Principles of Oral Health Management for the HIV/AIDS Patient A Course of Training for the Oral Health Professional Made possible from a grant to the New York State Department of Health AIDS Institute from the HIV/AIDS Bureau, Division of Community Based Programs, Health Resources and Services Administration, DHHS
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Principles of Oral Health Management for the HIV/AIDS Patient
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Principles of Oral HealthManagement for the
HIV/AIDS Patient
A Course of Training for the Oral Health Professional
Made possible from a grant to the New York State Department of Health AIDS Institute from the HIV/AIDS Bureau, Division of Community Based Programs, Health Resources and Services Administration, DHHS
June 2000
Jennifer L. Cleveland, DDS, MPHBarbara F. Gooch, DMD, MPH
Denise Cardo, MDHelene Bednarsh, RDH, MPHKathy J. Eklund, RDH, MHP
Jennifer L. Cleveland, DDS, MPHBarbara F. Gooch, DMD, MPH
Denise Cardo, MDHelene Bednarsh, RDH, MPHKathy J. Eklund, RDH, MHP
Module 1Occupational Exposures to
Bloodborne Pathogens: Risk, Prevention, and
Management
Module 1Occupational Exposures to
Bloodborne Pathogens: Risk, Prevention, and
Management
June 2000
Risk for transmission is low
Preventing exposures is primary goal
Prompt reporting and management is
essential
PEP may be effective in preventing HIV
Risk for transmission is low
Preventing exposures is primary goal
Prompt reporting and management is
essential
PEP may be effective in preventing HIV
SummarySummary
June 2000
Documented vs. possible case of HIV infection
Risk factors for HIV transmission
Characteristics of PIs in dentistry
Three categories of prevention strategies
Considerations for PEP
Qualifications of a health care provider
Documented vs. possible case of HIV infection
Risk factors for HIV transmission
Characteristics of PIs in dentistry
Three categories of prevention strategies
Considerations for PEP
Qualifications of a health care provider
ObjectivesObjectives
June 2000
Need for prompt medical evaluation
Dentist/employer role
Elements of an exposure report
Importance of counseling
Issues of confidentiality
Ethical and legal considerations
Need for prompt medical evaluation
Dentist/employer role
Elements of an exposure report
Importance of counseling
Issues of confidentiality
Ethical and legal considerations
ObjectivesObjectives
June 2000
Determinants of Risk
Determinants of Risk
Prevalence of infection in patients
Risk of infection after single blood contact
Nature and frequency of blood contacts
Prevalence of infection in patients
Risk of infection after single blood contact
Nature and frequency of blood contacts
June 2000
Health Care Workers with Documented and Possible Occupationally Acquired HIV/AIDS
Infection
Health Care Workers with Documented and Possible Occupationally Acquired HIV/AIDS
HIV Seroprevalence, U.S. DentistsHIV Seroprevalence, U.S. Dentists
Author
Flynn
Klein
ADA News
Siew
Author
Flynn
Klein
ADA News
Siew
Location
Sacramento,1987
ADA meeting and New York City,1986
ADA meetings, 1987–1998
AAOMS** meeting, 1992
Location
Sacramento,1987
ADA meeting and New York City,1986
ADA meetings, 1987–1998
AAOMS** meeting, 1992
No. Tested
89
1132*
>18,000
321
No. Tested
89
1132*
>18,000
321
No. Pos.(%)
0 (0)
1 (0.09)
2 (<0.01)
0 (0)
No. Pos.(%)
0 (0)
1 (0.09)
2 (<0.01)
0 (0)
* Community risk excluded** American Association of Oral and Maxillofacial Surgeons* Community risk excluded** American Association of Oral and Maxillofacial Surgeons
June 2000
Average Risk of HIV Infection to HCWs by Exposure Route (%)
Average Risk of HIV Infection to HCWs by Exposure Route (%)
Percutaneous 0.3
Mucous membrane 0.1
Non-intact skin <0.1
Percutaneous 0.3
Mucous membrane 0.1
Non-intact skin <0.1
June 2000
Average Risk of Transmissionafter Percutaneous Exposure to
Blood
Average Risk of Transmissionafter Percutaneous Exposure to
Blood
HIVHepatitis CHepatitis B (only HBeAg)
HIVHepatitis CHepatitis B (only HBeAg)
0.31.8
30.0
0.31.8
30.0
SourceSource Risk (%)Risk (%)
June 2000
Risk Factors for HIV Transmission after Percutaneous Exposure to HIV-Infected
Blood CDC Case-Control Study
Risk Factors for HIV Transmission after Percutaneous Exposure to HIV-Infected
Blood CDC Case-Control Study
Risk Factor Adjusted OR ratio (95% CI)
Deep injury 15.0 (6.0-41)
Visible blood on device 6.2 (2.2-21)
Procedure involving needle 4.3 (1.7-12) placed in artery or vein
Terminal illness in source patient 5.6 (2.0-16)
Postexposure use of zidovudine 0.19 (0.06-0.52)
Cardo et al., NEJM;1997;337:1485-90
Risk Factor Adjusted OR ratio (95% CI)
Deep injury 15.0 (6.0-41)
Visible blood on device 6.2 (2.2-21)
Procedure involving needle 4.3 (1.7-12) placed in artery or vein