Infection control attitudes and perceptions among dental students in Latin America: implications for dental education

Dental Students in Egypt: To What Extent Do They Perceive and Comply with Infection Control Measures?

This study was carried out in the dental school of Ahram Canadian University in Egypt to investigate the knowledge and compliance of senior students and interns toward infection control practices. A self‑administered questionnaire was employed with questions pertinent to the participants’ knowledge of risks in the dental settings, the practice of hand hygiene, the use of protective equipment, and the management of sharp injuries, among others. Although the knowledge and practice of the 240 surveyed participants were good; they were not up to the coveted standards. Despite being an integral part of their curriculum, an alarming percentage (19.6%) of the participants denied receiving knowledge about infection control instructions. Meanwhile, only 72.5% were aware of being at risk in the dental settings, and 78.3% confirmed their practice of hand hygiene. On the other hand, 84.6% of the surveyed participants confirmed the availability of protective equipment and 94.2% of them expressed their willingness to apply infection control measures in the future. The defects in the knowledge and practice mandate corrective actions to promote and upgrade the students’ compliance. Meanwhile, other gaps can be rectified via developing state-of-the-art communicative strategies. Efforts are warranted to enhance the attitude and motivate the students to conform to the protective safety measures. With all the infection control procedures already established in dental schools, the challenge lies in improving the students’ compliance with these recommendations.

Dentists' Perceptions of Their SARS-CoV-2 Risk and Infection Control Needs

Objective

Rapid worldwide dissemination of SARS-CoV-2 has prompted dental professionals to optimise their infection control procedures. To help identify areas of opportunity for protecting dentists and their patients, the aim of this investigation was to analyse Mexican dentists’ early perceptions of their risk of exposure to SARS-CoV-2 and their need for comprehensive infection control education.

Methods

This cross-sectional survey was conducted from May 9 to June 3, 2020, during the social distancing phase in Mexico. The survey adhered to relevant guidelines for ethical research design. The questionnaire was designed with Google Surveys and applied online in Spanish. The questionnaire included items on demographics and clinical specialisation. To obtain time-sensitive perceptions, statements were preceded by “While SARS-CoV-2 circulates in the community and new COVID-19 cases are reported”; responses were collected in a 5-point Likert-type scale.

Results

The survey's link received 1524 “clicks.” Over 25 days, 996 dentists participated (39% men; 89% working in Mexico and 11% in other Spanish-speaking Latin American countries). Most participants (73%) fully agreed that “Looking after patients will pose a risk for the dentist.” Total agreement was more common (P = .0001) amongst dentists in Mexico (76%) than amongst those in other countries (53%). Knowing someone with COVID-19 was more common amongst Mexican dentists (P = .0008). The perceived need for enhanced infection control procedures increased with age (P = .0001). Forty-nine percent totally agreed that they sterilise dental handpieces between patients. One-third expressed total agreement that everyone in their clinic was trained in infection control.

Conclusions

Amongst this nonprobabilistic self-selected sample of dentists, age and country of work influenced their perceptions about occupational exposure to SARS-CoV-2 and infection control needs. This survey revealed areas of opportunity to improve infection control education and training for dental professionals.

Identifying Trends of Percutaneous Injuries at an Australian Dental School

Objectives

The aim of this study was to retrospectively examine trends in percutaneous exposure incidences (PEIs) at the School of Dentistry (SoD) from 2009 to 2019 and to report on the underreporting rate of PEIs, current attitudes, and awareness of PEI safety protocols from clinical staff and students at the SoD in 2019.

Methods

Retrospective data were collected from deidentified archival incident reports from 2009 to 2019 from the SoD's incident reporting system (UQSafe and Legacy Database). Additionally, cross-sectional data were collected via the validated Percutaneous Exposure Incident Questionnaires (PEIQ) completed by clinical staff and students of the SoD in 2019.

Results

From the archival data, the majority (79.9%) of the 618 reported PEIs involved students. Local anaesthetic-related procedures were the most common cause in the archival (31.5%) and survey data (23.7%), whereas the needle-prick was the most common causative instrument in both data sets. Additionally, the finger was the most common site of injury found in the archival (53.0%) and survey data (52.8%). From 345 responses to the survey, 42.1% of PEIs sustained were not reported.

Conclusions

Students were at a higher risk of sustaining a PEI than staff members between 2009 and 2019. The reported knowledge on PEI classification and preventative measures is inadequate, suggesting that further PEI education is necessary. The study provides evidence of the trends in PEIs as well as data on the attitudes and awareness of student and staff at a dental teaching faculty to support the development of PEI safety management protocols.

Dental Education in the Time of COVID-19 Pandemic: Challenges and Recommendations

Moving within the second wave of the coronavirus (COVID-19) pandemic, dental education delivery has been profoundly affected by this crisis, so has the structure, evaluation, and future of dental education. Both pre-clinical and clinical dental education have experienced challenges ranging from fully online educational content to limited dental training for senior dental students. This crisis appears to be a tipping point that produced confusion in dental teaching especially clinical sciences. Although medical institutions immediately started to adapt to the unexpected COVID-19 crisis, dental and oral health educational services are profoundly impaired due to the dental team's propinquity to the patient and the aerosols generated during routine dental therapeutic procedures. Dental students unlike other medical students are considered to be at the highest risk due to the nature of their clinical training that includes working in the oral cavity of patients using aerosol-generating equipment. Some dental schools have taken the leadership and documented their modifications during this pandemic; however, there is a serious need for further investigation and wide range screening of the situation in the dental schools during the COVID-19 crisis. The aim of this mini-review is to present these challenges and how academic dental institutions have implemented strategies to overcome them.

Development and validation of an instrument to assess adherence to occupational health protocols in dentistry

OBJECTIVES

The purpose of this study was the creation and validation of an instrument to evaluate adherence to occupational health protocols used in dentistry that arise from official regulations and international recommendations on infection control, biosafety, and occupational health in dentistry. Additionally, in May 2017 the effectiveness of the instrument was documented within the dental care clinics in the postgraduate area.

METHODS

The instrument was developed based on constructs of occupational health, infection control, and biosafety in dentistry, made up of 21 indicators of 5 dimensions called protocols. Using direct observation through 35 measurements during 1 week, adherence to occupational health protocols was evaluated in postgraduate residents within the clinical sections of endodontics/pediatric dentistry, periodontics, prosthodontics, and orthodontics.

RESULTS

The instrument presents an index of 0.88 in Cronbach's alpha analysis. There is a 34.4% adherence within the postgraduate dental clinic to the proposed occupational health protocols. The protocol with the highest adherence at 41.1% was the personal protection protocol. The periodontics section had a 52.9% observance of the proposed protocols and had the highest adherence to occupational health protocols.

CONCLUSIONS

The proposed instrument is valid and reliable to evaluate adherence to the proposed occupational health protocols within dental care clinics. Dental clinics must be inspected and evaluated to ensure adherence to infection control, biosafety, and occupational health protocols within routine dental practice.

Impact of Stigma on People Living with Chronic Hepatitis B

Background

People with chronic infectious diseases such as hepatitis B can face stigma, which can influence everyday life as well as willingness to engage with medical professionals or disclose disease status. A systematic literature review was performed to characterize the level and type of stigma experienced by people infected with hepatitis B virus (HBV) as well as to identify instruments used to measure it.

Methods

A literature review was performed using the PubMed, Embase and Cochrane Library databases to identify studies describing HBV-related stigma. For inclusion, articles were required to be published in full-text form, in English and report quantitative or qualitative data on HBV-related stigma that could be extracted.

Results

A total of 23 (17 quantitative and 6 qualitative) articles examined HBV-related stigma. The scope of the review was global but nearly all identified studies were conducted in countries in the WHO Southeast Asia or Western Pacific regions or within immigrant communities in North America. Several quantitative studies utilized tools specifically designed to assess aspects of stigma. Qualitative studies were primarily conducted via patient interviews. Internalized and social stigma were common among people living with chronic HBV . Some people also perceived structural/institutional stigma, with up to 20% believing that they may be denied healthcare and up to 30% stating they may experience workplace discrimination due to HBV.

Conclusion

HBV-related stigma is common, particularly in some countries in Southeast Asia and the Western Pacific region and among Asian immigrant communities, but is poorly characterized in non-Asian populations. Initiatives are needed to document and combat stigma (particularly in settings/jurisdictions where it is poorly described) as well as its clinical and socioeconomic consequences.

Dentists Survey on Adverse Events During Their Clinical Training

BACKGROUND

Adverse events (AEs) begin challenging the safe practice of dentistry early when students start treating patients at dental school. We assessed the frequency with which dentists caused common AEs during their undergraduate clinical training.

METHODS

A convenience sample of dentists, graduated from more than 34 dental schools in Mexico and other Spanish speaking countries, answered a confidential, self-administered questionnaire with closed-format questions on common AEs they caused and their active errors that could have led to AEs in the teaching clinics.

RESULTS

Of 207 participants, 80% had graduated recently. As undergraduates, 79% caused AEs; 38% admitted to causing one adverse event, 41% to causing two or more, and 36% committed active errors that could have hurt patients. No significant associations between AEs and sex or type of school were observed.

CONCLUSIONS

The results indicate that dental students caused AEs or committed errors that placed patients at risk, during their clinical training.

PRACTICAL IMPLICATIONS

Dental schools must identify challenges to patient safety at their teaching clinics and introduce risk reduction strategies to protect their patients and foster a safety culture in dental education.

Infection Control Measures in Private Dental Clinics in Lebanon

Purpose

Evaluate infection control knowledge, attitude, and practice in Lebanese private dental clinics.

Materials and Methods

A survey including 46 questions related to routine safety procedures was sent to 1150 Lebanese dentists between July 1st and 2nd, 2015. The study sample was selected from the database of registered dentists based on a proportional random sampling ensuring equitable representation of the 5 geographic regions of Lebanon. A subset of 29 questions was used to generate an overall score of compliance (excellent, good, fair, and poor). Comparisons according to gender, type, region, and years of practice were performed.

Results

417 dentists returned the completed questionnaires. 96% expressed concern about infection transmission, 90.6% were vaccinated against Hepatitis B, and 61.8% asked routinely about patients medical history. Only 43% used protective eyewear. Although most dentists (65%) used autoclaves, dry heat was still used. Significant correlations were found between gender and use of personal protective equipment. Less compliance was shown by clinicians with fewer years of experience. In the overall compliance questionnaire, the mean percentage of correct answers was roughly 54% with <5% of the practitioners scoring “excellent.” Conclusions. The study found inadequacy of compliance in private Lebanese dental clinics necessitating improved educational training and sustained monitoring by regulatory bodies.

Observed infection control compliance in a dental school: A natural experiment

OBJECTIVE

The objective of this study was to determine student adherence to infection control policies at 1 dental school. A secondary objective was to determine the influence of Ebola virus disease (EVD)-related training on student infection control behaviors.

METHODS

An instrument to assess and record infection control behaviors was developed to reflect Centers for Disease Control and Prevention guidelines as well as current teaching. Third- and fourth-year dental students were observed during patient-care appointments and behaviors were recorded and analyzed. Behaviors observed before the EVD outbreak and subsequent mandatory in-service training were compared with behaviors observed after completion of the training.

RESULTS

Use of personal protective equipment was nearly universal. Overall compliance with infection control parameters was 88%. However, only a minority of students demonstrated no breaches of protocol. Most violations involved improper mask use and improper glove use during the intraoperative phase of an appointment and failure to wash hands after removing gloves. There were no significant overall differences in observed behavior pre- and post-EVD training.

CONCLUSION

Overall compliance with recommendations was high but some areas showed room for improvement. Future training in infection control should focus on these areas. Training related to EVD had no influence on student behavior.

Knowledge, attitudes and practices surrounding occupational blood-borne pathogen exposure amongst students in two Chinese dental schools

OBJECTIVE

To investigate the knowledge, attitudes and practices surrounding occupational blood-borne pathogen exposure amongst dental students at two Chinese dental schools, as well as important factors that are associated with their career choice and attitudes towards infected patients.

SUBJECT AND METHODS

The study was conducted using a student self-administered questionnaire from March to June 2013 at two Chinese dental schools. Chi-square tests and multivariable logistic regression were used to compare the categorical variables and identify the variables related to attitudes.

RESULTS

One hundred and seventy-one students answered the questionnaire (response rate 83%). Most participants had incomplete knowledge about occupational exposure and participants' compliance with the infection control programme during routine clinical work was low. Fifty-six participants (34%) experienced at least one occupational exposure, but only one reported the incident. Percutaneous injuries and mucous membrane exposures were the main causes for exposure. Protection of the eyes and post-exposure management were inadequate. According to most participants, they had received insufficient education. Their concerns about the risk of infectious professional exposure would influence their career choice and approach to patients. Only 14% and 26% of the participants were willing to treat human immunodeficiency virus- and hepatitis B virus-infected patients, respectively.

CONCLUSIONS

More effective education on prevention and management is required for dental students to reduce the harm caused by occupational exposure. It is important to ensure dental students' knowledge and understanding before allowing them to enter clinical training.

Hepatitis B: knowledge, vaccine situation and seroconversion of dentistry students of a public university

BACKGROUND

Viral hepatitis B (VHB) is an occupational risk for dentists. It is necessary that dental students start clinical practice immunized with the vaccine, response monitored and informed about the means of transmission of the disease. Rarely, there are studies, which evaluate concomitantly knowledge of these academics and their vaccine situation.

OBJECTIVES

To evaluate the knowledge about Hepatitis B, the vaccine situation and the immunization status of dental students and to investigate the probable correlation between the status of immunization, vaccination membership and adherence to the test of seroconversion and associated factors.

PATIENTS AND METHODS

189 students from the dentistry course at the Federal University of Piaui (UFPI) who attended from the 3rd to 9th period were invited to participate in the research. Their knowledge about HBV, attitude regarding protection and their vaccine situation were assessed through a self-administered form. Antibodies against surface antigens of Hepatitis B virus (Anti-HBs) and against the antigens of the virus nucleous of Hepatitis B (Anti-HBc total) were measured qualitatively using the enzyme-linked immunosorbent assay (ELISA).

RESULTS

Of the 179 students surveyed, 58.1% knew about the degree of virulence of the Hepatitis B virus (HBV). As to the means of transmission, 98.3% considered blood transmission, 82.6% plates and cutlery, 15.6% cough and 12.3% vertical transmission. Most students (87.4%) knew that they should take 3 doses of the vaccine and 62.2% completed the immunization schedule. A minority of students (48.6%) knew the about the Anti-HBs test and 5.6% took the test. Among the students who reported having taken three doses of the vaccine, 12.5% were not seroconverted. There was no significant correlation between the variables.

CONCLUSIONS

Dental academics were unsure about the means of infection and prevention against HBV. Many of them had not completed the immunization scheme and did not have the test of seroconversion. The serological analysis revealed unprotection, even after students completed the vaccination schedule.

Dental school deans' and dentists' perceptions of infection control and HIV/AIDS patient care: a challenge for dental education in Mexico

HIV/AIDS patients face unique oral diagnostic and treatment challenges. The aim of this investigation among dental school deans (DSD) and graduate school applicants (GSA) who had qualified from 30 different dental schools was to assess their perceptions on dental education relevant to infection control (IC) and HIV/AIDS patient care. The questionnaire included Likert-type scale evaluations of agreement with statements. Of 158 questionnaires, 23 DSD (68% response rate), and 123 GSA (100% response rate) returned valid questionnaires. Fifteen (65%) DSD and 89 (72%) GSA ranked as "very strong" their perception that infection control prevents the transmission of blood borne viruses. However, the perception prevailed, among DSD and GSA, that HIV infection was a "very strong" to "strong" occupational hazard. Special reprocessing of instruments used on HIV patients was frequently reported. Many considered "very strong" to "strong" that HIV/AIDS patients must be treated in specialized clinics, and nearly half (48%) of the DSD and one third (35%) of the GSA stated that their school does refer HIV/AIDS patients to dental treatment in specialized clinics. These results indicate that many dental schools in Mexico must provide better education on IC and HIV/AIDS patient care to enhance attitudes toward HIV/AIDS patients.

Attitudes and behavior of dental students concerning infection control rules: a study with a10-year interval

The study compared the attitudes and behavior of 4th-year dental students regarding infection control rules in 1995 and 2005. Self-administrated questionnaires were applied to 592 students at 5 different dental schools in 1995 (n=350) and in 2005 (n=242). The chi-square and Fisher's exact tests were used for statistical analysis of data. Significance level was set at p<0.05. The response rate was 90.3% in 1995 and 81.0% in 2005. There was no improvement in the use of rubber gloves (p=0.316), face masks (p=0.572) or gowns (p=0.862) between 1995 and 2005. There was a lesser frequency of the use of protective eyewear in 2005 (p<0.001). No student used the individual protection equipment correctly. There was a decrease in the sterilization of burs in 2005 when compared to 1995 (p<0.001). No student could describe the correct use of the autoclave. Disinfection and use of a dental chair barrier were done correctly by a minority of students in 1995 (2.8%) and 2005 (6.1%) (p=0.069). Most students correctly discarded perforating/cutting instruments in both years (p=0.749). The attitudes and behavior of dental students concerning infection control are worrisome. There was no improvement and, for some parameters, there was a worsening in the procedures over the time period evaluated.