|Year : 2016 | Volume
| Issue : 3 | Page : 302-307
Infection control measures among dental practitioners in a Southern state of India: A cross-sectional study
Vikram Simha Bommireddy, Srinivas Pachava, Suresh Sanikommu, Narayana Rao Vinnakota, Devaki Talluri, Bhanu Kiran Ghanta
Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
|Date of Web Publication||28-Jul-2016|
Vikram Simha Bommireddy
Flat No. 103, Nandi Arcade, Plot No. 55/3Rt, S. R. Nagar, Hyderabad - 500 038, Telangana
Source of Support: None, Conflict of Interest: None
Introduction: The identification of hepatitis B virus, human immunodeficiency virus as an occupational hazard in dentistry urged all practicing dentists, dental auxiliaries, and dental laboratories to employ appropriate infection control procedures. Aim: The aim of this study to investigate whether there is a scope for improvement in the practice of infection control measures. Materials and Methods: A cross-sectional study was conducted using self-administered questionnaire, to obtain information about procedures used for prevention of cross-infection in dental practices. The study subjects, dental practitioners in Guntur district, were obtained using snowball technique. Data were analyzed using SPSS version 19 software. Descriptive and inferential statistics were used to summarize the results and P < 0.05 was considered statistically significant. Results: The mean age of the study population was 36.48 ± 8.94 years. Of the 183 study subjects, 136 (74.3%) were males and 47 (25.7%) females. Of the total practitioners, 45% usually treated ≥10 patients per day, and 52% had the habit of taking medical history for all patients. Statistically significant difference had been found between the practitioners with Bachelor of Dental Surgery and Master of Dental Surgery as their highest qualification, regarding the method of sterilization of handpiece (P = 0.03). Conclusion: This study result suggests that there was a scope for improvement in the practice of infection control procedures among dental care professionals.
Keywords: Cross-infection control, dental practice, dentistry, healthcare-associated infection, infection control
|How to cite this article:|
Bommireddy VS, Pachava S, Sanikommu S, Vinnakota NR, Talluri D, Ghanta BK. Infection control measures among dental practitioners in a Southern state of India: A cross-sectional study. J Indian Assoc Public Health Dent 2016;14:302-7
|How to cite this URL:|
Bommireddy VS, Pachava S, Sanikommu S, Vinnakota NR, Talluri D, Ghanta BK. Infection control measures among dental practitioners in a Southern state of India: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2020 Dec 4];14:302-7. Available from: https://www.jiaphd.org/text.asp?2016/14/3/302/187178
| Introduction|| |
In the course of oro-dental examination or procedures, dentists, auxiliaries, and other healthcare personnel have an increased chance of getting exposed to a number of pathogens. Dental health care professionals (DHCPs) are at risk of infections triggered by various microorganisms such as Mycobacterium tuberculosis, hepatitis B virus (HBV) and hepatitis C virus, staphylococci, streptococci, herpes simplex virus types 1, human immunodeficiency virus (HIV), mumps, influenza, and rubella. Infections may be transmitted in the dental operatory through various means, including direct contact with blood, oral fluids, or other secretions; indirect contact with contaminated instruments, operatory equipment, or environmental surfaces; or contact with airborne contaminants present in either droplet splatter or aerosols of oral and respiratory fluid.
The recognition of dentists' potential to cause cross-infection early in the 1980s stimulated Centre for Disease Control, American Dental Association, and other professional agencies to escalate their call for dental practitioners to make adoption of the Universal precautions as their highest professional priority. Dental professionals have a legal duty of care to protect the health and safety of patients. The public expectations from a health care faculty are zero risk. Effective infection prevention and control is central to providing high-quality health care for patients and a safe working environment for those that work in healthcare settings. Despite the considerable emphasis placed on standardized infection control procedures, it appears that few dentists have adhered to these procedures in their clinical practice.,,,,,, Even in dental schools, future dentists have not always properly adhered to this procedures.,,,,,,
Infection control can be achieved by following the standard guidelines; however, there is evidence which shows that the DHCPs have an inadequate knowledge, negative attitudes, and poor practices regarding the infection control measures.,,, Periodic evaluation of the knowledge, attitude, and practices of DHCPs regarding infection control practices helps in the planning of educational interventions to improve the attitude and practices among DHCPs. The objective of this study was to investigate whether there is any scope for improvement in the practice of infection control measures by dental practitioners in Guntur district, Andhra Pradesh and whether the infection control measures among dental practitioners are related to years of practicing experience.
| Materials and Methods|| |
A cross-sectional study was carried out from April to May 2015, among the dental practitioners of Guntur district, Andhra Pradesh. This study was conducted in full accordance with the World Medical Association Declaration of Helsinki (as edited in Edinburgh, 2000). Ethical clearance for the study was obtained from the Institutional Review Board. Practitioners have been explained the purpose of the study and written consent was taken. Practitioners, who were available on the day of study in their respective workplace, were included in the study.
A pilot study was conducted on 10 study subjects to test the feasibility of the study and check the validity of the questionnaire. The test-retest reliability was found to be acceptable (Cohen's kappa statistic = 0.78), along with the face and content validity (Aiken's V index = 0.81). A self-administered questionnaire was structured, close-ended, and designed in English comprising eighteen questions. The demographic profile included details regarding age, sex, and education. Each respondent should then answer a series of questions about the infection control practices that they perform regularly in clinical practice.
Data about the distribution of dental practitioners in Guntur district was not available. Guntur district comprises 1 city and 24 major and minor towns. Data were collected using snowball sampling method. Based on information obtained from anecdotal conversations, practicing dentists were located, and information about the other practicing dentists was obtained subsequently. All the towns (n = 16) with at least one practicing dentist or dental clinic were selected for data collection, along with the Guntur city in the district. A total of 208 questionnaires were distributed in person, and 183 of them were returned. Data were analyzed using SPSS version 19.0. Armonk, NY: IBM Corp software. Descriptive and inferential statistics were used to summarize the results, and P < 0.05 was considered statistically significant.
| Results|| |
The mean age of the study population was 36.48 ± 8.94 years. Of the 183 study subjects, 136 (74.3%) were males and 47 (25.7%) females. The majority (86.4%) among age groups was 25–44 years. About 72% (n = 131) of the respondents had Bachelor of Dental Surgery (BDS) as their highest qualification. Nearly, 70% of the study subjects in the present study had <10 years of experience as dental practitioners [Table 1].
|Table 1: Frequency and percentage distribution of study subjects according to demographic details, professional characteristics, and infection control practice question|
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In the current study, 45% of the practitioners usually treat ≥10 patients per day, and 52% have the habit of taking medical history for all patients. Of the study population, 87.4% answered that they always wear gloves while treating the patient, whereas, only 18.6% answered that they always wear protective eyewear during the treatment procedure [Table 2].
|Table 2: Frequency and percentage distribution of responses given by the subjects of different age groups to various questions on infection control practices|
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Statistically significant difference had been found between the practitioners with BDS and Master of Dental Surgery (MDS) as their highest qualification, regarding the method of sterilization of airotor handpiece (P = 0.03). Notably, 3.1% (n = 4) of the clinicians with BDS degree had not been using any sterilization procedure for the handpiece, whereas, all the clinicians with MDS degree had been using one procedure or the other for sterilizing the airotor handpiece. With respect to the gender, statistically significant difference was found only for the type of disinfectant procedures used for dental chair (P = 0.039). When different age groups were cross-tabulated against the responses for various questions, the responses for questions, viz., wearing gloves while treating patients (P = 0.000), changing gloves between patients (P = 0.000), washing hands (P = 0.001), using separate instruments for Hepatitis and HIV patients (P = 0.001), type of sterilization/disinfectant procedures used for instruments (P = 0.01) showed statistical significance [Table 2].
When years of experience was cross-tabulated against the responses for various questions, patients seen per day (P = 0.003), wear gloves while treating patients (P = 0.02), change gloves between patients (P = 0.003), frequency of washing hands (P = 0.04), frequency of eye wear (P = 0.03), using separate instruments for hepatitis and HIV patient (P = 0.006), type of sterilization/disinfectant procedures used for instruments (P = 0.000), vaccination for HBV (P = 0.02) respectively, showed statistical significance [Table 3].
|Table 3: Frequency and percentage distribution of responses given by the subjects with different levels of clinical experience to various questions on infection control practices|
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| Discussion|| |
This study provides valuable information on the current infection control practices of dentists in Guntur district. Baseline information of this kind is of great significance in planning any program to improve the infection control practices of dentists. More than 75% of the respondents were aged below 40 years, indicating that most of the practitioners are young; thus, have more fruitful practice years to learn and adopt sound infection control practices.
In the current study, 57.7% of the respondents reported that they record medical history of all the patients attending their clinic; this is very low compared to that reported by Al-Rabeah and Moamed  (93%) and Sofola and Savage (92.5%). A dentist must know where a particular patient stands in the panorama of health and disease, before offering treatment or even advice. Knowledge on various communicable diseases, their potential for transmission, clinical features, progression, and outcomes, is necessary for a clinician. Dental treatments such as extraction may affect or be affected by the systemic condition of the patient. Identifying systemic illness is very important to the safety of the patient as the medication they use can have a broader range of action as well as serious interactions.
Hands are considered a major source of infection in dentistry and wearing of gloves by dental personnel had been an essential element of cross-infection control. Gloves may be single-use-disposable nonsterile exam gloves or single-use-disposable sterile surgical gloves that can be used in a patient's mouth. All the respondents in our study reported routine usage of gloves in the clinic. A study conducted on dental practitioners in Davangere, Karnataka reported that more than 90% of dentists use gloves routinely. However, another study conducted in Hyderabad city  reported that only 57% of the respondents use gloves routinely. About half of the respondents of the present study were using face masks, and protective eyewear routinely. This is comparable to the findings of the studies reported from Haryana (59%) and Hyderabad (60%). However, another study from Davangere  reported a much higher percentage (85%) of wearing a face mask. About half of the respondents used chemical disinfection for their airotor handpieces. Al-Rabeah and Moamed  reported that 37.9% of dentists sterilized their handpieces by autoclaving.
Hand hygiene substantially reduces potential pathogens and is considered a critical factor in reducing the risk of transmitting microorganisms between dentists and patients. Scrubbing hands all the way up to the elbow for about 2–6 min using a single-use disposable sponge or a soft scrub brush removes the dead cells along with the bacteria resident on the skin of the hands. Bacteria under the gloves rapidly multiply due to the humid and warm environment as opposed to a dry and cool area. If the soap has residual properties (staying on the skin on repeated washing with the antimicrobial soap), it tends to slow the multiplication of microbes. Only 59% of the respondents said that they wash their hands before and after treating a patient. This is much low compared to that (92.9%) reported in a study conducted by Suresh et al. in Davangere in 2006.
A preprocedural rinse with a product containing an antimicrobial product (e.g., chlorhexidine gluconate, essential oils, povidone iodine) had been known to reduce the level of oral microorganisms generated in aerosols or spatter during routine dental procedures with rotary instruments. As reported elsewhere, 55.4% of study subjects preferred oral mouth rinse before the commencement of any treatment procedure, whereas, only 39.3% always used antimicrobial mouthwash before intraoral procedure in our study. The dental team should never rely entirely on a sole protective tactic. Protective barriers such as masks, gloves, and safety glasses, which form the first line of defense in the reduction of infectious materials such as aerosols, should be supplemented with a second line of defense such as routine use of preprocedural mouth rinse like chlorhexidine.
Steam sterilization of the instruments was the method of choice for about 58% of the respondents in this study. Al-Omari and Al-Dwairi (Jordan) and Suresh et al. reported that 63% and 78.4% of respondents were using an autoclave for sterilization, respectively. When autoclaved, all bacteria, viruses, fungi, and spores are inactivated. Autoclaves are of particular importance in poorer countries due to the much greater amount of equipment that is re-used. Providing stove-top or solar autoclaves to rural medical centers has been the subject of several proposed medical aid missions.
Use of boiling water as a method of sterilization is no longer acceptable in dentistry. Simply boiling for 30 min or more will kill virtually all vegetative cells present, but will not kill spores, which can germinate shortly thereafter and resume growth. Therefore, boiling is an insufficient method to achieve sterilization. However, 21% of the respondents were using boiling water as the only method of sterilization in their clinics. In a study  conducted in Khartoum, Sudan, an African Country, which was considered to be under-developed, only 2% of the respondents were using boiling water for sterilization. The reported usage of boiling water for sterilization was 2.6% and 8% in New Zealand and Caribbean general dentists, respectively.,
Dentists and clinical dental staff being at a high risk for hepatitis B infection must be vaccinated for it. About 95% of the respondents were vaccinated for HBV, but the vaccination rate of the clinical dental staff was poor. About 60% of the respondents said their staff was either not vaccinated, or they were not sure of the vaccination status, owing to use of uncertified assistants who were with no proper training and protocol. Moreover, the assistants keep varying from time to time in most of the clinics. This was similar to the response obtained in the study conducted by Suresh et al. in Davangere. It is the responsibility of the dentists to see to it that the staff members are vaccinated for HBV.
Lack of properly channeled information regarding a number of dental clinics and dental practitioners in Guntur district was a drawback to our study. Nonetheless, we were able to attain the address of maximum number dental clinics' present, exploiting the advantage of snowball sampling. Considering the changes that take place in a person's social and personal life, the 10 years age range seemed appropriate. However, as only few participants were present in certain age groups, the results should not interpreted solely based on percentages, but frequencies should also be considered. One more limitation could be, relying solely on the responses given by the practitioners and using no method for assessment of the infection practices that was used in reality. Therefore, unlike intended, the responses might have not accurately reflected the infection control measures being practiced.
An educational program on infection control, isolation, and precautions for all healthcare workers to allow compliance with infection control policies are necessary to reduce infectious hazards among not only DHCPs but also their patients. Apart from this, careful monitoring of infection control practices should also be done by the government authorities to increase the percentage of DHCPs practicing adequate infection control measures.
| Conclusion|| |
The present study result concludes that infection control practices among dental practitioners are related to years of practicing experience, and there was a scope for improvement in the practice of infection control procedures among dental care professionals.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]