3 pillars of infection control

Richard Downs PHOTO CREDIT: Contributed

The CDC, WHO and other infection control agencies, health care professionals, regulatory boards and government leaders have given us valuable information on slowing and stopping the spread of infectious diseases, including COVID-19.

They include the often repeated standards of social distancing, frequent hand washing and wearing a face mask. They have, at times, closed nonessential businesses, schools and public recreation areas to control the spread of virus.

These measures were hygiene standards long before the pandemic but seldom were considered as important as they are today. This heightened awareness and re-education of the public could pay dividends long into the future for improving general hygiene for the seasonal flu and many other diseases.

For far too long we have been lazy, relying on our expectation that these measures could be somewhat ignored because we have such wonderful medical treatment to overcome those diseases. We relied on pills, vaccinations and advanced medical treatment instead. This pandemic has been a wake-up call for many because there is no present vaccine, pill or medical care to routinely control COVID-19.

There are, of course, other impacts of the pandemic that can be equally important. Economies cannot shut down long term. These shutdowns also can have health impacts. Less than half the usual diagnosis of cancers are taking place and likely will have life and death long-term effects.

Studies have found that more than 14,000 children per year are reported by schools for child abuse. Children staying home will have fewer discoveries of home child abuse and some will suffer from malnutrition due to the suspension of these positive impacts our public schools have in these two areas of health — not to mention the other areas of child care health they impact.

Parents will not be able to work if they do not have children in school. Homelessness and inability to purchase needed medicines can become dangerous.

The pandemic has had another positive effect and that is that there is a furious effort to find ways to mitigate it and cure it. There are many countries working on a vaccine with different approaches. Medical care for those who are sick has improved, and medicines to combat the virus are advancing rapidly.

Old medicines that were little used or not used are finding off-label ways to be used against the virus. Hygiene products are being increased and improved. Equipment and ventilation systems are being revamped. Businesses, schools and health care facilities are becoming safer.

As a dentist, I have access to new infection control equipment and products that did not exist before the pandemic. I will touch on some of the information I have gained during this pandemic and offer them as possible solutions to other businesses and public places.

I have a unique position as a health care worker because I am a founder of a health care products company that makes products to combat microbes that cause disease. I also am a stockholder and on the board of another company that was positioned to address infection control in its product line. Both have had the blessing to be in higher demand during this pandemic rather than be hurt by this economy. I have researched other companies that I do not have any ownership in that also have what I consider the best solution to the three pillars of infection control.

Those pillars are: Personal infection control, surface decontamination and air infection control.

As dentists, we realized that treatment of the oral cavity was of particular concern. Patients cannot wear a mask while you treat them. In addition, when a dental handpiece is turned on, it generates an aerosol of water and saliva with some tooth microfragments into the room air.

These aerosols likely will carry bacteria, viruses and fungi into the room and onto the dentist and staff, as well as the surfaces in the room. How are we going to mitigate that?

Some of the answers are high-speed vacuums to remove the aerosol before it leaves the mouth; face shields, eye protection and efficient masks; pre-rinsing with a virus killer mouth rinse before any treatment; standard COVID-19 screening questions and temperature taking; having patients not sit in the waiting room; strict surface decontamination procedures and waterline ultrafiltration systems.

There are other measures but these are the main ones being addressed in our office and three of them will be addressed for this column.

So far, there is no documented case I know of where a patient has become infected with SARS coV 2 in a dental office. Let’s hope that continues. I will present other pillars in follow-up columns.

Personal Infection control Pillar No. 1

Hand washing, showering, mask wear, clothing washing, social distancing: We are all constantly reminded of these hygiene measures. But what about oral health hygiene?

If the virus is spread via speaking, coughing and sneezing, why would this not be something we address? In dental care, I consider it the very first and most important aerosol mitigation step.

No patient will be examined or treated in our office without first pre-rinsing with an antiviral mouthrinse. The old standard of care using chlorhexidine prescription rinse for pre-rinsing has been shown to be ineffective against viruses.

The CDC has recommended pre-rinsing with peroxide or iodine. These do work but have some toxicity drawbacks. What is important to note is that no pre-rinsing product has been tested against SARS Cov 2.

We do believe iodine and peroxide are effective and that oxidizing agents, in general, do kill the SARS Cov 2 virus. My company, Dentist Select, had its oxidizing chlorine dioxide/chlorous acid mouthrinse, Oracare, tested at Microchem Laboratory in Texas on coronavirus 229e, which is the SARS Cov 2 surrogate virus many products are being tested against for efficacy against a virus of similar structure to SARS Cov 2. The results with Oracare were outstanding. All viruses were killed at even one minute of exposure time in this test. They at the same time tested this rinse for toxicity on lung fibroblast cells and found zero toxicity.

What is equally important is that since we know Oracare kills coronavirus 229e, we recommend patients take it home to use every day to clean their mouth and throat. We have them not only rinse the mouth but the back of the throat. We have no studies to show that it will kill the SARS Cov 2 viruses in the throat but I believe it will.

An ENT physician in California is testing an iodine solution rinse called Betadine mixed in salt water in the nose to kill SARS Cov 2. He is not using it in the mouth. I believe both the mouth and the nose rinsing is a better approach.

Testing is taking place on his iodine solution for nasal rinsing. This physician believes strongly that rinsing the nose has the potential to prevent infection of COVID-19 if used daily as a preventive procedure. I have contacted their testers to see if Oracare can do the same. I have used Oracare in the nose as a rinse but our company is not at this time advocating it for that use.

Another product called Aeronabs, an antibody like protein made in the lab, is being tested for nasal rinsing and shows promise. Results for testing are not out yet.

In the next issue I will talk about Pillar No. 2, surface infection control.