#116 Infectious Diseases Update July 2023

The Compliance Divas bring another episode of infectious disease updates that may affect dental patients and teams.   Learn about updates to MRSA guidance, the new RSV vaccine and cases of locally acquired (non-travel related) in the U.S., and more.

Resources:

• CDC Resources on https://www.cdc.gov/mrsa/index.htmlMRSA 
• SHEA Updated guidance on MRSA https://bit.ly/3Ov8grj
• FDA Announcement on RSV Vaccine https://bit.ly/3pXNwz7
• Abrysvo (RSV vaccine) website:  https://bit.ly/44FT2Wc
• CDC HAN on Malaria https://bit.ly/3OsXiT4

                                                 https://www.thecompliancedivas.com

Transcript

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SPEAKER_02 0:05

Welcome. I'm Leslie Cannum. I'm Mary Gavoni. I'm Linda Harvey. I'm Olivia Long, and together we are the Compliance Divas. Welcome to the Compliance Divas Podcast. I'm Mary Gavoni and I'll be your moderator for this episode. The compliance divas bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. You can subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website, thecompliancedeevas.com. All of the resources we mentioned during our podcast can be found on the compliancedeevas.com website. You can submit any questions by email to support at thecompliancedivas.com. One of the key missions of the ComplianceDivas is to keep our listeners up to date on what is happening in infection control as well as the rest of the regulatory world. And it's a critical part of a dental practices infection prevention and control program to stay up to date on what are the current issues regarding infectious disease. Now, not all of the issues are directly connected to your dental practice, but they exist out there in the world. They may affect your patients, and your patients may ask you questions. So today, in this episode, we're going to talk about some of the infectious diseases. We're going beyond COVID, other infectious diseases that have been in the news lately that we need to be concerned about. So we're going to start off with Linda talking about MERSA, which is not new to us, but there's some updates.

SPEAKER_00 1:52

Mary, when we think about MERSA, we've been using that acronym for many, many years now. So what I'd like to do for our listeners is step back just a minute and let's talk about what it is and what it means, and then how we're addressed to address it in our practice. MERSA stands for methicillin resistant staphylococcus oris. And it's the cause of staph infection that is very difficult to treat because it's resistant to some antibiotics. Staph is a type of bacteria and it's found on people's skins. And then again, some of these strains have become resistant to methicillin. So methicillin is a synthetic derivative of penicillin. So it's a type of antibiotic. And when some of these bacteria become resistant to it, it makes it harder to treat when someone gets MRSA. So who gets MRSA? Who's at risk? Well, anyone can actually get MRSA. And I recall back probably at least 10 years ago now, Mary, there was a dental assistant in one of my client offices that had MRSA. And at the time, correct me if I'm wrong, you didn't have to quarantine if you had MRSA, but you had to keep the sores bandaged. So she had one on her forehead. And it was really challenging. So I think we did send her home until she could get it bandaged and keep it feel safe and secure because that was pretty obvious. But when it was on her arm or someplace that could be covered by PPE and stay bandaged, you know, it was fine to come to work. But anyway, the risk of increases within with activities or places that involve crowding. And even though we don't see crowding in a dental plate office, we do have contact and patients may come in with MERSA open source and it can be on the dental chair or wherever they touch. And it does involve skin to skin contact and shared equipment or supplies. So while dental teams are wearing their PPE, so there's not skin to skin contact, patients are touching items and sitting in our chairs. So some of the people who carry MERSA can go on without a MERSA infection, or they can go on to get it. When you think about non-attack skin, that's how it's spread, just like any other infection. You have to have open skin, you have to have that portal of entry. And it can be a cut or abrasion. And then that's the site where the infection will get started. So we think about it, and we've heard it happening in the news stories in the past with gyms and daycares and schools with a lot of close contact and children or people sweating in the gyms and children playing in daycares. So it's very important that we be mindful of MERSA. As a matter of fact, approximately 5% of the patients in U.S. hospitals carry MRSA in their nose or on their skin. And you probably have heard and seen the stories where some of the ambulatory surgery centers and hospitals are swabbing the patient's nails to be sure they don't have MRSA. So that way if they contract it after the fact, they know that they came in with MRSA and it was not a hospital-acquired infection. And that's a big deal when something is a hospital-acquired infection because you don't want to go into the hospital and come out with something you didn't go in with, an additional infection, for example. But what how do you know when you have MRSA? Well, let's talk about that. A couple of the symptoms include the fact that it's a bump or some kind of infected area on the skin. It can be red and swollen, it's pretty painful, might be warm to touch, like you think with an infection, and it's but it's full of drainage and pus. And sometimes it's accompanied by a fever. So when you look at a little bump on your arm or skin, be sure that it's not just a mosquito bite that's gotten infected because that infection could be MRSA. So, Mary, I'd like to wrap up and just talk about what we should do in a dental setting to be sure we prevent the spread of MRSA. But that reminds me of another story a good 15 years ago, where a dental practice, one of the team members was in charge of cleaning the office and she brought her teenage daughter with her to help her one day. And that child had MRSA. So the whole office was freaking out because both of them had been in the office and they were the ones responsible for cleaning. What do we need to do? And that was more towards the beginning of not being sure whether our surface disinfection products would adequately kill MRSA. Now, please, if you're listening today, go back and look at your disinfectant wipes or spray because you will see that it kills MRSA, as well as your hand hygiene products. So let's start with hand hygiene. Diligent, good hand hygiene. Just be mindful of how you are cleaning your hands, especially if you have any polish. You should not have acrylic nails, but if you have nails, keep them short and be sure you're cleaning under your nails effectively, because we know our fingertips are the most contaminated part of our hands. Be diligent with your surface disinfectant and be sure you use your utility gloves to be OSHA compliant and to be safer and to save on the budget with exam gloves. So that's my soapbox on utility gloves, Mary. So the surface disinfection products, follow the manufacturer's instructions for use. I know oftentimes we become creative and we decide to use two different products because we think it's going to uh kill everything faster and be more effective. And perhaps all we're doing is just rendering them inactive and we're damaging our equipment in the long run. And then a third tip if you have contaminated laundry in your practice. So for example, you're laundering the scrub jackets, you have uh lab towels or patient blankets, don't ever handle the laundry, contaminated laundry without wearing gloves. And that's an OSHA requirement as well. So I think those are three tips that our listeners can be safe and be aware of about MRSA, Mary.

SPEAKER_02 7:16

Thanks, Linda. And thank you for bringing that last tip up about the laundry. I didn't even think about that initially when you were going through your tips. So that's a great reminder. So the likelihood of us contacting a patient with MERSA is not that great. The threat is really more in a hospital setting or perhaps in a patient's home if they have MERSA. But one of the things we can do in dentistry is help to prevent MERSA. And that is through the whole concept of antibiotic stewardship, which we have discussed before in one of our podcasts. And that is being very judicious and very, very conservative about doctors prescribing antibiotics for patients, because the more patients take antibiotics, the more resistance they develop, which helps then to increase the spread of MERSA. So our Diva Olivia couldn't be here with us today, but she wanted us to know about the Food and Drug Administration's recent action about RSV vaccines. RSV respiratory sensitial virus has been very much in the news in the last few months because we had a big surge of it, not only in children, which is the typical group that shows RSV, but in older adults as well who became quite ill and needed to be hospitalized from RSV viruses. And you're probably seeing ads on the news right now about how RSV can interfere with your life. My favorite one is Magic Johnson, of course. He's my homie from Lansing, Michigan. And so I'm always interested to see him. But in any event, there are two FDA-approved vaccines. One of them is going to be ready hopefully soon for distribution. But the recommendation right now is that these vaccines are meant for adults 60 and older. So it may apply to some of the team members or to your patients. So something to talk to your patients about if they ask you, refer them to their physician, refer them to the CDC for more information about the RSV vaccine if it's appropriate for them. Another new development that was recently announced is that for children, they will not necessarily receive an RSV vaccine, but they will receive an injection of antibody that will protect them from the RSV virus, which is great timing because what we typically see is an upsurge of cases of RSV when the kids go back to school. Now they're together again, they're indoors instead of outdoors, like they were over summer break, and it starts circulating again. So hopefully we'll get some more good news from the FDA. Leslie, another thing that we've seen in the news has been reports of locally acquired malaria. What can you tell us about that?

SPEAKER_01 10:20

Well, Mary, first of all, we had not only news broadcasts about it, but CDC also issued what they call a health alert network. And this is interesting because locally acquired mosquito-borne malaria has not occurred in the United States since 2003, when there were just eight cases of locally acquired malaria identified in Palm Beach, Florida. So the there were two new cases that were identified. And the concern is malaria is a serious and potentially fatal disease that's transmitted through the bite of an infective female mosquito. And although it's rare, malaria can be transmitted congenitally from mother to fetus or neo to the neomatic at birth. So this can happen also through blood transfusion or organ transplantation. Also through hearing needles is another way that this can be transmitted. But almost all of the cases of malaria in the United States are imported. And there's a roughly 240 million cases of malaria that is diagnosed each year, with 95% of those cases in Africa. But there were uh several cases that were diagnosed now before COVID-19, there was approximately 2,000 cases of mostly travel-related malaria that was diagnosed in the United States each year. So approximately 300 people experienced severe disease, five to ten people with malaria died yearly. Most of the cases of malaria in the United States are diagnosed during the summer and early fall. In 2023, CDT expects summer international travel among U.S. residents will be increasing to the pre-COVID level. So that means that we may be seeing more cases of malaria. Now, the summary that the health advisory that uh gave to us from CDT was that public health authorities and clinicians should be aware and be able to identify locally acquired cases of malaria in the two states where they've been detected in Florida and Texas, which has been in the last two months. So that would have been in uh June and it would have been in May. There's concern for a potential rise in imported cases of malaria associated with the increased international travel. And also they need to plan for rapid access to medications and treatment for severe malaria in the United States. So that is the warning that's issued, and everyone should remember that while it's infrequent that we see cases diagnosed in the United States, malaria is a medical emergency and should be treated accordingly. So any patients who are suspected of having malaria should be urgently evaluated in a facility that's able to provide rapid diagnosis and treatment within 24 hours of presentation. Mary?

SPEAKER_02 13:26

Thank you, Leslie. That that is of great concern as so many of us are outdoors and in mosquito infested areas. And I know a lot of areas of the country have had a lot of rain, which then brings the mosquitoes with them. So wear your mosquito repellent and wear long-sleeve shirts and long pants if you're going to be outside for long periods of time, which is not so easy to do when it's so hot. A couple of other things that have been very much on the news lately. In fact, I just read something this morning about cruise ships, noroviruses, those nasty gastrointestinal viruses are making appearances again on cruise ships. So whether there are so many more people or the infection prevention protocols on the cruise ships or the screening is is kind of backing down after COVID, we're not really sure. But the thing to remember about neuroviruses is that once your symptoms subside, you're still infectious for two to three days afterwards. And we have studies that show that neuroviruses not only are spread through fecal oral contact, but through saliva. So you could potentially see a patient. I tell you they've been sick, but they're better. It's within that two to three day window of time, but their saliva is still infectious. So this is the take no prisoners rule. Make sure that you are wearing appropriate PPE to protect yourself from potential exposure. The CDC has also issued an alert to individuals traveling outside the US this summer, which is focused on measles immunity or exposure to measles. So make sure that if you're planning a trip or you have a trip planned outside the country, that you know that you're up to date on your measles vaccine. That's a key recommendation to most countries. They're seeing outbreaks in Europe. They're seeing a lot of outbreaks around the globe. So make sure that you're following that. And of course, you still should be contacting your local health department regularly to see what the level of COVID cases are in your city or county because we are still seeing the spread. So, Divas, does anyone have anything else that they would like to talk about? Linda.

SPEAKER_00 15:51

Mary, I'd like to remind our listeners to just go back to a recent podcast, number 115, to hear what we talked about, the Candida Ourus, the fungal disease that was called the fungus among us that Olivia narrated. It was a great podcast. So that's another area to stay current with. Thank you. And Leslie.

SPEAKER_01 16:11

You know, when we're responsible for our patient's care and particularly in charge of infection control, we should be well aware of what the circulating infectious disease is of the day. And also what is highlighted by TDC, especially when there's a health alert network. Our patients listen to the news. And I think we should be listening as well so we know what our patients are hearing. And I recommend that dental practices download the fact sheet from the TDC website of the infection resource. Whatever it is that is circulating, whatever it is that's on the news, whatever the health alert networks are, whether it's dental unit water contamination or whether it is malaria or MRT. It is so good to have our team be knowledgeable about what the various circulating infectious diseases are, whether they're bacteria or viruses, whether our disinfectants are effective. A couple of podcasts on MPOC, and we talked about how to locate whether your disinfection is effective against uh MPOX, and where to find that on the EPA website related to recommend our listeners go back to that podcast. What is if they were able to answer questions on the fly because they had a statute, they communicated in the transportation room and during the morning tunnel with a brief discussion about RSV. The RSV and COVID and influenza. And so our patients may be asking questions. Let's get as uh well informed as we possibly can be so we can demonstrate that when it comes to infection control, not only are we brilliant in the dental practice, but we're brilliant with regards to what the circulating infectious diseases are.

SPEAKER_02 18:14

Could not have said that better, Leslie. That was awesome. And that again is the mission of our podcast is to create this community of people who are very knowledgeable, who can answer those patients' questions and who are proactive instead of reactive to infectious disease risks. Where so many times we see or we hear um comments about, well, it doesn't affect dentistry, it doesn't matter. It affects people. And so if it affects people, it matters because patients, of course, are people. And so are we as dental professionals. So we need to stay up to date, we need to be credible. What we don't want to be doing is looking uninformed or appearing uninformed to our patients. So we thank you for joining us for this episode. Remember that the compliance divas bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. You may submit any questions by email to support at thecompliancedeevas.com. And all of the resources that we mentioned from the CDC and the FDA and others during this podcast will be posted in the show notes on your favorite podcast app and also on our website. Thanks again for listening, and we'll see you next time.