open access
메뉴ISSN : 0376-4672
SARS-CoV-2 감염으로 인한 COVID-19의 발생은 전 세계로 퍼져 보건의료 체계에 있어 대유행을 일으켰다. 이 질병은 호흡기 혹은 에어로졸을 통하여 전염되는 것으로 알려져 있다. 치과 치료의 특성상 체액, 혈액 및 타액을 포함한 에어로졸의 생성은 피할 수 없다. 본 연구는 여러 문헌 조사를 통하여 COVID-19의 치과 병원 내 잠재적 감염 위험을 조사하고, 병원 내 감염을 최소화하기 위한 방안을 모색하였다. 서울대학교치과병원은 질병관리본부의 가이드라인 및 이용가능한 문헌조사를 바탕으로 임상 상황에 대응하기 위한 대책을 마련했다. 감염 관리를 포함하여 환자 예약 및 일정 관리를 통한 병원 내 시공간적 분리에 대한 고려도 함께 이루어졌다. 치과 병원에서의 여러 대책들은 전염성 호흡기 질환에 직면한 여러 치과병원들이 참조할 수 있도록 하였다.
The outbreak of COVID-19, caused by SARS-CoV-2 infection, has spread worldwide and resulted in a pandemic for health systems. The disease is transmitted via respiration as droplets or aerosol. Due to the nature of dental treatment, aerosols, including body fluid, blood, and saliva, are frequently produced in dental hospitals. The present study investigated the potential risk of nosocomial infection of COVID-19 in dental hospitals to provide recommendations in clinical situations. The Seoul National University Dental Hospital in Korea established a countermeasure to cope with the clinical situation based on The Guidelines of Korean Centers for Disease Control & Prevention (KCDC) for dental practitioners and the available literature. Notably, numerous considerations for patient reservation and schedule management are required for space separation in the hospital, including infection control. Experiences in dental hospitals in Korea would be referable for other dental hospitals facing this infectious respiratory disease.
1. Centers for Disease Control & Prevention. Swine influenza a (h1n1)infection in two children--southern california, march-april 2009. MMWR Morb Mortal Wkly Rep. 2009;58(15):400-402
2. Korea Centers for Disease Control & Prevention. Middle east respiratory syndrome coronavirus outbreak in the republic of korea, Osong Public Health Res Perspect. 2015;6(4):269-278.
3. Zhong NS, Zheng BJ, Li YM, Poon, Xie ZH, Chan KH, Li PH, Tan SY, Chang Q, Xie JP et al. Epidemiology and cause of severe acute respiratory syndrome (sars) in guangdong, people's republic of china, in february, Lancet. 2003.;62(9393):1353-1358.
4, Han Y, Yang H. The transmission and diagnosis of 2019 novel coronavirus infection disease (COVID-19): A Chinese perspective. J Med Virol. 2020;92(6):639-644.
5. Korean Centers for Disease Control & Prevention. Regular briefing:Covid-19 domestic outbreak status [in Korean]. [April 26, 2020 updated;April 26, 2020 accessed]. https://is.cdc.go.kr/upload_comm/syview/doc.html?fn=158787611297800.pdf&rs=/upload_comm/docu/0015
6. Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199-1207.
7. World Health Organization, Coronavirus disease 2019 (covid-19)situation report - 56. 2020. [March 16, 2020 updated; April 26, 2020 accessed]. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200316-sitrep-56-covid-19. pdf?sfvrsn=9fda7db2_6
8. World Health Organization. 2020. Report of the who-china joint mission on coronavirus disease 2019 (covid-19). [Febrary 28, 2020Updated; April 24, 2020 accessed]. https://www.who.int/publications-detail/report-of-the-who-china-joint-mission-on-coronavirus-disease-2019-(covid-19)
9. Bennett AM, Fulford MR, Walker JT, Bradshaw DJ, Martin MV, Marsh PD. Microbial aerosols in general dental practice. Br Dent J. 2000;189(12):664-667.
10. Liu L, Wei Q, Alvarez X, Wang H, Du Y, Zhu H, Jiang H, Zhou J, Lam P, Zhang L et al. Epithelial cells lining salivary gland ducts are early target cells of severe acute respiratory syndrome coronavirus infection in the upper respiratory tracts of rhesus macaques. Journal of virology. 2011;85(8):4025-4030.
11. Liu K, Fang YY, Deng Y, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl). 2020;133(9):1025-1031.
12. Korean Society of Infectious Diseases Korean Society of Pediatric Infectious Diseases Korean Society of Epidemiology Korean Society for Antimicrobial Therapy Korean Society for Healthcare-associated Infection Control and Prevention and Korea Centers for Disease Control and Prevention Report on the Epidemiological Features of Coronavirus Disease 2019 (COVID-19) Outbreak in the Republic of Korea from January 19 to March 2, 2020, J Korean Med Sci. 2020;35(10):e112.
13. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, Zimmer T, Thiel V, Janke C, Guggemos W et al. Transmission of 2019-ncov infection from an asymptomatic contact in germany. N Engl J Med. 2020;382(10):970-971.
14. Siegel JD, Rhinehart E, Jackson M, Chiarello L; Health Care Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control. 2007;35(10 Suppl 2):S65-S164.
15. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X et al. Clinical features of patients infected with 2019 novel coronavirus in wuhan, china. Lancet. 2020;395(10223):497-506.
16. Zayet S, Klopfenstein T, Mercier J, et al. Contribution of anosmia and dysgeusia for diagnostic of COVID-19 in outpatients [published online ahead of print, 2020 May 14]. Inefction. 2020;1-5.
17. Slots J. 2010. Human viruses in periodontitis. Periodontology 2000;53:89-110.
18. Han C, Duan C, Zhang S, et al. Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes. Am J Gastroenterol. 2020;115(6):916-923.
19. Pan L, Mu M, Yang P, et al. Clinical Characteristics of COVID-19Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol. 2020;115(5):766-773.
20. Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-ncov and controls in dental practice. Int J Oral Sci. 2020;12(1):9.
21. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, Xing F, Liu J, Yip CC, Poon RW et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission:A study of a family cluster. Lancet. 2020;395(10223):514-523.
22. Liu J, Liao X, Qian S, et al. Community Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, Shenzhen, China, 2020. Emerg Infect Dis. 2020;26(6):1320-1323.
23. Micik RE, Miller RL, Mazzarella MA, Ryge G. Studies on dental aerobiology. I. Bacterial aerosols generated during dental procedures. J Dent Res. 1969;48(1):49-56.
24. Timmerman MF, Menso L, Steinfort J, van Winkelhoff AJ, van der Weijden GA. Atmospheric contamination during ultrasonic scaling. J Clin Periodontol. 2004;31(6):458-462.
25. Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, Centers for Disease C, Prevention. Guidelines for infection control in dental health-care settings--2003. MMWR Recomm Rep. 2003;52(RR-17):1-61.
26. Lu CW, Liu XF, Jia ZF. 2019-ncov transmission through the ocular surface must not be ignored. Lancet. 2020;395(10224):e39.
27. Chan KH, Peiris JS, Lam SY, Poon LL, Yuen KY, Seto WH. 2011. The effects of temperature and relative humidity on the viability of the sars coronavirus. Adv Virol. 2011;734690.
28. Muller A, Tillmann RL, Muller A, Simon A, Schildgen O. Stability of human metapneumovirus and human coronavirus nl63 on medical instruments and in the patient environment. J Hosp Infect. 2008;69(4):406-408.
29. Rabenau HF, Cinatl J, Morgenstern B, Bauer G, Preiser W, Doerr HW. Stability and inactivation of sars coronavirus. Med Microbiol Immunol. 2005;194(1-2):1-6.
30. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, Tamin A, Harcourt JL, Thornburg NJ, Gerber SI et al. Aerosol and surface stability of sars-cov-2 as compared with sars-cov-1. N Engl J Med. 2020;382(16):1564-1567.
31. Eggers M, Koburger-Janssen T, Eickmann M, Zorn J. In vitro bactericidal and virucidal efficacy of povidone-iodine gargle/mouthwash against respiratory and oral tract pathogens. Infect Dis Ther. 2018;7(2):249-259.
32. Kanagalingam J, Feliciano R, Hah JH, Labib H, Le TA, Lin JC. Practical use of povidone-iodine antiseptic in the maintenance of oral health and in the prevention and treatment of common oropharyngeal infections. International journal of clinical practice. 2015;69(11):1247-1256.
33. Zemouri C, de Soet H, Crielaard W, Laheij A. A scoping review on bio-aerosols in healthcare and the dental environment. PLoS One. 2017;12(5):e0178007.
34. The National Health Commission of the People’s Republic of China. 7th edition of the guideline for the diagnosis and treatment of novel coronavirus pneumonia. [March 3, 2020 updated; April 26, 2020accessed]. https://www.elotus.org/promo-files/COVID-19_resources/Guidance%20for%20Corona%20Virus%20Disease%202019%20(English%207th%20Edition%20Draft).pdf
35. Saknimit M, Inatsuki I, Sugiyama Y, Yagami K. Virucidal efficacy of physico-chemical treatments against coronaviruses and parvoviruses of laboratory animals. Jikken Dobutsu. 1988;37(3):341-345.
36. Bernstein D, Schiff G, Echler G, Prince A, Feller M, Briner W. In vitro virucidal effectiveness of a 0.12%-chlorhexidine gluconate mouthrinse. J Dent Res. 1990;69(3):874-876.
37. Cameron SO, Carman WF. The use of the orasure collection device for hepatitis virus testing in health care settings. Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology. 2005;34 Suppl 1:S22-28.
38. Gallo D, George JR, Fitchen JH, Goldstein AS, Hindahl MS. Evaluation of a system using oral mucosal transudate for hiv-1 antibody screening and confirmatory testing. Orasure hiv clinical trials group. Jama. 1997;277(3):254-258.