Latest / Orthodontic Products Podcast / Measles: How To Keep Staff and Patients Safe From Infection

Transcript

Measles: How To Keep Staff and Patients Safe From Infection · Orthodontic Products Podcast

• 0:06
  Alison Werner: Hello and welcome to the Orthodontic Products
• 0:07
  podcast. I'm your host Alison Werner. We have a special
• 0:10
  episode this week touching on a timely issue that may be
• 0:13
  affecting your community and your practice. Specifically the
• 0:16
  rise in measles cases in certain parts of the United States. To
• 0:20
  break down the current situation and what the orthodontic team
• 0:22
  needs to know to protect staff and patients is infection
• 0:26
  prevention expert Jackie Dorst. Jackie, thanks for joining me
• 0:29
  today.
• 0:30
  Jackie Dorst: Thanks, Alison. It's always good to share
• 0:32
  information with your viewers.
• 0:35
  Alison Werner: Great. Well, so I know this is a topic that came
• 0:38
  up recently on the AAO Staff Club Facebook group. So some of
• 0:43
  our listeners may be aware of the outbreak in Florida and more
• 0:46
  recently, they there have been some cases in Michigan. Can you
• 0:49
  talk about what's currently going on?
• 0:52
  Jackie Dorst: Yes, the Michelle Ritterscamp with AAO, who
• 0:55
  manages the AAO staff club, had read about increasing numbers of
• 1:00
  measles cases in the United States. And she contacted me and
• 1:04
  she said, Is this a concern for ortho offices? And if so, is
• 1:08
  there some information that we should be sharing? And so I put
• 1:12
  together a short informational posting to include on the staff
• 1:17
  club webpage or a Facebook page with them about the current
• 1:22
  status of measles infections in the United States, and concerns
• 1:26
  for the orthodontic office and how we can manage these
• 1:31
  potential infections if they had an outbreak in their community.
• 1:34
  So it's very timely information as this, it seems like daily
• 1:40
  that I'm getting updates from both CDC and in the news media
• 1:44
  about measles cases in different communities.
• 1:49
  Alison Werner: Okay, so let's talk about measles. It actually
• 1:52
  was declared eradicated in the US in 2000. But there have of
• 1:56
  course, been outbreaks since then they are increasing. So
• 2:00
  what do we need to know about measles?
• 2:04
  Jackie Dorst: Well, measles is caused by a virus. It is an
• 2:07
  airborne transmission of the virus. And it is the most highly
• 2:11
  infectious of airborne transmitted diseases. You know,
• 2:15
  we learned about R-naughts the infectivity during the pandemic,
• 2:19
  and it has an R naught of that estimated between between 15 and
• 2:24
  18, and is used as the standard really for how infectious are
• 2:29
  airborne diseases. Measles is a childhood disease that is
• 2:35
  vaccine preventable. The vaccine is very effective, over 90%
• 2:41
  protection from it. But we have to have vaccination of 95% of
• 2:48
  the population to provide that herd immunity. So with the
• 2:54
  pandemic, interrupting socially and healthcare wise vaccination
• 3:00
  rates, we've seen a drop in the vaccinations and even prior to
• 3:04
  that, for whatever reason, there have been communities where
• 3:07
  vaccination levels have dropped below that 95%. And since 2000,
• 3:12
  there have been a few years where there was an incidence of
• 3:17
  measles back diseases with it, and believe the year was 2014.
• 3:22
  Just to give you an example, Alison, that there was one child
• 3:28
  who visited Disneyland in California that was infected
• 3:32
  with measles. And within 14 days, there were over 800 cases
• 3:39
  of measles that cropped up because of that one child, the
• 3:44
  zero patient, if you will, being at Disneyland. So we've seen,
• 3:48
  you know, just a few cases, again of this vaccine
• 3:52
  preventable diseases until 2019. And then in 2019, it was is if
• 4:00
  the herd immunity was lost, we dip down in enough communities
• 4:05
  that there was a peak in infections. And in 2019, there
• 4:10
  were actually 1,274 infections and the health the public
• 4:17
  health, you know, was concerned. And then what happened? We had
• 4:21
  the pandemic and all of the respiratory protections that was
• 4:25
  implemented with wearing masks, hand hygiene, fresh air in the
• 4:31
  office and air filtration to prevent COVID transmission
• 4:35
  prevented respiratory diseases in general, both influenza,
• 4:40
  colds, RSV, and potentially measles with it, and we didn't
• 4:46
  see another incident. Now, as we've exited the pandemic, we're
• 4:52
  in our new normal with it now. People have dropped precautions,
• 4:55
  right. And we're getting out socially and we're going to
• 4:59
  sporting events and entertainment events where
• 5:01
  there's crowds of people and traveling a lot more
• 5:04
  internationally. And yes, measles was supposed to have
• 5:08
  been eradicated from the United States in 2000, but not
• 5:11
  globally. And that's where we've seen, there are other countries
• 5:15
  where there are higher rates, such as in India and in England,
• 5:20
  that we're seeing higher rates of measles transmission. And
• 5:23
  with travel, then you can have patients come back to the United
• 5:26
  States that acquire an infection. Unvaccinated people,
• 5:31
  even adults are at risk of an infection, but especially
• 5:35
  infants. An infant under one year old, they don't receive
• 5:39
  their, their measles vaccine, their MMR vaccines, measles,
• 5:43
  mumps, and rubella. All three vaccines are given when the
• 5:47
  baby's one year old. Younger than that they have their
• 5:50
  mother's protection with it, and their immune system hasn't
• 5:54
  developed enough for them to produce antibodies with it. So
• 5:58
  that's why that vaccinate vaccination is scheduled for the
• 6:02
  one year mark on it. And babies could get infected during that
• 6:05
  international travel with it. So highly infectious airborne
• 6:09
  disease.
• 6:10
  Alison Werner: So what are some of the symptoms that people
• 6:12
  should be looking out for?
• 6:15
  Jackie Dorst: Well, like all virus, respiratory diseases,
• 6:19
  that cough, you can have a cough with it, runny nose, oh my gosh,
• 6:23
  that is one of the first symptoms that you'll see. And
• 6:27
  high fever, fever will run up to 104, possibly 105 with a measles
• 6:33
  infection. But for us in the orthodontic world, in oral
• 6:38
  health, one of the first symptoms will be lesions inside
• 6:42
  the mouth. Before they might even develop the cough or the
• 6:46
  fever, there is a unique oral lesion called a Koplik spot. And
• 6:53
  I think you've got some photos of it that you can bring up with
• 6:56
  us for our viewers to see with it. And they'll usually be on
• 7:00
  the inside of the buccal mucosa, or on the soft palate. So that's
• 7:04
  one of the things that I would encourage ortho offices, if you
• 7:09
  hear of a one or two cases, even in your community, start doing
• 7:13
  that oral exam, you know, when we look at a patient's mouth,
• 7:16
  the first thing they're going to look at is the alignment of the
• 7:18
  teeth. And are there any brackets off? And you know, are
• 7:22
  we changing archwires today? Or are you due for a new aligner
• 7:26
  with it? But look on the inside of the cheek, look at the soft
• 7:29
  palate, do that quick oral soft tissue exam. And if you see any
• 7:33
  of those Koplik dots, then definitely that's an alert. I
• 7:39
  would segregate the patient into another room even not even in
• 7:44
  the open bay area. Because this virus with it being an airborne
• 7:49
  disease, it can stay suspended in the air for up to two hours
• 7:53
  after an infected patient is even sitting in the reception
• 7:57
  room for 15 minutes or in the open bay. So you would want to
• 8:01
  segregate them immediately. And then dismiss them and reschedule
• 8:05
  them for another appointment and just say, you know, we are
• 8:09
  suspicious of this, looks like we're not definite, please go
• 8:13
  see your doctor. And because we don't have I airborne isolation
• 8:17
  rooms in our ortho office. So you don't want to put the rest
• 8:20
  of the team or other patients at risk.
• 8:23
  Alison Werner: Okay. And then what are the complications with
• 8:26
  measles?
• 8:27
  Jackie Dorst: Well, a measles infection, we think of it is a
• 8:30
  childhood disease and you know you're sick for a week or so
• 8:34
  stay out of school. I was born before 1957, which is the year
• 8:39
  that the measles vaccine was introduced in it and we saw mass
• 8:45
  vaccination starting in the 60s with it. And CDC says that
• 8:49
  anyone born before 1957 is assumed to have acquired
• 8:53
  immunity having had that infection. And I remember when I
• 8:57
  had it, and one of the things is having ear complications with
• 9:02
  it. The infection can actually affect the ear and cause hearing
• 9:07
  loss that is a lifelong hearing loss or affects the eyes. I
• 9:10
  remember both with chickenpox and measles, my mom said, Hey,
• 9:14
  I've got to stay in a dark room, you're not gonna play outside in
• 9:16
  the bright sunshine, while you have that ocular eye infection.
• 9:21
  And of course, it's the rash over the full body. The high
• 9:24
  temperature can be a risk with it. And it can be there are
• 9:29
  fatalities with it. Not a lot. It's you know, maybe one in 1000
• 9:34
  and it's usually from complications such as developing
• 9:36
  pneumonia. So initially, the cough, runny nose with it and
• 9:41
  the high fever and of course, like any viral infection, the
• 9:45
  aches and pains, the fatigue with it, but those oral lesions
• 9:49
  are a real early symptom that we can identify in our orthodontic
• 9:55
  practices.
• 9:57
  Alison Werner: Okay, so you talked about the oral exam and
• 9:59
  those are only And so what can staff do? What can the ortho
• 10:05
  team be doing to protect staff and patients?
• 10:08
  Jackie Dorst: Well, let's go back to what we learned during
• 10:12
  the pandemic. And it's about protecting against all of those
• 10:16
  airborne diseases. And I'm going to call in CDC refers to them as
• 10:21
  ILI, influenza like illnesses. So flu, RSV, colds, all of those
• 10:30
  diseases that can be transmitted in the air, then we want to take
• 10:35
  precautions. So number one, how is your heating and air
• 10:38
  conditioning system working is it at its maximum efficiency,
• 10:42
  you want to have at least six air changes per hour. When have
• 10:47
  you change your your filter on the heating and air conditioning
• 10:49
  system. We learned that a MERV 13, minimum efficiency reporting
• 10:54
  value, provides at least 50% filtration of point three micron
• 10:59
  size particles. And that should be changed on a regular basis. I
• 11:03
  can't give you how often, it depends on how busy your ortho
• 11:07
  practice is. If you're working four days a week, and you're
• 11:10
  seeing 200 patients a day, you probably need to change your
• 11:13
  filter more frequently than an office that works three days a
• 11:16
  week and maybe sees 40 to 60 patients. So what's the traffic
• 11:21
  in your office how you know that you need to change that filter.
• 11:25
  And I would suggest at least once a quarter if not once a
• 11:29
  month, depending on the traffic with it, and then you want as
• 11:32
  much fresh air coming into the building as possible. And we use
• 11:37
  an indirect way of measuring that looking at the carbon
• 11:40
  dioxide. Because the more densely populated we have the
• 11:45
  office, more patients the team members in the office. If that
• 11:49
  carbon dioxide where we're exhaling each time gets above
• 11:53
  800 parts per million, then the risk of acquiring an airborne
• 11:56
  infectious disease is greater normal outdoor carbon dioxide
• 12:00
  levels are at 400 parts per million. So keeping a simple co2
• 12:05
  monitor that you can buy online, in the reception room and in the
• 12:09
  open bay area is a good way to monitor, Do we have enough fresh
• 12:14
  air in our office. And then I would definitely check with the
• 12:18
  vaccination status of all your employees. I think that's
• 12:22
  important. We've had new team members join our offices as we
• 12:27
  had some maybe early retirements during the pandemic, if you have
• 12:31
  a team member who was not vaccinated as a child, then
• 12:35
  they're going to be at high risk of acquiring infection, and
• 12:38
  especially for say, young women in their 20s and 30s who could
• 12:43
  possibly be pregnant. If they were not vaccinated and acquire
• 12:48
  a measles infection, then it could affect their developing
• 12:52
  fetus. So again, recommending they go get that vaccine. It's
• 12:57
  one of the vaccines recommended for all healthcare providers by
• 13:01
  CDC in the US. And even if they haven't been previously
• 13:05
  vaccinated, if you had an outbreak in your community and a
• 13:08
  patient was identified as infectious, then go get that
• 13:11
  vaccine right now because even you having that vaccine before
• 13:17
  you develop signs or symptoms can help reduce symptoms or even
• 13:20
  prevent an infection. So it wouldn't be too late to say, oh,
• 13:24
  I've already been exposed. The vaccine won't do me any good.
• 13:28
  Alison Werner: Okay. And then what should offices do if there
• 13:33
  is an exposure in their office?
• 13:34
  Jackie Dorst: Because the disease is so highly infectious,
• 13:37
  let's say you do have that patient come in, and you do the
• 13:41
  oral exam and you see the lesions and you go, I would go
• 13:45
  ahead and notify patients that, you know, there has been a
• 13:49
  measles outbreak in the community, and it's been
• 13:53
  identified in within your office because of the risk. You want to
• 13:58
  notify patients. And if those patients have any unvaccinated
• 14:03
  family members or patients that were in your office within the
• 14:08
  last five days or so, because again, patients can be
• 14:13
  infectious before they show signs or symptoms, and then
• 14:16
  they're highly infectious for that three to five days
• 14:18
  afterwards. I would say, Please watch for symptoms. And if you
• 14:22
  do observe symptoms, please immediately go for a measles
• 14:26
  vaccine, see your physician and go from measles vaccination. And
• 14:31
  I would say watch for symptoms for 14 days, because the
• 14:34
  incubation period can be anywhere from 10 to 14 days with
• 14:37
  measles.
• 14:40
  Alison Werner: Okay. And then just to go back to keeping the
• 14:44
  ortho team and patients say, what are the masking what what
• 14:48
  do you recommend in terms of masking just to keep the
• 14:51
  practice safe?
• 14:52
  Jackie Dorst: Well, I've had a there's a debate and it's just
• 14:56
  going to be an office policy at this time. Ortho offices need to
• 15:00
  watch for postings on their local health department about
• 15:05
  airborne diseases especially such as measles, and we're going
• 15:08
  to see other emerging and reemerging diseases in the
• 15:11
  future. So you just need to stay aware of community transmission
• 15:16
  and your office, verify that you are current with your infection
• 15:21
  control standards with your know what your disinfectants are, are
• 15:25
  they effective against healthcare acquired infections.
• 15:30
  And speaking of that, EPA, which regulates disinfectants, now
• 15:35
  just published a new blood borne pathogens list that is called
• 15:39
  the EPA List S. And it combined about five different lists that
• 15:44
  EPA had. So you want to make sure that your, your
• 15:49
  disinfectant that you're using is on that List S, you know, as
• 15:53
  a health care disinfect disinfectant. Review your
• 15:57
  airborne disease transmission precautions, and then screening
• 16:01
  patients with it. Wearing a mask is always from the respiratory
• 16:06
  disease system from October until April a wise precaution.
• 16:12
  It is a prevention with it. And it doesn't have to be that N95
• 16:16
  respirator mask. It can be a level two, or a level three.
• 16:21
  Both of those procedure masks provide the same level of
• 16:25
  particle filtration. With them, the only difference is a slight
• 16:29
  fluid increase with the level three on there. So it would be
• 16:33
  wise to wear that mask as a prevention for both the front
• 16:37
  desk team and the clinical team. Because this disease is not one
• 16:41
  that's just transmitted in blood or saliva, it's airborne. So the
• 16:45
  entire team needs to be protected. And many hospitals
• 16:49
  during the season are reimplementing mas protocols for
• 16:52
  both visitors, patients and staff during this time,
• 16:56
  especially during the community outbreak, so you have to use
• 16:59
  good professional judgment and keep up with community
• 17:03
  transmission of diseases in your area.
• 17:05
  Alison Werner: Right. And they can find that information
• 17:07
  through their their local health department.
• 17:10
  Jackie Dorst: The their local health department. And I have in
• 17:13
  my Google Alerts. That's what I go through every morning what
• 17:16
  pops up in the entire United States and even globally on
• 17:20
  safety and infectious diseases. But the health department in
• 17:25
  both the media, the media has been good to alert about the
• 17:29
  outbreaks that are in Florida now. I know this morning, I saw
• 17:33
  three new cases that were just in Michigan. And when you have
• 17:37
  an outbreak there, it can spread like fire through a community
• 17:43
  because of the high infectivity and the airborne disease. So
• 17:46
  keeping up with your your local health department is one of the
• 17:50
  best ways to stay informed.
• 17:52
  Alison Werner: Okay. And I know you wanted to make a
• 17:55
  recommendation to doctors to visit the CDC website page
• 17:59
  focused on measles. Should they Well,
• 18:01
  Jackie Dorst: as the case has started reemerging. I thought I
• 18:04
  need to review what are signs and symptoms complications. And
• 18:07
  the CDC are this is another improvement that we're seeing
• 18:12
  post pandemic with it. CDC is updating their website. I didn't
• 18:19
  realize it but there are over 220,000 web pages in the CDC
• 18:25
  website. And if you've been looking for information, and
• 18:28
  especially during the pandemic, we will all spend maybe two or
• 18:31
  three hours trying to find a specific page with it. They are
• 18:35
  in the beta test. Now I was privileged to sit in on the
• 18:38
  initial introductory meeting for that last week. And it's going
• 18:42
  to be a huge improvement. Much, much more user friendly, easy to
• 18:49
  locate information with it. And we won't lose information as the
• 18:54
  CDC is revamping their website. Some of it that's not that's it
• 18:59
  will be archived. And it will still be available if you want
• 19:02
  to do a deep search on it. But it's going to bring up the more
• 19:05
  relevant information and as things change that there'll be
• 19:09
  posted with it. So I looked up measles on the CDC website,
• 19:14
  you'll go to the main page, then go down to what health care
• 19:18
  professionals need to know. Click on that. And there is an
• 19:22
  educational video. And the same PowerPoint slides that were used
• 19:27
  in the video that came were posted in last fall. And it was
• 19:33
  from what's called COCA and it's the communication on for
• 19:39
  communities on issues of health for CDC that they put out and
• 19:45
  they do COCA calls routinely with emerging issues such as
• 19:49
  measles with it. And just reviewing those the PowerPoint
• 19:52
  slides, it took me about maybe five to 10 minutes to click
• 19:56
  through about 40 of those relevant slides. How the disease
• 20:00
  is transmitted, what are the symptoms? What's the prevention
• 20:04
  with it? And what are the risks or complications with the
• 20:07
  disease? I think it's wise for every doctor and for the
• 20:11
  clinical team to quickly review those slides. If they prefer to
• 20:14
  listen to the video, they have the option of listening to the
• 20:17
  video just to update themselves on measles, and the measles
• 20:22
  complications with it and how it could affect the orthodontic
• 20:26
  practice.
• 20:26
  Alison Werner: Okay, well, we will provide a link to that
• 20:30
  measles website, as well as the direct page for the video and
• 20:34
  then a direct page or direct link for the for the PowerPoint
• 20:38
  slide, Jackie, as always, it's great to see you and thank you
• 20:41
  so much for all this information.
• 20:44
  Jackie Dorst: Well, thank you for sharing this information. I
• 20:46
  think it's very timely Alison. And my hope is that this measles
• 20:50
  infection will just be a little blip. But it's wise for us to
• 20:55
  share the information in case there are is a bigger spread
• 20:59
  with communities. And the orthodontic team knows how to
• 21:04
  care for patients safely and to prevent transmissions in their
• 21:07
  office. So thank you for sharing the information about the AAO's
• 21:12
  orthodontic staff club and the AAO being proactive and sharing
• 21:16
  this information and for getting the information out. There are
• 21:21
  always emerging issues that we can do to be the best in our
• 21:26
  orthodontic practices.
• 21:28
  Alison Werner: Exactly. All right. Well, thank you so much.
• 21:31
  As always, thank you for joining us. Be sure to subscribe to the
• 21:33
  orthodontic products podcast to keep up with the latest
• 21:35
  episodes. And be sure to check out orthodontic products
• 21:38
  online.com to keep up with the latest industry news. Until next
• 21:41
  time, take care