THE PARLIAMENTARY REVIEW Highlighting best practice
The two papers concluded firstly that disinfecting a patient’s skin from a spray bottle prior to injection caused a serratia marcescens infection, and secondly that a bottle which had not been washed before refilling caused a similar infection in a patient during heart bypass surgery. Serratia marcescens is recognised as an important and potentially hazardous pathogen, commonly involved in hospital-acquired infections, particularly catheter- associated infections, urinary tract infections and wound infections. It could be a life-threatening infection, but there are a number of reasons why this recommendation is incorrect. Serratia marcescens is naturally occurring in water and soil, even sometimes in the mouth, and is an opportunistic pathogen. This means it will cause harm when it gets into the “wrong places” but is otherwise harmless. Crucially, the evidence and research are hospital-based, and the reported incidences upon which the recommendation is based are unrelated to the procedures used in a dental practice. There are some significant issues with conclusions drawn from the papers, with both the unwashed bottle and injection through skin being causal factors, plus the fact that the operation took place in a sterile body cavity using contaminated equipment. These must also be seen as contributing factors. In conclusion, I suggest that, in a dental practice operating environment where spray bottles are used to disinfect surfaces between patients, there is no evidence of an infection risk from this bacterium. We do not disinfect or inject skin, unless in a medical emergency, and we would then use individually packed sterile alcohol wipes. We do not
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An example: plastic waste Recommendations state that we must throw away refillable plastic spray bottles that are used to spray disinfectant onto the surgery surfaces between patients. A plastic item that can easily be washed and reused is turned into a single-use item that goes to landfill. I vehemently object to this and approached Public Health England to access the clinical papers upon which this recommendation is based.
Our media constantly feed the public with misleading statistical analysis