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The Ethics of Infection Control

Dr. Tonya A. Parris-Wilkins and Joseph D. Wilkins, DPT, MSHA

At least once every year, the news media reports on an infection control case that is a perfect storm infused with one of the following elements: a provider willfully unfamiliar with infection control, a systemic sterilization failure absent of checks and balances, and/or a staff whose complacency supersedes morality. While the above statement may sound harsh, imagine the devastation experienced by patients when they are informed that the provider, practice or hospital system that they trusted may have exposed them to a potentially deadly disease.

This year’s hallmark case chronicled Dr. Wayne Harrington, an oral surgeon with 35 years of experience and the operator of two practices in the state of Oklahoma. The State Dental Board of Oklahoma launched an investigation against Dr. Harrington after a patient tested positive for HIV and Hepatitis C with no known risk factors except receiving recent dental surgery.  During an unannounced visit to the doctor’s practice, the board discovered several violations including but not limited to poor sterilization technique. The Oklahoma Department of Public Health recommended that approximately 6,000 patients be tested for infectious diseases due to the deplorable sterilization technique discovered in Dr. Harrington’s office. In addition, the department labeled him as a “menace to public health”. Dr. Harrington voluntarily relinquished his license to practice dentistry in the state of Oklahoma. In addition, several criminal charges against him are pending. 1,2

Other cases which received national attention include:

·       March 2011- 535 veterans who received care between January 2002 and July 2010  at the Dayton, Ohio Veterans Administration Medical Center’s dental clinic were notified that they needed to be screened for infectious disease due to poor infection control and sterilization techniques.  The staff approached hospital administration and complained that a provider was not changing gloves in between patients and instruments were not properly sterilized.  It was reported that staff were aware of the issues with infection control for years.  Upon testing, it was revealed that seven patients were positive for Hepatitis C and two tested positive for Hepatitis B. Out of these nine patients with positive test results, none of them tested positive prior to receiving treatment at the Dayton Veterans Administration’s dental facility. As a result of poor infection control practices, the clinic was closed from August-September 2013.  Four employees were transferred from the clinic and the dentist in question voluntarily retired. 3

·       July 2012- More than 1800 dental patients at the St. Louis Veterans Administration Medical Center received notification that they may have been exposed to HIV and/or hepatitis due to improper sterilization techniques. 4

·       Duke University Hospital System in 2005 - In this particular incident, hydraulic fluid was mistakenly used to sterilize instruments used in the operating room during surgeries. In November and December of 2004, roughly 3,800 patients were operated on using instruments sterilized with this fluid. After staff complained that the instruments were “slick” an investigation was launched. It was determined that hydraulic fluid drained from elevator repairs at Durham Regional Hospital and Duke University Medical Center were placed in sterilization fluid bottles. These bottles were improperly tagged and returned to the hospitals which were in turn used on patients. In 2008, the university hospital system reached a $26 million settlement with 127 patients who suffered damages as a result of this systemic sterilization failure. 5,6

Why is Infection Control an Ethical Issue?

When the aforementioned Dr. Harrington was questioned about the infection control procedures used by his office, his response was, “[my staff] takes care of that”. I don’t”. However the issue of infection control is ethical and one of personal accountability.  As members of the healthcare community, we are responsible for the patients we treat; this includes ensuring they are not exposed to potentially debilitating and/or deadly diseases via improperly sterilized instruments. Nonmaleficence or “do no harm”, one of the tenets of medical ethics, also applies to the instruments we use in everyday practice. 7

The sheer dismissal of infection control as something that our staff “handles” is inappropriate and has grave consequences on the patients we serve, our practices and the profession as a whole.  Dentists are accountable for all aspects of care rendered to their patients. This charge undoubtedly extends into the area of infection control. The responsibility of knowing proper infection control practices and directing our personnel to meet the standard is ours.  These standards must be met to ensure the safety of our patients and to sustain the respectability and longevity of our profession.

Resources for your practice:

1.     Guidelines for Infection Control in Dental Healthcare Settings. MMWR. December 19, 2003. 52 (RR17); 1-61.   http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm.

2.     The ADA Practical Guide to Effective Infection Control. Available for purchase at www.ada.org.

3.     Virginia Department of Health. OSHA Checklist #2/ Dental Practices.

http://www.vahealth.org/dental/manual/documents/2008/pdfs/QaForms/QAOSHACheckList.pdf



1 Associated Press. Dentist HIV scare: Inside the Oklahoma dentist’s office where dirty instruments, unsanitary practices may have exposed thousands to hepatitis and HIV. NY Daily News. March 29, 2013.

http://www.nydailynews.com/life-style/health/oklahoma-dentist-hiv-scare-article-1.1302360

[2] Mariano Castillo. Dentist’s office a ‘perfect storm’ for HIV, hepatitis exposure, health official says. CNN Health. March 29, 2013. http://www.cnn.com/2013/03/29/health/oklahoma-dental-warning/

[3] Ben Sutherly. At least 9 Dayton VA dental patients test positive for hepatitis. Dayton Daily News. March 3, 2011. http://www.daytondailynews.com/news/news/local/at-least-9-dayton-va-dental-patients-test-positive/nMpfc/

[4] David W. Freeman. 1,800 Vets May Have Been Exposed to HIV, Hepatitis: What Went Wrong? CBS News. June 30, 2010. http://www.cbsnews.com/news/1800-vets-may-have-been-exposed-to-hiv-hepatitis-what-went-wrong/

[5] Matthew Burns. Court rules insurer off hook in Duke tainted instruments case. WRAL.com. February 11, 2013. http://www.wral.com/court-rules-insurer-off-hook-in-duke-tainted-instruments-case/12093025/

[6] Associated Press. Surgical tools washed in hydraulic fluid. NBCNews.com. June 13, 2005. http://www.nbcnews.com/id/8197203/#.UpuUTfGA34g

[7] American Dental Association. Principles, Code of Professional Conduct and Advisory Opinions. Section 2. http://www.ada.org/1379.aspx

Virginia Dental Journal, Volume 91, Number 1 - January-March 2014