WASHINGTON, April 11, 2013 - Dr. W. Scott Harrington DMD, of Tulsa, Oklahoma may have infected thousands of his patients with HIV and/or hepatitis by using instruments that were not properly sterilized.
Dr. Harrington’s procedures were discovered after one of Dr. Harrington’s patients with no other risk factors tested positive for hepatitis C and HIV.
Tracing the point of infection back to Dr. Harrington, investigators discovered that the dentist was guilty of improper sterilization practices leading to the cross contamination of instruments.
Investigators discovered that the device to sterilize the instruments, known as an autoclave, did not function properly. In addition Harrington was using outdated drugs.
Procedures are that the autoclave must be tested monthly, yet workers in the office state that to their knowledge it had not been tested for at least six years. Additionally, Harrington kept a set of rusting tools for use on patients known to be infectious. Dentists are required to keep a second set of tools for known infectious patients.
Proper sterilization techniques are designed to prevent this type of incident from occurring. An autoclave, the sterilization device, works by first sealing the object inside where all air is then removed. Once the air has been removed, steam at temperatures of 134 degrees Centigrade is introduced. This will sterilize the instruments in just three minutes.
Another method is downward displacement, or gravity displacement. In this type of autoclave, steam is introduced and displaces the air. As the air is forced out through a “drain,” temperature sensors determine when to actuate a solenoid valve that then seals the autoclave; the sterilization process begins when the autoclave is sealed.
The ADA divides instruments into three levels, according to the CDC (Centers for Disease Control):
Critical Instruments are used to penetrate soft tissue and bone. These include forceps, scalpels, bone chisels, scalers, and surgical burrs.
Semi-critical Instruments that do not penetrate soft tissue or bone but do come in contact with the mucous membranes or non-intact skin (i.e. the inside of the mouth and open wounds). These items include mirrors, reusable impression trays, and amalgam condensers.
Non-critical Instruments that come in contact only with intact skin. They include items such as a blood pressure cuff, x-ray heads or pulse oximeters.
Critical and most semi-critical instruments require sterilization in an autoclave. Some semi-critical items that cannot be exposed to those conditions can be sterilized with high level disinfectants that are registered with the EPA as a “sterilant/disinfectant.” Non-critical instruments are sterilized by the use of an intermediate level EPA registered “hospital disinfectant labeled for tuberculocidal activity” or a low level EPA registered “hospital disinfectant” not labeled for tuberculoidal activity.
Following ADA guidelines for instruments sterilization is required by law and for good reason. Failure to follow these guidelines can and will spread infectious disease, as in the case of Dr. Harrington. Recommended certification is once a month for maintaining autoclaves. An employee at Dr. Harrington’s reported she had worked there six years and cannot recall the autoclave being maintained (that’s 72 monthly testing sessions missed).
Dr. Harrington has practiced dentistry for 36 years, but because his records only go back to 2007, the full extent of damage he caused may never be known. Seven thousand patients who visited his office since 2007 will be sent notification to be tested for Hepatitis B and C and HIV. They can be tested free at Tulsa Health Department’s North Regional Health and Wellness Center.
Dr. Harrington’s offices in both Tulsa and Owasso have both been shut down and Dr. Harrington is cooperating with investigators as he awaits his April 19 hearing, where he could lose his license to practice.
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