Safeguards for Personal Health
Personal protection prior to departure: Immunizations are an essential part of prevention and infection-control programs before a trip. Dental health care personnel are considered to be at substantial risk for acquiring or transmitting hepatitis B, influenza, measles, mumps, rubella, typhoid, varicella, and yellow fever. Those diseases are preventable with vaccines. Volunteers should be vaccinated or have documented immunity to the diseases prior to a trip. Complete information about individual needs and U.S. and host government requirements can be obtained by going online and reading the CDC General Recommendations on Immunization at www.cdc.gov/travel.
Personal protection in the clinical area: All dental health care personnel who could possibly be occupationally exposed to infectious materials, including bodily substances, contaminated supplies, environmental surfaces, equipment, air, or water, during a trip should read or be informed about basic rules and recommendations prior to starting any clinical work. Important information is available at the Organization for Safety and Asepsis Procedures (OSAP) Web site at www.osap.org. OSAP is dedicated to promoting infection-control and safety policies and practices supported by science and research to the global dental community.
The universal precautions regarding infection control described in the next subsection are based on the concept that all blood and body fluids from patients should be considered to be infectious. Since most patients come from remote areas with few infection-control measures, patients can be asymptomatic or unaware that they are carrying any infectious disease, such as the human immunodeficiency virus (HIV) or hepatitis B and hepatitis C. The best protection for volunteers is to use proper standard precautions that include the following: 1) thorough hand-washing, 2) use of gloves, masks, protective eyewear, and gowns, 3) cautious handling of sharp instruments, and 4) possible use of some kind of rubber dam to minimize blood spattering.
Clinical accidents usually occur when an operator is in a hurry, is using an improper technique, or is tired. Conditions and the environment in the field might be completely different from those in a dentist’s practice in the United States, so the possibility of such accidents is even greater in a foreign country. Dental health personnel should take breaks from the clinic and make sure they remain hydrated and are getting enough rest.
Disinfection, sterilization, and infection-control guidelines: The most updated guidelines concerning disinfection, sterilization, and infection control in health care and dental care facilities are available online in the Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, which can be found at www.cdc.gov/ncidod/dhqp/pdf/guidelines/Disinfection_Nov_2008.pdf and in the CDC Guidelines for Infection Control in Dental Health-Care Settings, which was published in Morbidity and Mortality Weekly Report in 2003 and which can be accessed online at www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm. The survival of a virus can depend on its individual characteristics, the condition of the environment, and other factors. The Centers for Disease Control and Prevention has one of the best online sources for credible health information on many health topics, including viral disease, and can be obtained at www.cdc.gov/health.
A percutaneous exposure with a contaminated instrument can be a serious concern to a volunteer. Planning for this eventuality should be included in pretrip preparations. Knowledge about the overall prevalence of HIV infection in the country and region where the volunteer mission will be located should be obtained beforehand, and if a percutaneous injury should occur, the HIV status of the patient from whom an infection might have been spread should be determined. The penetrated site should be washed with soap and water or a disinfectant. The use of bleach at the site or squeezing the site to express blood is not recommended.
Although the risk of developing HIV subsequent to a percutaneous exposure is low (approximately 0.3 percent), fear of HIV exposure is perhaps the greatest cause of anxiety among volunteers who have been injured. The risks to an individual and the population as well as the risks of treatment versus the benefits must be weighed, however. Recommendations and further details for exposure and post-exposure prophylaxis against HIV, hepatitis B, and hepatitis C are available online from the U.S. Centers for Disease Control and Prevention at stacks.cdc.gov/view/cdc/20711. A volunteer may want to take OraQuick HIV quick diagnosis test and a course of antivirals in case of exposure with an infected patient
In many cases, the project’s host provides meals to volunteers. In some situations, personal provisions or funds to obtain meals will be necessary. In all situations, there are some general rules regarding food consumption. Many rural areas use untreated animal or human manure, or night soil, as fertilizer. Because of this, raw vegetables or fruits that cannot be peeled should not be eaten. Salads with lettuce or cabbage can also be a problem. Fruit that has had its skin or rind punctured should not be eaten. The tip of a banana should be cut off before taking a bite because little flies or worms could be residing in the exposed end of the fruit. If food cannot be peeled, boiled, or cooked, it should not be eaten.
As for liquids, soda and beer bottles should be checked before drinking because reusable bottles may not have been thoroughly cleaned or might have rust rings at the opening. Coffee is usually not a problem, because the water is boiled in the process of brewing it. Lemonade with ice, though, could be a different issue altogether. Ice, an easily overlooked source of pathogens, should be avoided unless the water in-country is absolutely safe. It is wise to check on the availability of certain foods if you have special dietary requirements.