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
#174 DICAM Interview with Dr. John Molinari
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Who better to update dental teams on what is currently happening with respect to infection and control than, our friend and internationally know expert, Dr. John Molinari. Join the Divas as they ask Dr. Molinari about COVID surges, Fifth Disease, Avian flu and more as we kick off Dental Infection Control Awareness Month (DICAM).
Welcome. I'm Leslie Cannon. I'm Mary Gavoni.
SPEAKER_03I'm Linda Harvey. I'm Olivia Long. And together we are the Compliance Divas.
SPEAKER_04Welcome to the Compliance Divas podcast. I'm Mary Gavoni and I'll be the moderator for this episode, which is a very special one. And this is how the Divas are going to kick off Dental Infection Control Awareness Month or DICAM. We have a very special guest, and I'll save the surprise for just a minute. But the Compliance Divas bring clarity and simplicity to the regulatory world by navigating that regulatory world to keep you on course. You can subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website, thecompliancedivas.com. Any resources that we mention can be found in the show notes on your podcast app. You can submit questions to the ComplianceDivas to support at the ComplianceDivas.com. And we also ask that you scroll down after you finish listening to the podcast and leave us a review or give us a rating. So our very special guest today is none other than our friend infection control expert, Dr. John Molinari, professor emeritus of the University of Detroit Mercy and worldwide expert on infection prevention and control in dentistry. And for many of our listeners who've had the privilege of hearing John lecture, you know that science is his thing, and he always bases all of his recommendations on what is the science telling us, but he also makes it so practical for us to be able to go back to the office and do the right thing. So, John, welcome. We're so glad to have you with us.
SPEAKER_00Thank you for inviting me, guys. It's a pleasure.
SPEAKER_04Great. So we've got some questions for you because many people have, of course, kind of slacked off on infection prevention and gone back to the pre-pandemic protocols that they've been following, but we know that some things are happening. So Leslie is gonna ask you our first question for today.
SPEAKER_01Thank you again, Dr. Molinari, for joining us today. You've always been the trusted resource for everyone in dentistry. And in your time, it was your calling, I think, during COVID. We seem like we are experiencing COVID in a little bit in the rearview mirror, but now we're seeing surges in COVID-19 cases. And some of those surges, from what I hear, people are suffering. And they're obviously not dying and not going into intensive care, but but it seems like they're having a nasty bound of illness. What recommendations do you have for us? What should dental team members know about COVID at this time?
SPEAKER_00Well, the recommendations for the dental team, I'll get to in a second, but as far as the surge, the spring-summer surge, uh, it's it's real, of course. Uh part of the issue is because the testing centers have for the most part been closed, the cases are not being reported. So we're we're doing, we're seeing people have them. Probably you have them in your families and friends that you know as I do. But they are getting serious because these new variants, this uh what they call the Fort variants, KP1, 2, and 3, are much more infectious than the earlier ones that we lived through during the height of the pandemic. And that is making the infections more transmissible. The other side of the coin is while the surge is there, we're seeing that for the most people, uh they're sick for a few days, maybe five days or whatever it is, but they don't report it. It's like, yeah, I had COVID, you know, I passed it among my family. We had a wedding and things like this. I've I've heard all this. The problem is we're seeing more hospitalizations. And that's been the indication that the CDC is coming out with their recommendations saying more hospitalizations. There's been a real upcase in uh uh in uh uh viral concentrations in wastewater testing around the country. Uh and that is a concern. But as you said, people are sort of like forgetting about it because you know there was the worst, and we had to, we were all scared. Well, now let's get back to normal. The problem is once you've made an improvement in infection control, you don't go back. Uh, I'm talking to the wrong group. I'm talking to you guys who are absolutely incredible. People don't want to use respirators. Um, but the fact is, I I I tell people, I said, once you got the hepatitis B vaccine back in the 80s, did you stop wearing gloves? Well, of course not, because there were other things. There was hepatitis C, there was HIV, other diseases. There are other airborne diseases out there and challenges that are coming down the road that are going to require us to use those things again. The CDC has tried to take this into account with their recommendations, and I think part is because that they're getting pressure. And they're saying when you're treating people who you don't suspect with COVID, at least consider a respirator. You know, wear a high-level mask, like a level three, but consider use of a respirator. So, my my message to the dental team is don't forget what you did. You did a good job, but don't just abandon it because once you've made that improvement, that becomes part of your infection control armamentarium. And you guys see this all the time at your meetings. People say, Oh, you know, I'm tired, I don't want to do this. Well, this the sale of respirators has gone down dramatically, but people cannot forget that that's what you need to protect against these aerosol-mediated diseases, and there's more and more of them coming out. And the message is don't forget what you did and consider and periodically use respirators, they aren't that terrible to use. We all got used to it. So, you know, what's the big deal?
SPEAKER_04Well said, John. I we needed to hear that. It's like what we did during the pandemic, we know worked, and so why would we quit doing it? So yeah, it we can't. I guess we can't always teach common sense. I don't know.
SPEAKER_00No, no, people aren't people aren't afraid anymore, and I think the fear spurred that partially to do the right thing. I I I think dentists want to do the right things. I think the dental practice wants to do the right things. So let's let's get that as a baseline. But the fact is we have other challenges, and SARS-CoV-2 is not going to be the last one that we see for airborne disease. Absolutely not. Uh later on, you have questions about bird flu. And that's a that's a whole other thing to look at down the road. But part of this is we have more and more people living with immune compromised conditions, children and adults. And the greater the percentage of immune-compromised persons, the more we're going to see some of these organisms that may have been relatively minor raise their ugly heads. Because those people's immune systems are not like yours or mine, where we can fight these things off without even realizing it. And so we're seeing the emergence of diseases because we have a higher concentration of people who are really susceptible to the more severe clinical manifestations. Same thing in your practices. I tell people all the time in the seminars: look at the people in your practices. You have more immune-compromised persons than you used to 10, 15 years ago, cancer survivors, whatever. And that is part and parcel of what why you do some of the infection control.
SPEAKER_04Absolutely. And many times we think of wearing those respirators as more protection for us. But yeah, you're right. We do see a lot of those immune compromised patients. And speaking of parvovirus, which you just mentioned, Olivia's got a question for you about that.
SPEAKER_03Go ahead. So, John, I'm really concerned because I'm looking at CDC's website and it indicates emergency preparedness and response, increase in human parvovirus, B19 activity in the US. And under that, it says this is an official CDC health advisory. So talk to us about this. Is this something that we could catch in a dental office?
SPEAKER_00You could. The problem with with the parvovirus is I have to admit, in school and taught and teaching my students, I hardly mention parvovirus. For me, it was a it was a virus that was passed between cats and dogs, very rarely the humans. Um, but there is human parvirus, and most people get it when they're kids. It's very easily transmitted by by coughing, sneezing. Kids, of course, cough at each other all the time and sneeze, and most people don't even realize they've had it because they don't get symptoms. But now we're seeing cases in young kids, and typically that's okay. Uh the slap cheek, the fifth disease stuff comes about a few days after they're infectious. So by the time they develop the face rash, they're not infectious anymore. Um but again, as as I just mentioned to Mary, part of the problem why this is becoming more known now is there is a very specific recommendation by the CDC that people with immune compromised conditions uh could develop more severe complications, like adults, joint pains, you know, things like this, high fever. We didn't used to see that, but now that we're seeing more compromised individuals, HIV, cancer survivors, uh sickle cell kids, uh those types of immune compromised conditions can lead to this virus causing more systemic manifestations than just respiratory. But if but if you do a a uh a serologic study on adults and children, most people have had it. But they just never realized it. Now, because we're seeing some more severe cases, we're seeing outbreaks in what elementary schools, I think, um, it's it's become a health emergency, as as it should be, because you have more people who can have some severe problems with it. Dentistry, I think, my own opinion, as long as you wear the right respiratory protection, at the very least, a high-level mask that's a good tight-fitting mask, you're gonna be okay. And of course, in a dental office, if somebody comes in, even a kid that's coughing, sneezing, hacking, they're typically going to defer care and refer them until they're asymptomatic. And by then they're not infectious.
SPEAKER_03Thanks for that update, John. And I thought it was odd on the site, it said that no, that children and adults with parvo virus B19 are no longer contagious once the characteristic facial rash appears. Right.
SPEAKER_00It seems like it'd be the opposite. Um what happens is the virus, of course, it's gonna be spread by airborne droplets, fat or stuff like this. But the virus can affect epithelial tissues and then the and the cheeks of the place. So by the time those few days have gone, the viral concentration in the respiratory tissues has decreased dramatically. Not saying it's gone, but the person is not really infectious as they were during the earliest parts of the infection. It is it is it a hundred percent absolutely not, but that's pretty much the consensus.
SPEAKER_03Thanks for sharing that information.
SPEAKER_00You're welcome.
SPEAKER_04Absolutely. And I keep thinking as we're talking about all these other viruses that are circulating, it is time for back to school. And so when these kids are going back to school, do you think we're gonna see a surge of things like RSV or um it's probably early for influenza? Are we gonna see more uh more cases, do you think, as the kids go back to school?
SPEAKER_00I think I think RSV is always gonna be an issue. Um, what happened with the um uptick in RSV two years ago led to a real increase in childhood vaccinations. I know older adults are supposed to get as well, um, you know, like like like me anyway. Um so that's helped a lot before people didn't even think of RSV. Now it becomes part and parcel part of the flu vaccine series and stuff like that. And I like the fact that they're they're looking at influenza, uh, the COVID updated vaccination and RSV in the same, not necessarily the same injections, because people don't necessarily want to do that, but at least they're pushing to get that complete series. The problem with that, Mary, and I apologize because I'm digressing now, is we're seeing a, in my opinion, a very scary decrease in childhood vaccinations. And that is across the US. Some states are much worse than others. My state has greater than 95% childhood vaccinations by the time they have six or seven, you know, entering first grade, whatever it is. Other states are below uh way below 90%, some below 80%. And that is important because that is why we're seeing increases in measles, and you're really opening up these kids to a number of respiratory problems.
SPEAKER_04Thanks, John. That's that's really helpful and and a little scary to think about what's going on. So earlier you alluded to the avian flu H5N1, and Linda has a question for you about that.
SPEAKER_02Thanks, Mary. Before John, I shoot my question to you. I just want to make a follow-up comment on your immunocompromised patients. There's a scenario that I've seen lately that I want to share with our listeners and you as well. Recently, a person crossed my path who has some serious eczema issues, skin issues, and their dermatologists put them on a drug that lowers the immune system to control the itching and outbreaks and so forth. Well, when that happens, when that individual takes their weekly dose, they begin to get symptoms of shingles because they've had shingles in the past. So now there's two things they're combating, how they're going to work on that strategy. Maybe they don't take the medication as frequently or they make sure they have their shingle shots, whatever it is. But it does create some issues. And those are the kind of average patients, in my opinion, that can slip through the crack in a general practice because this is a complex situation that you don't even think about somebody who could be taking a medication like this.
SPEAKER_00Were they vaccinated against shingles?
SPEAKER_02Oh, yes. Uh-huh. And they've had the updates and everything too. And and they still have the and they still have the uh it subsided once they got the update of uh shingles vaccinations, but just originally that happened. So it drew it just drew my attention to one, the two things, the shingles situation, and two, the fact that I'm not sure that every dental practitioner is up to date with all the medications and all these other areas of medicine that are being just prescribed to their patients. Because as we know, patients don't always tell us the truth.
SPEAKER_00Yeah. Well, you know, it's it's it's it's it's tough for the practitioners because there are so many new medications that come out um to keep up on everything. Uh heck, the physicians have trouble keeping up on it.
SPEAKER_02That's true. That's why there's so many specialists, right? So let's circle back then to the H5N1 avian flu. Um, does there need to be concerned with that, John? What's your take?
SPEAKER_00Well, at this point, of course, the the the risk for the public is low, according to CDC, which is true. Um, it is it is not an easy virus to transmit to humans. Uh, that's been historical going back to 1997 when they had the first outbreak in Hong Kong, uh, where it was passed to about 16 people and then spread occasionally throughout Asia. I think as of today, there are less than a thousand cases. Uh, the problem is it's very lethal. The death rate is over 50 percent, and that's a problem. So that's been tracked now by the World Health Organization for years. And uh, as far as the US goes, our issue really uh, if you want to say, started in uh a few years ago, 2022, where the um uh uh I forget what government agency was testing wild birds, which which passed this virus, and they started finding wild birds that had the virus, H5N1. And no human cases in the US. Then they started finding it, of course, in domestic uh flocks of chickens, ducks, geese, stuff like that. And at this point, they've had over a hundred million cases. And when that happens in a flock of chickens, for example, commercial flock, you have to cull the whole flock because there's no treatment if it's highly pathogenic. They're low pathogenic, they can survive. But because people come in contact with these, they've had now cases. Uh clinical cases, probably about four cases in the U.S., uh, three with cattle, two in Michigan, by the way, Mary, uh, as you know. But um, they've done serologic testing, they found about 14 cases in the U.S. So the risk public health-wise is low. My concern, and other people's concern, is uh that this is an influenza virus that can change very, very quickly. And because these viruses jump species very quickly, it's only a matter of time until it jumps to humans. So it started to jump to humans a little bit. So they have to be very careful because once it gets into humans, history has shown us it can be very fatal. Fortunately, at this point, it's not that infectious. But my understanding, and I I have some friends still in the government agencies, CDC, etc., not as many as I used to. But what I'm hearing is that the farmers are not willing to test the flocks or the cattle like they should be. Part of the concern is if they find the virus there, that can have detrimental effects on the herd. You know, the cattle can be treated maybe, but the chickens maybe not. And so they're telling them gloves, masks, all this sort of stuff. And I think that that's going to take a while to catch on because that's very different from what these people have done before. Uh so again, while it's not a major public health risk at all, and the risk is low, the potential for that virus to jump to humans has always been there. And when it does, then if it goes human to human, like influenza, we have a problem.
SPEAKER_02That's very informative, John. And on one hand, very alarming. I know that what you just said numerous times that you know there's not a risk right now. Everything is very low for humans, but just the potential would want to keep us on our toes. And the fact that the farmers, you know, livestock, those that own and have ranches, are reluctant to test their animals is concerning. Um, you know, it raises the question, not that we have time to go into this today, but just the different levels of the ethical issues that are there. You know, what about them taking care of their workers? You know, some like yeah.
SPEAKER_00I I think more and more of them are testing. I know there have been regulations now, certainly recommendations about moving animals from one farm to another, certainly chickens, ducks, stuff like that, cattle the same way. Um now, now that they have found it in cattle, which was not a normal host for this virus, uh that's an issue. So they have to really keep keep testing the cattle. And I think that that's what they're trying to do. Plus, they're trying, you know. Maybe if you go to a chicken ranch or a cattle ranch, as they're handling the cattle or doing some uh procedure, uh veterinary procedures or cleaning of the animal house, uh, you might find them wearing gloves now, the way they didn't used to wear gloves. So it it's taking time. It's it's it's it's it's just something very, very different.
SPEAKER_02It is, you're right. It's very, very different. And that was a great uh explanation and some good guidelines there. Thank you, John.
SPEAKER_04Thank you. Thank you. John, you are always such a wealth of knowledge. All these things to think about. Um, I loved what you said earlier about wearing respirators that we should consider. And I'd love for you to just kind of repeat that, but also you've mentioned a couple of times wearing a well-fitting mask. Tell us what that means to you, because I think our listeners want to know that.
SPEAKER_00To me, level three mask is the way to go, period. Level three mask is going to give you the best protection. Virtually all the level three masks that I can think of may have a nose piece, like a metal or plastic nose piece, and more and more of them have the bottom piece that also is a tight-fitting one. Uh, there have been studies, uh, there was a recent study that came out of the University of Maryland that showed that these things fit pretty well. And while they're not as good as respirators, they're more comfortable for people. People are more used to masks than respirators. At the very least, to me, that's that's what people should use. And I and I I don't get a commission from any company saying whichever mask you should use. Obviously, there are a number, but what I don't want people to forget is the use of respirators because they did it. And I mean, I I miss talking in front of audiences all the time. I do more webinars now. I have a couple of lectures coming up, but more webinar. But the thing is, I would tell them, you did it, don't go back. You know, you did it, you got used to it. Respirators are with us. I mean, I I used to maybe this is not politically correct, and I apologize. I used to be at the airport, Mary, and remember we'd see people from Asia wearing masks all the time. We say, Why are they wearing masks? Well, obviously, they they were wearing it for pollution, they're wearing it because of whatever was going on in their country. My wife and I wear masks all the time at the airport on a plane. Absolutely, there's no question about it. We wear masks now going into the large grocery stores, Costco, for example, because we're having a surge in California. My county's not terrible, but it's here. And I'm and I'm a little bit older than I used to be. So there's nothing wrong with it in your practice to say you did the job. Respiratory protection is is basic because that's your major route of exposure. You're not wearing level one masks like you used to do back in the 80s and 90s. You need to improve your protection because you are at risk from things that you don't even know is out or out there anymore.
SPEAKER_04Absolutely. That's it. Leslie, do you want to chime in here about what's going on in California with respirators?
SPEAKER_01Well, with CalOSHA, they have a very specific requirement that the employer does a hazard assessment to determine the risk. That used to be easy when we had the COVID-19 data tracker. Now it's again, like you said, John, it has to do with wastewater measurements. And now we got some hospitalizations. Dentists would be wise to consider continuing to offer N95 respirators, whether it's voluntary use or whether they mandate it. It should be part of the PPE in a dental practice. And you're right.
SPEAKER_00I agree.
SPEAKER_01Level three masks are a way that we can be better protected over level one or a level two procedural masks. But I same thing as what you said. People don't want to wear respirators. They're they're not comfortable. We've found many different styles that seem to be more comfortable. We've gotten samples from different companies. And so there's a way to go with those. But I don't want uh our listeners in California to forget that if they mandate masks, then they means a whole respiratory protection program. But voluntary use of uh, pardon me, not mask, N95s, voluntary use is a lot less restrictive for the dentist employer.
SPEAKER_04So, John, what about things like um putting a face mask over the top of a respirator like some people did during COVID-19? And I still get questions from people can they can they wear two masks? Can they put a one, a level one, and a level two? And does that equal a level three?
SPEAKER_00No, absolutely not. I you know, okay. To me, this is um I think people think it's a great idea, you know. Oh, I'm I'm getting double a protection now, but the face shield is the way to go now. I mean, face shields have always been there. Uh you wear a mask, you can still wear a face shield over it. Two masks are gonna cut down on the effectiveness, believe it or not, of each one. Especially if you have a a mask over a respirator. Remember when people were wearing masks over respirators to save the respirators. Um plus, and just as important, it makes the breathing more difficult, which seems to be one of the major problems people have with wearing respirators. Now, two masks, obviously you're gonna be able to breathe better, but it's not the same as a respirator. Put on a freaking respirator and then wear a face shield. The face shields have been around since the early blood borne pathogen standard in 1991. More and more people were using them, but COVID really exploded on the face shields, and and and that's great. So wear a face shield. I I think people have responded to that, not not because of anything I've said or you said. I I think that it just makes sense. But when when when people were panicking about wanting to not wear respirators or having discomfort with it, they were looking for other solutions. This is a basic solution, you know. The face shields work, clean them between patience, and you're fine, you know, if they're reusable.
SPEAKER_04Great. And from your lips to God's ears, John. Um thank you so much. Um, Divas, does anybody have any other questions for John while we while we have him here with us today?
SPEAKER_02Great job as always. Thank you for joining us, John.
SPEAKER_00Oh, thank you, and appreciate it. My pleasure. Anytime, guys.
SPEAKER_04You are a treasure to dentistry, and we thank you. Thank you, thank you for joining us. Take care until you're better if I said hi. I will do that. So, in closing out this kickoff diecam episode of the Compliance Divas podcast, we want to remind you that we bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. If you have questions, you may submit them by email to support at the compliancedevas.com. And we do have some resources that we will post in the show notes. And please scroll down at the end of your podcast and give us a rating or um give us uh some feedback and some comments. Thanks for joining us. See you next time.