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ORIGINAL ARTICLE
Year : 2021  |  Volume : 19  |  Issue : 1  |  Page : 65-70

Assessment of knowledge, attitude and practice towards infection control among dental undergraduate students-A cross-sectional survey


1 Department of Oral and Maxillofacial Surgery, School of Dentistry, DY Patil University, Navi Mumbai, Maharashtra, India
2 Department of Public Health Dentistry, School of Dentistry DY Patil University, Navi Mumbai, Maharashtra, India
3 Department of Prosthodontics Crowns and Bridges, School of Dentistry, DY Patil University, Navi Mumbai, Maharashtra, India
4 Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, United States
5 Private Practitioner, Happy 32 Dental and Cosmetic Clinic, Andheri West, Mumbai, Maharashtra, India
6 Department of Population Health, New York University, Grossman School of Medicine, New York, United States

Date of Submission13-Jan-2020
Date of Acceptance11-Feb-2021
Date of Web Publication31-Mar-2021

Correspondence Address:
Siddharth Acharya
C 307, Daffodil, Neelkanth Garden, Govandi Station (E), Mumbai - 400 088, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_122_19

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  Abstract 


Introduction: Health-care personnel are always susceptible to infectious diseases if inadequate infection control measures are undertaken. In a dental setup, transmission occurs through air, blood, saliva droplets, or improper sterilization of instruments. Despite various standardized protocols in infection control, dental undergraduate students fail to obey the same. Aims: We aimed to assess the knowledge, attitude, and practice regarding infection control among dental undergraduate students of Mumbai. Methods: A cross-sectional questionnaire-based study comprising a 13-point close-ended, self-administered questionnaire was prepared and distributed among interns, final-year dental students, and 3rd-year dental students across six dental colleges. The questions were divided into three categories: knowledge, attitude, and practice. The responses were used for data collection and accordingly results were made. The analysis was done using IBM SPSS Statistics version 22. The statistical significance was considered at P ≤ 0.05. Results: A total of 851 undergraduate students were assessed for knowledge, attitude, and practice toward infection control. Only 40% of the interns, 40% of the final-year students, and 42% of the 3rd-year students had precise knowledge about infection control measures. Twenty-four percent of the interns, 27% of the final-year students, and 25% of the 3rd-year students showed accurate attitude for infection control. Finally, 41% of the interns, 44% of the final-year students, and 39% of the 3rd-year students inculcated right practice in controlling infection. Conclusion: Infection control is essential to reduce the risk of occupational infection to the practitioner and the auxiliary staff. Dental schools should give more emphasis on infection control protocols.

Keywords: Communicable disease, dentist, students, universal procedures


How to cite this article:
Girotra C, Acharya S, Shetty O, Savla S, Punjani M, Shah T. Assessment of knowledge, attitude and practice towards infection control among dental undergraduate students-A cross-sectional survey. J Indian Assoc Public Health Dent 2021;19:65-70

How to cite this URL:
Girotra C, Acharya S, Shetty O, Savla S, Punjani M, Shah T. Assessment of knowledge, attitude and practice towards infection control among dental undergraduate students-A cross-sectional survey. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2021 Apr 17];19:65-70. Available from: https://www.jiaphd.org/text.asp?2021/19/1/65/312635




  Introduction Top


Human oral cavity is vulnerable for transmission, inoculation, and development of agents that can be harmful to others.[1] Therefore, transmission of various existing and emerging new infections can easily occur in dental clinics through various courses which include direct contact with blood, oral fluids, other secretions, indirect contact with contaminated instruments, operatory instruments, and contact with airborne contaminants present in either droplet splatter.[2],[3] Various microorganisms are responsible for the transmission of diseases which include Mycobacterium tuberculosis, hepatitis B virus (HBV), hepatitis C virus, staphylococci, streptococci, herpes simplex virus type 1, human immunodeficiency virus, mumps, influenza, and rubella.[3] Infectious diseases constitute prime public health problems all across the world.[4]

The most common people who are susceptible to contracting harmful diseases are the health-care workers if they fail to follow proper infection control procedures.[5] Transmission of infection has increased due to an era of eco-epidemiology with global emergence of the same.[4] Blood-borne infections are emerging to a greater extent due to exposure of enumerable blood-borne pathogens by various ways.[6]

To control these risks of infections in the health-care setting, standard precautions are formulated which include eye protection with lateral shields, facemask, and protective clothing.[3],[7] Graduates in dental education all across the world should have an exorbitant level of clinical skills and knowledge on infection control.[1],[8] In spite of many guidelines and protocols made by the medical and dental associations and also the government organizations, many studies show that some dental undergraduates lack the required knowledge and clinical skills about infection control and that infection is not controlled well in some dental hospitals.[3],[4] Therefore, to analyze the knowledge, attitude, and practice of dental undergraduate students toward infection control, this study was carried out.


  Methods Top


A cross-sectional questionnaire-based study comprising a 13-point close-ended self-administered questionnaire was prepared with the help of experts in the field and was conducted among undergraduate dental students from dental colleges across Mumbai and Navi Mumbai. Before beginning the study, an approval was taken from the university's ethical committee (Ethical Clearance No. FRC/2018/OS/01). The sample comprised 292 interns, 311 final-year students, and 248 3rd-year students. A nonprobability purposive sampling method was used. All the students present on the day were included in the study. The sample size was not calculated a priori. Furthermore, the anonymity of the participating individuals was maintained. The data received from the questionnaire were then used to prepare the results. There were four questions assessing the knowledge, three questions assessing the attitude, and six questions assessing the practice of the undergraduate students and the interns.

The close-ended self-administered questionnaire was pretested on a random sample of dental undergraduate students to ensure the validity and practicability of the questionnaire and also the interpretation of responses of the same. The questionnaire was discussed with experts in the field before finalization. A pilot study was conducted on a sample of 50 participants.

The inclusion criteria for the study were as follows:

  1. Students in the 3rd year, students in the final year, and interns
  2. Students available on the day of the study
  3. Students willing to participate in the study
  4. Students who complete the entire questionnaire.


The data were entered in Microsoft Excel. The analysis was done using IBM SPSS Statistics Version 25, New York, United States of America. The unpaired t-test was used for comparing the difference of the variables. The statistical significance was considered at P ≤ 0.05.


  Results Top


A total of 851 undergraduate students were included in the present survey – 292 interns, 311 final-year students, and 248 3rd-year students.

[Table 1] shows students' knowledge, attitude and practice regarding infection control in terms of percentage of total dental undergraduate students to each question. Majority of the students (65%) considered washing their hands after removing gloves, whereas many students (57%) thought that latex gloves were the most effective type of gloves used as a barrier against contaminants. In addition to this, a lot of undergraduate students (67%) did not have any knowledge about N95 mouth masks. Furthermore, 64% of the students prefer wearing an eyewear while performing dental procedures. To our surprise, 64% of the students did not use a sterilized drape for any dental procedure including extractions. In case of a contaminated needle stick injury, 50% of the students used a disinfectant. Fifty percent of undergraduate dental students were vaccinated for HBV [Table 1].
Table 1: Students' knowledge, attitude, and practice regarding infection control by percentage of total dental undergraduate students to each question

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Comparison between the three variables using unpaired t-test presented a comparison between interns and final-year students, interns and 3rd-year students, and finally, final- and 3rd-year students. When interns and final-year students were compared, question numbers 4 (P = 0.0029) and 8 (P = 0.0048) were significant. Whereas, when interns and 3rd-year students were compared, question numbers 2–8, 11, and 13 were found to be significant. Finally, when final- and 3rd-year students were compared, question numbers 1–8 and 10–13 were found to be significant [Table 2].
Table 2: Comparison between three variables using unpaired t-test

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There was a linear correlation among knowledge, attitude, and practice with varied correlation coefficients and significant (P < 0.001) [Table 3].
Table 3: Correlation among knowledge, attitude, and practice

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To find the percentage of responses, all the questions were divided into three categories:

  1. Knowledge
  2. Attitude
  3. Practice.


[Figure 1] shows the percentage of responses in “knowledge” category. It shows that 40% of the interns, 40% of the final-year students, and 42% of the 3rd-year students had precise knowledge about infection control measures.
Figure 1: The percentage of responses in “knowledge” category

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[Figure 2] shows the percentage of responses in “attitude” category. It shows that only 24% of the interns, 27% of the final-year students, and 25% of the 3rd-year students had accurate attitude for infection control.
Figure 2: The percentage of responses in “attitude” category

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[Figure 3] shows the percentage of responses in “practice” category. It shows that 41% of the interns, 44% of the final-year students, and 39% of the 3rd-year students inculcated right practice in controlling infection.
Figure 3: The percentage of responses in “practice” category

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  Discussion Top


Health-care workers are at long risk of impairing the immune system because of deadly transmissible infections.[9],[10],[11] This decline in the health by transmission of germs occurs due to lack of knowledge, attitude, and practice about various infection control measures.[9] Accessing the level of knowledge and attitude of undergraduate dental students thereby becomes an important facet in today's medial world.

The present study shows that 64% of the dental students wore protective eyewear during dental procedures while the rest 36% of the students did not prefer to wear the same while performing procedures which is quite less when compared to a study conducted in a university in Saudi Arabia which showed that 73.3% of the students were less concern about protective eyewears.[1] This result can also be compared to another study where the use of protective eyewear was less among dental students in Saudi Arabia.[12] A study in Central India showed that 69.8% of the dental students performed procedures without the use of protective eyewear and protective clothing.[3]

Around 84% of the students were well known about the correct needle-recapping procedure in the current study which is quite high when compared to a study carried out in South Kerala (49%).[5] However, this value in our current study is low when compared to a survey done in UAE (88.5%).[13]

Fifty percent of the undergraduate students in the present study were vaccinated for HBV. However, according to the study performed in Central India, 61.2% of the undergraduate dental students had not been vaccinated for HBV.[3] According to the responses by the undergraduate dental students, only 31% of the students wash their hands before and after removing gloves whereas 95.5% of the students were noted to wash their hands before and after examination.[3]

Surprisingly, only 33% of the dental students were aware about N95 surgical mouth masks which are mandatory for performing dental procedures while the rest 67% did not have the knowledge of these masks. Sterilization is the principal part in infection control measures when we deal with patients. According to the survey, 56% of the students were not aware of the sterilization strips used to monitor sterilization procedure. Lack of knowledge regarding sterilization leads to transmission of various infectious germs or bacteria. The most shocking result of our survey was that 50% of the undergraduate students did not attend or wished to attend hands-on workshops on infection control.

In the present survey, a significant relation between knowledge, attitude, and practice among dental students (final-year students > interns > 3rd-year students). Furthermore, there was a positive linear correlation between knowledge, attitude, and practice and it is found to significant with P < 0.001.

Furthermore, there was a lack of knowledge, attitude, and practice about infection control among students.

According to the results mentioned above, many dental undergraduate students lack the motivation and show reluctance to inherit the knowledge, attitude, and practice of infection control measures. The reason behind such attitude could vary considerably. It might be due to their heavy clinical schedule or considerable short time to meet their clinical requirements.[6] A survey carried out by Smoot shows that most of the time it is the staff and residents that do not undertake the precautionary measures and hence there is no strong compliance executed by the faculty members of the university on the students.[14] Insufficient supply of protective equipment or poor training about essential infection control measures could also be the reason for the lack of knowledge, attitude, and practice of undergraduate dental students toward infection control.[3]

Strength of our study: Survey included a larger sample size than other studies till date to best our knowledge. Limitations of our study: Survey was totally based on student's self-assessment and not on the practice which could not thoroughly reflect the knowledge, attitude, and practice of the dental student on infection control.

The findings in this study indicate that efforts are needed to improve the attitude of the undergraduate students toward infection control protocols and to implement it in their routine practice. Not only education but also training based on competence should be taken into consideration. Dental colleges can arrange for various mandatory infection control workshops. Furthermore, a curriculum which encompasses more lectures in order to give a deep insight about infection control and sterilization protocols should be put into consideration. These lectures can include interactive sessions, innovative presentations, and quizzes in order to keep the students motivated and help them to understand the importance about infection control measures. Strict monitoring of the routine use of infection control guidelines should be adhered to by all dental schools for the safety of patients and health-care workers. This will help the dental undergraduate students to instill a positive attitude toward infection control and hence improve their quality of dental practice and life. More such surveys should be carried out to authenticate our results, thereby accomplishing the goal of infection-free practice.


  Conclusion Top


The findings in this study indicate that efforts are needed to improve the attitude of the undergraduate students towards infection control protocols and to implement it in their routine practice. Not only education but also training based on competence should be taken into consideration. Dental colleges can arrange for various mandatory infection control workshops. Also, a curriculum which encompasses more lectures in order to give a deep insight about infection control and sterilization protocols should be put into consideration. These lectures can include interactive sessions, innovative presentations, quizzes etc. in order to keep the students motivated and help them to understand the importance about infection control measures. Strict monitoring of the routine use of infection control guidelines should be adhered by all dental schools for the safety of patients and health care workers. This will help the dental undergraduate students to instil a positive attitude towards infection control hence improve their quality of dental practice and life. More such surveys should be carried out to authenticate our results there by to accomplish the goal of infection free practice

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Alshiddi IF. Attitude and awareness of dental students and interns toward infection control measures in prosthodontic clinics. Dent Oral Craniofac Res 2015;1:116-2.  Back to cited text no. 1
    
2.
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. 2
    
3.
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. J Dent Educ 2011;75:421-7.  Back to cited text no. 3
    
4.
Ibrahim NK, Alwafi HA, Sangoof SO, Turkistani AK, Alattas BM. Cross-infection and infection control in dentistry: Knowledge, attitude and practice of patients attended dental clinics in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. J Infect Public Health 2017;10:438-45.  Back to cited text no. 4
    
5.
Benley G, Carel B, Mulamootil VM, Cherian SA. Awareness on infection control procedures among dental students in dental school in south Kerala. Health Sci 2014;1:JS001E.  Back to cited text no. 5
    
6.
Jaber MA. A survey of needle sticks and other sharp injuries among dental undergraduate students. Int J Infect Control 2011;7:???.  Back to cited text no. 6
    
7.
Santra DK, Tripathi S, Ganger A. Study to access the level of knowledge, attitude and practices of infection control among dental professionals. J Dent Sci Oral Rehabilitation 2010;57-60.  Back to cited text no. 7
    
8.
Milward MR, Cooper PR. Competency assessment for infection control in the undergraduate dental curriculum. Eur J Dent Educ 2007;11:148-54.  Back to cited text no. 8
    
9.
Mosley JW, Edwards VM, Casey G, Redeker AG, White E. Hepatitis B virus infection in dentists. N Engl J Med 1975;293:729-34.  Back to cited text no. 9
    
10.
Trumbell ML, Greiner DJ. Homologous serum hepatitis: An occupational hazard to medical personnel. JAMA. 1951;145: 965 7.  Back to cited text no. 10
    
11.
Byrne EB. Viral hepatitis: An occupational hazard of medical personnel. Experience of the Yalenew Haven Hospital, 1952 to 1965. JAMA 1966;195:362-4.  Back to cited text no. 11
    
12.
Ahmad IA, Rehan EA, Pani SC. Compliance of Saudi dental students with infection control guidelines. Int Dent J 2013;63:196-201.  Back to cited text no. 12
    
13.
Jaber MA. A survey of needle sticks and other sharp injuries among dental undergraduate students. Int J Infect Control 2011;7:1-10.  Back to cited text no. 13
    
14.
Smoot EC. Practical precautions for avoiding sharp injuries and blood exposure. Plast Reconstr Surg 1998;101:528-34.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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