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UK's HIV dentists to practise again?
10th Aug 2011
If you take a week's holiday away from the surgery, on the first day back to work you may well decide to arrive at the surgery a little earlier than usual in anticipation of a few things that you need to catch up with.
A little preparation before the first patient arrives can help prevent you from running late, while your adrenaline levels struggle to adjust from the relaxed holiday setting into something a little more energised.
The lapse of time
If you take a month off work, not only do you have a lot more to catch up with, but there may also be some aspects of previously planned treatment that you may feel less confident about tackling, deciding instead to reschedule them for another day; all the more so if you find an unfamiliar dental nurse has been allocated to assist you on your first day back.
'Dental students who are currently required to take an HIV test before starting their training can progress through their course without the fear that they might suddenly be forced to discard the time and money invested in tuition because of a momentary indiscretion'
Taking a career break to raise a family or to pursue other interests can leave the clinician even more insecure. Periods of a year or more which are spent away from clinical activity can result in significant de-skilling for any clinician and, consequently, a loss of confidence.
In the past, the Department of Health funded the Keep in Touch Scheme (KITS) in an effort to attract back-to-work female dentists who had left the profession to raise a family. The deaneries now operate a ‘get back to work' scheme that allows individual dentists to undertake training to support their own personal skills development.
Back to work
This is exactly the same situation that could soon be facing dentists and hygienists who stopped practising when they discovered they were HIV positive. 2012 may be the first time in almost 20 years that this group of individuals will not be subject to the precautionary guidance that took them away from their chosen careers – or at least the exposure-prone elements of dentistry which is almost everything apart from making full dentures and the examination of the edentulous mouth.
Why were these precautions required?
Most undergraduates entering dental schools this year were not yet born when, in 1990, the world witnessed the public demise of an American dental patient named Kimberly Bergalis. She was one of six dental patients believed to have been infected with HIV by a dentist (Dr David Acer) in Florida, who was known to have AIDS.
The facts surrounding this one and only presumptive transmission of HIV from a dentist to a patient have been the subject of an extended debate that has failed to establish the route of transmission in the six patients. Nor could any criminal intent be excluded on the part of the dentist.
Regulatory bodies in most countries responded to the extensive emotional coverage in the media in very different ways – some banned HIV-infected oral healthcare professionals (OHCP+) from working outright, others promulgated updated infection control guidelines. In the UK the government and its advisors opted for the ultimate precaution.
They decided to prohibit healthcare workers with HIV from undertaking procedures which were exposure-prone. Dentistry was placed in the same category as orthopaedic surgery because, during treatment, the tips of the fingers were not always in full view of the clinician to whom they were attached.
20 years' later
Apart from the case of Dr Acer, no other transmissions of HIV in the dental setting have been demonstrated.
The data available from patient notification exercises supports the conclusion that the overall risk of transmission of HIV from infected healthcare workers to patients is extremely low. Between 1988 and 2003 in the UK, there were 28 patient notification exercises. However, there was no detectable transmission of HIV from an infected healthcare worker to a patient, despite more than 7,000 patients having been tested.
Two major developments
Since the Acer case back in 1990, there have been two developments that would suggest that the precautionary response that had been adopted in the UK should now be reviewed:
• The advances in the medical management of HIV disease
• Significant improvements in infection control standards.
Combination antiretroviral therapy (HAART) introduced in 1995 successfully diminishes viral replication and can lead to undetectable levels of HIV in plasma. Indeed, studies have shown that HAART is sufficiently effective to protect (at least 96% of the time) an uninfected partner when having unprotected sex with a person who has been taking anti-retroviral medication to treat their underlying HIV status. As you will have probably realised, unprotected sex is a fairly efficient way of transmitting HIV (as is sharing needles) while dentistry is not effective.
Just recently, infection control standards in UK dental surgeries have been upgraded again with the universal adoption of HTM 01-05. In addition, the introduction of bodies like CQC – and its equivalent in Wales, Scotland and Northern Ireland – will provide a regular audit of those newly elevated infection control standards, thereby assuring the track record that has already been proven to successfully prevent transmission of blood-borne pathogens (in both directions, from patient to dentist and dentist to patient).
What next?
Any OHCP+ who withdrew from practice and is now interested in returning to work would be well advised to contact their defence organisation regarding registration with the GDC (if that has lapsed) and for support while organising a programme of skills development in conjunction with their local deanery.
In this way, the necessary CPD requirements can also be achieved. Dental students who are currently required to take an HIV test before starting their training can progress through their course without the fear that they might suddenly be forced to discard the time and money invested in tuition because of a momentary indiscretion.
Dentists can at last join the rest of mankind in seeing a diagnosis of HIV as a signal to concentrate on their health and the available treatment, rather than being confronted with the immediate end to their career, combined with an immediate loss of income that can only compound the stress produced by that same diagnosis.
So all together now, ‘Why are we waiting…?'
Lord Colwyn: ‘To ask Her Majesty's Government whether they have received the report of the Tripartite Working Group established to review the current guidance on HIV-infected healthcare workers; whether they propose to publish it; and what steps they propose to take in relation to the guidance.' [HL9369] The parliamentary under-secretary of state, Department of Health (Earl Howe): ‘Professor Dame Sally Davies, the government's chief medical officer, received the Tripartite Working Group's report on the management of HIV-infected healthcare workers on 20 April 2011. Officials are currently considering the report and will be providing advice to Ministers in due course.' Even though the answer from Earl Howe is lacking in detail, it is likely we will see an announcement from the Department of Health on this subject in the near future, prior to a public consultation on the proposed changes in the management of the treatment provided by HIV-infected oral healthcare professionals (OHCP+).
The following extract from Hansard during May 2011 confirms that the current regulations are set to change.
Author
David Croser
David Croser was the clinical lead for the dental service dedicated to HIV patients in Kensington, Chelsea and Westminster. The service ran for 20 years and was part of the Community Dental Service. It now has general access. David is now the communications manager at Dental Protection.
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