Occupational hygiene practices of dentists in southern Thailand

OBJECTIVES: The aims of this study were to investigate the prevalence and nature of infection control, radiation control and handling of mercury, reported by dentists in southern Thailand. METHOD: A cross-sectional study with self-report questionnaire to all 220 dentists working in 14 provinces in southern Thailand in 1997. RESULTS: 178 dentists (80.9%) aged 22-54 years responded. All reported wearing personal protective measures, at least sometimes and using high level disinfection (formerly sterilisation) procedures for handpieces. Most (93.8%) reported changing sterilised handpieces for each patient. The most commonly reported method of high level disinfection was alcohol (37.1%). Just over two-thirds (68.0%) reported having HBV vaccination. Most (94.3%) reportedly took precautions when radiographs were taken and (89.9%) reported protecting their eyes with a UV/blue light shield or filter while using these units. About half of dentists (51.7%) reported storing excess amalgam under water compared with 20.1% that they stored it in a closed box. 77.7% reported using sealed mercury amalgam capsule systems, at least sometimes. Nearly half (47.1%) reported disposing of used capsules in the bin. CONCLUSIONS: The present study has indicated that occupational hygiene practices of dentists in southern Thailand are generally consistent with published guidelines for infection control and also with other populations of dentists studied in the areas of infection control and radiation protection. Further continuing education and investigation of appropriate interventions to promote good occupational hygiene standards may also be needed.     

Occupational exposure to biological fluids among a cohort of Brazilian dentists

Objective : To evaluate the epidemiology of percutaneous occupational exposure to biologic fluids and the level of compliance with some recommendations contained in the ‘Standard Precautions’ among dentists. Setting : Sertãozinho city, Brazil. Participants : All dentists who were currently working in public or private offices in the study city, and who agreed to participate, resulting in a study population of 135 dentists. Methods : All participants were personally interviewed from August 2001 to April 2002. Results : Of the dentists interviewed, 31.1% reported accidents, with a mean incidence of 2.02 accidents/professional/year; 90.0% recapped needles after using them, while 8.1% re‐used gloves. Injuries involved the hands and the item most frequently mentioned was a needle. Inadequate procedures were observed regarding the disposal of sharp devices and hand hygiene. Conclusions : Dentists evaluated do not properly obey the norms for infection control during their clinical activities, with consequent risks for their own and their patients' health. Measures must be adopted by class institutions, universities, public agencies, and especially by these professionals in order to reverse this situation.     

Hand hygiene among general practice dentists: a survey of knowledge, attitudes and practices

BACKGROUND: Hand hygiene (HH) is a primary practice used to reduce the risk and spread of infection. The authors conducted a study to examine the self-reported knowledge, attitudes and practices of general practice dentists (GPDs) regarding HH and factors associated with HH and skin condition. METHODS: The authors mailed a four-page closed-ended questionnaire to a random sample of active GPDs drawn from a list supplied by the New York State Dental Association. The authors classified eight GPDs as ineligible, leaving a net sample of 352. They received 234 responses, for a response rate of 66 percent. RESULTS: At the start of the practice day, 71 percent of GPDs often/almost always/always washed with soap but never/almost never disinfected with an alcohol-based hand sanitizer. Twenty-two percent often/almost always/always washed with soap and disinfected with alcohol-based hand sanitizers. GPDs with good/excellent knowledge of the Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene in Health-Care Settings were more likely to report acceptable HH behavior. Approximately one-third of GPDs had limited/ moderate knowledge of the CDC HH guideline. CONCLUSIONS: Most GPDs use soap and water for HH frequently, and a smaller number of GPDs use alcohol-based hand sanitizers for HH frequently. Results show that 25 percent of GPDs or fewer maintain inadequate HH. Knowledge of the CDC HH guideline needs to be heightened. Practice Implications. Further education of the dental community is warranted to improve HH compliance, efficacy of HH practices and skin health.     

Endodontic infection control routines among general dental practitioners in Sweden and Norway: a questionnaire survey

Objective: The purpose of this study was to investigate endodontic infection prevention and control routines among general dental practitioners in Sweden and Norway.

Materials and methods: A questionnaire was sent by email to 1384 general dental practitioners employed in Sweden and Norway. The participants were asked questions concerning different aspects of infection prevention and control during endodontic treatment; use of rubber dam, sealing of rubber dam, antibacterial solutions, and use of hand disinfectant and gloves.

Results: The response rate was 61.4% (n: 819). 96.9% reported routinely using rubber dam during endodontic treatment. 88.3% reported always, or sometimes, sealing the area between rubber dam and tooth. Most disinfected the endodontic operative field, but the antibacterial solutions used varied. 11.9% did not use gloves at all during treatment, and 10.5% did not use hand disinfectant during treatment.

Conclusions: Most of the general dental practitioners took measures to establish and maintain aseptics during endodontic treatment, which infers an awareness of the importance of endodontic infection prevention and control. But the results were self-reported and there may be a gap between claimed and actual behaviour. Further studies using observation methodologies are needed to assess how infection control routines are performed in everyday clinical practice.     

Compliance with infection control recommendations in South African dental practices: a review of studies published between 1990 and 2007

In a country where the prevalence of infectious diseases ranks among the highest in the world, infection control in health care facilities should not be debatable. This unfortunately does not seem to be the case in South African oral health care facilities. This study is a systematic review of available literature on the adherence of South African oral health care professionals to infection control recommendations. Nine focus areas were investigated with regard to infection control practices: knowledge of infectious occupational hazards; personal hygiene and care of hands; correct application of personal protective equipment; use of environmental barriers and disposable items; sterilisation (recirculation) of instruments and handpieces; disinfection (surfaces) and sound housekeeping; management of waste disposal; quality control of dental unit waterlines, biofilms and water; as well as other special considerations. Although South African studies are limited and most of them relied on self‐reports, which could have resulted in a serious overestimation of compliance, even these studies indicate serious shortcomings with regard to infection control practices in oral health care facilities in this country. This review highlights opportunity for improvement. Furthermore, it identifies possibilities for future research in infection control and also opportunities to improve infection control education for all oral health care workers in the country.     

Gender differences in characteristics, infection control practices, knowledge and attitudes related to HIV among Ontario dentists

Abstract We surveyed 5,997 dentists in Ontario to investigate gender differences in the characteristics, infection control practices, knowledge and attitudes regarding the treatment of HIV-infected patients. The response rate was 70.3%. Reports indicated that female dentists are younger and more likely to work in larger urban centres (P<0.00001), and in general practice (P<0.0001) than their male counterparts. Multiple logistic regression analyses indicated that many significant gender differences in the univariate analyses could be explained by the confounding influence of age, practice location, and specialty; however, some differences remain significant: Women were more likely than men to report attending continuing education dealing with HIV/AIDS in the past two years (P<0.001), and to use masks and eye protection (P<0.00001). Men reported more economic concerns than women: they were more concerned about the financial burden of infection control costs (P<0.00001), and losing patients from their practice if it is known that they treat patients with HIV (P<0.05). However, there were no significant differences in willingness to provide treatment for patients with HIV. We conclude that there is little evidence to show that access to oral care for patients with HIV is affected by gender differences.     

Competency assessment for infection control in the undergraduate dental curriculum

OBJECTIVES: This study aimed at investigating the introduction of an infection control competency assessment on undergraduate dental student's awareness and knowledge of infection control. METHOD: A short course, including an introductory lecture and a three component competency based assessment exercise testing student's knowledge and ability in infection control measures was incorporated into the previously established training programme. The assessment exercises included a written test of students' knowledge of the Infection Control Policy, a unit management exercise and a hand hygiene assessment. The infection control competency was initially incorporated into the final term of the second year in 2004 and is now an established part of the 5-year dental undergraduate degree programme. Re-assessments were scheduled (at the start of third year) for students failing to meet the required standard as successful completion of this course was compulsory prior to students being allowed to treat their first patients. Student performance over the last 2 years on this course and during their first year on clinic were analysed to determine potential improvements in student knowledge and application in infection control. Examination results from the year 3, infection control spot test were compared with those of earlier years. In addition, the opinions, as assessed by questionnaire analysis, of dental staff and students on the infection control competency were obtained. RESULTS: All students successfully completed the infection control competency (either at first or second attempt) and were subsequently allowed to enter clinical training in year 3. Significant improvements were seen in students passing the course at their initial attempt, 42% and 78%, in the 2004 and 2005 academic years, respectively. Also subsequent testing of these students during their first year on clinic showed marked increases in awareness and knowledge of the infection control protocols. Staff and student feedback on this course was also found to be highly supportive of the introduction of the infection control competency. CONCLUSION: Incorporation of additional formal pre-clinical teaching and introduction of an infection competency potentially provides enduring knowledge and clinical application benefits.     

Current biomedical waste management practices and cross-infection control procedures of dentists in India

Objectives: To investigate the knowledge, attitudes and behaviour of dentists working in dental clinics and dental hospitals regarding biomedical waste management and cross‐infection control. Methods: A national survey was conducted. Self‐administered questionnaires were sent to 800 dentists across India. Results: A total of 494 dentists responded, giving a response rate of 61.8%. Of these, 228 of 323 (70.6%) general dentists reported using boiling water as a sterilising medium and 339 (68.6%) dentists reported disposing of hazardous waste such as syringes, blades and ampoules in dustbins and emptying these into municipal corporation bins. Conclusions: Dentists should undergo continuing education programmes on biomedical waste management and infection control guidelines. Greater cooperation between dental clinics and hospitals and pollution control boards is needed to ensure the proper handling and disposal of biomedical waste.     

Cross-infection control in dental practice in the Republic of Ireland

OBJECTIVE: The purpose of this study was to examine the infection control procedures used in general dental practices in the Republic of Ireland. DESIGN: Postal survey. SETTING: The Republic of Ireland. PARTICIPANTS: 250 general dental practices. METHODS: Postal questionnaire. MAIN OUTCOME MEASURES: Use of infection control procedures; gloves, masks, sterilisation of instruments, staff training. RESULTS: A 74% response rate (n = 177), with 162 wearing gloves for all patients, 97% of whom used latex gloves. Routine glove use by 69% of dental nurses. Approximately one third of respondents complained of hand skin irritation attributed to the wearing of latex gloves. Routine mask wearing during treatment was reported by 68% of respondents. The method of choice for sterilising instruments was the steam autoclave for 97%. Time spent on surgery cleaning between patients was less than one minute in 12 per cent of practices. CONCLUSIONS: Cross-infection control procedures practiced by a high proportion of the respondents to the survey conform to guidelines suggested by various authorities. Further education may be appropriate in a number of areas such as mask wearing and the need to change gloves between patients.     

A 10-year survey of compliance with recommended procedures for infection control by dentists in Beijing

Objectives: This study aimed to survey changes in practices of infection control (IC) procedures by dentists in Beijing between 2000 and 2010. Methods: Data were based on the feedback of 592 and 769 dentists surveyed in 2000 and 2010, respectively. Statistical analysis was conducted using Pearson’s chi‐squared test. Results: Response rates of 95% (2000) and 94% (2010) were achieved. The percentages of dentists who had received training in IC were 62.96% (2000) and 76.21% (2010). Improvements in practices in 2010 over those in 2000 included increases in: the percentage of vaccination for hepatitis B virus from 32.66% to 68.14%; the routine use of gloves from 73.31% to 99.73%; the use of face shields or eyewear as protection against splatter during dental treatment from 13.94% to 95.45%; the use of protective gowns from 14.51% to 54.23%; the use of high‐volume suction from 11.19% to 74.34%; routine changing of gloves between patients from 63.25% to 99.22%; pressured steam sterilisation of dental handpieces between patients from 41.24% to 96.10%, and the flushing of dental unit waterlines after each treatment from 42.01% to 73.49%. Conclusions: Although compliance with recommended IC practices by dentists in Beijing improved between 2000 and 2010, not all dentists are properly familiar with IC procedures. Education in IC in dental schools and in continuing training in hospitals, and mandatory regulations are needed to improve IC practices in dental health care settings.     

The role of age- and population- based differences in the attitudes, knowledge and infection control practices of Canadian dentists

OBJECTIVES: To investigate age- and population-based differences in dentists' infection control practices and willingness and refusal to treat patients with HIV. METHODS: A national mailed survey of a stratified random sample of dentists in Canada (n = 6444) with three follow-up attempts. Pearson's chi-square test and multiple logistic regression were used for data analysis. Predictor variables included population, age, gender, marital status, specialty, number of patients treated per day and continuing education on HIV/AIDS. RESULTS: The adjusted response rate was 66.4%. The best predictors of willingness to treat patients with HIV were younger age (compared with dentists > or = 60 years of age: < 30 years, OR = 8.6, 30-39, OR = 3.4; 40-49, OR = 2.7; 50-59, OR = 1.6), attending continuing education on HIV/AIDS in the past 2 years (> 10 hours, OR = 1.6 compared with zero hours), practicing in small population centres < 10,000 (OR = 1.6 compared with > 500,000) and gender (male OR = 1.3). The best predictors of refusal to treat patients with HIV were older age (compared with dentists < 30 years of age: > or = 60, OR = 6.1; 50-59, OR = 4.1; 40-49, OR = 3.0; 30-39, OR = 2.6); and practicing in population centres > 500,000 (OR = 1.5 compared with < 10,000). However, the latter group also reported treating more HIV patients than respondents in smaller communities. Infection control practices varied significantly with age and population centre. Dentists in communities of < 10,000 were more compliant with HBV vaccination, but less compliant with handwashing after degloving and the use of infection control manuals. Similarly, dentists > 60 years of age were the least compliant with HBV immunization, routine use of barriers and sterilization of handpieces, but reported the highest compliance with handwashing. CONCLUSIONS: Age- and population-based differences need to be considered in planning educational interventions to improve both access to care for patients with HIV and dentists' compliance with recommended infection control procedures.     

Infection control measures among senior dental students in Rio de Janeiro State, Brazil

OBJECTIVE: The aim of this study was to verify the practices and attitudes of senior dental students about infection control procedures. METHODS: A cross-sectional survey was performed during the 1st semester of 2003. Open- and close-ended questions were given to 196 students in 6 universities. RESULTS: Overall, 90.8% of students had been vaccinated for hepatitis B. Only 25.0% have been assessed for anti-HBs. A total of 99.5% students reported always using gloves for all procedures. Eye protection were always used by 84.2% of students, and all the students used face masks for all procedures. Caps or hair covers were used by 92.3% of students and 87.8% reported no objection to treating patients with infectious diseases. Among instructors, the students observed that 60.2% of them did not use gloves for all procedures, 43.4% of those didn't change gloves between patients. CONCLUSIONS: These results address the need for an improved quality assurance, in order for the students and faculty to improve their practices and attitudes on infection control measures.     

Compliance with infection prevention and control in oral health‐care facilities: a global perspective

Many publications are available on the topic of compliance with infection prevention and control in oral health‐care facilities all over the world. The approaches of developing and developed countries show wide variation, but the principles of infection prevention and control are the same globally. This study is a systematic review and global perspective of the available literature on infection prevention and control in oral health‐care facilities. Nine focus areas on compliance with infection‐control measures were investigated: knowledge of infectious occupational hazards; personal hygiene and care of hands; correct application of personal protective equipment; use of environmental barriers and disposable items; sterilisation (recirculation) of instruments and handpieces; disinfection (surfaces) and housekeeping; management of waste disposal; quality control of dental unit waterlines, biofilms and water; and some special considerations. Various international studies from developed countries have reported highly scientific evidence‐based information. In developed countries, the resources for infection prevention and control are freely available, which is not the case in developing countries. The studies in developing countries also indicate serious shortcomings with regard to infection prevention and control knowledge and education in oral health‐care facilities. This review highlights the fact that availability of resources will always be a challenge, but more so in developing countries. This presents unique challenges and the opportunity for innovative thinking to promote infection prevention and control.     

Antibacterial efficacy of calcium hydroxide intracanal dressing: a systematic review and meta-analysis

AIM: To determine to what extent does calcium hydroxide intracanal medication eliminate bacteria from human root canals, compared with the same canals before medication, as measured by the number of positive cultures, in patients undergoing root canal treatment for apical periodontitis (teeth with an infected root canal system). METHODOLOGY: CENTRAL, MEDLINE and EMBASE databases were searched. Reference lists from identified articles were scanned. A forward search was undertaken on the authors of the identified articles. Papers that had cited these articles were also identified through the Science Citation Index to identify potentially relevant subsequent primary research. REVIEW METHODS: The included studies were pre-/post-test clinical trials comparing the number of positive bacterial cultures from treated canals. Data in those studies were independently extracted. Risk differences of included studies were combined using the generic inverse variance and random effect method. RESULTS: Eight studies were identified and included in the review, covering 257 cases. Sample size varied from 18 to 60 cases; six studies demonstrated a statistically significant difference between pre- and post-medicated canals, whilst two did not. There was considerable heterogeneity among studies. Pooled risk difference was -21%; 95% CI: -47% to 6%. The difference between pre- and post-medication was not statistically significant (P = 0.12). CONCLUSIONS: Calcium hydroxide has limited effectiveness in eliminating bacteria from human root canal when assessed by culture techniques.     

Burnout and professional quality of life among Israeli dentists: the role of sensory processing sensitivity

Aim: Dentistry is a stressful and exhausting profession with high levels of burnout. Sensory processing sensitivity (SPS) is a basic personality trait characterised by a gradient of sensitivity to both internal and external stimuli, including social and emotional cues. In this study, the influence of SPS on burnout and professional quality of life among Israeli dentists was analysed. Methods: Two-hundred and forty-three Israeli dentists responded to questionnaires that collected information on their SPS and professional quality of life (burnout, satisfaction at work and level of secondary traumatic stress), as well demographic variables, professional specialisation and workload. Results: Linear regression analyses showed that burnout can be predicted by the three aspects of SPS (ease of excitation, low sensory threshold and aesthetic sensitivity; 32% of the variance). Additionally, the same three aspects of SPS also predicted dentists’ satisfaction at work (24% of the variance). Ease of excitation and low sensory threshold, but not aesthetic sensitivity, predicted dentists’ reaction to their patients’ stress and trauma (23% of the variance). Conclusions: Sensory processing sensitivity can serve as a tool to identify dentists who are prone to develop burnout and whose professional quality of life can be adversely affected by their profession.Key words: Dentistry, sensory processing sensitivity, burnout, secondary traumatic stress, professional quality of life, compassion satisfaction     

Nonresponse bias in a national study of dentists' infection control practices and attitudes related to HIV

Abstract The aim was to investigate late response and nonresponse bias in a survey related to HIV and infection control. Questionnaires with ID numbers were mailed to a stratified random sample of dentists in Canada with additional mailings 4 and 7 weeks later (n=6444). We compared responses received after <4 weeks, 4–7 weeks, >7 weeks. Extrapolation was used to estimate nonresponse bias. Univariate analyses showed significant differences between responses received <4 weeks after initial mailing and those received later for items on sociodemographics, knowledge, infection control practices and attitudes: late responders were more likely to report that they would refuse to treat any patients with HIV (P<0.01). Multiple logistic regression indicated that the best predictors of responses received ≥4 weeks were disagreement that HBV is more infectious than HIV (OR=1.7); unwillingness to attend a dentist who treats HIV/AIDS patients (OR=1.3); incorrect perception of the risk of HIV infection after an HIV-contaminated needlestick injury (OR =1.2): and sometimes or never heat-sterilizing handpieces after each patient (OR=1.2). Extrapolation indicated that the percentage of all respondents who reported refusal to treat (15.2%) would have been 17.1% if a 100% response rate had been obtained. We found significant evidence of late response and nonresponse bias primarily in knowledge and fears related to HIV infectivity; however, the impact on the final results was small and we concluded that additional follow-up to improve response rates would not be worthwhile.     

Knowledge of and attitudes about blood-borne viruses and infection control in Brazilian dental practice

OBJECTIVE: To determine whether there were any recent changes in hepatitis B immunisation of dental staff, infection control or understanding of viral infections in Brazilian dentists.
DESIGN: A randomised survey was conducted on 740 dentists attending the National Dental Congress in Sao Paulo, Brazil in 1994.
SUBJECTS AND METHODS: The 740 dentists were questioned as to the presence of various viruses in saliva, the perceived risks of dental staff and long-term sequelae, the availability and uptake of vaccines, willingness to treat virus-infected persons, and means of infection control. Nearly 69% of respondents were female dentists, of mean age 30 years. Results were compared with a similar survey from 1990.
RESULTS: Most respondents knew that HIV and hepatitis viruses could appear in saliva and almost all knew of infective risks from hepatitis B (HBV), and the availability of the vaccine. Less than half knew of the association of HBV with liver cancer. There was a four-fold increase in those vaccinated against HBV since the low figure of 9% in 1990. Nearly two-thirds of respondents perceived an occupational risk to dental staff from HIV, and a similar proportion were also unwilling to treat virus-infected persons. A similar proportion also used chemical disinfection for some dental instruments.
CONCLUSIONS: The results show little improvement over a 4-year period except a much greater proportion of dentists were immunised against HBV. However, still only one third of dentists had been vaccinated, in a country with a high prevalence of infection in the general population.     

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

Latin American dental schools are at diverse stages in the continuum of implementation of infection control (IC) programmes that comply with evidence-based recommendations. Poor IC training may result in low compliance and negative attitudes against patients infected with blood borne pathogens (BBP). OBJECTIVE: To evaluate students' knowledge on IC and attitudes toward occupational BBP risks, in six dental schools in Latin America. METHODS: This survey was administered to convenience samples of dental students at one school in Costa Rica; four schools in Mexico, and one in Venezuela. The questionnaire included Likert-type scale evaluations of agreement with statements. Study variables included knowledge about and confidence in recommended IC procedures, degree of concern about HIV and HBV transmission in dental settings, and attitudes toward patients infected with BBP. Possible associations between variables were analysed using Pearson's Chi square and Kruskal Wallis tests. RESULTS: Substantial numbers of students had incomplete knowledge and often lacked confidence on IC and procedures; believed that HIV and HBV could be transmitted during clinical procedures; felt worried about occupational exposure to BBP, and held prejudices towards HIV and HBV infected individuals. CONCLUSIONS: Educational efforts are needed to enhance IC teaching and compliance. Diverse educational resources and international networks for research collaboration are available from organisations specialised in IC, hopefully paving the way to harmonising regional standards.