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| ORIGINAL ARTICLE |
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| Year : 2016 | Volume
: 14
| Issue : 3 | Page : 338-343 |
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Perceptions of dental outpatients toward cross-infection control measures in Jabalpur city
Suryakant C Deogade1, Sneha S Mantri1, K Sumathi1, Gunjan Dube2, Jaiprakash R Rathod3, Dinesh Naitam4
1 Department of Prosthodontics and Crown and Bridge, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
2 Department of Oral and Maxillofacial Surgery, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
3 Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Mumbai, Maharashtra, India
4 Department of Dentistry, Government Medical College, Akola, Maharashtra, India
| Date of Web Publication | 6-Sep-2016 |
Correspondence Address:
Suryakant C Deogade
Flat No. 502, Block-D, Apsara Apartment, South Civil Lines, Pachpedi Road, Jabalpur - 482 001, Madhya Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2319-5932.189836
Introduction: Infection control practices are crucial and important elements in clinical dentistry as there is an enormous increase in the prevalence of infectious diseases among dental patients. This necessitates the application of recommended procedures for infection control in the dental schools and clinics. Aim: The aim of this study was to assess patients' perception toward the use of protective barriers (such as gloves, face masks, and eye goggles) by working dentists in a private dental teaching school in Jabalpur, Madhya Pradesh (India). Materials and Methods: A cross-sectional descriptive study of a convenient sample of patients visiting the dental school of RDU was conducted in 2015. A structured, close-ended, self-administered questionnaire was distributed among 700 patients and a response rate of 89% was obtained. The questionnaire consisted of a series of questions related to awareness, knowledge, attitude, and perception of patients toward infection control measures. Data analysis included frequency distribution tables. Results: Of 664 patients (298 males and 366 females), 97.7%, 93.5%, and 43.6% of the patients believed that dentist should wear gloves, face masks, and eye goggles, respectively, when treating patients. The majority of them (95.3%) refused to undergo treatment if the dentist is not wearing gloves and face masks. More than two-thirds (73.3%) denied receiving treatment from a dentist, who is not immunized against hepatitis B. Nearly 79.2% of patients refused to attend school if they knew that human immunodeficiency virus (HIV) and hepatitis B virus (HBV) patients treated there. The majority of patients (92.7%, 72.3%, and 23.1%) believed that gloves, facemasks, and eye goggles protect both dentist and patient, respectively. Only 44.9% said that autoclave is the best method of sterilization. A significantly higher knowledge of infection control was observed among the previous dental visitors compared to the first-time visitors (P < 0.05). Conclusions: Patients revealed adequate knowledge toward the use of gloves, face masks, and eye goggles by a dentist. However, their knowledge regarding the use of autoclave was poor. This documentation will serve in planning more effective interventions to enhance public awareness about infection control in dentistry in Jabalpur city, India. Keywords: Attitude, dental outpatients, infection control procedures, knowledge
How to cite this article:
Deogade SC, Mantri SS, Sumathi K, Dube G, Rathod JR, Naitam D. Perceptions of dental outpatients toward cross-infection control measures in Jabalpur city. J Indian Assoc Public Health Dent 2016;14:338-43 |
| Introduction | |  |
The patients visiting dental clinics for their dental and oral health care may be healthy or suffering from various infectious diseases. Many times, the patients may be carriers of infectious diseases that cannot be easily detected clinically. Even, many infected patients are not aware of their health status because of long incubation periods of infectious microbes and postinfection window period during which antibodies cannot be detected.[1] These patients may spread cross-infection among dental health care personnel (DHP) and even to other patients in dental clinics. The transmission of infectious agents between infected patients and DHP may be through blood, salivary droplets, inhalation, and/or contaminated instruments.
Several workers [2],[3] have suggested evidence of such cross-infection during surgical procedures through intact skin or mucosa due to accidents with sharps or direct inoculation onto cuts and abrasions in the skin. Various bloodborne pathogenic microorganisms such as HBV, hepatitis C virus (HCV), HIV, cytomegalovirus, herpes simplex virus types 1 and 2, Mycobacterium tuberculosis, streptococci, staphylococci, and other microbes are associated with cross-infection among DHP.[4],[5],[6] Due to the prevalence of individuals infected with HBV and HIV, cross-infection has become a major and crucial issue to the DHP and the patients visiting dental clinics. In view of increased morbidity and mortality associated with these infections, an increased awareness of the risks of cross-infection between visiting patients, operating dentists, and their assisting personnel has been documented.[7] HBV infection is reported to be the most prevalent chronic infectious disease, which is widely spread worldwide. It is estimated that more than 400 million people are infected with HBV at the global level.[8],[9] HCV infections affect about 170 million persons worldwide.[10]
The dental clinical practice has undergone drastic change since the inception of HIV to the Western countries. Increased awareness among DHP of cross-infection has led to the routine use of barrier techniques (gloves, masks, eye protection) and autoclaves during dental procedures.[11],[12] These infection control measures have proven in preventing the three major routes of transmission, i.e. DHP to patient, patient to DHP, and patient to patient in dental practice.
The public perception of cross-infection control in dental clinics is changing, probably fueled by media coverage.[11] Several studies were carried out in different countries such as Nigeria, Egypt, United Kingdom, Hong Kong, Ireland, Glasgow region, and Saudi Arabia to assess the patient's perception toward infection control practices attending dental clinics.[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23] In these studies, the previous visitors of dental clinics showed higher knowledge of infection control as compared to the first-time visitors. The different factors affecting the attitude and perception of patients toward cross-infection include age groups, gender, educational status, language, dental clinics attending pattern, country of origin, number of hospital visits in the previous year, and geographical location.[11],[13],[14],[15],[24] Assessment of dental patient's awareness, knowledge, and attitudes toward cross-infection in a certain locality area may assist in planning effective public health care delivery since such perception is affected by the geographic location of the patient.
There are few indexed research and available data on patients' perception of cross-infection control measures existing in the Indian environment. Hence, the objective of this study was to assess the knowledge and attitude among the people of Jabalpur city, Madhya Pradesh (India), toward the use of gloves, face masks, and eye protection visiting a private dental school. The other objective was to assess their perception toward the various methods of infection control measures in dentistry. Furthermore, it was decided to assess whether there is any difference in knowledge of infection control measures between previous and first-time dental visitors.
| Materials and Methods | | |
An approval was obtained from the Ethical Committee of Rani Durgawati University, after which this study was conducted from December 2014 to March 2015. A convenience sampling methodology was followed to select the patients seeking dental health care in the dental clinics of Hitkarini Dental College and Hospital (HDCH), Jabalpur, Madhya Pradesh (India).
A self-administered, close-ended questionnaire was prepared in Hindi language and the content authenticity was pretested on a sample of dental patients attending HDCH to ascertain practicability, cogency, and description of responses. After modification of a few questions, a final version of the questionnaire was prepared and distributed among the 700 patients. Based on the results of pilot study, 5% level of significance, and 80% power of study, a sample size of 700 patients was calculated for the present study.
The patients were interviewed at main waiting area of the clinics of HDCH. About 664 patients responded positively by returning the filled questionnaire, and a response rate of 94.86% was obtained. Each patient took 5 min to complete the questionnaire. The questionnaire consisted of three parts:First part included sociodemographic data (age, gender, income, occupation, education and visit to the dental school); the second part included the related questions to assess the awareness and knowledge about the infection spread and control methods in the dental operatory; the third part had related questions to assess the perceived attitudes of patients toward infection control measures.
The knowledge responses (yes, no, and do not know) and attitude responses (strongly agree, disagree, and strongly disagree) obtained from the questionnaires were coded and entered into the Statistical Package for Social Scineces (SPSS Inc., Chicago, USA) software package version 20. Frequency distribution tables were obtained for demographic data, knowledge, and attitude responses. Mann–Whitney tests were performed to compare the mean ranks of knowledge and attitudes between different genders, occupation, level of education, and visit to dental clinical groups. The level of significance was set at P < 0.05.
| Results | | |
Of 664 respondents, 252 (37.96%) were male and 412 (62.04%) were female [Figure 1]. Majority of the respondents belonged to the age group of 20–30 (34.9%) years [Figure 2] and <5000 (65.6%) INR (Indian rupees) monthly income [Figure 3]. Approximately, more than half of the patients (55.42%) were employed [Figure 4] and 62.9% of the patients had college/tertiary education [Figure 5]. The distribution of respondents according to their perception toward barrier usage in dentistry is shown in [Table 1]. Approximately, 74.8% of patients were previous visitors and 25.2% were new visitors to the dental school [Figure 6]. The patients who visited dental school previously showed a higher mean ranks for knowledge as compared to the first-time visitors and the difference was statistically significant (P< 0.05) [Table 2]. Gender, education, and occupation did not show any significance toward knowledge and attitude of infection control measures. | Figure 3: Distribution of respondents according to their household's monthly income (in Indian rupees-INR)
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 | Figure 5: Distribution of the respondents according to their level of education
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 | Table 1: Participants' perception of questions regarding barrier usage in dentistry (n=664)
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 | Figure 6: Respondents' distribution according to their visits to the dental clinics
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 | Table 2: Comparison of infection control knowledge and attitude among study subjects by Mann-Whitney U-test (n=664)
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The majority of patients (97.7%) believed that dentist should always wear protective gloves when treating patients [Figure 7]. Around 93.5% and 43.6% of respondents believed that dentist should wear face masks and eye goggles, respectively, when treating patients. Approximately, 95.3% of respondents believed that dentist should not treat more than one patient with a pair of gloves. More than two-third of the respondents (82.8%) denied undergoing dental treatment from a dentist, who is not wearing gloves and face mask. Nearly 73.3% of respondents refused to receive treatment from a dentist, who is not immunized against HBV. The majority of respondents (79.2%) refused undergoing treatment in dental clinic if they knew HIV and HBV patients treated there. Approximately, 88.9% of respondents showed their awareness of cross-infection in the dental clinic. Nearly, 92.7% and 72.3% of respondents felt that gloves and face masks protect both dentist and patient, respectively [Figure 8]. However, 69.7% of respondents believed that wearing of eye goggle protects dentists only. Approximately, 44.9% of respondents said that autoclave is the best method of sterilization [Figure 9]. | Figure 7: Participants' perception of questions regarding barrier usage in dentistry. I: Do you believe that dentist should always wear gloves while treating patients? II: Do you believe that dentist should always wear face mask while treating patients? III: Do you believe that dentist should always wear eye goggles while treating patients? IV: Can dentist treat more than one patient with a pair of gloves? V: Would you refuse to receive treatment from a dentist, who is not wearing gloves and face mask? VI: Would you receive treatment from a dentist, who is not immunized against hepatitis B? VII: Do you believe you can catch infection (such as human immunodeficiency virus and hepatitis B virus) during dental treatment? VIII: Would you receive treatment if they knew human immunodeficiency virus and hepatitis B virus patients treated there?
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 | Figure 8: Participants' perception of the protective function of gloves, face masks, and eye goggles
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| Discussion | | |
The present survey evaluated the knowledge and attitudes of dental patients toward infection control measures visiting dental clinics of a private dental school in Jabalpur city, India. Only limited infection control procedures were surveyed to maintain the maximum response rate from the respondents. This investigation showed an adequate awareness, knowledge, and attitude of dental patients toward infection control measures.
In this study, 97.7% of respondents believed that the dentist should wear protective gloves when treating patients. This result was higher than the previously documented investigations.[7],[13],[14],[15],[18],[19],[25],[26] However; it was almost similar to the findings of Baseer et al.[22] Approximately, 95.3% of respondents believed that the dentist should not use the same pair of gloves when treating more than one patient. This result was little higher than the results obtained by Azodo et al.[27] and Otuyemi et al. whereas it was almost similar to the findings reported by Baseer et al.[22] The Centers for Disease Control and Prevention recommended that a separate pair of gloves must be used for each new patient to avoid cross-infection.[28]
When asked about the protection provided by wearing of the gloves, 92.7% of respondents believed that gloves protect both the dentist and patient from cross-infection. This response was lower than that reported by Azodo et al.[27] and was higher than that reported by Baseer et al.[22] and Otuyemi et al.[13] In the present study, 93.5% of respondents believed that the dentist should wear face masks when treating patients. This response was similar to the study reported by Baseer et al.[22] while it was higher than the other reported studies.[15],[16],[19],[27] About 23.2% of respondents felt that masks protect dentist only. This response was little higher than that reported by Azodo et al.[27] When enquired about wearing eye protection, nearly 43.6% of respondents felt the necessity of eye goggle wearing by the dentist. This response was lower to that reported by Baseer et al.[22] and Azodo et al.[27] However, it was almost similar to that reported by Porter et al.[16] for British patients.
About, 82.8% of respondents denied undergoing treatment if they would come to know that their dentist is not wearing gloves and face masks. This response was higher than that reported by Azodo et al.[27] Approximately, 73.3% of respondents refused to receive treatment from a dentist, who is not immunized against hepatitis B. This response was lower than that reported by Baseer et al.[22] The knowledge of contaminating HIV and HBV infection while undergoing dental treatment was found to be 88.9% among respondents. This knowledgeable response was higher than that reported by Sofola et al.,[14] Mousa et al.,[15] Baseer et al.,[22] and Azodo et al.[27] Majority of the respondents (79.2%) denied undergoing dental treatment if they would come to know that HIV and HBV patients are treated in the clinics. This response was higher than that reported by Sofola et al.,[14] Samaranayake and McDonald,[18] and Baseer et al.[22]
In this investigation, 44.9% of the respondents believed that autoclave is the best method of sterilization of instruments. This response was higher than that reported by Baseer et al.[22] and Azodo et al.[27] When compared the knowledge of cross-infection control measures between the previous visitors and the new visitors, the former group revealed a higher level of knowledge over the later. Familiarity and first-hand experiences of previous visitors toward infection control measures practiced by a dentist could be the probable explanation for this variance. The factor such as a visit to dentist showed a significant difference in this investigation. This is in agreement with that reported by Baseer et al.[22] No other parameters such as gender, occupation, and level of education showed significant differences in this study. The data of this investigation will assist in providing baseline information while planning effective and efficient public awareness on infection control measures in dentistry in Jabalpur city, India.
The results presented indicate the opinions of Central Indian dental patients in certain areas. Whether such opinions would be widely held on a nationwide basis remains to be determined by conducting similar surveys in other parts of Central India. The media must take the initiative to draw the public's attention to the transmission of infectious diseases in the dental clinics. This will encourage patients to become more aware of the safety of oral and dental care. In rural areas, media such as T.V. and radio can be employed to give more information about infection control measures in dental clinics. The findings of this study would be widely held on a nationwide basis after conducting similar investigations in government-based and other newer private-based dental schools of Madhya Pradesh state.
| Conclusions | | |
Patients visiting dental clinics of HDCH revealed adequate knowledge of wearing protective gloves, face masks, and eye protection by dentists when performing clinical procedures to prevent cross-infection. However, their knowledge regarding the use of autoclave for sterilizing dental instruments was not satisfactory. Patients who visited dental clinics previously showed higher knowledge of infection control measures as compared to the first-time visitors. The data of this investigation will assist in providing baseline information while planning effective and efficient public awareness on infection control measures in dentistry in Jabalpur city, India.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
[Table 1], [Table 2]
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