Percutaneous injuries among dental professionals in Washington State

Needle Stick Injury: A Decade Retrospection Among Health Care Workers in a Tertiary Care Center

Needle stick injury (NSI) is a common incidence in a health care facility which can have a great impact on the psychological status of a health care worker (HCW). In the present study, over a decade, 76 incidents of NSI were reported. Nurses (47.3%) were at high risk followed by doctors (28.94%). Recapping (30.2%) was the major activity associated with NSI. Percutaneous injury (97.3%) with a hollow bore needle to the fingers was the most common type of injury. Three (3.9%) of the sources were positive for Hepatitis B virus (HBV), and one (1.3%) for human immunodeficiency virus (HIV). Postexposure prophylaxis was administered to eight (10.5%) HCWs with high-risk exposure. The incidence of NSI is low, as there exists an underreporting which cannot be denied. Following stringent universal precautions and adoption of safety-guided devices can reduce the rate of injury to a great extent. Regular training, monitoring, auditing, and adequate control modalities are the core strategies to reduce the incidence of NSI.

Needlestick injuries in dentistry: Time to revisit

BACKGROUND

Blood-borne pathogens (BBPs) are infectious microorganisms that are found in human blood and can cause diseases in humans. Health care workers such as physicians, surgeons, nurses, dentists, dental students, dental assistants, laboratory technicians, personnel handling infectious waste, and other health care employees are at increased risk of exposure to these pathogens. Percutaneous injuries from needles or other sharp objects are the major sources of BBPs in the workplace. Needlestick injuries (NSIs) have the most potential to transmit and have the easiest mode of transmission of BBPs.

TYPES OF STUDIES REVIEWED

The authors searched electronic databases (PubMed, Web of Science, Google Scholar, Scopus, Embase, MEDLINE-Ovid) for studies and articles focused on the various aspects of NSIs, their possible causes, prevention, and management protocols.

RESULTS

There is a lack of literature on the global prevalence of NSIs among dental practitioners and underreporting of NSIs by clinicians. The authors also found that dental students and inexperienced practitioners were the most vulnerable. They found apparent inconsistencies in guidelines and recommendations from various regulatory and statutory agencies in charge of limiting and managing NSIs.

CONCLUSION

The most significant occupational risks for health care workers globally are NSIs. Dentists are recognized as one of the high-risk groups for exposure to NSIs. Although the reporting rate was noticeably low, the frequency of NSIs among dental students was alarmingly high.

PRACTICAL IMPLICATIONS

Appropriate and succinct training of dental health care workers is crucial for prevention and management of NSIs. It is recommended that dentists familiarize themselves with recommendations from such agencies and organizations as the Center for Disease Control and Prevention, Occupational Safety and Health Administration, and American Dental Association.

Exposure to Biological Fluids in Dental Practice-Narrative Review on Appropriate Risk Assessment to Guide Post-Exposure Management

Accidental exposure to blood or other biological fluids is a common occurrence in dentistry, and its post-exposure management is a key component of infection prevention and control programs designed to prevent the transmission of blood-borne pathogens such as hepatitis B and C viruses (HBV, HCV) and human immunodeficiency virus (HIV). This narrative review aims to comprehensively review the risk assessment process for each of these pathogens at all steps of the epidemiological process, i.e., source-exposure route-receptive person, in order to provide a better understanding of the delicate differences that influence the transmission risk and that drive the individualized post-exposure management.

Infectious healthcare waste management among private dental practitioners in the Rabat-Salé-Kénitra region, Morocco: A cross-sectional study on knowledge, attitudes, and practices

The increase in dental healthcare facilities and the use of single-use equipment have increased the production of healthcare waste. Their mismanagement exposes healthcare workers, waste managers, and the population to an infectious risk and negatively impacts the environment. Therefore, a correct management procedure has to be adopted from separation through storage to disposal. This study aimed to investigate dentists' knowledge, attitudes, and practices regarding managing infectious healthcare waste in private dental offices. A descriptive and analytical cross-sectional survey was conducted between December 2020 and March 2021 among private dentists registered at the Moroccan National Council of Dentists in the Rabat-Salé-Kénitra region. A questionnaire was developed to assess waste management in dental offices. Of the 500 questionnaires distributed, 190 completed and exploitable questionnaires were collected. Only 27.3% of healthcare waste managers in dental practices received training, 21,5% of practitioners assimilated the used gloves into household waste, 71.5% disposed of the waste generated by their offices directly into public bins, and 86.4% were unaware of Moroccan law 28-00 on waste management and disposal. This study highlights dentists' apparent lack of knowledge regarding healthcare waste management, and significant gaps were identified between actual practices and recommended regulations. To address these issues, developing a comprehensive medical waste management plan is crucial to encourage the practical cooperation of all stakeholders in this sector.

Primary care dental professionals' experiences of sharp injuries in Qatar: A cross-sectional study

OBJECTIVES

Very few studies assess sharp injuries solely among dental professionals globally. This study aims to understand the experiences of sharp injuries among primary care dental professionals in Qatar.

METHODS

This is a cross-sectional study where dental professionals working at the Primary Health Care Corporation (PHCC), a public sector healthcare organization and Qatar's largest primary care provider with 27 primary healthcare centers in Qatar, were invited to participate. An online questionnaire was administered to understand participants' experience of sharp injuries and access to occupational health services and training.

FINDINGS

A total of 114 dental professionals participated in this study. In total, 68.42% (N=78) of participants reported experiencing a sharp injury in the 12 months prior to the survey. Majority (N=58; 75.36%) of the reported causes of sharp injuries were related to dental explorers (N=31; 40.26%) and dental injection needles (N=27; 40.26%). Of those who had experienced a sharp injury, 84.47% (N=87) did not report them.

CONCLUSION

In conclusion, the results highlight that sharp injuries are common among primary care dental professionals, and despite having good access to occupational support services, most dental professionals did not report their injuries. Continuous education and training programs must be implemented to improve knowledge and raise awareness to reduce the burden of sharp injuries among dental professionals. More studies from other dental settings are needed to better understand dental professionals' experiences of sharp injuries in Qatar and elsewhere.

Knowledge, Attitudes, and Practices of Dental Healthcare Workers toward Hepatitis B Virus in Khartoum/Sudan

OBJECTIVE

The aim of the present study is to evaluate dental healthcare workers' knowledge, attitudes, and practices toward hepatitis B infection.

MATERIALS AND METHODS

This study was a cross-sectional self-administered, structured questionnaire survey that was conducted in Khartoum/Sudan. The questionnaire was completed by 177 dental healthcare providers who practice in public dental clinics in Khartoum state. The completion rate was 100%.

RESULTS

The study participants showed relatively acceptable knowledge of hepatitis B virus (HBV) infection. The majority (98.3%) were familiar with hepatitis B infection. About 93% answered correctly that blood, blood products, and needles/sharps are the route of transmission of HBV. About 65.5% completed HBV vaccination. About 59.3% had a history of needle sticks and only 16% reported their injury. Dentists and nurses almost had the same knowledge, but dentists were slightly having better knowledge in some aspects. Statistical Package for Social Sciences (SPSS) version 20 was used. Chi-square test was used to determine the relationship between categorical variables.

CONCLUSION

Most of the study participants were aware of HBV infection, routes of transmission, prevention, and necessity of vaccination, but they are deficient in some areas, like needle-stick injury protocol and post-exposure prophylaxis (PEP). The study revealed a low level of HBV vaccination coverage rate. Further strategies for preventing workplace exposure, training programs on HBV infection, including PEP, and increasing the vaccination coverage rate of all healthcare workers are highly recommended.

CLINICAL SIGNIFICANCE

Dental healthcare workers are at high risk of acquiring hepatitis B infection. The majority of exposure in dentistry is preventable. Understanding the knowledge and awareness of dental health toward hepatitis B is crucial to design and apply preventive measures to control transmission and potential complications.

A 19-Year Study of Dental Needlestick and Sharps Injuries in Japan

BACKGROUND

Needlestick and sharps injuries (NSIs) are serious problems for dental health care workers (DHCWs) because they are at risk for occupational blood-borne infections. In this study, risk factors for NSIs in DHCWs at Tohoku University Hospital (TUH) in Japan over 19 years were analysed.

METHODS

NSI data of DHCWs at TUH from April 2002 to March 2020 were collected from the Exposure Prevention Information Network (EPINet) and statistically analysed.

RESULTS

A total of 195 NSIs occurred during the 19-year study period. Approximately 58.5% of NSIs occurred in DHCWs with less than 5 years of experience. Injection needles were the most frequent cause of NSIs (19.0%) followed by suture needles (13.3%) and ultrasonic scaler chips (12.8%). Needle injuries occurred mainly on the left hand, whereas ultrasonic scaler chip and bur injuries occurred on the right hand and other body parts whilst DHCWs were placing the instruments back on the dental unit hanging holder without removing the sharps. NSIs from other instruments primarily occurred on both hands and foot insteps during cleanup. No case of occupational blood-borne infection caused by NSIs was observed during the study period at TUH.

CONCLUSIONS

NSIs occurred in DHCWs with less experience, and there were associations between the instruments, timing of use, and NSI site. EPINet was considered a valuable tool for monitoring NSIs in order to develop future strategies for minimising NSIs.

Percutaneous exposure injuries amongst dental staff and students at a university dental clinic in Australia: A 6-year retrospective study

PURPOSE/OBJECTIVES

Dental care providers are at risk of percutaneous exposure injuries (PEIs) due to the intimate nature of the patient-dentist environment and the routine use of sharp instruments. They are the most vulnerable to accidental exposure of blood-borne viruses. The aim of this study was to determine the types of PEIs sustained by staff and students at the Griffith University Dental Clinic over a 6-year period.

METHODS

Data were collected regarding PEIs sustained amongst dental staff and students between 2014 and 2019. Data were obtained from the risk incident reporting system (GSafe) and the patient management Software (Titanium), and then analysed using IBM SPSS. The chi-squared tests and multinomial logistic regressions were performed with significance set at <.05.

RESULTS

Over the 6-year period, there were 308 PEIs with an incidence rate of 0.109%, with 67 being needle stick injuries (0.023%). These injuries happened more often in restorative procedures, followed by local anaesthesia and oral surgery. Dental students were at a greater risk of sustaining PEIs (65.6%) when compared with professional staff (34.4%). Most common instruments included needles (21.8%), probes (20.5%) and burs (18.2%).

CONCLUSION

Overall, the incidence of percutaneous injuries at the Griffith University Dental Clinic was low. The most common instruments were needles, probes and burs, and dental students were at greatest risk of sustaining injuries. Prevention of injuries by not recapping needles, immediate removal of burs from handpieces, the use of cassettes and single-use instruments has effectively decreased PEIs experienced by dental students and staff.

Acidentes ocupacionais entre cirurgiões-dentistas: exposição a material biológico

Objetivo Determinar o perfil dos acidentes ocupacionais entre cirurgiões-dentistas, envolvendo material biológico, em Fortaleza, CE. Métodos O estudo tem caráter transversal de natureza descritiva e analítica, realizado em Fortaleza, CE, em 2020, a partir de uma amostra de 206 cirurgiões-dentistas. Além das frequências absolutas e percentuais, utilizaram-se testes de Qui-quadrado de Pearson e/ou Razão de verossimilhança, ao nível de significância de 5%. Encontraram-se 120 (58.3%) profissionais que sofreram acidentes e destes 107 (89%) através de lesão percutânea. Resultados Dos cirurgiões-dentistas que sofreram acidentes, envolvendo material biológico, identificou-se associação significativa entre ocorrência de acidentes com cirurgiões-dentistas que possuíam uma especialidade (p<0,001) e entre faixa etária e sexo (p=0,008). A maioria relatou ter sido imunizada contra hepatite B 193 (98%) e buscou testes de confirmação sorológica 101 (52%). A procura por atenção especiali-zada após um acidente foi baixa 45 (38%). Conclusão Cirurgiões-dentistas no exercício do atendimento clínico estão passíveis de sofrerem acidentes. Medidas preventivas são importantes, como a utilização correta de equipamentos de proteção individual.

Epidemiology of needlestick injury exposures among dental students during clinical training in a major teaching institution of China: A cross-sectional study

Background/purpose

Dental students are particularly vulnerable for needlestick injuries (NSI). However, the epidemiology of NSI exposures among Chinese dental students was rarely reported. The objectives of this study were to determine the prevalence of NSI among dental students in a major teaching institution of China, and to identify associated factors.

Materials and methods

A self-administrated online questionnaire was developed based on previously published studies, and distributed to dental students of Class 2011–2015 recruited from Peking University School and Hospital of Stomatology.

Results

Two hundred and sixty-eight dental students including 38.8% of males and 61.2% of females (response rate of 90.0%) completed the survey. Approximately 36.2% of the respondents had sustained at least one NSI. A total of 112 NSI cases were reported. The majority of NSIs were related to the procedures of local anesthesia administration (15.2%) and tooth cleaning or scaling (15.2%). Syringe needles, dental burs and ultrasonic chips were the most notorious devices. Statistical analysis showed significant distribution in NSI occurrence between July–September and October–December. The main cause was lapse in concentration (67.9%), followed by fatigue (22.3%). Up to 66.1% of the exposures occurred when the student was working alone, while only 10.7% with assisting. Unfortunately, 26.8% of the incidents were under-reported.

Conclusion

Dental students are prone to needlestick injuries. The present study clearly reveals a need for increased awareness of NSI prevention among dental students. The quality of infection control education at dental teaching institutions is crucial and indispensable for reducing NSI exposures.

Occupational Infections among Dental Health Workers in Germany-14-Year Time Trends

Dental health workers (DHW) are at increased risk of acquiring occupational infections. Due to various protective measures, it can be assumed that infections have decreased over the past 14 years. Secondary data from a German accident insurance company was analyzed in terms of reported and confirmed occupational diseases (OD) in DHW from 2006 to 2019. A total of 271 claims were reported, of which 112 were confirmed as OD, representing an average of eight per year. However, the number of claims and confirmed ODs has decreased by 65.6% and 85.7%, respectively. The decrease was most evident for hepatitis B (HBV) and C (HCV) infections, while tuberculosis (TB) infections were stable. A total of 44 HCV, 33 HBV, 6 TB and 24 latent TB infections were confirmed as ODs. For DHW, 0.05, and for hospital workers, 0.48 claims per 1000 full-time equivalents (FTE) were registered in 2019. In a separate documentation system, between March 2020 and February 2021, 155 COVID-19 claims were registered, and 47 cases were confirmed as ODs. For DHW, 0.7, and for hospital workers, 47.3 COVID-19 claims per 1000 FTE were registered since 2020. Occupational infectious diseases rarely occur among DHW. Nevertheless, new infectious diseases such as COVID-19 pose a major challenge for DHW. Continued attention should be paid to infectious disease prevention.

Needlestick injuries among Malaysian healthcare workers

BACKGROUND

Needlestick injury (NSI) is a significant occupational health issue among healthcare workers (HCWs).

AIMS

To determine the national self-reported incidence and risk factors for NSI among Malaysian Ministry of Health (MOH) HCWs.

METHODS

Using data from the MOH national sharps injury surveillance programme, information on reported NSIs over a 1-year period (2016) for different HCW subgroups were extracted and analysed.

RESULTS

A total of 1234 NSI cases were reported in 2016, giving an overall incidence of 6 injuries per 1000 HCWs. Medical doctors recorded the highest incidence (21.1 per 1000 HCWs) followed by dental staff (7.5), pharmacy staff (4.2), nurses (3.7), medical assistants (3.4) and allied and auxiliary staff (1.0). Doctors had significantly increased risk of NSI compared with allied and auxiliary staff (relative risk [RR] = 20.7, 95% confidence interval [CI] 15.5-27.5), medical assistants (RR = 6.1, 95% CI 4.5-8.2), nurses (RR = 5.7, 95% CI 5.0-6.6), pharmacy staff (RR = 5.0, 95% CI 3.7-6.6) and dental staff (RR = 2.8, 95% CI 2.2-3.5). Significant differences were found in age and sharps- handling experience between occupational subgroups (P < 0.001 for both variables). Male employees had higher risk than females (RR = 1.33, 95% CI 1.18-1.50), with a significant difference seen in their sharps-handling experience (P < 0.01). Important risk factors included unsafe practices such as recapping of needles and their improper disposal.

CONCLUSIONS

The national incidence of NSI amongst Malaysian HCWs was lower compared with other countries, but unsafe practices remain an important concern. There is a need to formulate, implement and monitor safe and consistent practices for the different healthcare professionals.

Occupational Injuries among Dentists in Croatia

Objectives

Dental profession is characterized by a high risk of injuries at work due to exposure to specific working conditions. The operating area in a patient's mouth is small, and it is handled by a large number of sharp instruments and drills that rotate at high speed, which creates an aerosol contaminated with particles of saliva and blood. This poses a risk of transmitting infections from patients to the dentist through stabbing incidents and cuts, which are some of the most common occupational injuries that are reported in the scientific literature.

Objective

The aim of this study was to examine the frequency of occupational injuries among dentists in Croatia, to establish most common injuries, and to determine the main risk factors. The aim of this research was also to determine the dentists’ opinion on causes that are responsible for the occupational diseases and injuries.

Materials and methods

The survey was conducted based on a sample of 406 dentists from Croatia as respondents to an electronic survey.

Results

63.05% of the respondents suffered injuries caused by dental practitioners. The most common injuries were needle puncture incidents (57.75%) and cuts (20.86%), followed by eye injuries (13.37%), patient bite (4.81%) and punches (1.60%). The largest number of respondents stated the improper posture as the most important cause of occupational diseases and injuries, followed by stress, infection and noise.

Conclusion

Knowledge of risk factors is the first step of injury prevention. Our respondents were largely aware of the dangers surrounding them. Nevertheless, the frequency of injuries was high and there is still a need for preventive measures to minimize the frequency of injuries in dentistry.

Dog-assisted therapy in the dental clinic. Part B. Hazards and assessment of potential risks to the health and safety of the dental therapy dog

Background

A dental therapy dog may help anxious patients in the dental clinic overcome their fear and facilitate the completion of necessary dental care. Dental clinic activities are associated with hazards that may pose potential risks to the health and safety of the dental therapy dog.

Objectives

To describe potential hazards associated with risks to health and safety to therapy dogs in dental clinics and to present suggestions for risk minimisation by adopting best practices in dental clinic settings.

Materials and method

Literature searches in Medline, http://Clinicaltrials.gov, and Google Scholar for qualitative and quantitative assessments of occupational hazards and risks in dental clinics, in combination with a review of the reference list of the included studies. Identified hazards and risks were analysed relative to their relevance for the health and welfare of a therapy dog present in a dental clinic setting.

Results

Workplace hazards in the dental clinic that apply to both humans and therapy dogs are allergies, sharps injury, eye injury, stress, rhinitis, hearing impairment, and other hazards. Additional concerns associated with risks for the dental therapy dog are situations involving erratic patient behaviour and threats if the patient is an undisclosed disease carrier. Risks to the health and safety of the dental therapy dog in the clinics are present but are low if the dental clinical staff and dog handlers comply with best practices.

Conclusions

Best practice includes awareness amongst the clinic staff and the dog handler of all potential hazards in the dental clinic and on how to reduce these hazards as well as adverse events that may scare the dental therapy dog. The dental therapy dog team must be specially trained to work in a dental clinic. Each treatment session has to be exclusively tailored to that specific appointment and the individual patient.

Knowledge, attitudes and practices regarding methicillin-resistant Staphylococcus aureus (MRSA) infection control and nasal MRSA carriage rate among dental health-care professionals

BACKGROUND

Dental health-care professionals (DHCPs) with nasal colonisation of methicillin-resistant Staphylococcus aureus (MRSA) can serve as a reservoir for MRSA transmission to others and be exposed to self-contamination with MRSA. Evaluating the knowledge, attitudes and actual practice of DHCPs is imperative for appropriate infection control.

METHODS

Dentists, dental hygienists and dental technologists from Seoul National University Dental Hospital were recruited to participate in a cross-sectional survey and undergo nasal sampling of MRSA. The survey included demographic questions, six questions about knowledge, eight questions about attitudes/perceptions and six questions about practices/behaviours regarding MRSA infection control. Nasal samples from the participants were analysed for MRSA presence, antimicrobial susceptibility and staphylococcal cassette chromosome mec (SCCmec) typing. MRSA carriers underwent decolonisation with topical mupirocin.

RESULTS

Among 139 DHCPs, four (2.9%) were nasal MRSA carriers. Decolonisation was successful in three participants. One participant was decolonised with topical fusidic acid after failure to decolonise with mupirocin. Dentists had a higher knowledge score compared with the other professionals (P < 0.05). Dental hygienists scored higher on practice questions compared with the other professionals (P < 0.05). There was a significant, positive correlation between attitude and practice scores (P < 0.01).

CONCLUSIONS

The nasal MRSA carriage rate among DHCPs is 2.9%, which is higher than that in the general population but lower than that in other health-care professionals. Further education of DHCPs on MRSA, especially regarding its seriousness, is needed to improve MRSA infection control in a dental hospital setting.

Evaluation of the Knowledge and Attitudes of Dental Students toward Occupational Blood Exposure Accidents at the End of the Dental Training Program

Aims and Objectives:

This study was conducted to assess knowledge, attitudes, and behavior regarding occupational blood exposure accidents (OBEA) among dental students at the end of the whole dental education program.

Materials and Methods:

The survey was performed using a student self-administered questionnaire during July 2015 in the dental teaching hospital in Rabat. It was conducted on 117 dental students registered in the 5^th year. The results were analyzed by SPSS Software, Version 13.0. Univariate analysis was performed by descriptive statistics, and bivariate analysis was used to identify correlations between different variables.

Results:

Eighty-three students answered the questionnaire (participation rate: 70%). Most participants had incomplete knowledge about the management and the risks of OBEA. Thirty-five participants (42%) experienced at least one occupational exposure to patients' blood. Needle recapping has been the main cause of such injuries (41%). Most accidents occurred, respectively, in the oral surgery (51%) and the restorative dentistry (17%) departments. According to many participants, they had received insufficient education concerning this topic.

Conclusions:

More effective education on prevention and management of OBEA is highly recommended to reduce the prevalence of such injuries. Dental schools should set up a local management unit for following and supporting the exposed students.

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.

Use of Bloodborne Pathogens Exposure Control Plans in Private Dental Practices: Results and Clinical Implications of a National Survey

Dental healthcare workers (DHWs) are at risk for occupational exposure to bloodborne pathogens (BBPs). The Occupational Safety and Health Administration Bloodborne Pathogens Standard requires employers to have a written exposure control plan (ECP) detailing methods and means to reduce and manage occupational BBP exposures. Because little information is available on whether ECPs are created and used, the National Institute for Occupational Safety and Health and the Organization for Safety, Asepsis and Prevention conducted an online survey to determine if dental practices had an ECP, whether present ECPs had the necessary components, and if impediments existed to prevent having an ECP in place. Respondents were primarily from nonfranchised practices (69%) and dentists who owned the practice (63%). Seventy-two percent of survey participants had an ECP, and 20% were unaware of any federal requirements for an ECP prior to the survey. Engineering controls were used by many practices, although the type varied. Fifteen percent of practices did not offer the hepatitis B vaccine for employees. The survey revealed many dental practices were unaware of or were lacking required elements of the ECP. Findings from this survey indicate DHWs would benefit from increased education regarding methods to prevent occupational exposures to BBPs.

An unusual ocular complication following dental anaesthesia: case report

Used routinely by dental practitioners, local anaesthetics are generally a safe and effective means of achieving pain control during invasive dental procedures. Delivery, however, is technique sensitive and the potential for patient complication exists. Although reasonably rare, ocular complications have occurred, often leaving the patient and the clinician in distress. Such reported events have almost always involved tissue responses ipsilateral to the injection site. The current case report presents an unusual event involving involuntary fasciculation or hemifacial spasm and eventual eyelid closure on the contralateral side following a routine inferior alveolar nerve block. Aspects including the patient's history, the observed response, a pathophysiological hypothesis and patient management are discussed.

Knowledge, attitude, and practice of needle stick and sharps injuries among dental professionals of Bangalore, India

Background:

A needle stick injury (NSI) is an accidental skin-penetrating stab wound from a hollow-bore needle containing another person's blood or body fluid. Healthcare workers (HCWs) including dental professionals are at an occupational risk of exposure to blood-borne pathogens following NSIs and sharps injuries (SIs). A thorough understanding of the safe practices while handling needles and sharps is crucial for HCWs to create a risk-free work place environment.

Aims and Objectives:

To assess the knowledge, attitude, practice, and prevalence of NSIs and SIs among dental professionals in a dental college at Bangalore.

Materials and Methods:

A cross-sectional survey was conducted in September 2012 using a structured, pretested, guided interview-based questionnaire that was administered to 200 dental professionals in a dental college at Bangalore to assess the knowledge, attitude, practices, and self-report information of NSIs.

Results:

In the present study, 81.5% of dental professionals were vaccinated against hepatitis B. A total of 27.5% participants had an NSI during the previous 12 months. About 41.80% of NSIs occurred during device recapping. Most common reason for failure to report the incidents of NSIs, as declared by 29.09% of the participants, included the fear of being blamed or getting into trouble for having an NSI.

Conclusion:

The knowledge of dental professionals on NSIs and their preventive measures are inadequate; however, training on Universal Precaution Guidelines, protocols regarding post-exposure prophylaxis, and safety devices has to be provided to prevent such injuries in future among the dental professionals.

Occupational Exposure of Shiraz Dental Students to Patients' Blood and Body Fluid

STATEMENT OF THE PROBLEM

Exposure to patients' blood and body fluids would prone the dental students to the risk of blood borne infections. Several studies have shown a high prevalence of these exposures in dental settings particularly in developing countries. However, few studies have evaluated the epidemiology of these exposures in dental students in Iran.

PURPOSE

To assess the epidemiology of occupational exposures among dental students and consequently designing the appropriate interventions in order to prevent these exposures.

MATERIALS AND METHOD

In this cross-sectional study performed during March to June 2011, all 191 Shiraz clinical dental students were asked to complete a self-administered questionnaire. This questionnaire included demographic information and experience of sharp injuries and mucocutaneous contaminations. Chi square and t-test were employed to evaluate the risk factors of exposure.

RESULTS

80%of the participants were exposed to the patients' blood or body fluids during their clinical course. No association was found between the exposure and demographic factors. Injection needle and recapping were the most common causes of these injuries. The most common sites that were injured and caused mucocutaneous contamination were finger and face, respectively. The most frequent activity causing contamination was using high-speed rotary instruments. Only 6.4% of the exposures had been reported to the related authorities and the remains were underreported.

CONCLUSION

Blood and body fluid exposure in dental setting is common and a lot of them are not reported. To reduce the hazards of these exposures, infection control authorities should design interventions especially for mentioned high-risk conditions. They should change dental students' behavior especially regarding not recapping injection needles and using eyewear. Dental schools seem to need a management center and a standard protocol for following up the exposures.

Knowledge of HIV and willingness to conduct oral rapid HIV testing among dentists in Xi'an China

Introduction

China is considered a country of low HIV prevalence (780,000 people living with HIV), however, HIV infections among high-risk populations continue to grow at alarming rates. Voluntary Counseling and Testing services were first implemented in 2003, and oral rapid HIV testing (ORHT) began in 2012. Dentists, as oral health experts, would be well placed to conduct ORHT. We assessed willingness of dentists to undertake ORHT in their clinical practice.

Methods

A cross-sectional, paper-based survey of dentists from the Xi’an region of China was conducted from April to June 2013. Dentists were recruited from Shaanxi Stomatological Association using a stratified sampling methodology. A 40-item survey was used to measure knowledge of HIV, attitudes toward people living with HIV and willingness to conduct ORHT.

Results

477 dentists completed the survey with a mean HIV knowledge test score of 13.2/18 (SD 1.9). If made available in the dental setting, 276 (57.9%) preferred to use blood to diagnose HIV, only 190 (39.8%) preferred saliva or both. Four hundred and thirty-five (91.2%) thought that ORHT was needed in dental clinics. Female dentists felt more accepting of ORHT than males (93.8% vs. 87.8%; χ²=5.145; p<0.05). 42.6% of the participants who responded thought that lack of education on ORHT for dentists was the most urgent problem to solve for ORHT, 144 (31.3%) thought that lack of support for ORHT from patients was the most urgent problem. There was statistically significant difference among dental hospital, dentistry and department of dentistry (χ²=24.176; p<0.05).

Conclusions

The majority of Chinese dentists thought that ORHT was needed in the dental setting. Providing opportunities for dentists and dental students to learn about HIV testing guidelines and practices is needed as well as feasibility and implementation science research.

Risk of Methicillin-Resistant Staphylococcus aureus Transmission in the Dental Healthcare Setting: A Narrative Review

Objective.

Information on the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection transmission in dental healthcare settings was incomplete only few years ago; therefore, MRSA infection control guidelines were necessarily based on data extrapolated from other fields. Recently, publication of specific studies have made it possible to review such risk.

Methods.

Studies of MRSA infection in dentistry were searched for using EMBASE, MEDLINE, and Google and were allocated into the following sections: (1) direct evidence: documented cases of MRSA transmission in dentistry; (2) indirect evidence: carriage rates among dental healthcare providers (DHCPs) and patients (high carriage rates suggest that transmission is likely); (3) speculative evidence: MRSA occurrence in the dental environment (high environmental contamination probably increases the risk of infection); and (4) speculative evidence: MRSA carriage in human dental plaque and saliva (oral carriers may spread MRSA in the environment during dental therapy, with consequent environmental contamination and probable increased risk of infection).

Results.

Our findings were as follows. First, transmission has been ascertained during surgical interventions, particularly in surgical units and among head and neck cancer patients. Second, carriage rates among DHCPs were lower than those among other healthcare workers. Carriage rates among adult patients were low, whereas among pedodontic and special care patients rates were higher than those in the general population. Third, MRSA has been detected in the environment of emergency and surgical units and in dental hospitals. Some individuals in poor general condition were oral MRSA carriers.

Conclusions.

The occupational risk of MRSA infection among DHCPs is minimal. Among special patients (eg, special care, hospitalized and cancer patients) the risk of infection is high, whereas among the remaining patients undergoing conventional therapy such risk is probably low.

HBV vaccination status and response to hepatitis B vaccine among Iranian dentists, correlation with risk factors and preventive measures

BACKGROUND

Studies showed that HBV vaccination and consequent level of antibody are not completely adequate among dentists despite performance of highly exposure prone procedures.

OBJECTIVES

The objectives of the study were to evaluate the levels of responsiveness to HBV vaccine and to determine the occupational factors associated among dental staff.

MATERIALS AND METHODS

In total, 1612 dental health care workers were recruited. The level of anti-HBs was tested using a commercially enzyme-linked immunosorbent assay (ELISA). Data on demographic, risk factors associated with dental practice and level of protective procedures and occupational exposure aspects were collected through self-reported questionnaires.

RESULTS

Of 1538 vaccinated individuals, 55 (3.7%), 126 (8.4%) and 1309 (87.9%) had received one, two and full three doses of vaccine, respectively. One-hundred-seventy-six (11.5%) were nonimmune (anti-HBs < 10 IU/mL) and 1362 (88.5%) were immune (anti-HBs > 10 IU/ mL). 392/542 (72.3%) of dentists who received their third dose of vaccination less than five years before the commencement of study were completely immune compared to those who had completed all three recommended doses in a longer period (308/491, 64.3%) (P = 0.001). Fifty-eight (3.59%) of participants did not receive any HBV vaccine at all; however, they had positive results for anti-HBs, indicating a past HBV infection. Statistically, the levels of anti-HBs were significantly associated with gender, age, duration of dental practice engagement and regularly use of mask, glasses and shield.

CONCLUSIONS

Since dental care workers have a high risk of exposure to hepatitis virus, they should be advised to receive hepatitis B vaccine and it should be confirmed if they have acquired immunity to HBV by testing the level of anti-HBs.

Hepatitis C virus; its implication for endodontists

Over 170 million patients worldwide are chronically infected with Hepatitis C virus (HCV); making it a globally important infection. Dentists constantly handle sharp instruments infected with biological fluids and are therefore considered at high-risk of contracting HCV infection. Needle-stick injuries seem to be the most common route of exposure to blood-borne pathogens in dental practice. Moreover, endodontist's constant use of sharp instruments such as endodontic files with limited operative vision in a small working field (i.e. root canal system) increases their risk of exposure to infection. The aim of this study was to review the epidemiology of HCV infection in dental healthcare staff and the tests required for its diagnosis. We also look at the protocols for dental treatment in infected individuals and screening and dental examination tailored for HCV patients.

Registration of Blood Exposure Accidents in the Netherlands by a Nationally Operating Call Center

Objective.

Healthcare providers and other employees, especially those who do not work in a hospital, may not easily find help after the occurrence of a blood exposure accident. In 2006, a national call center was established in the Netherlands to fill this gap.

Methods.

All occupational blood exposure accidents reported to the 24-hours-per-day, 7-days-per-week call center from 2007, 2008, and 2009 were analyzed retrospectively for incidence rates, risk assessment, handling, and preventive measures taken.

Results.

A total of 2,927 accidents were reported. The highest incidence rates were reported for private clinics and hospitals (68.5 and 54.3 accidents per 1,000 person-years, respectively). Dental practices started reporting incidents frequently after the arrangement of a collective financial agreement with the call center. Employees of ambulance services, midwife practices, and private clinics reported mostly high-risk accidents, whereas penitentiaries frequently reported low-risk accidents. Employees in mental healthcare facilities, private clinics, and midwife practices reported accidents relatively late. The extent of hepatitis B vaccination in mental healthcare facilities, penitentiaries, occupational health services, and cleaning services was low (<70%).

Conclusions.

The national call center successfully organized the national registration and handling of blood exposure accidents. The risk of blood exposure accidents could be estimated on the basis of this information for several occupational branches. Targeted preventive measures for healthcare providers and other employees at risk can next be developed.

Infect Control Hosp Epidemiol 2012;33(10):1017-1023

The risk of blood exposure incidents in dental practices in the Netherlands

OBJECTIVES

An awareness of the risk of blood-borne infections among dentists has been promoted by the Dutch Dental Association (NMT) as part of their quality and safety programme, and a nationally operating expert counselling centre was contracted to manage all reported incidents.

METHODS

We analysed data on hepatitis B vaccination status, sex and age for all reported incidents recorded by this centre during 2008. We compared this with data collected at same time during a national survey to assess the performance of the centre. The number of blood exposure injuries among dentists and their assistants, and reporting behaviour, were also assessed.

RESULTS

In 2008, 387 incidents were reported to the counselling centre. The percentage of high-risk incidents was 16, with a risk of hepatitis B, hepatitis C and HIV infections. In the hepatitis B cases, 12% had no or insufficient immunization. Eight per cent of those injured were unable to start HIV Post-Exposition Prophylaxis because they reported too late. Of the 1442 surveys sent, 487 (34%) were returned. Dentists estimated levels of hepatitis B vaccination at 98%. Thirty-two per cent reported to have had one or more injuries in their practice in 2008. Of these, 37% were counselled by the expert centre, 18% were counselled by others and 45% sought no medical attention. The performance of the counselling centre received a positive score (95%). A need for more information about vaccination and blood-borne infections in dentistry (52%) was reported.

CONCLUSIONS

Nationwide data show blood exposure incidents occur frequently in dental settings, with a considerable number of high-risk incidents. Administering anaesthetics and cleaning-up are major risk factors. There is a need to intensify measures for safe working conditions in dental care settings in the Netherlands, irrespective of the type of dental practice.

Factors affecting occupational exposure to needlestick and sharps injuries among dentists in Taiwan: a nationwide survey

Background

Although the risks of needlestick and sharps injuries (NSIs) for dentists are well recognized, most papers published only described the frequency of occupational exposure to NSIs. Less has been reported assessing factors contributing to exposure to NSIs. The purpose of this study was to update the epidemiology of NSIs among dentists in Taiwan and identify factors affecting NSIs in order to find preventive strategies.

Methodology/Principal Findings

A nationwide survey was conducted in dentists at 60 hospitals and 340 clinics in Taiwan. The survey included questions about factors supposedly affecting exposure to NSIs, such as dentist and facility characteristics, knowledge and attitudes about infectious diseases, and practices related to infection control. Univariate and multivariate logistic regression analyses were conducted to determine the association between risk factors and exposure to NSIs. In total, 434 (74.8%) of 580 dentists returned the survey questionnaires, and 100 (23.0%) reported that they had experienced more than one NSI per week. Our data showed that the risk of occupational NSIs is similarly heightened by an older age (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.62–6.25), more years in practice (OR, 2.57; 95% CI, 1.41–4.69), working in clinics (OR, 1.73; 95% CI, 1.08–2.77), exhibiting less compliance with infection-control procedures (OR, 1.82; 95% CI, 1.04–3.18), having insufficient knowledge of blood-borne pathogens (OR, 1.67; 95% CI, 1.04–2.67), and being more worried about being infected by blood-borne pathogens (OR, 1.82; 95% CI, 1.05–3.13).

Conclusions/Significance

High rates of NSIs and low compliance with infection-control procedures highly contribute to the chance of acquiring a blood-borne pathogen infection and threaten occupational safety. This study reveals the possible affecting factors and helps in designing prevention strategies for occupational exposure to NSIs.

Decontamination in primary care dentistry

Decontamination of reusable dental instruments has been a subject of debate within the dental profes sion since the publication in 2009 of Health Technical Memorandum 01-05: Decontamination in primary care dental practices. This paper provides a brief history of instrument reprocessing in dentistry and reviews the evidence on pre-soaking, cleaning, sterilisation and storage.

A case-control study of risk factors for hepatitis B virus infection in North Jordan

Jordan is a country with intermediate endemicity for hepatitis B virus (HBV) infection where risk factors for viral transmission and their relative contributions are not well known. A case-control study of 100 hepatitis B virus seropositive patients and another 100 seronegative controls was conducted. Univariate analysis and logistic regression model were performed to examine probable risk factors for acquisition of hepatitis B virus infections. Logistic-regression analysis showed that significant risk factors for acquisition of hepatitis B virus infection were sharing toothbrushes (odds ratio = 10.167; 95% confidence interval, 1.181-87.509), unhygienic dental care (odds ratio = 2.455; 95% confidence interval, 1.294-4.658), and living abroad for at least 1 year (odds ratio = 20.018; 95% confidence interval, 2.268-176.685). The presence of these risk factors emphasizes the need for both increasing the use of hepatitis B vaccines and risk-targeted public health education. Development and enforcement of appropriate infection control guidelines for dental care services are also necessary to curtail HBV transmission. Further research that controls for confounding factors is needed to assess the relative contribution of the identified risk factors in the Jordanian community.

The psychological consequences of occupational blood and body fluid exposure injuries

PURPOSE

This article describes the psychological impact of occupational blood and body fluid (BBF) exposure injuries and provides suggestions for improving clinical practice.

METHOD

A literature review was conducted to search for articles relating to the psychological consequences and management of these work injuries.

RESULTS

Acute psychological symptoms including posttraumatic stress, anxiety and depression are frequently experienced postexposure, which appear to be the major contributing factors of time loss from work. Furthermore, a subgroup is at risk for chronic symptoms and disability that persists beyond notification that no disease transmission occurred. Distressed workers often go unrecognised and untreated, and their assistance needs are largely unknown. Accordingly, this article draws upon the posttraumatic stress literature to offer suggestions for advancing the postexposure management of these injuries.

CONCLUSIONS

This clinical commentary underscores the serious yet understudied secondary psychological effects of occupational BBF exposure injuries. Postexposure management programmes need to place greater emphasis on psychosocial and educational initiatives to improve the identification and treatment of symptomatic workers.

Occupational exposures to bloodborne viruses among German dental professionals and students in a clinical setting

PURPOSE

Exposures to bloodborne pathogens pose a serious risk to dental healthcare workers (DHCW). Despite improved methods of preventing exposures like needlestick injuries (NSI), occupational exposures still continue to occur. The purpose of this study was to evaluate the incidence of occupational exposures to patient body fluids among German DHCW, to assess the rate of reporting of such incidents, and to evaluate the association of various factors with these exposures.

METHODS

Data was obtained through an anonymous questionnaire.

RESULTS

Our study confirms that occupational skills are an important factor concerning NSI. It turned out that dental students (0.74 NSI p. a.) had nearly twice the number of NSI compared with dentists with more or less than 10 years working experience (0.42, 0.49 NSI p. a., respectively, P < 0.0001). Overall, 54.3% (n = 144/265) of respondents had sustained at least one NSI in their professional life. Only 28.5% of injured dental students and DHCW reported all of their NSI, the main reason (19.1%) for not reporting NSI was little or no perception of risk on behalf of the respondent. One-fourth of respondents were not wearing a mask and 55.6% were not wearing protective goggles during their last occupational exposures.

CONCLUSIONS

Occupational exposure to blood or body fluids is a common problem among DHCW and dental students. Measures must be adopted by official institutions, public health service, occupational health association and universities in order to reverse this situation.

Needlestick injuries among health care workers: occupational hazard or avoidable hazard?

OBJECTIVES: The objective of this study was to describe the mechanisms and preventability of occupational percutaneous blood exposure of healthcare workers through needlestick injuries and to discuss rational strategies for prevention. METHODS: To calculate the preventability, we surveyed in a first step the number and kind of needlestick injuries and in a second step the reasons for the injuries and the working conditions of the healthcare workers. Both data sets were collected in independent anonymous questionnaire covering occupational blood exposure among healthcare workers in a German university hospital. RESULTS: Needlestick injuries were caused through unsafe procedures, difficult working conditions and unsafe devices. On average, 50.3% (n = 492/978) of all needlestick injuries could have been avoided by the use of safety devices, whereas only 15.2% could have been prevented by organizational measures. In our study, 31.5% (n = 503/1598) of participant healthcare workers had sustained at least one needlestick injury in the past twelve months. The rate of underreporting was about 75%. After introduction of safety devices, 91.8% of the healthcare workers reported being satisfied with the anti-needlestick devices and 83.4% believed that safety devices would increase the safety of the work environment. CONCLUSIONS: Occupational exposure to blood is a common problem among healthcare workers. The introduction of safety devises is one of the main starting points for avoidance of needlestick injuries, and acceptance among healthcare workers is high. Further targets for preventive measures, such as training in safe working routines, are necessary for improvement of safe work conditions.

Intraoperative handling and wound healing of arthroscopic portal wounds: a clinical study comparing nylon suture with wound closure strips

This prospective, single-centre study compared wound closure methods in patients undergoing arthroscopy. Closure of arthroscopic portal wounds with sterile adhesive strips is effective and convenient for wound management. The method was associated with a reduced potential for infection, faster renewal of tensile strength, greater cost effectiveness, and better cosmetic effects comparing with suture closure. This method of wound closure may also reduce the incidence of needle stick injury in the theatre environment. Thereby the incidence of percutaneous exposure following a surgical procedure may not facilitate transmission of blood borne pathogens such as human immunodeficiency virus (HIV), hepatitis C virus and hepatitis B virus. As a result it may reduce litigation in today's changing healthcare climate.