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328 JADA 145(4) http://jada.ada.org April 2014

Authors’ response: Dr. Reed raises an important issue of what is to be done, especially in alterna-tive care delivery situations, when clinicians (volunteers) are faced with the need to provide clinical services while they lack the most basic amenities such as electricity or autoclaves. It is difficult to answer the question raised by Dr. Reed without knowing more details about a specific environment. Is there po-table water available? Is there access to a dependable source of heat such as propane?

Depending on those answers (and others), it may be possible to use a pressure cooker. In such resource-constrained situations, pressure cookers can be used for steriliza-tion if they can reach and sustain a temperature of 250°F (121°C) at 15 pounds of pressure for 30 minutes. It should be remembered, though, that this requires access to potable water and dependable fuel sources.

Dr. Reed’s question highlights an even more important consid-eration. As was noted in the West Virginia hepatitis B transmission report, it can be challenging to ensure adequate infection control while providing dental care in tem-porary settings using volunteers.1 These challenges are even more pronounced in resource-challenged environments.

In such resource-challenged envi-ronments, it is critical that clinicians balance the desire to improve access to dental/oral health care with the need to “first, do no harm.” Many

factors must be considered in mak-ing such a calculation.

One excellent resource is the Organization for Safety, Asepsis and Prevention (OSAP) Guide to Safety and Infection Control for Oral Healthcare Missions.2 This guide contains 52 pages of advice, sugges-tions and sample forms and work-sheets to help keep dental workers and patients safe while humanitarian aid is rendered in nontraditional care settings.

OSAP also has developed the OSAP Infection Control Checklist for Dental Programs Using Mo-bile and Portable Dental Equip-ment as well as a number of other infection prevention, control and safety resources, training materials and toolkits for dentistry.3 Other resources include the American Dental Association’s International Dental Volunteer Organizations,4,5 the World Health Organization6 and the Centers for Disease Control and Prevention.7

As we noted in the guest editorial, we in dentistry have a responsibil-ity to those we serve to provide the highest level of care and to ensure the care is provided safely. This holds true regardless of whether we are working in our private office or in the most remote African hut. Volun-teers working to improve the health of others must be aware of the infec-tion control challenges they will face and they must be trained to mini-mize those challenges to the point where they can ensure the safety of themselves and their patients prior

to rendering care. If we cannot ensure that level of

safety, we need to remember our obligation to “first, do no harm.” There are occasions where no or limited care is better than unsafe care. Ultimately, it is important to develop sustainable oral health infrastructure, negating the need for such volunteer-based temporary care clinics.

Kathy Eklund, RDH, MHPDirector of Occupational

Health and Safety andPatient Advocate

The Forthsyth InstituteCambridge, Mass.

Donald Marianos, DDS, MPHSecretary

Board of DirectorsOrganization for Safety, Asepsis

and PreventionAnnapolis, Md.

1. Radcliffe RA, Bixler D, Moorman A, et al. Hepatitis B virus transmissions associated with a portable dental clinic, West Virginia, 2009. JADA 2013;144(10):1110-1118.

2. Organization for Safety, Asepsis and Pre-vention. Guide for Safety and Infection Control for Oral Healthcare Missions. www.osap.org/resource/resmgr/Docs/dental_aid_guide.pdf. Accessed Feb. 28, 2014.

3. Organization for Safety, Asepsis and Pre-vention. www.osap.org. Accessed Feb. 28, 2014.

4. American Dental Association. Interna-tional Dental Volunteer Organizations. Get involved: sharing knowledge. http://internationalvolunteer.ada.org/get-involved/sharing-knowledge. Accessed Feb. 28, 2014.

5. American Dental Association. Interna-tional Dental Volunteer Organizations. Get involved: get prepared. http://international-volunteer.ada.org/get-involved/get-prepared. Accessed March 4, 2014.

6. World Health Organization. www.who.org. Accessed Feb. 28, 2014.

7. Centers for Disease Control and Preven-tion. www.cdc.gov. Accessed Feb. 28, 2014.

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