Herpes simplex virus infection (oral) – standard or transmission based precautions (for dental treatment)

[Kylie Robb]

Hi everyone,

A question that comes up every now and then is whether a dental practitioner can refuse/delay to treat a patient who has oral herpes simplex virus (HSV) based on the principles of risk management and transmission based precautions (delay treatment).

Apparently a dental practice treated a patient who had HSV and then a couple of days later – the dentist and the assistant both developed a cold sore.

I am definitely not an infectious disease expert, however I do question the likelihood of this happening – especially if the chances of them both having previous exposure to the virus is probably likely. But you never know. Maybe they were both stressed and their latent viruses reactivated coincidentally at the same time, or maybe it was some other infection. Not sure.

I’ve attempted to do my homework by looking at the new NHMRC IC Guidelines P266 (image below) which indicates that it’s Standard (S) precautions – and yes, if there was a transmission, could that have been from a lack of adequate standard precautions such as hand hygiene, PPE and environmental cleaning (also inadequate reprocessing of shared patient equipment). I also consider whether any other patients contracted HSV along with the HCWs.

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The point I try to make is that it’s probably not appropriate to tell a patient (that wants treatment) they don’t want to see them simply because their infection control (standard precautions) is below average. This is a great case study to then lead on to the importance of hand hygiene, PPE and environmental cleaning etc.

But is this correct! I wonder whether the NHMRC Guidelines and Standard precaution recommendation is only for a patient that simply has a cold sore, not if you are conducting aerosol generating appointments for this patient.

To be honest, most patients with a cold sore simply reschedule as it really hurts to have lips and cheeks pulled around during treatment, but it appears this is not always the case.

I would value the insights of the knowledgeable brains trust with this one.

Thanks and happy Friday.
Kylie

Kylie Robb
Practice Services Manager
MHSM (Clinical Leadership) CICP-P
Australian Dental Association NSW Branch
Level 1, 1 Atchison Street, St Leonards, New South Wales 2065
t: 02 8436 9936
E: kylie.robb@adansw.com.au | W: http://www.adansw.com.au

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