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 Table of Contents  
ORIGINAL RESEARCH
Year : 2018  |  Volume : 10  |  Issue : 2  |  Page : 83-87

Knowledge, attitude, and practice of infection control among dental students in King Khalid University, Abha


1 Department of Diagnostic Science and Oral Biology, College of Dentistry, King Khalid Univeristy, Abha, KSA
2 Department of Periodontology, Guardian College of Dental Science and Research Center, Ambernath, Thane, Maharashtra, India
3 Department of Maxillofacial Diagnostic Science, College of Dentistry, King Khalid Univeristy, Abha, KSA

Date of Web Publication23-Apr-2018

Correspondence Address:
Dr. Shaik Mohammed Asif
Department of Diagnostic Sciences, College of Dental Surgery, King Khalid University, Aseer Region, P.O. Box: 3263, Abha
KSA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_6_18

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  Abstract 

Aim: The aim of this study was to investigate attitude and practice of infection control among senior dental students of the College of Dentistry, King Khalid University, Abha. Materials and Methods: The study sample comprised of 191 students of the College of Dentistry, King Khalid University, Abha. A standardized self-administered questionnaire was developed with 25 open- and closed-ended questions related to barrier techniques, vaccination status, infection control practices, and awareness. These questionnaires were distributed among the senior dental students after obtaining the consent form. Each questionnaire was coded to ensure the confidentiality of the response. Results: The compliance with the use of protective barriers was high with the exception of protective eyewear, utilized by only 22% of students. There was a significant difference between 5th-year, 6th-year students and interns' attitudes (P < 0.05) regarding the treatment of patients with infectious diseases. About 59% of interns and 27.8% of 6th-year and 56.2% of 5th-year students suffered from percutaneous injury (P < 0.05), and needlestick injury was the most common source of accidental exposure. Conclusion: Efforts are needed to improve the attitude and motivate students in the correct and routine use of infection control measures. With all infection control protocols already implemented in dental schools, the challenge remains on improving compliance with infection control recommendations.

Keywords: Dental students, infection control, oral health


How to cite this article:
Assiri KI, Naheeda, Kaleem SM, Ibrahim M, Alam T, Asif SM. Knowledge, attitude, and practice of infection control among dental students in King Khalid University, Abha. J Int Oral Health 2018;10:83-7

How to cite this URL:
Assiri KI, Naheeda, Kaleem SM, Ibrahim M, Alam T, Asif SM. Knowledge, attitude, and practice of infection control among dental students in King Khalid University, Abha. J Int Oral Health [serial online] 2018 [cited 2018 Dec 17];10:83-7. Available from: http://www.jioh.org/text.asp?2018/10/2/83/230863


  Introduction Top


Dental clinic is an environment where the disease transmission occurs easily and dentists are at high risk of exposure to cross-infection with blood-borne pathogens.[1] Infections may be transmitted in the dental operatory through several routes including direct contact with blood or oral fluids and indirect contact with contaminated instruments or environmental surfaces.[2],[3] With emergence of AIDS epidemic in the 1980s, even more stringent precautions became necessary to effectively protect health-care workers, leading to the recommendations by the US Centers for Disease Control and Prevention (CDC) concerning the prevention of HIV transmission in health-care settings and universal precaution guidelines.[4] However, the limitations of universal precautions were recognized subsequently, and in 1996, CDC adopted the term “standard precautions” to embrace a broader concept of prevention and transmission of infections.[5],[6] Hands are considered to be a major source of infection and infected blood may retain beneath the fingernails for up to 5 days.[7] It is difficult to remove contaminated material from hands, particularly from the subungual and nail-fold areas, unless there is meticulous mechanical cleansing. Direct involvement in patient treatment as part of their clinical training puts dental students at risk of exposure to pathogens. As majority of carriers of infectious disease cannot be identified, implementation of standard universal precautions in dental schools is the most effective way of controlling cross-infection.[8] Dental education can play an important role in training of dentists, helping them to adopt adequate knowledge and attitudes related to infection control measures. Hence, the aim of the present study was to investigate attitude and practice of infection control procedures among senior dental students of the College of Dentistry, King Khalid University, Abha.


  Materials and Methods Top


This study was conducted in College of Dentistry, King Khalid University, Abha, Saudi Arabia, during the academic year 2013–2014. An informed consent (duly approved by Institutional and Research Committee SRC/EH/2013-14/21) verbally and a written declaration were obtained and documented from the students before answering the questionnaire. A pilot study was carried out to determine the sample size on the results obtained and to check for the feasibility and note if any difficulties encountered during study process. The study group comprised of 5th-year, 6th-year dental students and interns (n = 191). The questioner used was adapted and modified from the article published by de Souza et al.[9] The questionnaire consisted of 25 open- and closed-ended questions related to barrier techniques, vaccination status, and percutaneous exposures in addition to the dental treatment of infected patients, infection control practices, and awareness. Two of the co-authors approached students at the beginning of the student's sessions and invited them to participate in the study. Students, who agreed to participate, were included in the study; students who were absent and not willing to participate in the study were excluded from the study. The self-administered questionnaires were distributed and collected after completion of questionnaire. To ensure confidentiality of responses, the questionnaires were coded. The data were tabulated and analyzed by Chi-square test. All the analysis was done using SPSS version 18 by IBM. P < 0.05 was considered statistically significant.


  Results Top


In this questionnaire-based descriptive cross-sectional study, 191 undergraduate students participated in the study. The average age of participants in the present study was 22 years in females and 24 years in males with 82% of them were male students and 18% of them were females. [Table 1] shows the vaccination status of dental students where 91.8% of 5th-year, 48.1% of 6th-year students and 89.7% of interns were hepatitis B vaccinated (P< 0.001). About 32.9% of 5th-year and 19% of 6th-year students and 43.6% of interns have taken three doses of hepatitis B vaccination. However, 57.5% of 5th-year and 75.9% of 6th-year students and 82.1% of interns did not tested for posthepatitis B virus (HBV) immunization which was statistically significant (P 0.009). With reference to the questionnaire would you get hepatitis B vaccinated if it was not mandatory in the dental school, 61.6% of 5th-year and 86.1% of 6th-year students and 89.7% of interns agreed to get vaccinated which was statistically significant (P< 0.001).
Table 1: Vaccination status

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All 5th-year students, interns, and 98.7% of 6th-year students agreed wearing gloves during the dental procedure [Table 2]. Similarly, all 5th-year students, interns, and 98.7% of 6th year students agreed changing gloves from one patient to other patient; however, it was not statistically significant [Table 2]. 89.7% interns & all 5th & 6th year students agreed that their instructor changes gloves from one patient to another patient (p<0.001). Nearly 83.6% of 5th-year and 84.8% of 6th-year students and 89.7% of interns feel that dental clinics are more prone to infectious disease than other medical field. However; it was not statistically significant [Table 3]. Only 43.8% of 5th-year students, 46.2% of 6th-year students, and 31.6% of interns were ready to treat patients with infectious diseases. Nearly 93.2% of 5th-year and 60.8% 6th-year students and 89.7% of interns feel that dental schools are responsible for implementation of infection control protocol which was statistically significant (P< 0.001). About 56.2% of 5th-year and 27.8% of 6th-year students and 59% of interns suffered accidental injuries in their dental clinics [Table 4]. Needlestick injury was the most common source of injury among dental students and it was seen more among interns (41%). All the students of different levels agreed to follow infection control procedure in their future clinics [Table 4].
Table 2: Use of protective barrier

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Table 3: Exposure to infectious diseases

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Table 4: Percutaneous injuries and miscellaneous

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  Discussion Top


Most susceptible people for infectious diseases in working environment are health-care professionals.[10] Dentists are repeatedly exposed to many microorganisms present in blood and saliva. As a consequence, incidence of certain diseases is high among them when compared to general population.[11] Dental students are the future dental professionals, who will provide oral health care for general population. They tend to practice infection control procedures what they acquired during their training in dental school. Thus, this study investigated the compliance and practice of infection control procedure among senior dental students of the College of Dentistry, King Khalid University, Abha. Students of the present dental school attend lectures on infection control during the 2nd year of their undergraduate program. Practice guidelines are received in the 3rd and 4th years during their clinical training. Moreover, a standard infection control protocol is adopted at the institution, and the clinical faculty pays attention for student adherence to the recommended infection control protocol. The results of the present study regarding HBV immunization showed that 91.8% of 5th-year students and 89.7% of interns were vaccinated which was statistically significant. These results are in accordance with study conducted by de Souza et al. where 90.8% of all senior students received vaccinations in 6 dental schools in Rio de Janeiro, Brazil.[9] However, Singh et al. stated that 61.2% of undergraduate students in a dental school in Central India were not vaccinated for HBV even though it was mandatory. They concluded a positive attitude but poor compliance of infection control practices among their students.[12] Among those vaccinated, only 32.9% of 5th-year and 19% of 6th-year students and 43.6% of interns completed the minimum required dose (three doses) which is needed to obtain adequate immunity. These numbers are somewhat alarming and low when compared to other studies.[9],[10] The lower rate of HBV vaccination in our study emphasizes the need to encourage students for proper vaccination so as to reduce the risk of acquiring HBV. Among the vaccinated students, 42.5% of 5th-year and 24.1% of 6th-year students and 17.9% of interns [Table 1] have been tested for post-HBV immunization serology. These findings are in compliance with study conducted by de Souza et al., where only 27.5% of participants reported postimmunization serology.[9] In McCarthy and Britton's study, a significant proportion of students failed to confirm post-HBV immunization serology.[13] The use of gloves among dental students in our study was 99.5% and the use of mask was 93%. These findings are in accordance with study conducted among dental faculty and dental nurses in Jordan.[14] Compliance to the regular use of eyewear was quite low in our study [Table 2] when compared to other studies.[8],[9] Students should be reminded that neglecting the use of protective eyewear might put them at risk of transmission of infectious diseases through the exposed membranes. There was a 45% compliance with the use of caps by dental students in our study which was statistically significant. Personal protective clothing such as disposable gowns or scrubs is worn as a barrier to prevent transmission of microorganisms between patients and dental health-care workers. Research has shown that aerosol and splatter containing pathogens can contaminate clinical wear, targeting the chest and forearms, and remain for several days.[2],[4] Majority of students in our study reported that they wear their scrubs during dental procedure; however, it was not statistically significant [Table 2]. Majority of students in our study mentioned changing their scrubs if there was any contamination. It has been recommended that the dental uniforms be changed immediately after a blood splatter to prevent cross-contamination. There was a low compliance reported among the dental students regarding washing their hands after each glove change [Table 2]. Similar findings were reported by Musu M et al. where there was only 45% compliance of hand hygiene among dental graduates.[15] The low compliance with regular handwash necessitates strict measures to remind the students for the importance of handwashing. Handwashing signs can be placed near each basin in dental clinics as washing of hands is a significant element in infection control. Majority of the students believe that dental clinics are more prone for infectious disease than other medical field [Table 3]. These findings are in accordance with the study conducted by Rahman et al. where 87.1% of students thought that dental clinics are more prone for infectious disease when compared to other medical field.[16] Students of higher level (interns) were ready to treat patients with infectious disease [Table 3]. Among the treated cases, 25.6% of patients were hepatitis B and 12.8% of cases were nonhepatitis B. The students who treated these patients have thorough knowledge and were well trained about the precautionary measures to be followed during their undergraduate program. About 59% of interns in our study had suffered accidental injury. The significant difference between interns and other students who suffered from accidental injuries [Table 4] may be due to the fact that interns have longer clinical exposure and operate patient independently as compared to 5th- and 6th-year students. Majority of injuries were due to needlestick injury. These findings are in accordance with various other studies.[8],[9],[16] At the College of Dentistry, there is a postexposure management protocol for occupational injuries where students are referred to higher centers for further management. Some limitations of the present study should be acknowledged. This is first of its kind of study conducted in Asser Province of Abha and it was conducted in a single institution, and thus, results cannot be generalized to other dental schools of Saudi Arabia and the response of the students was based on student's self-assessment rather under the supervision by investigator of the study in a clinical environment. Therefore, the response may not accurately reflect the actual infection control practices of dental students. However, these findings would be useful for planning additional educational interventions and improving the infection control protocol at this institution.


  Conclusion Top


It is necessary to effectively communicate with students about associated risks and importance of transmission of infectious diseases and exposure during dental treatments. Efforts are needed to motivate students regarding correct and routine use of infection control measures. With all infection control protocols already implemented in dental school, the challenge remains on improving compliance with infection control recommendations.

Acknowledgment

The authors would like to acknowledge the Dean and students of the College of Dentistry for their participation and constant support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Taiwo JO, Aderinokun GA. Assessing cross infection prevention measures at the Dental Clinic, University College Hospital, Ibadan. Afr J Med Med Sci 2002;31:213-7.  Back to cited text no. 1
    
2.
Antonioli P, Manzalini MC, Stefanati A, Bonato B, Verzola A, Formaglio A, et al. Temporal trends of healthcare associated infections and antimicrobial use in 2011-2013, observed with annual point prevalence surveys in Ferrara University Hospital, Italy. J Prev Med Hyg 2016;57:E135-41.  Back to cited text no. 2
    
3.
Campagna M, Maria Mereu N, Mulas L, Pilia R, Francesca Piazza M, Spada L, et al. Pattern of hepatitis A virus epidemiology in nursing students and adherence to preventive measures at two training wards of a university hospital. Hepat Mon 2016;16:e34219.  Back to cited text no. 3
    
4.
Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Available from: http://www.cdc.gov/hicpac/pdf/isolation/isolation2007.pdf. [Last accessed on 2017 Mar 06].  Back to cited text no. 4
    
5.
Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health Care Settings, 2003: Recommendations and Reports. December 19, 2003/52 (RR17). Atlanta: Centers for Disease Control and Prevention; 2003.  Back to cited text no. 5
    
6.
Shah R, Collins JM, Hodge TM, Laing ER. A national study of cross infection control: 'Are we clean enough?'. Br Dent J 2009;207:267-74.  Back to cited text no. 6
    
7.
Brosio F, Kuhdari P, Stefanati A, Sulcaj N, Lupi S, Guidi E, et al. Knowledge and behaviour of nursing students on the prevention of healthcare associated infections. J Prev Med Hyg 2017;58:E99-104.  Back to cited text no. 7
    
8.
Arias AV, Garcell HG, Ochoa YR, Arias KF, Miranda FR. Assessment of hand hygiene techniques using the World Health Organization's six steps. J Infect Public Health 2016;9:366-9.  Back to cited text no. 8
    
9.
de Souza RA, Namen FM, Galan J Jr., Vieira C, Sedano HO. Infection control measures among senior dental students in Rio de Janeiro State, Brazil. J Public Health Dent 2006;66:282-4.  Back to cited text no. 9
    
10.
Askarian M, Assadian O. Infection control practices among dental professionals in Shiraz dentistry school, Iran. Arch Iran Med 2009;12:48-51.  Back to cited text no. 10
    
11.
Acosta-Gío AE, Borges-Yáñez SA, Flores M, Herrera A, Jerónimo J, Martínez M, et al. Infection control attitudes and perceptions among dental students in Latin America: Implications for dental education. Int Dent J 2008;58:187-93.  Back to cited text no. 11
    
12.
Singh A, Purohit BM, Bhambal A, Saxena S, Singh A, Gupta A, et al. Knowledge, attitudes, and practice regarding infection control measures among dental students in central India. J Dent Educ 2011;75:421-7.  Back to cited text no. 12
    
13.
McCarthy GM, Britton JE. A survey of final-year dental, medical and nursing students: Occupational injuries and infection control. J Can Dent Assoc 2000;66:561.  Back to cited text no. 13
    
14.
Qudeimat MA, Farrah RY, Owais AI. Infection control knowledge and practices among dentists and dental nurses at a Jordanian university teaching center. Am J Infect Control 2006;34:218-22.  Back to cited text no. 14
    
15.
Musu M, Lai A, Mereu NM, Galletta M, Campagna M, Tidore M, et al. Assessing hand hygiene compliance among healthcare workers in six Intensive Care Units. J Prev Med Hyg 2017;58:E231-7.  Back to cited text no. 15
    
16.
Rahman B, Abraham SB, Alsalami AM, Alkhaja FE, Najem SI. Attitudes and practices of infection control among senior dental students at college of dentistry, university of Sharjah in the United Arab Emirates. Eur J Dent 2013;7:S15-9.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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