Ebola Awareness for the Dental Environment

ebola-info-dental-nursesSince September there have been many warnings about Ebola entering the UK. The government and hospitals across the country are alert and ready to screen for Ebola. Public Health England stated:

“Overall, the risk of Ebola being imported into the United Kingdom is currently considered to be low. We may expect a handful of cases over coming weeks if the current situation persists.

  • the risk of transmission occurring within the community in the UK is, and will remain, very low due to the range of robust measures that have been put in place
  • healthcare workers remain a risk group, but outside of treatment of confirmed cases, the risk remains very low”  

Read the full report here.

The Ebola virus was first discovered in the Republic of Congo in 1976. The recent outbreaks started in small villages in Central and West Africa. This year’s outbreaks started unexpectedly in Guinea, which has not ever been affected before. From the villages, Ebola spread to the capital, Conkary, and then to Sierra Leone.

On the 24th of August this year an English nurse was flown back to London to be treated for the early symptoms of Ebola. He recovered fully and was discharged from the Royal Free Hospital on the 3rd of September. 

In October this year, a nurse in Spain who was treating the missionaries who had died of Ebola in Madrid was infected with the virus. There have also been outbreaks in the US - but how much is known about Ebola among dental professionals, and do we need to be scared of becoming contaminated?

Ebola is a serious infectious illness which is often fatal. The virus originates from fruit bats and people become infected through direct contact between the virus and broken skin. Infection may also occur through direct contact between broken skin and bedding, chairs, surfaces or clothing. The virus is not airborne, so very close contact with an infected person must take place for contamination to occur. However, in dentistry there is very close contact between the patient, the dentist, and the nurse. 

It takes between one day and twenty-one days for the symptoms of the virus to show. Once the symptoms start to show, the patient becomes infectious. 

Symptoms can be easily mistaken for the onset of flu. The early signs of Ebola include: sudden high fever, muscle pain, tiredness, headaches and sore throat. The above symptoms are followed by vomiting, diarrhoea and bleeding. Bleeding can be external or internal, coming from the gums, eyes, nose and ears. 

Patients can therefore die from dehydration, internal bleeding and organ failure. So far, there is no cure for Ebola. Severely ill patients must be isolated from others and rehydrated very quickly intravenously.

I am a dental nurse working in one of the biggest London hospitals. We have had several meetings and precaution tests to ensure we know how to avoid contact with an infected person and thus avoid catching the virus. We provide dental treatment to different age groups and to people from all over the world. It is very unlikely that a patient with symptoms of Ebola will need urgent dental treatment. In addition, patients with flu-like symptoms are generally not supposed to attend dental appointments. However, all team members in a dental practices and dental hospitals must be aware of the outbreak and raise immediate concern if Ebola is suspected.

Staff who are in contact with any patient should wear all the standard PPE. Gloves, masks, eye protection and plastic aprons should be worn at all times during contact with patients, especially for surgical procedures. Staff wearing their own glasses should still wear surgical visor masks to eliminate any splashes and fluids getting into the eye tissues. Any droplets from a sneeze can get directly into our eyes. 

Plastic aprons should be worn on a regular basis to protect the scrubs and tunics which we wear during lunchtimes and breaks. 

If we have a patient in a dental chair and they are showing possible Ebola symptoms, we must make hand hygiene our top priority. Washing hands every few minutes with soap can be very time-consuming and not too good for dry skin, but Ebola is readily inactivated by the use of soap and alcohol gels. 

If droplets from a patient with possible Ebola symptoms get onto your skin, the area must be washed immediately and the incident must be reported to the manager of the premises in which you are working.

If the same patient needs to use the washroom of your surgery, it should be locked and designated ‘out of use’ immediately after the patient has left. It must then be decontaminated with bleach, preferably by the inspection unit team. 

The biggest risk of infection occurs during the cleaning process following contact with the suspected Ebola patient. Any laundry or clinical waste must be incinerated. Any hand pieces and clinical instruments need to be sent off for sterilization immediately. Without proper sterilization, the virus transmission can continue rapidly. 

To sum up, I would like to remind all of us to be open-minded and sensible when we treat patients with flu-like symptoms and remember the risk of ebola being imported to the UK is currently considered to be low. These symptoms can be misleading, and thus carry a hidden risk in the form of the Ebola virus. We must protect ourselves and other staff as much as we can, and must not forget to use all our PPE equipment during all the time we are working in close contact with patients. 

Patients should be treated with dignity and respect, and we have to remember to treat all our patients equally. If we are worried and notice something suspicious, we cannot panic and make the situation appear worse than it is. We must stay calm and professional, and seek help as quickly as possible. 

I hope that as dental professionals we are all here to help our patients, and feel comfortable working with Ebola risks in the background. For more information and help, see the following webpages:

Department of Health

NHS England

WHO

Written by Sylvia Borgeouis  RDN, MSc, DTTLS

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