Chapter 6

Legal and Ethical Issues in Infection Control

Aim

To understand the ethical obligations of dental healthcare workers in the prevention of infection in the dental surgery.

Outcome

After reading this chapter, you should have an understanding of the need to behave in an ethical manner with respect to infection control issues. You will also understand the obligation to act within the laws that relate to the need to practise in a safe manner and environment.

Legal and Ethical Obligations

Although the law relating to infection control differs in detail around the world, it is usually contained within an overarching health and safety set of statutes. Dental practitioners each have an individual responsibility to practise in a safe manner, even though they may practise in a group or corporate environment.

Dental health professionals who fall short in their standards of infection control may be subject to action under either, or both, the criminal and civil legal systems. The state may prosecute persons who fail to provide a safe working environment and, if convicted, the penalties are often punitive, ranging from imprisonment to very large fines. Patients or staff who feel that they have been harmed as a result of inadequate infection control measures in their dental practice may bring a civil case for negligence.

In some countries it may not be necessary to prove that harm has been done, only that it may have occurred. It may be very difficult to refute such allegations without being able to robustly demonstrate compliance with the law and that professional guidelines have been strictly adhered to. It is not always necessary for a patient or member of staff to prove unequivocally that they contracted an illness through a dental procedure; it may be sufficient to show that on the balance of probabilities that an event occurred. This is made possible because the illnesses that can be transmitted often have long incubation periods, so proving cause and effect is often impossible.

Any conviction is liable to be brought to the attention of the national professional regulatory/licensing body and is therefore liable to jeopardise the future career of the health professional.

Ethics, on the other hand, are not contained within a framework of written laws, but are a set of guiding principles that should be followed to protect the integrity of the individual and the profession as a whole. Dental practitioners have a duty of care to protect the health and well-being of their patients and employees; proper infection control is fundamental to this duty. There is a public expectation that patients will be treated in a safe environment and their treatment will be delivered to as high a standard as possible, and that their general health will not be compromised by dental treatment. The general public have come to expect ever higher standards often fuelled by “scare stories” in the media. The hysteria that surrounded the emergence of AIDS in the 1980s led to fears that transmission could occur during dental treatment, even though there was no evidence of this, with a single exception in the USA (see Chapter 1). There was, however, as a result of this event a heightened awareness of the need to practise good standards of infection control in dentistry.

Standards have risen inexorably since that time, often with the dental profession feeling that there was not a sufficient evidence base behind the changes. Nevertheless, guidance on matters relating to infection control a/>

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