NHS Infection prevention and control conference 2022

Infection Prevention and ControlLearning from Covid-19 & AMR

26 & 27 April 2022, National Conference Centre, Birmingham

This year, the NHS Infection Prevention and Control Conference takes place over two days and explored the lessons learnt from the COVID-19 pandemic and the important issues of antimicrobial resistance and Gram-Negative bloodstream infections.

Topics examined during the conference included outbreak management, improving hand hygiene (and auditing procedures), and decontamination/cleaning protocols. Speakers discussed the theme of infection prevention, review current control standards and celebrate best practice.

The accompanying exhibition will showcase the latest innovation and technology available globally.

For further details of the programme, visit https://www.infectionpreventioncontrol.net/conference-programme/

For a full list of invited speakers, go to https://www.infectionpreventioncontrol.net/speakers/

Aimed at all healthcare professionals, delegates can choose to attend either or both days.

Healthcare professionals working for the NHS, can register for a fully funded conference place here: https://www.infectionpreventioncontrol.net/tickets/

Fully funded places for CGDent members

CGDent members also qualified for access to a limited number of fully funded places, whether working in NHS or private practice.

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Remember, remember, the aims of November

Abhi Pal, President of the College of General Dentistry, says action by dental teams to promote understanding of oral cancer, antimicrobial resistance and the perils of excess sugar consumption can help reduce the burden of disease and prevent premature death.

Of the many significant causes which our College of dental professionals supports, it so happens that three of those around which annual campaigns are organised fall in November.

Mouth Cancer Action Month, organised by the Oral Health Foundation, raises public awareness of oral cancer, highlights the risk factors, educates people on what to look for and how to self-check, and encourages those who see anything unusual to visit their dental practice as soon as possible.[i]

Despite this vital work, the incidence of oral cancer has risen by 97% in the UK over the last 20 years, driven by a variety of lifestyle factors such as tobacco use and alcohol consumption.[ii]

Another of the causes is a rise in infection with human papillomavirus (HPV), which causes 5% of all cancers and is the leading cause of oropharyngeal cancers. Over two-thirds of oral cancer diagnoses are in men [iii], and those who were members of the Faculty of General Dental Practice UK (FGDP) should feel proud to be have been part of the successful HPV Action campaign – backed in a poll by 97% of FGDP and BDA members – for boys to be offered vaccination against HPV (just as girls have been since 2008), which will offer protection to 400,000 young men each year once fully rolled out.[iv]

Public awareness of the major signs and symptoms of oral cancer is, however, as low as 23%, and diagnosis is often at a late stage, and the number of deaths is also rising.[v] But chances of survival are much improved if cancer is detected and treated early, and general dental practitioners are uniquely placed to highlight risky behaviours to patients, to check for signs of cancers of the head and neck during the routine examination, to make referrals where they suspect a patient may have cancer or a pre-cancerous lesion, and to reassure, support and encourage patients to attend their referral appointment.

Dental practices can also play an important preventative role by raising awareness and displaying information in waiting areas, and crucially help ensure speedy access to treatment if needed by knowing their local referral pathway in advance.

CGDent’s new oral cancer webpage highlights guidelines, recommendations, webinars, posters and other resources which can help general dental teams play their part in tempering the rise in oral cancer, and I encourage you to take a look and bring it to the attention of practice colleagues.

World Antimicrobial Awareness Week, instigated by the World Health Organisation, runs from 18-24 November each year, starting with European Antibiotic Awareness Day on 18th.[vi] Antimicrobial resistance (AMR) is a global problem that leads to antibiotics no longer being effective in treating even simple infections, and there are serious consequences for everyone, particularly those undergoing major surgery, chemotherapy, organ or stem cell transplants.

Public discussion on this subject can sometimes give the impression that this is an issue for future generations to worry about, perhaps even a hypothetical one, but the scale of the problem is already significant. More than 2.8 million antibiotic-resistant infections occur in the US each year, and more than 35,000 people die as a result.[vii] And every year 25,000 people across Europe, and 700,000 worldwide, die from antibiotic-resistant infections, and it has been estimated that the annual global toll could be as high as 10 million by 2050.[viii]

Dentists issue around 5-7% of all antibiotic prescriptions in the NHS, and dental teams have a vital role to play in keeping antibiotics working by prescribing them only when necessary, and by educating patients to take and dispose of them responsibly.

It is a requirement of all healthcare providers in England that “procedures should be in place to ensure prudent prescribing and antimicrobial stewardship. There should be an ongoing programme of audit, revision and update” [ix], and these are good principles to follow regardless of where you practise.

Three key resources which can help you to do so were co-developed by the FGDP, and are now published by the College via our Standards & Guidance homepage:

  • The Antimicrobial Prescribing Self-Audit Tool helps dental prescribers to complete a clinical audit of their antimicrobial prescribing and management of dental infections, and to compare audited practice against the guidance

For many years the Faculty, together with the Association of Clinical Oral Microbiologists (ACOM), co-ordinated a collaboration of organisations to promote stewardship of antimicrobials, and this year the College picked up the Faculty’s role, working with ACOM to bring together 11 organisations across medicine and dentistry to hammer home the message that ‘antibiotics don’t cure toothache’.

Last year, our AMR Lead, Dr Wendy Thompson, presented a webinar on this theme called Now the drugs won’t work – treating people with toothache. Tonight she also led a new webinar called Talking standards: Antimicrobial prescribing in dentistry, offering a refresher on the guidelines, exploring how dental teams can help keep patients safe from untreatable infections, considering why dental practitioners might overprescribe antibiotics, and discussing the impact of COVID-19 on prescribing rates. We also heard powerful testimony from Vanessa Carter, a survivor of a multi-drug-resistant strain of MRSA, and member of the WHO Strategic Technical Advisory Group on antimicrobial resistance, which really illustrated the importance of antimicrobial stewardship, and I would commend you to watch. Co-produced with our CPD partner, ProDental, both recordings are available to CGDent members free of charge using the links above.

Sugar Awareness Week, organised by Action on Sugar from 8-14 November, aims to raise public awareness of the poor health outcomes associated with excess sugar consumption, and to get people talking about the importance of sugar reduction.[x]

The College of General Dentistry’s support continues that previously given by the FGDP, and the two organisations were among those who successfully campaigned for a ‘sugar tax’ on soft drinks, which since its introduction in 2016 has seen a 29% reduction in the sugar content of drinks subject to the tax, and a shift in purchasing towards lower sugar alternatives.[xi] We have also been pleased to see the further restrictions on the advertising and promotion of high sugar items which are starting to take place, and hope this will continue.

Action on Sugar’s analyses of the sugar content of individual food products and product categories frequently provide the substance behind extensive media coverage of this issue that you will have seen in recent years, and this year’s campaign focussed on the high sugar content often seen in snack foods marketed as healthy, and also called for the removal of misleading sugar claims on sweet baby and toddler snacks such as biscuits and rusks.

As a dental organisation, the College works with Action on Sugar to highlight the association between sugar consumption and poor oral health. As dental teams know all too well, tooth decay, despite being almost wholly preventable, affects around a quarter of 5-year-olds [xii], a third of 12-year-olds and almost half of 15-year-olds [xiii], and tooth extraction is the number one reason young children are admitted to hospital [xiv]. Reducing sugar intake also lowers our risk of a wide range of illnesses including obesity, type 2 diabetes, heart disease, stroke – and indirectly of some cancers.

My sense is that public understanding of these links has been growing for some time, yet as a nation we consume three times the amount of sugar we should be [xv]. The scale of the challenge to produce a decisive shift in behaviour therefore remains daunting, but dental practices have long been at the forefront of promoting reduced sugar consumption. To complement the messages delivered during clinical appointments, I would encourage practices to browse the many resources available on Action on Sugar’s website (http://www.actiononsugar.org/) and consider displaying its posters in their waiting area.

You may also be interested to watch the webinar recording Helping Our Patients to Kick Sugar, presented by London dentist and author of the ‘Kick Sugar’ cookbook, James Goolnik. As above, this is available free of charge to College members and comes with CPD hours.

As a member of the FGDP for almost a quarter of a century, I was extremely proud of its consistent work promoting action to tackle oral cancer, antimicrobial resistance and the overconsumption of sugar, and as President of the College of General Dentistry I am delighted to say that we are picking up where the Faculty left off.

Attracting and sustaining the public’s attention is very difficult. Raising awareness, changing perceptions, and advocating for change to the point that action is seen by decision makers as both necessary and likely to receive popular support, is often the work of decades. But it can and has been done in many areas, starting with a small army of committed advocates spreading the word at every opportunity, eventually leading to widespread understanding and support among the public, the media and politicians.

So while these three campaigns run each November, general dental practice teams can make a huge difference all year round, helping to promote a reduction in the burden of disease and premature death through their daily actions. These are issues which require our thought and conscientious action on a perennial basis – we must remember, remember.

[i] Mouth Cancer Action Month, Oral Health Foundation: https://www.dentalhealth.org/mouthcancer (accessed November 2021)

[ii] The State of Mouth Cancer UK Report 2020/21, Oral Health Foundation and Denplan (2021): https://www.dentalhealth.org/Handlers/Download.ashx?IDMF=33f0d4c5-aa47-4e06-9454-9914e2476614

[iii] Head and Neck Cancer statistics, Cancer Research UK: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/head-and-neck-cancers (accessed November 2021)

[iv] ‘’Decision to finally offer boys HPV vaccine will save many lives’: Declares charity’, Oral Health Foundation (2018): https://www.dentalhealth.org/news/decision-to-finally-offer-boys-hpv-vaccine-will-save-many-lives-declares-charity

[v] The State of Mouth Cancer UK Report 2020/21, Oral Health Foundation and Denplan (2021): https://www.dentalhealth.org/Handlers/Download.ashx?IDMF=33f0d4c5-aa47-4e06-9454-9914e2476614

[vi] World Antimicrobial Awareness Week, World Health Organisation: https://www.who.int/campaigns/world-antimicrobial-awareness-week/2021 (accessed November 2021)

[vii] Antibiotic Resistance Threats in the United States, 2019, Centers for Disease Control and Prevention (2019): https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf

[viii] Tackling Drug-Resistant Infections Globally: Final Report and Recommendations, The Review on Antimicrobial Resistance (2016): https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf

[ix] The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance, UK Department of Health (2015): https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/449049/Code_of_practice_280715_acc.pdf

[x] See http://www.actiononsugar.org/sugar-awareness-week/sugar-awareness-week-2021/get-involved/

[xi] Sugar reduction: Report on progress between 2015 and 2018, Public Health England (2019): https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/839756/Sugar_reduction_yr2_progress_report.pdf

[xii] ‘Tooth decay in 5-year-olds now increasing in some parts of England’, Faculty of Dental Surgery of the Royal College of Surgeons of England (2018): https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/phe-oral-health-2017/

[xiii] Child Dental Health Survey 2013, England, Wales and Northern Ireland, Health and Social Care Information Centre (2015): https://digital.nhs.uk/data-and-information/publications/statistical/children-s-dental-health-survey/child-dental-health-survey-2013-england-wales-and-northern-ireland

[xiv] ‘Every 10 minutes a child in England has a rotten tooth removed’, Public Health England (2018): https://www.gov.uk/government/news/every-10-minutes-a-child-in-england-has-a-rotten-tooth-removed

[xv] National Diet and Nutrition Survey: results from years 7 and 8 (combined), Public Health England and the Food Standards Agency (2018): https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined

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Dental and medical organisations join forces to say “Antibiotics do not cure toothache!”

National dental and medical organisations have come together again to support the World Health Organisation’s Antimicrobial Awareness Week, which runs from 18-24 November.

The Association of Clinical Oral Microbiologists and College of General Dentistry, supported by the Association of Dental Hospitals, British Dental Association, Healthcare Improvement Scotland, British Association of Oral Surgery, British Society for Antimicrobial Chemotherapy, British & Irish Society for Oral Medicine, Faculty of Dental Surgery of the Royal College of Surgeons of England, Faculty of Dental Surgery of the Royal College of Surgeons of Edinburgh, and the Faculty of Dental Surgery of the Royal College of Physicians and Surgeons of Glasgow, are reminding patients that “antibiotics do not cure toothache”, and encouraging the dental team to adhere to best practice and only prescribe antibiotics as an adjunct to definitive clinical management of the cause when indicated according to national guidelines.1-2

Prudent prescribing of antimicrobials can slow down the development of antimicrobial resistance, and all healthcare prescribers play a vital role. The dental profession has shown its commitment to addressing antimicrobial resistance by significantly reducing the use of antibiotics over the last decade, both in dental practice and a hospital setting. Dental hospitals in the UK and Ireland reduced antibiotic prescriptions by 22% and 30% for therapeutic and prophylactic indications respectively between 2018 and 2020 (prior to the COVID-19 pandemic).

It has been reported that COVID-19 had a negative effect on the profession’s endeavours in improving antibiotic prescribing patterns. The organisations therefore encourage dental teams in both general practice and hospital settings to re-start auditing3 their practice of antibiotic prescribing against the recently updated national guidelines1-2, as this will help to reduce the use of antimicrobials and improve patient outcomes.

The successful management of acute dental infections requires accurate diagnosis and definitive treatment, and patients who have prompt access to emergency dental services have a much-reduced risk of developing life-threatening sepsis. Dental teams are encouraged to use the following resources to update their knowledge on the latest national recommendations on the use of antimicrobial agents in dentistry, and to audit their practice:

  1. Guidelines for antimicrobial prescribing in dentistry are available at https://cgdent.uk/standards-guidance/ and https://bnf.nice.org.uk
  2. Guidance for antimicrobials in dentistry in Scotland are available at  https://www.sdcep.org.uk/published-guidance/drug-prescribing/ and  https://www.sapg.scot/media/5473/statement-on-pen-v-in-dental-infections.pdf
  3. Antimicrobial prescribing audit tools are available at https://cgdent.uk/standards-guidance/ and https://heiw.nhs.wales/education-and-training/dental/quality-improvement/national-audit-projects/antimicrobial-prescribing/
  4. Other resources, including the Dental Antimicrobial Stewardship Toolkit, are available via https://cgdent.uk/standards-guidance/ and https://bda.org/amr

In a recent blog for the College of General Dentistry, Dr Wendy Thompson, the College’s lead on Antimicrobial Resistance, says it’s time to reduce antibiotic prescribing in dentistry to pre-pandemic levels.

Wendy is also the guest speaker on our upcoming ‘Talking Standards’ webinar on Thursday 25 November, which will be looking at Antimicrobial Prescribing in Dentistry: Good Practice Guidelines. The event will be free to view live for all members of the dental professions, and CGDent members and ProDentalCPD subscribers can claim CPD hours for free and have access to the recording after the event. REGISTER HERE.

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Reduce antibiotic prescribing to pre-pandemic levels – it’s time to act!

Ahead of the annual global campaign on antibiotic awareness, Dr Wendy Thompson says that rates of antimicrobial prescribing across dentistry have been slow to reduce since passing the peak of COVID-19, even though we are returning to more normal practice and dentists should no longer be providing remote prescriptions.   

Providing the right care for patients with acute dental pain or infection at the right time was a challenge even before the coronavirus pandemic struck. At the CGDent/ProDental webinar on Tuesday 5 October, we heard some shocking statistics about how the public continues to experience urgent dental care.

Jacob Lant from HealthWatch told us that before COVID-19, dentistry accounted for around 5% of feedback from members of the public. However, the situation has deteriorated over time and the most recent statistics from Spring/Summer 2021 show that 25% of all feedback received by HealthWatch relates to dentistry. Sadly, the vast majority is about negative experience from people who are unable to access care for their toothache. Without additional funding, how on earth is the NHS system to deal with this backlog of care caused by the pandemic?

But to my mind doing this whilst keeping our patients safe from the potential adverse events of antibiotics is even more of a problem. We know that procedures are the most effective way to cure someone’s toothache and that dental surgeons are well equipped to diagnose and treat dental pain and infection during urgent dental appointments. However, we also know that this needs appointments which are at least 20 minutes long. The 15-minute appointment slots referenced in the NHS unscheduled dental care commissioning standard are simply not long enough to provide the procedures indicated by clinical guidelines.

The COVID-19 lockdown dramatically reduced access to urgent dental care suddenly and almost totally. For a while, remote care via advice, analgesics and antimicrobial (where appropriate) became the emergency guidance to get us out of a hole where there was simply not enough provision. Unsurprisingly during this time, rates of prescribing rather than procedures increased dramatically.

Confidently diagnosing acute dental conditions remotely is really hard. And without a diagnosis there should be no treatment. In normal times, therefore, remote diagnosis and management is rarely appropriate for dentistry.

Imagine how you would feel if your patient suffered a dramatic adverse reaction to the antibiotic which you remotely prescribed. How would you defend your position to the Coroner about why you gave a remote prescription rather than booking them into a face-to-face appointment? How would it wash that you, as a highly trained professional, were doing what a manager (with no prescribing competences within their scope of practice) told you to do?

In December 2020, the FGDP(UK) Antimicrobial Prescribing in Dentistry Good Practice Guidelines were updated, including highlighting the benefits of penicillin V over amoxicillin. Penicillin V is a narrower spectrum antibiotic and therefore less likely to drive the development and spread of antibiotic resistance. Now that we are returning to a more normal practice after COVID-19, the care we provide to patients with acute dental pain or infection should also be returning to normal. It is no longer appropriate to be providing remote prescriptions.  If someone’s condition is bad enough that they might need an antibiotic (ie a spreading swelling as indicated by guidance), then it’s bad enough for them to need to be seen.

Unfortunately, the rates of antibiotic prescribing across dentistry have been slow to reduce and the whole dental profession needs to work together to get back to the prescribing levels we were at before the pandemic. This isn’t just about dentists prescribing less, it’s about practice owners leading by example and holding their dental teams to account.  

Within the NHS, it’s about national commissioning teams, Local Dental Networks and managers within dental provider organisations setting the context to facilitate low rates of antibiotic prescribing, including long enough appointments for urgent dental procedures AND managing and monitoring service provision to ensure inappropriate antibiotic use is minimised (as per the Health and Social Care Act’s code of practice on the prevention and control of infections – Appendix B Primary Dental Care).

In the latest issue of the Primary Dental Journal, it is my pleasure to share with you papers from around the world about how urgent dental care has been provided since the start of the COVID-19 pandemic.  I am especially proud of a paper authored by members of dental teams who participated in (and helped deliver) my doctoral research about urgent dental care in general dental practice and out-of-hours clinics. The insight was particularly useful for me as I plan my next research in urgent dental clinics, and I hope that it might encourage you to get involved in research in the future.

During the World Health Organisation’s World Antimicrobial Awareness Week 2021, I will be hosting a CGDent webinar on antimicrobial prescribing and how dental professionals around the world are tackling antimicrobial resistance locally. The webinar is free to view live for everyone (Thursday 25 November, 7pm – register here) and CGDent members can also access the recording and CPD hours for free. If you aren’t a CGDent member, there is a small free to receive certified CPD or to access the recording.  I hope to see you there!

Dr Wendy Thompson PhD MCGDent is a general dental practitioner, lecturer in Primary Dental Care and the College of General Dentistry’s lead on antimicrobial prescribing and stewardship. A College Ambassador, she also holds advisory roles on tackling antibiotic resistance with the Office of the Chief Dental Officer (England), FDI World Dental Federation and the National Institute for Health and Care Excellence.

Guest Editor of the forthcoming issue of the Primary Dental Journal, which examines Urgent Dental Care and COVID-19, she hosted a recent College webinar on this topic, and is also the host of the upcoming College webinar on antimicrobial prescribing. Our full list of upcoming webinars and events is available here, with more webinars added regularly. In addition to our live webinars, CGDent members have free, on demand access to a rich library of 900+ hours of CPD and a linked e-PDP with our partner ProDental CPD.

Membership of the College of General Dentistry is open to all registered dental professionals. Membership for dentists is available from £94, and for other registered dental professionals from £33. The full list of CGDent membership rates is at https://cgdent.uk/membership-fees/

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Antimicrobial prescribing in dentistry

Recorded webinar. Thursday 25 November 2021.

In the first of our Talking Standards webinar series, which sets out to examine areas covered by our evidence-based standards and guidance, we shone the spotlight on global efforts to tackle antimicrobial resistance locally.

We explore the ways in which dental teams can help keep patients safe from untreatable infections, consider why dental practitioners might overprescribe antibiotics and discuss the impact of COVID-19, referring to the Antimicrobial Prescribing in Dentistry Good Practice Guidelines.

Speakers:

  • Dr Wendy Thompson, general dental practitioner and academic
  • Vanessa Carter, ePatient and hcsm Consultant

CGDent members and ProDental subscribers can claim CPD hours for free and have access to the recording after the event.  A £20 fee will apply for non-members/non-subscribers who wish to claim CPD.

This webinar is part of the new partnership between the College of General Dentistry (CGDent) and ProDental CPD.

Membership of the College of General Dentistry is open to all registered dental professionals. Membership for dentists is available from £94, and for other registered dental professionals from £33. The full list of CGDent membership rates is at https://cgdent.uk/membership-fees/

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Urgent dental care and COVID-19

Recorded webinar. Tuesday 5 October 2021.

Participants take an honest look at urgent dental care (UDC) during and after the initial period of the COVID-19 pandemic. The opportunities and challenges that arose during the pandemic are examined and new models for UDC considered.

Chair:

Dr Wendy Thompson, general dental practitioner and academic

Speakers:

  • Simon Hearnshaw, Training Programme Director, Yorkshire and the Humber
  • Ian Kerr, general dental practitioner
  • Rachel England, dental hygienist
  • Jacob Lant, Head of Policy and Research, Healthwatch England
  • Dr Heidi Rabie, Chief Dentist of AHS Public Health Dental Clinics

CGDent members and ProDental subscribers have access to the recording of this event, and can claim CPD hours, free of charge.  A £20 fee applies for non-members/non-subscribers.

Part of the partnership between the College and ProDental CPD, this webinar is in our PDJ Live series, which discusses issues and topics highlighted in the College’s themed, member journal, Primary Dental Journal. To receive information on further upcoming events, sign up to the CGDent newsletter.

Membership of the College of General Dentistry is open to all registered dental professionals. Membership for dentists is available from £94, and for other registered dental professionals from £33. The full list of CGDent membership rates is at https://cgdent.uk/membership-fees/