An

Observational Study of Cross Infection control in

Iloilo City Dental Health Clinics, The Philippines

Cara Turner: 2015/2016

The aim of this project was to evaluate the cross infection control procedures in Iloilo City Dental
Health Clinics, The Philippines, and compare these with cross infection policy at Bristol Dental
Hospital (BDH), United Kingdom. During my time in Iloilo I kept a diary of my observations of the
following cross infection control procedures: hand washing technique, (including whether any
chemical agents were used), wearing clinical attire, (and whether it was worn outside the hospital
and changed between patients), cleaning of the clinical environment, sterilisation of instruments,
(including the chemical and physical processes which were employed), the extent to which single
use instruments were used and the mechanism for the disposal of clinical waste. In my daily diary I
kept a record of my observations of all the above points. In my final report I evaluated my
observations, and compared the practices observed in Iloilo with practices at BDH.

Iloilo City is at the forefront of improving oral health in The Philippines. However reports from
previous students visiting The Philippines, suggest that cross infection control varies considerably
from the standards we employ in the United Kingdom. My observations show that there are many
differences in the level of cross infection control between the two locations, and between the
practices observed in Iloilo. These include variations on glove use and hand hygiene techniques. In
conclusion, although there were many differences between cross-infection control practices at BDH
and those in Iloilo, these reflect the different backgrounds in which dental treatment is given. In
Iloilo there is less funding for dental treatment, and so there is more emphasis on cost effectiveness.
Spending on cross infection is restricted, potentially putting patients at risk, however, it must be
recognised that reducing costs helps bring the cost of extraction into reach of a greater percentage
of Filipinos. However, I feel there are some areas, for example hand hygiene and instrument
cleaning, where it is more a lack of education and enforced protocols, and thus these are areas
where improvements in cross infection control could be achieved without great expense.

During my two weeks in Iloilo I was fortunate to join 3 supervisors in 4 Government practices. During
the mornings we performed exclusively extractions. Despite extractions being the only treatment
eligible for Government support, they still cost the patient 100 Peso per tooth. The average daily
wage in Iloilo is just 200 Peso (approximately 2.90), this may account for many Filipinos only
presenting with very late stage disease. However, if a tooth is restorable and not indicated for
extraction, this is explained to the patient, and although the patients predominantly still opt for
extraction, on occasion they chose to seek private dental care. The chairs in which extractions were
carried out were very similar to those in BDH.
During the afternoons we visited various schools, during which I saw approximately 85 children aged
between 5 and 6. I completed oral examinations on 60 children; placing fluoride varnish on any
permanent teeth present. I carried out 2 oral hygiene drills with 2 classes, and spent one afternoon

fissure sealing and performing extractions as necessary. I thoroughly enjoyed participating in the
schools programme, which I believe is an excellent pioneering scheme to help improve oral health in
the Philippines. In addition to receiving treatment, the children all received a toothbrush and the
teachers were provided with a bottle of toothpaste to enable them to brush their teeth at least
once a day, Monday-Friday.

Some photos from my time in Iloilo;