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KNOWLEDGE, ATTITUDE AND PRACTICE CONCERNING INFECTION CONTROL MEASURES AMONG DENTAL HEALTH CARE PROVIDERS OF DOW UNIVERSITY OF HEALTH SCIENCES.

Byline: MEHWISH FEROZ ALI, AZMINA HUSSAIN and AFSHEEN MAQSOOD

Abstract

A cross sectional study was conducted among dental students of Dow International Dental College (DUHS) to find out their level of knowledge attitude and practice about infection control measures. If any significant linear correlation was present between the knowledge attitudes and practice their scores were observed. Statistical analyses for knowledge attitude and practice descriptive statistics were computed using the SPSS software for Windows version 17. ANOVA was used to calculate p-val- ue of knowledge attitudes and practice values. Pearson's test was used to compute the correlation among knowledge attitudes and practice scores. A p value of =0.05 was considered to be significant for all statistical analyses. Mean scores of knowledge attitudes and practice were 9.66 (1.38) 6.98 (1.36) and 10.16 (1.42) respectively.

Significant differences between the study groups were noticed for means of practice scores (=0.01) and significant linear correlation was observed between knowledge and practice scores (p=0.01). Among knowledge-attitude and attitude-practice scores no differences were seen. The knowledge and attitude of dental students about cross infection control is enhancing but there is still some room for developing a firm attitude. This attitude can be improved by refresh- ing and upgrading their knowledge by obtaining continues education regarding universal infection control measures through arranging sessions or lectures for students of each professional year and keeping all the vaccination especially Hepatitis B mandatory

for students prior to take admission in any dental institution.

Key Words: Cross infection control Dental health care providers.

INTRODUCTION

Infection transmission can easily occur in routine dental practice. Therefore protection from cross infec- tion in the dental setup is a critical aspect of dental practice.1 Dental health care professionals are supposed to perform measures for preventing cross infection when they are practicing. Dental personnels are at high risk of receiving infections in clinical environment from infected patients and equipments. Such infections are caused by varied microorganism most commonly Hepatitis B Hepatitis C Human Immunodeficiency viruses Herpes Simplex virus and Mycobacterium Tuberculosis.23

Cross infection can be defined as the transmission of infectious agents between patients and staff in a clinical setting. In dental practice transfer of infections from one person to another or from object to person can take place through various ways. Pathogens can enter the host via direct contact while examining dentition and oral soft tissues with bare hands or coming in contact with blood/serum of infected patients. Indirect trans- mission can occur through contact with contaminated needle or improperly sterilized instruments contact with contaminated units or surfaces. Transmission can also occur via blood serum or air borne droplets if protective measures like wearing masks and protective eye wears are not taken.45

Infection can be established when subsequent factors are present like patient having active viral or bacterial diseases sufficient number of causative mi- croorganism individuals without any prior vaccination or no immunity against pathogen and a porch through which the causative microorganism can easily enter the host. In order to protect host from getting exposed to infections effective strategies are required to be planned in order to break one or more of these links in the chain and establish safety.

In 2003 the Center for Disease Control and Pre- vention of the United States of America (CDC) updated their guidelines for infection control in dental settings. These guidelines include standard precautions which intend to make sure a safe and sound working atmo- sphere along with preventing potential transmission of professional and nosocomial infections among dentists dental health care professionals and their patients.3

These CDC guidelines pay firm emphasis on wearing face masks and gloves on each and every patient chang- ing face mask and gloves after completing the individual patient wearing protective clothes and protective eye wear which should be properly disinfected or sterilized before reuse. After each and every patient hands must be thoroughly washed with an antimicrobial solution and drying of the hands.67 The objective of this study was to determine the level of knowledge attitude and practice in regards to standard precautions among den- tal students and faculty of DOW University of Health Science (DUHS) Karachi Pakistan.

METHODOLOGY

A cross sectional study was carried out among den- tal students and fresh graduates of Dow International Dental College (DUHS). The data comprised of one sixty (160) dental students house officers and freshly graduated dentists. House officers are the graduates of the same university with equally rotating in each and every department during the period of one year (internship). Education of infection control is primarily provided in all the four years of dental studies and various sessions are also conducted on infection control and its measures during house job (internship) as well.

The questionnaire was selected from a previous research on relevant topic and few amendments in the questionnaire were made with the help of professionals. The questions in the questionnaire were related to cross infection control topic of their dental curriculum.

The study population of 200 dental students voluntarily completed a questionnaire consisting of fourteen close ended questions. The dental students were given the questionnaire in the lecture hall and asked to fill it out without conferring it with their fellow students.

The house officers were given the same questionnaire in their respective departments. Through this we ob- tained information about Knowledge Attitudes and Practice of Infection Control procedures among Dental practitioners.

Statistical analyses for knowledge attitude and practice descriptive statistics were computed using the Statistical Package for Social Sciences (SPSS) software for Windows version 17. Chi-square test was used to determine the demographic details of study population. One way ANOVA was used to calculate p-value of knowledge attitudes and practice values. Pearson's test was used to compute the correlation among knowledge attitudes and practice scores. A p value of =0.05 was considered to be important for all statistical analyses.

RESULTS

Among 160 dental students and interns 47 males and 113 females filled the questionnaire. The percent- age of female dentists was 70.6% higher than the male dentists (only 29.4% Table 1). Almost all the dental practitioners washed their hands before and after ex- amining patients but ratio of using antiseptic solution was only 43.8% while ordinary hand wash was 51.3%. Dental students and interns had an excellent knowl- edge (98.8%) that appropriate isolation is a key method to prevent cross infection and believed that (91.3%) disinfection of dental chair clinic and dental office is also necessary. Thirty percent of undergraduate dental students were not immunized against Hepatitis B virus which makes them vulnerable to get this infection from infected patient while practicing. All the protective measures like face masks gloves protective eye wear and clothing to prevent cross infection were practiced by 72.5% of students and fresh graduates (Table 2).

The mean total of knowledge attitudes and prac- tice scores were computed individually. Mean scores of knowledge attitudes and practice were 9.66 (1.38) 6.98 (1.36) and 10.16 (1.42) respectively. Significant differences between the study groups were noticed for means of practice scores (=0.01) (Table 3). Significant linear correlation was observed between knowledge and practice scores (p=0.01). Among knowledge-attitude and attitude-practice scores no differences were seen (Table 4).

TABLE 1:DEMOGRAPHIC CHARACTERISTICS OF DENTAL HEALTH CARE PROVIDERS

###BDS_year

###Sec-###Third###Final###House

###ond###year###year###offi-

###year###cer and###Total

###fresh

###grad-

###uates

Gender###13###12###8###14###47

Male###8.1%###7.5%###29.4%

Female###37###38###17###21###113

###70.6%

TABLE 2: DENTAL STUDENTS AND INTERNS WERE QUESTIONED TO EVALUATE

###KNOWLEDGE ATTITUDES AND PRACTICE OF CROSS INFECTION CONTROL MEASURES

###IN FREQUENCY AND PERCENTAGE

Question###Answer###Frequency###Percentage

Q1. Do you wash your hands before and after Yes###160###100%

examining patients

###No###0

Q2. What aid do you use to wash your hands after Plain soap###8###5%

completing the diagnosis or treatment of patients Hand Wash###82###51.3%

###Antiseptic solution###70###43.8%

Q3. Do you prefer oral mouth wash before com- Yes###98###61.3%

mencing any treatment procedure###No###62###38.8%

Q4. Do you think isolation is important in infec- Yes###158###98.8%

tion control###No###2###1.3%

Q5. Have you been vaccinated against the vaccines Hepatitis B###6###3.8%

listed in the column###Tuberculosis (BCG)###12###7.5%

###All of the above###108###67.5%

###Tetanus and BCG###34###21.3%

Q6.Which of the means do you or your dentist Autoclave###126###78.8%

use to sterilize instruments in dental clinics###Washing/ Boiling###2###1.3%

###Washing and disinfecting###32###20.0%

Q7. What is the minimum time required for 5 min###10###6.3%

sterilization in autoclave###10 min###22###13.8%

###15 min###128###80%

Q8. What is the optimal temperature for steril- 100 C at 15 lbs###14###8.8%

ization in autoclave###121 C at 15 lbs###140###87.5%

###150 C at 15 lbs###6###3.8%

Q9. Which disease has the highest rate of trans- Hepatitis B###88###55%

mission via saliva###AIDS###20###12.5%

###Tuberculosis###42###26.3%

###Don't know###10###6.3%

Q10. What immediate action should be taken in Anti-HIV Igs###36###22.5%

case of direct blood contact with an HIV patient Anti-HIV drugs###16###10%

###Blood tests###76###47.5%

###None of the above###16###10%

###Don't know###16###10%

Q11. As a clinician what protective measures do Face mask/###44###27.5%

you or your dentist take to prevent from injury glovesEyewear###0###0%

###Protective clothing###0###0%

###All the above###116###72.5%

Q12. After using gloves on a patient what do Dispose them off Reuse###160###100%c

you do with them###them after wash Reuse

###after sterilization

Q13. During clinical practice an ineffective ster- Yes###160###100%

ilization can transmit infection from one patient No

to another

###Don't know

Q14. Other than sterilization of instruments Yes###146###91.3%

disinfection of dental chair clinic dental office No###8###5%

is necessary

###Don't know###6###3.8%

TABLE 3:MEAN (SD) OF KNOWLEDGE ATTITUDES AND PRACTICE SCORES REGARDING INFEC-

###TION CONTROL

Years of BDS###Knoweldge Mean (SD)###Practice Mean (SD)###Attitude Mean (SD)

Second year BDS###9.80(1.46)###6.96(1.35)###10.38(1.28)

Third year BDS###9.28(1.47)###6.44(1.62)###10.10(1.54)

Final year BDS###10.28(1.40)###7.08(1.26)###10.28(1.31)

Interns###9.57(.92)###7.69(.47)###9.86(1.52)

Total###9.66(1.38)###6.98(1.36)###10.16(1.42)

p-Value###.022###.000###.387

TABLE 4: CORRELATION AMONG KNOWLEDGE ATTITUDES AND PRACTICE SCORES

Variables###Correlation###p-value

###Coefficient

Knowledge###.124###.118

attitude

Attitude###-.079###.321

practice

Knowledge###.302###0.01

Practice

DISCUSSION

In present time awareness concerning cross infection con- trol has improved among dental practitioners in dental settings. This awareness has been heightening due to increase transmis- sion of HIV Hepatitis or other diseases to dental patients and DCP.8 9 This study shows a better outcome regarding attitude of dentists towards hepatitis B vaccination of dental students and fresh graduates as compared to a survey conducted in Pa- kistan ten yearsback.10 But there is further demand of making each and every dental student dentist and dental personnel to be vaccinated with hepatitis B in order to acquire absolute in- fection control. Most of the dental institutions keep vaccination of tetanus MMR and Hepatitis B as a compulsory component of their admission procedure for dental students and employees as well.

The purpose of infection control measures is to break the chain by consistently practicing standard protocols which would prevent the infectious agent from moving from one person to another. Nearly all dental practi- tioners believe that isolation prevents the transmission of hazardous infections. Majority of study population considered disinfection of dental chair surfaces and dental clinic is mandatory along with sterilization of instruments.11 12 Inspite of having thorough knowledge of using antiseptic solution as a universal means of preventing infections still half of the dental health care providers over here are using ordinary hand wash to clean their hands after examining the patient.

The knowledge and attitude of cross infection control is increasing among dental students but there is some room for further improvement.13 14 The study results demonstrate that practices of standard proto- cols is better among dental students interns and fresh graduates in the Dow University of Health Sciences. Two third of dental students and interns practice all the protective measures like gloves face mask protective eye wear and clothing but one third of study population is lacking behind in protecting themselves from infec- tion.15 In many researches improvement in utilization of protective measures has been published like ninety percent or more of the dental students in Turkey Brazil and Iran uses standard protective measures but only seventy percent practice in Central India.

It is well known that disinfection alone is not adequate to kill all the bacteria viruses and theirs pores due to which more powerful and best technique such as autoclave is necessary for sterilizing dental instruments.18 In this study 78.8% of dental practi- tioner preferred autoclave as a mean of sterilization 80% estimated the correct time 87.5% answered the accurate temperature and pressure which revealed a good knowledge and practice.16 In different studies authors have mentioned that more than ninety percent dentists sterilize instruments through autoclave but in Turkey only 18% dentists autoclave hand pieces and instruments at the end of the day.1316

Mean score for knowledge attitudes and practice were 9.66(1.38) 6.98 (1.36) and 10.16 (1.42) respec- tively. Statistically significant differences were noted between the study groups for knowledge and practice scores (p=0.01). This gives a good impression that dental health care providers are practicing standard infection control measures in their dental practice. The result suggests that thorough infection control measure exercises at all the stages of dental education is of paramount importance. Even though significant linear correlations occurred between knowledge and practice (p=0.01) no correlation was obtained among knowledge-attitude and attitude-practice.

This study shows that knowledge of infection control measure is sound among dental students but need some improvement towards developing a firm attitude.17 This attitude can be improved by refreshing and upgrading their knowledge by providing continu- ous education of universal infection control measures through arranging sessions or lectures for students of each professional year.18 19 Such lecture programs should also be conducted for healthcare workers especially DHPs on ongoing basis as they come more in contact with contaminated instruments needles handpieces blood spilled surfaces and others objects. The rate of transmission of infectious agent like Hepatitis B virus among dental care professions is higher as compared to general dental practitioners. If Dental Care Profes- sionals will practice standard protocols for infection control meticulously than a beneficial and protective environment will be created for everyone in the dental setup.1220

CONCLUSION

The outcome of this study was favorable about the knowledge regarding infection control measures among dental students. The only need is to transfer that acquired knowledge into daily practices in order to create a healthy environment for everyone. Improved compliance with recommended infection control mea- sures should be compulsory for all students dentists and Dental Care Professionals. Continuing education programs and refreshing courses regarding cross infec- tion control procedures are necessary to improve the knowledge of dental practitioners.

REFERENCES

1 Singh A Purohit BM Bhambal A Saxena S Singh A Gupta A. Knowledge attitudes and practice regarding infection control measures among dental students in Central India. Journal of dental education. 2011;75(3):421-27.

2 YA1/4zbasioglu E Sarac D Canbaz S Sarac YS Cengiz S. A survey of cross-infection control procedures: knowledge and attitudes of Turkish dentists. Journal of Applied Oral Science. 2009;17(6):565-69.

3 DTMH OAM. Infection control practices among dental profes- sionals in Shiraz Dentistry School Iran. Archives of Iranian medicine. 2009;12(1):48-51.

4 Mousa AA Mahmoud NM El-Din AMT. Knowledge and attitudes of dental patients towards cross-infection.Eastern Mediterra- nean Health Journal. 1997; Volume 3 issue 2: 263-73.

5 Harrel SK Molinari J. Aerosols and splatter in dentistry: a brief review of the literature and infection control implications. Journal of the American Dental Association. 2004;135(4):429-37.

6 Kohn WG Collins AS Cleveland JL Harte JA Eklund KJ Malvitz DM. Guidelines for infection control in dental health- care settings-2003. US Government Printing Office; 2003.

7 Harte JA. Looking inside the 2003 CDC dental infection con- trol guidelines. Journal of the California Dental Association. 2004;32(11):919-30.

8 Sofola OO Folayan MO Denloye OO Okeigbemen SA. Occu- pational exposure to bloodborne pathogens and management of exposure incidents in Nigerian dental schools. Journal of dental education. 2007;71(6):832-37.

9 Hudson-Davies S Jones J Sarll D. Cross-infection control in general dental practice: dentists' behaviour compared with their knowledge and opinions. British dental journal. 1995;178(10):365-69.

10 Puttaiah R Miller K Bedi R Shetty S Almas K Tse E et al. Comparison of Knowledge Attitudes and Practice of Dental Safety from Eight Countries at the Turn ofthe Century. The journal of contemporary dental practice. 2011;12(1):1-7.

11 Crawford J. State-of-the-art: practical infection control in dentistry. Journal of the American Dental Association (1939). 1985;110(4):629-33.

12 Thomas MV Jarboe G Frazer RQ. Infection control in the dental office. Dental Clinics of North America. 2008;52(3):609-28.

13 Ebrahimi M Ajami B Rezaeian A. Longer Years of Practice and Higher Education Levels Promote Infection Control in Iranian Dental Practitioners. Iranian Red Crescent Medical Journal. 2012;14(7):422.

14 Cheng H-C Su C-Y Huang C-F Chuang C-Y. Changes in compliance with recommended infection control practices and affecting factors among dentists in Taiwan. Journal of dental education. 2012;76(12):1684-90.

15 Qudeimat MA Farrah RY Owais AI. Infection control knowledge and practices among dentists and dental nurses at a Jordanian university teaching center. American journal of infection control. 2006;34(4):218-22.

16 Abreu MHNGd Lopes-Terra MC Braz LF Rimulo AL Paiva SM Pordeus IA. Attitudes and behavior of dental students con- cerning infection control rules: a study with a10-year interval. Brazilian dental journal. 2009;20(3):221-25.

17 Souza RA Namen FM Vieira C Sedano HO. Infection control measures among senior dental students in Rio de Janeiro State Brazil. Journal of public health dentistry. 2006;66(4):282-84.

18 Myers JE Myers R Wheat ME Yin MT. Dental students and bloodborne pathogens: occupational exposures knowledge and attitudes. Journal of dental education. 2012;76(4):479-86.

19 Alavian SM Mahboobi N Mahboobi N Savadrudbari MM Azar PS Daneshvar S. Iranian dental students' knowledge of hepatitis B virus infection and its control practices. Journal of dental education. 2011;75(12):1627-34.

20 Larson E Kretzer E. Compliance with handwashing and barrier precautions. Journal of Hospital Infection. 1995;30:88-106.
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Date:Sep 30, 2014
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