Putative Pathogens Associated with HAIs in Oral Healthcare Settings

Oral HCP and patients can be exposed to bloodborne pathogens and other pathogenic microorganisms. These organisms can be transmitted in oral healthcare settings from patient-to-patient, patient-to-provider, and provider-to-patient through contact with infected blood and other potentially infectious materials; inhalation of droplets and droplet nuclei generated when infected persons cough, sneeze, shout, sing, or talk; and less frequently by contact with freshly contaminated articles and environmental surfaces.4

Standard Precautions apply to contact with blood and other potentially infectious materials, nonintact skin, and mucous membranes; other measures, such as Transmission-based Precautions, might be necessary to prevent the spread of some pathogenic organisms (e.g., Mycobacterium tuberculosis).4 Still other infections are vaccine preventable. It is axiomatic that oral HCP should be familiar with the modes of transmission of putative pathogens in oral healthcare settings and take appropriate precautions to minimize HAIs:1,8-26

Hepatitis B virus1,8

  • Condition: acute and/or chronic inflammatory liver disease.
  • Modes of transmission: bloodborne pathogen; transmitted by contact with infected blood and other potentially infectious material, e.g., saliva, semen, and vaginal secretions; healthcare and public safety personnel are at risk for occupational exposure.
  • Precautions: vaccine-preventable; standard precautions.

 

Hepatitis C virus1,9

  • Condition: acute and chronic inflammatory liver disease.
  • Modes of transmission: bloodborne pathogen; transmitted primarily through large or repeated percutaneous exposure to infected blood: most frequent mode of transmission is needle sharing among IV drug users; after a needlestick or sharps exposure to HCV-positive blood, the risk of HCV infection among HCP is approximately 1.8%.
  • Precautions: standard precautions.

 

Human Immunodeficiency Virus1,10

  • Condition: acquired immune deficiency syndrome (AIDS).
  • Modes of transmission: bloodborne pathogen; acquired most readily either across mucous membranes or parenterally; in healthcare settings the risk for transmission following a percutaneous (needlestick injury) or mucous membrane (eyes, nose, and mouth) exposure to blood infected with the HIV is approximately 0.3% and 0.09%, respectively.
  • Precautions: standard precautions.

 

Measles virus1,11

  • Condition: measles (rubeola).
  • Modes of transmission: airborne droplets and droplet nuclei generated by an infected person during talking, breathing, coughing, and sneezing; by direct contact with nasal or throat secretions from an infected person; and less frequently by touching freshly contaminated articles and environmental surfaces.
  • Precautions: vaccine-preventable; airborne and standard precautions.

 

Mumps virus1,12

  • Condition: mumps.
  • Modes of transmission: airborne droplets of saliva and mucus from the mouth, nose, and throat of infected persons generated during speaking, breathing, coughing, or sneezing; by direct contact with saliva and mucus from an infected person; and less frequently by touching freshly contaminated articles and environmental surfaces.
  • Precautions: vaccine-preventable; droplet and standard precautions.

 

Rubella (German measles) virus1,13

  • Condition: German measles (rubella).
  • Modes of transmission: airborne droplets generated during talking, breathing, coughing, and sneezing; by direct contact with nasal or throat secretions; and less frequently by touching freshly contaminated articles and environmental surfaces.
  • Precautions: vaccine-preventable; droplet and standard precautions.

 

Varicella Zoster virus1,14,15

  • Condition: chickenpox and varicella zoster infections.
  • Modes of transmission: person to person by direct contact with vesicular fluid; inhalation of aerosols from vesicular fluid or infected respiratory tract secretions; and less frequently, by contact with freshly contaminated articles and environmental surfaces.
  • Precautions: vaccine-preventable; airborne, contact, and standard precautions.

 

Herpes simplex virus1,16,17

  • Condition: primary and recurrent mucocutaneous herpetic infections.
  • Modes of transmission: direct contact with lesions or infected body fluids, e.g., vesicular exudates, saliva, and genital fluids; less frequently by touching freshly contaminated articles and environmental surfaces.
  • Precautions: contact and standard precautions.

 

Human papilloma virus1,18

  • Condition: nodular or papillomatous or wart-like lesions.
  • Modes of transmission: person-to-person through cuts, abrasions or small tears in skin or mucous membranes.
  • Precautions: vaccine-preventable; standard precautions.

 

Influenza virus1,19

  • Condition: seasonal influenza.
  • Modes of transmission: person-to-person primarily via droplets generated during talking, breathing, coughing, and sneezing; and less frequently by contact with freshly contaminated articles and environmental surfaces.
  • Precautions: vaccine-preventable, droplet and standard precautions.

 

Mycobacterium tuberculosis1,20

  • Condition: tuberculous infection and tuberculosis (extrapulmonary, pulmonary, laryngeal).
  • Modes of transmission: inhalation of droplets and droplet nuclei generated when infected persons cough, sneeze, shout, sing, or talk; and less frequently by contact with freshly contaminated articles and environmental surfaces.
  • Precautions: airborne and standard precautions.

 

Corynebacterium diphtheriae1,21

  • Condition: diphtheria (respiratory mucosa and skin).
  • Modes of transmission: person-to-person usually through respiratory droplets generated by coughing or sneezing; contact with contaminated objects; and rarely, C. diphtheriae is shed from skin lesions or contaminated clothes.
  • Precautions: droplet and standard precautions.

 

Clostridium tetani1,22

  • Condition: tetanus.
  • Modes of transmission: spores enter the body through non-intact skin, usually cuts or puncture wounds caused by contaminated objects; less commonly, tetanus has been linked to clean superficial wounds, chronic sores, insect bites, dental infections, compound fractures with exposed bone, and intravenous (IV) drug use.
  • Precautions: vaccine-preventable; standard precautions.

 

Bordetella pertussis1,23

  • Condition: pertussis (whooping cough).
  • Modes of transmission: person-to-person by direct contact with respiratory secretions or by airborne droplets generated by coughing or sneezing.
  • Precautions: vaccine-preventable; droplet and standard precautions.

 

Neisseria meningitidis1,24

  • Condition: bacterial meningococcal disease (meningitis).
  • Modes of transmission: airborne droplets and direct contact with respiratory secretions and saliva.
  • Precautions: vaccine-preventable; droplet and standard precautions.

 

Streptococcus pneumoniae1,25

  • Condition: middle ear infections (acute otitis media) in children; pneumonia among adults.
  • Modes of transmission: transmitted person-to-person via airborne droplets generated by coughing and sneezing and by direct contact with respiratory secretions and saliva.
  • Precautions: vaccine-preventable; droplet and standard precautions.

 

Methicillin-resistant Staphylococcus aureus1,26

  • Condition: infections usually involve the skin.
  • Modes of transmission: direct contact with an infected wound or contaminated bed linens, bed rails, bathroom fixtures, medical equipment, and personal items; about one in three people carry S. aureus and two in 100 carry MRSA in their nose or on skin.
  • Precautions: contact and standard precautions.