Infection control in an emergency

In March, when floodwaters submerged the generator substation supplying Greater Darwin, the region’s water supply was thrown into chaos.

Heavy tropical rains saw homes inundated without warning, remote communities evacuated and roads under
water. The event also caused the Darwin River Dam to reach capacity and overflow, and subsequent flash flooding submerged the pump station’s generators, cutting off the ability to draw water from the dam entirely.

Because bore water was being used to supplement the water supply while authorities worked urgently to restore the system, NT Health issued a rare boil water alert for Darwin, Katherine, Wugularr (Beswick) and Tindal. The 140,000-strong population was advised to boil water before drinking it due to the possibility of contamination from domestic and wastewater treatment and septic systems.

As reported by the ABC, school water fountains were switched off, restaurants could only serve bottled water and every home’s kettle went into overdrive. As the entire area came to grips with the directive, local dentists were left wondering about their next steps and questioning if they could keep their practices open and conduct anything that resembled business as usual.

Within 48 hours of the Darwin boil water alert, the ADA’s Infection Control Committee had rallied to provide ADA NT members with practical, specific advice to help them respond to the situation.

A test under pressure

Dr Emma Neibling, then President of the ADA Northern Territory, explained: “The March emergency resulted in NT Health releasing a boil water alert that directly impacted our ability to practice and provide safe care for our patients.”

“We obviously have water from mains running into clinics for the chair and sterilisation. It was even affecting things like hand hygiene,” Dr Neibling explained.

“Dentists were asking: how do we ensure hand hygiene under a boil water alert? What do we need to do
differently? And how do we provide safe treatment to patients while this is happening? The lack of reliably clean water impacted everyone significantly.”

There were no Australian dental guidelines specifically for this scenario, and no local precedent to reach for, which meant some practitioners closed their doors as a precaution.

Confidence to practice safely

Fortunately, the Infection Control Committee’s response was swift. They got straight to work to deliver guidance into members’ inboxes.

“The Committee were able to look at the specific alert we had given them, look at our local issue in particular, and create specific recommendations including practical things that clinicians could do to make the water safe, and how to change their practice in order to provide safe treatment,” said Dr Neibling.

“This meant practitioners could have an understanding of how to move through the boil water alert, whether they needed to change anything or whether they could actually commence practice.”

“For the dentists who had closed their doors because they weren’t sure how to proceed safely, the information gave them the confidence to continue to offer their services.”

The guidance didn’t stop when water sources were given the all-clear.

“The issue wasn’t just during the alert. We also received information about what to do after the alert was lifted as well, including how to flush lines and how to treat dental unit waterlines. The alert lasted three days. The resource will last considerably longer. Something like this could happen again.”

“We get so much rain up here from cyclones and wet seasons. This was the biggest event people had seen in a while, but it’s how the Top End works. Having a resource we can use again, if required, is really helpful.”

“Trying to contact NT Health specifically about dental things is challenging because the differences between what hospitals do versus what we do are significant. This is why having specific information was so important. The information the Infection Control Committee provided us with prevented the spread of misinformation, and a situation where practitioners didn’t know how to safely provide treatment,” said Dr Neibling.

Interpreters for the dental profession

The Northern Territory floods are a reminder that the Infection Control Committee does more than set the guidelines and support compliance. The COVID-19 pandemic showed us that not only does the Infection Control Committee excel at providing ongoing advice and assistance, when something happens the committee rallies to ensure no dental practitioner has to manage a complex and urgent situation on their own.

Dr Heidi Munchenberg, the current Infection Control Committee Chair, says “We’re a bit like an interpreter, guide and even the ‘agony aunt’ for our profession.”

“If we didn’t have the Federal ADA Committee as a single voice, we’d have more varied advice, more individual interpretation and variation in practice. If you have ever tried to read a standards document yourself, you’ll know that interpreting it can be difficult. Having the information put in plain language is so valuable.”

“The principles of infection control go across the whole health sector. They’re not just for dental. But our job is to explain how infection control fits into what dentists do every day in their clinic.”

“Our guidelines have been the go-to for infection control in the dental profession for many decades, We make them available at no charge, because our focus is on lifting the whole profession. But our members gain access to so much more via the Infection Control Library,” said Dr Munchenberg.

More than the mandate

The ADA Infection Control Committee’s formal mandate covers researching infection control policy and advising the ADA Board, but that description understates its day-to-day impact.

In practice, Committee members meet regularly to maintain the publicly available infection prevention and control guidelines, develop supporting library resources, answer member questions, and represent dentistry at a national level. Committee members sit on Standards Australia committees covering reprocessing and personal protective equipment, and contribute to the Australasian College of Infection Prevention and Control to ensure dentistry has a voice in national health policy.

As the Darwin event showed, this dedicated group of volunteers is the reliable engine working behind-the-scenes to ensure that evidence-based, best practice infection prevention and control remains consistent for every dental practitioner across the country.