fixed component of good hygiene in healthcare, but the contribution of good hand hygiene was only really seriously addressed much later. Only when the HIV infections were diagnosed for the first time in 1983 did the medical (dental) world wake up and the use of disposable examination gloves became more general. Use of this had been the advice much earlier, because of the high risk of contamination of the much longer known HBV. For various reasons, however, the medical world did not respond to this (cost? Inconvenience? Lack of time?) And besides hand washing with soap and water, other hand hygiene was not yet included as routine in general medical practice. This was undiminished for the dental practices. Only since 1985 are gloves increasingly worn in dentistry, and the awareness of the seriousness and value of good infection prevention is slowly coming through.
In the eighties of the last century the patients (!) Gradually became accustomed to being approached with gloves and mouth-nose masks. At first, the distrust among patients aroused and reproaches such as: "Where did these protection measures come from? I do not have AIDS! "
In order to clarify the practice hygiene in oral care, the guideline on dental hygiene practice was written in 1995 by the Working Group on Infection Prevention, or WIP for short. This working group, founded on 3 November 1980, aims to draw up national guidelines for infection prevention in health care. Updating the existing guidelines is also part of the WIP's task.
These WIP guidelines are taken very seriously in all healthcare institutions. In principle, the WIP guidelines are generally accepted (authorized) by all professionals and organizations involved in health care and therefore have (!) The status of professional standards in the areas described, ranging from hospital hygiene to the use of personal protective equipment. Based on this status, the WIP guidelines can be used by the Healthcare Inspectorate (IGZ) to test care providers at the hygiene level (and indirectly patient safety).
Progressive insights, adapted legislation and regulations and stricter requirements for patient safety prompted a revised guideline for dental care, which became known as Infection Prevention in Dental Practice (WIP 2007). As an important point, the cleaning and thermal disinfection was preferably propagated with the aid of a thermodisinfector. This not only served patient safety, but also provided a safe workplace for employees. It was also described that extraction pliers no longer had to be sterilized for use in normal extractions. This met with a lot of resistance and disbelief, so that in many cases these instruments have always been sterilized (packaged). The same was true for the curettes and scalers: they did not believe in the effectiveness of 'only' thermal disinfection. According to the WIP plan, this guideline would be revised after five years. Due to lack of time of the members of the WIP committee, a long time was not made to actually proceed with a review. Ultimately, the largest professional association of dentists, the Royal Dutch Society for the Promotion of Dentistry (KNMT), took the initiative in 2012 to implement a revision. Due to a large number of difficulties, varying from unrest in the staffing of the appointed working group to substantively diverging views of the mandated committee members, it took until April 2016 before the new directive could be put into use by the profession. This third version of the guideline on infection prevention in oral care was given the title: guideline Infection prevention in oral care practices (KNMT 2016).
In dentistry, the subject of infection prevention has become closely linked over time to the Infection Prevention Working Group. It is therefore frequently spoken about 'the WIP' in an appropriate way. Because of this stubborn commitment, the KNMT guideline Infection Prevention in oral care practices will most likely continue to be long-term and unjustified as a 'WIP guideline'.
From the moment of publication, this KNMT guideline had to be regarded as the 'gold standard' for all employees in oral care who are directly or indirectly involved in clinical activities.
The Healthcare Inspectorate stipulated that the new guideline would only be enforced from 1 January 2017 to allow oral healthcare practices to follow all measures and, where necessary, to adapt protocols, materials or equipment to the KNMT guideline. . From January 2017, therefore, the practices are expected to be in order with regard to infection prevention and the inspectors (through unannounced visits) are strictly enforced.
The Working Group on Infection Prevention (WIP) was part of an independent foundation and has played a pioneering role in many areas, both at European level and at global level. Unfortunately, due to insufficient cost coverage on 17 May 2017, the work of this special working group was ended.