The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#108 CDC May 2023 Update on Mpox
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After being detected in May 2022, U.S. Mpox cases increased rapidly, peaking in August of 2022. In 1 year, more than 30,000 cases were reported. DHCP need to be well versed on the trending infectious disease outbreaks so they can answer questions from patients who may be concerned.
- CDC and M-pox https://www.cdc.gov/poxvirus/mpox/index.html
- MMWR - The CDC Domestic Mpox Response 2022-2023. https://www.cdc.gov/mmwr/volumes/72/wr/mm7220a2.htm
- U.S. Mpox Case Trends Reported to the CDC https://www.cdc.gov/poxvirus/mpox/response/2022/mpx-trends.html
- CDC Health Alert Network https://www.emergency.cdc.gov/han
- EPA List Q for Disinfectants Effective Against Mpox https://www.epa.gov/pesticide-registration/disinfectants-emerging-viral-pathogens-evps-list-q
Welcome.
SPEAKER_02I'm Leslie Cannum. I'm Mary Gavoni.
SPEAKER_00I'm Linda Harvey. I'm Olivia Wan, and together we are the Compliance Divas.
SPEAKER_03Hello, my name is Leslie Cannum, and I'll be your moderator for today's podcast on MPOX, formerly known as MonkeyPox. As the Compliance Divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website, thecompliancedivas.com. Resources we mentioned during our podcast can be found on the Compliance Divas website or on the show notes. Please also feel free to submit your questions to support at thecompliancedivas.com. After being detected in March of 2022, US MPOX cases increased rapidly, peaking in August of 2022. In a year, more than 30,000 cases were reported. Dental health care providers need to be well versed on the trending infectious disease outbreaks so they can answer questions from patients who may be concerned. The compliance divas did a podcast on MPOX back in August of 2022. And during that period of time, there was only about 2,000 cases. That case count now is over 30,500. And so we felt it would be timely to have a podcast to update our listeners on MPOX. Mary, can you kick this off by giving us a little recap on what MPOX is? Absolutely, Leslie.
SPEAKER_02According to the Centers for Disease Control and Prevention, MPOX is a rare but potentially serious disease that's caused by the MPOX virus. And as Leslie said, it used to be known as monkeypox. The MPOX virus is from the same virus family as smallpox, but it's less severe and less transmissible than smallpox. Many people die from smallpox. There are not a lot of documented deaths from MPOX. MPOX can spread from infected humans, animals, and materials contaminated with the virus. It's characterized by a new unexplained rash and skin lesion. So something we might see on a patient that presented for treatment that had MPOX. It's usually found in Central and West Africa and normally doesn't spread in the US. But as Leslie said, in 2022, we started seeing it spreading in other countries, including the US. The global outbreak has been linked to prolonged close personal contact with other people who are sick. And I believe Linda is going to give us a little more detail about that. But the concern again is that these cases are now rising again. It is very possible we could see one of these patients in our practice. So one of the questions our listeners might have is how would I know when these kinds of things are happening? And the way that the CDC communicates this is through their health alert network or HAN, H A N. You may have seen information, and I believe we have a podcast about the health alert network related to dental unit waterline contamination and infections that were spread that way. So it would be a good idea for at least one person in a dental practice, preferably the infection control coordinator or the OSHA safety manager, to subscribe to the health alert network. And you can simply do that on the CDC's homepage. We'll have a link in the resources for that. And then you will directly receive these network alerts when they occur. So you'll know what is happening in that instance.
SPEAKER_03Mary, thank you for that great explanation. And of course, a reminder for dental healthcare providers to subscribe to that HAN network so they can be made aware of whatever CDC is concerned about when it comes to outbreaks. I'd like to now go to Olivia and ask her a little bit more about the current global outbreak. When did that begin? Are there vaccines? Is there potentially a resurgent outbreak expected in the United States? And what are health officials saying about this?
SPEAKER_00Leslie, I think it's a good idea to back up just a little bit and learn that MPOX was actually discovered in the late 50s. There were two outbreaks of uh pox-like disease among monkeys that were kept for research. And obviously that's how it got its name, monkeypox. And then it was the first human case reported in 1970. But Leslie, the outbreak that we're talking about occurred last year in 2022, and as you mentioned early on, there have been around 30,500 cases in the United States and globally 87,545. So one of the things that's a little bit concerning is that although most of the inpox cases in people were outside of Africa were linked to international travel through imported animals, there are considerations for those who would be at greater risk. And good thing, Leslie, there is a vaccine that is available that we could discuss in greater detail, particularly if we continue to see uh outbreaks of MPOX. Health officials in larger cities are working to raise awareness because, interestingly, you know, they're still learning about it. And what about dental practices? What risk would they have if someone comes in with MPOX? And would that be something that the CDC would recommend for dental workers such as our listeners? I was curious about what the MPOX looks like when it manifests on the skin, and it looks pretty disturbing and very painful. And I wonder about the potential for scarring. So, in summary, Leslie, we want to look at this outbreak back in 2022, and CDC is obviously trying to protect us in providing the information about MPOX and what are the risks for transmitting, especially in dental settings where people come in for dental services. How can we take those precautions and whether this vaccine would be added to vaccines that would be recommended for dental workers or not?
SPEAKER_03Olivia, thank you very much for giving us insights on the outbreak and the potential of getting vaccination on the list of recommended vaccines for dental workers. We'll be staying tuned to find out what CDC is going to say about that. As we get closer to summer, I know health officials are particularly concerned about a resurgent uh outbreak and in dental offices. Many times our patients do come in wearing shorts or short sleeves, tank tops, flip-flops. And uh, so I know that uh there's a potential that they could be a person who has the monkeypox virus and perhaps sit in our dental chair. So now I'm going to ask Linda, how does MPOX spread? Can you give us some insight here?
SPEAKER_01Sure, Leslie. I think it's important to be aware of MPOX. And I know it is a little bit concerning when we heard the statistics that were up to about 30,000 cases and what's changed since we did our first podcast on this topic. But then it brings us to that question, as you just said, how do we contract or could we contract MPOX in a dental setting? So empox can spread to anyone through close, personal, often skin-to-skin contact, including direct contact with the MPOX rash itself and any scabs from a person with the MPOX. And it can occur, transmission can occur through contact with saliva and upper respiratory secretions. And we think about that in everything that we do in a dental setting, right? Aerosol-generated procedures, aerosols flying everywhere. But the direct contact we we first think of with MPOX is through close intimate contact, you know, sexual contact. But it's also as well as prolonged face-to-face contact, such as a dental visit when we're close to a patient in that close proximity for a long length of time. Um, and if the patient has a lesion or is shedding, they could be contagious. So while the risk is low or considered to be low right now, Leslie, for getting empox by touching an object like a fabric or a surface that has been used by someone with empox and hasn't been disinfected, whether that's clothing, bedding, or just clinical contact surfaces. And think about a patient blanket in our dental settings. As you just mentioned, you know, Mary did it, but patients are coming in, and I'm here in Florida, but many parts of the country, they're coming in in flip-flops and shorts and tank tops and so forth. And I've heard lots of dental professionals tell me that some patients will take their shoes off and put their feet up in the chair because they're more comfortable and they think they're doing the right thing by not putting their shoe at the on the chair. So now we have, you know, patients contact everywhere throughout the chair and that patient blanket that's used. So a person with inpox can spread it to others from the time the symptoms start. That's important, from the time the symptoms start. Even if someone doesn't know they have empox, just like with COVID, they may not realize they have COVID, but there's some symptoms starting. How many times do patients think there's just uh there are allergies with COVID and all of a sudden they're in a full-blown case of COVID? But this rash, you know, until the time the rash starts, until it has fully healed, and there has to be a fresh layer of skin formed over that sore or that lesion. So as of earlier this year, Leslie, February 2023, some new data show that people can spread MPOX to others from one to four days before symptoms appear. Before symptoms appear. So just like that window of being contagious with COVID that we don't know, or uh, it's a similar situation. So as I mentioned before, just thinking about what happens in a dental setting. So, you know, infections can occur through other exposures, not just intimate contact, but there's in fact any contact with the infectious lesion in any kind of clinic setting, but especially dental setting where we're working so intimately with the patients in a closed space for a long tank period of time. Now, a couple other considerations to think about, Leslie, are empox and pregnancy. So the empox virus can be spread from the fetus or to the fetus, pardon me, through pregnancy or to the newborn uh through close contact with skin after birth. So there's a contagious uh aspect to that. And then also infected animals. Anyone in close personal contact with a person or animal with epox can become infected and should take precautions to protect themselves because as Olivia pointed out, it started, you know, with with the monkeys and the monkey being called monkeypox. But I want to kind of close this little piece out, Leslie, just by saying that scientists are still researching how often and the circumstances that MPOX virus is spread through respiratory secretions. So we can't rule it out with everything that we know that's going on at dental office today. We cannot rule it out that empox could be spread through airborne, you know, and aerosol transmitted diseases and aerosol-generated procedures. So while we're waiting for more research, Leslie, I think that it's best to be precautious. It's better to be safe than sorry, and just be safe all the way around and take precautions.
SPEAKER_03Linda, that's such good information. And when we think about standard precautions, like with bloodborne pathogens, whether a person has indicated that they have hepatitis or HIV or not, we always practice with standard precautions in mind. And I think that prevention extends over, especially since you told us that people can be uh shed the virus and spread the virus up to four days before they have symptoms. So a patient may not even know that they carry the monkeypox virus or MPOX virus and be in our dental office and perhaps sit in our dental chair and perhaps leave some of the virus behind. So there are disinfectants that are uh labeled as effective against MPOX. And the best way to find those disinfectants would be to go to the EPA, Environmental Protection Agency list Q. Q is in Queen. You may remember that we uh talked about in our prior podcast list. Many people are aware of ListN, that was for the list of disinfectants that are effective against SARS-CoV-2. But if you're looking for emerging viral pathogen efficacy, list Q is the list that you would want to go to. And it's very simple to go to that list, just Google EPA and then uh go to list N when you get to the search bar, and there's going to be a section for you to put in the EPA registration number, which you can find right on the container of your disinfectant. You put that in and you push the search button, and you should see a list of disinfectants come up. That uh, well, when it's an EPA registration number, let me back up and say that if the EPA registration number is one that is a formulation that does uh kill MPOX, then it will come up. If it is not on their list queue, then your red your disinfectant will not appear. Also remember that the EPA number stands for the formulation. So the brand name of what you're using for a disinfectant may be different, even though the EPA number is the same as another brand name. So uh don't be confused by that. If the EPA number matches what's on the EPA website and what's on your container of disinfectant, then that's the same formulation. I recommend that our listeners review their infection control protocols for decontaminating treatment rooms and frequently touched surfaces. And one more thing to do is to listen carefully to what you're hearing on the news and what you see maybe in newspapers or on social media about the infection du jour. And if monkeypox comes up, your patients are going to be hearing about it too. They'll probably ask about monkeypox. They may not say MPOX, formerly known as monkeypox. And you want to be mindful that they can ask questions about their safety in your chair. The more educated you are about the virus and about the infection prevention protocols that you have and the level of disinfectants that you have, the more you can assure your patient that they're safe in your care. So, what I'd like to do now is just take a little trip around the uh the diva, we call it a round robin, and and ask our divas uh some questions. I want to start with Olivia and ask you um, why is it so important to train patients on how to screen, pardon me, train your employees on how to screen patients.
SPEAKER_00As I mentioned earlier, Leslie, I think it's important for uh dental team members to recognize what MPOX looks like when it manifests on the skin. Because as Linda pointed out, with it being summertime and people are wearing short sleeves and short pants, we may notice that the individual has what they think might be just a rash. And so if we see the manifestation on the skin or the patient is complaining about it, the dental professional might be the first one to recognize MPOX and get that individual to a healthcare professional. So just like we've all had experiences and worked with dental team members who were the first one to get a patient motivated to pursue uh treatment with a medical professional, whether that was high blood pressure or potential for diabetes, the dental team member might be the first one to recognize MPOX.
SPEAKER_03Thanks so much for that explanation. I know that in California, we are required to screen patients for aerosol transmissible diseases. And while MPOX is both contract trans contact transmissible and aerosol transmissible, it is on our list of aerosol transmissible diseases. So we are still required to screen our patients prior to dental treatment for aerosol transmissible diseases and clear them before we bring them in for treatment. And it's so uh so um important that we do uh refer our patients to a healthcare provider if they are uh a candidate to be perhaps uh suspected of having an aerosol transmissible disease, whether it's MPOX or whether it is something else. And with that, I'd like to turn over to Mary and ask if you have something to contribute here. I do, Leslie. Um, thank you.
SPEAKER_02I just wanted to go back to um the disinfectant um discussion from earlier about looking at that um list Q at the EPA to determine if your um product that you use is on that list, that it would be effective against MPOX. But don't forget that you also have to um make sure that your disinfectant has a tuberculosidal kill claim, and that would be on list B at the EPA. So um, and I'm guessing, only guessing at this point, that we're going to see the same sort of situation that we did with um COVID in the beginning, that a lot of people switched out their disinfectants for ones that already had the label claim on list N against COVID. And what they might have done is actually, for lack of better description, downgraded their disinfecting product because now they used one that was effective against COVID, which is very easy to kill, doesn't have a lot of antimicrobial resistance, in lieu of using a tuberculosidal disinfectant, which can kill many um resistant microorganisms, including COVID and most likely um MPOX as well. So I I wouldn't go rushing to switch disinfectants again. Um, stick with what you have. If it has a tuberculosidal kill claim, you should be good.
SPEAKER_03Thank you, Mary. That makes a lot of sense. And I I just didn't even think of the possibility of individuals choosing a product that has is on list in and then downgrading their disinfectant. So that makes a lot of sense. That's a very good point. Linda, you had something to add.
SPEAKER_01Well, I'd like to just piggyback off of Mary's comment because what we saw during COVID was offices would do many things that because one of the shorters they couldn't buy their exact product, or they were buying extra products that they could have on hand, whatever they could grab, and commingling different brands on their surfaces, you know, which is not advisable. So I just think that Mary had hit the nail on the head. Stick with the product that you have, read the labels properly, don't become creative when it comes to cleaning and disinfecting the operatory, stick to what the manufacturer's instructions for use say. This just like that old saying, the facts and nothing but the facts, ma'am. Stick to those instructions because as we start deviating, and this is not like a recipe at home where you can tinker with it and change the rest, you know, add in some different spices and do all these different things. Add stick to the facts and use the disinfectant, spray or wipe according to manufacturers' directions, Leslie.
SPEAKER_03Well, thank you for that. And I also want to remind our listeners that if you go to the CDC website, you can frequently find fact sheets that are one or two page sheets that you can print out. And it's awfully good to have that fact sheet, maybe uh print it out and tape it, put it in your uh wherever you have your morning huddle, and have a brief discussion about what the infection du jour is, what are the infectious outbreaks are, whether it's RSV or whether it is uh MERSA, um, if we have the MPOX tends to surge over the summer, if we have a resurgence of COVID, let's have the facts so that we can be well educated, each and every one of our team members. And with that, I'd like to close this updated podcast on MPOX and remind everyone that as the Compliance Divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Submit your questions to support at the compliancedeevas.com and look for our resources on the compliance divas website as well as in the show notes of this podcast. Thank you for listening.