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H1N1 vaccination recommendations for dental providers
Overview
Frequently Asked Questions
Summary
Resources
Free online CE credit
The Centers for Disease Control and Prevention is providing important, up-to-date information to the public and health care providers on the recent outbreak of the H1N1 virus (swine flu) in humans.
Go to the CDC swine flu Web site for:
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Interim CDC Guidance for Clinicians & Public Health Professionals regarding case identification
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Infection Control for Care of Patients with Confirmed or Suspected H1N1 Virus (swine flu) Infection in a Health Care Setting
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Mask and respirator use
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Other topics pertinent to dental health care providers
Information will be updated regularly, so check frequently for the latest information.
Dental health care providers are urged to view the main CDC swine flu Web page for the latest updates. See below for frequently asked questions by dental professionals. Or, view specific recommendations for dental health care settings.
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Health care worker vaccination recommendations
Protect your patients and yourself from influenze: Get vaccinated!
The CDC recommends seasonal and 2009 monovalent H1N1 influenza vaccination for all health care workers because of their critical role in the health care system and their increased risk of exposure to patients with influenza, as well as concern about transmission of the viruses to susceptible patients. Specifically, the Wisconsin Department of Health Services considers dentists and dental hygienists as "front line health care workers" and should receive top priority in H1N1 vaccinations. The best way for dentists and dental team members to find the nearest clinic is to contact their city or county health department, identify themselves as licensed individuals, reference the CDC guidelines and ask where they can obtain the vaccination. The 2009 H1N1 monovalent influenza vaccine is made in the same way as seasonal flu vaccine, which has a very good safety track record. Preliminary data suggest that the immunogenicity and safety of these vaccines are similar to those of seasonal influenza vaccines. Seasonal influenza vaccination among health care personnel reduces the flu-related mortality risk among patients at highest risk of severe illness. Despite the documented benefits of health care worker vaccination, seasonal influenza vaccine coverage in past seasons among this group has remained low (less than 50 percent) nationwide. Influenza outbreaks in hospitals and long-term care facilities have been associated with low vaccination rates among health care workers, while higher vaccination levels among staff are associated with a lower incidence of nosocomial influenza cases. |
Prevention of disease transmission in the dental health care setting
Patients with an acute respiratory illness may present for dental treatment at outpatient dental settings. The primary infection control goal is to prevent transmission of disease. Early detection of a suspected or confirmed case of H1N1 virus (swine flu) and prompt isolation from susceptible persons will reduce the risk of transmission.
According to Wisconsin's Pandemic Flu Resource, a clinical description of H1N1 (preliminary findings) include:
- Fever - 94%
- Cough - 92%
- Sore throat - 66%
- Vomiting - 25%*
- Diarrhea - 25%*
- V and D - 38%*
To prevent transmission of respiratory infections in health care settings, including influenza, respiratory hygiene/cough etiquette infection control measures should be implemented at the first point of contact with a potentially infected person.
Infection control issues during patient assessment
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Patients with an acute respiratory illness should be identified at check-in and placed in a single-patient room with the door kept closed.
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Offer a disposable surgical mask to persons who are coughing or provide tissues and no-touch receptacles for used tissue disposal.
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The ill person should wear a surgical mask when outside of the patient room.
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Dental Health Ccare Personnel assessing a patient with influenza like illness should wear disposable surgical facemask*, non-sterile gloves, gown and eye protection (e.g., goggles) to prevent direct skin and conjunctival exposure. These recommendations may change as additional information becomes available, so check the CDC Web site for updates.
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Patient and dental health care workers should perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic handwash) after having contact with respiratory secretions and contaminated objects/materials.
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Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental management of H1N1 virus (swine flu). Click here for more information.
*Until additional, specific information is available regarding the behavior of this influenza A (H1N1/swine flu), the October 2006 “Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings during an Influenza Pandemic” is referenced at this time and reflected in the above recommendations. These interim recommendations will be updated as additional information becomes available.
1. What to do if a patient presents for routine treatment and has acute respiratory symptoms with or without fever?
If the dentist suspects the illness could be due to swine influenza (symptoms include fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea), elective dental treatment should be deferred and the patient should be advised to contact his or her general health care provider. The general health care provider will determine whether influenza testing or treatment is needed. Refer to the CDC Web site for case definition and other information.
2. What to do if a patient with acute respiratory symptoms requires urgent dental care?
If urgent dental care is required and swine flu has been confirmed or is suspected, the care should be provided in a facility (e.g., hospital with dental care capabilities) that provides airborne infection isolation (i.e., airborne infection isolation room with negative pressure air handling with 6 to 12 air changes per hour).
For aerosol-generating procedures, use a procedure room with negative pressure air handling. Personnel providing direct patient care for suspected or confirmed swine influenza A (H1N1) cases should wear a fit-tested disposable N95 respirator when entering the patient room and when performing dental procedures.
Respirator use should be in the context of a complete respiratory protection program in accordance with Occupational Safety and Health Administration regulations. Visit the OSHA Web site for information on respiratory protection programs and fit test procedure.
3. What to do if staff report to work with acute respiratory symptoms?
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Staff experiencing influenza-like-illness (fever with either cough or sore throat, muscle aches) should not report to work.
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Staff who experience influenza-like-illness and wish to seek medical care should contact their health care providers to report illness (by telephone or other remote means) before seeking care at a clinic, physician’s office or hospital.
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According to CDC guidance, staff not using appropriate personal protective equipment during close contact with a confirmed, probable or suspect case of swine influenza A (H1N1) virus infection during the case’s infectious period should receive chemoprophylaxis according to CDC guidance.
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Staff who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention.
Respiratory hygiene/cough etiquette infection control measures along with contact precautions are currently recommended for preventing transmission of swine influenza in a dental health care setting.
The CDC is working very closely with officials in states where human cases of swine influenza A (H1N1) have been identified, as well as with health officials in Mexico, Canada and the World Health Organization.
This is a rapidly evolving situation and CDC will provide updated guidance and new information as it becomes available.
Additional guidance is available from:
- Centers for Disease Control & Prevention
- OSHA
- National Institutes of Health
- World Health Organization
- Department of Health & Human Services - includes new preparedness guide for small businesses
In an effort to encourage the profession to play an active role in both preparedness and response to this outbreak, the New York State Dental Foundation is offering one free home study credit for those completing a short quiz based on the CDC document titled "Prevention of H1N1 Influenza A (Swine Flu) in the Dental Healthcare Setting."
This credit applies for Wisconsin's CE requirements for dentists and dental hygienists.