Compliance of Jordanian dentists with infection control strategies

Objectives : To assess whether dentists in Jordan are employing recommended infection techniques in their clinics and to identify the level of compliance of dentists with the recommended infection techniques commonly found in western countries. Participants : Dentists in Jordan (n=300). Methods : A questionnaire incorporating information regarding: infection control practices, vaccination, personal barrier protection, instrument sterilisation and disinfection, were distributed to 300 dentists in private and public practices. Results : A (93%) response rate (n=279) was available for analysis. Gloves were used by 73.3% of dentists; masks by 69.5%, protective eye wear by 43.8% and white coats worn by 75.9%. About 25% recorded patient medical histories. Offices in Jordan were found to be in compliance with respect to the use of disposable anaesthetic needles and carpules but only 27% use plastic containers for sharps; 72.6% of dentists had been vaccinated against hepatitis B viruses; approximately 70% use an autoclave for sterilisation but only 15% always use plastic bags for packing sterilised instruments. Conclusions : The majority of dental practitioners were found to be in compliance with most of the recommended infection control regulations. In this study the overall compliance with infection control procedures was 61.17% among dentists in Jordan. Further education may be appropriate in taking a medical history of each patient before treatment, wearing of masks and protective glasses and the use of plastic bags to wrap sterilised instruments.     

Basic infection control procedures in dental practice in Khartoum-Sudan

OBJECTIVES: To survey the infection control procedures used by dental practitioners in Khartoum, Sudan. METHODS: Questionnaires were distributed to150 randomly sampled dentists practising in Khartoum state. Each questionnaire comprised 17 questions about basic infection control procedures. RESULTS: A 100% response rate to the questionnaire showed that 92% of dentists routinely wore gloves when treating patients, 50% face masks, 61% a gown and 14.7% protective eye wear. Furthermore 52% of the practitioners had been immunised against Hepatitis B. The majority of practitioners (72%) used dry heat as their method of instrument sterilisation, 22% used an autoclave, 2% used boiling water and the remainder used chemical sterilisation. Safe disposal of clinical waste was undertaken by only 23% of dentists although 47% of practitioners stored sharp items in closed containers. All respondents used disposable dental needles, but only a few used other disposable items. There was a significant difference in the implementation of cross infection control procedures between salaried and private dental practitioners, especially with regard to handpiece sterilisation, use of disposables, the wearing of face masks and the availability of additional sets of instruments. CONCLUSION: There is a clear need to improve the existing situation particularly with regard to immunisation of dentists against Hepatitis B, the safe disposal of clinical waste and instrument sterilisation in Khartoum.     

Infection control procedures in commercial dental laboratories in Jordan

The risk of cross-infection in dental clinics and laboratories has attracted the attention of practitioners for the past few years, yet several medical centers have discarded compliance with infection control guidelines, resulting in a non-safe environment for research and medical care. In Jordan, there is lack of known standard infection control programs that are conducted by the Jordanian Dental Technology Association and routinely practiced in commercial dental laboratories. The aim of this study was to examine the knowledge and practices in infection control among dental technicians working in commercial dental laboratories in Jordan. Data were collected from the dental technicians by a mailed questionnaire developed by the author. The questionnaire asked respondents to provide demographic data about age and gender and to answer questions about their knowledge and practice of infection control measures: use of gloves, use of protective eyeglasses and face shields, hepatitis B virus (HBV) vaccination, laboratory work disinfection when sent to or received from dental offices. and regularly changing pot water or pumice slurry. Of the total respondents, 135 were males (67.5 percent) and sixty-five were females (32.5 percent) with a mean age of twenty-seven years. The results showed that 24 percent of laboratory technicians wore gloves when receiving dental impressions, while 16 percent continued to wear them while working. Eyeglasses and protective face shields were regularly worn by 35 percent (70/200) and 40 percent (80/200) of technicians, respectively. Fourteen (14 percent) had received an HBV vaccination, and 17 percent inquired if any disinfection measures were taken in the clinic. Eighty-six percent of the technicians reported that pumice slurry and curing bath water were rarely changed. Only five dental technicians (two males and three females) were considered to be fully compliant with the inventory of infection control measures, a compliance rate of 2.5 percent with no significant difference between males and females (p>0.05). In conclusion, there is lack of compliance with infection control procedures of dental technicians working in commercial laboratories in Jordan.     

Knowledge of and attitudes toward severe acute respiratory syndrome among a cohort of dental patients in Hong Kong following a major local outbreak

OBJECTIVE: To assess the knowledge of and attitudes toward severe acute respiratory syndrome (SARS) among patients attending a teaching dental hospital and private dental practices in Hong Kong during a major local SARS outbreak. METHODS: 250 dental patients were interviewed by questionnaire and 213 were interviewed by phone. RESULTS: Less than one-third (30.0%) of the 463 respondents said they were not afraid of contracting the SARS coronavirus from their dentists and did not avoid dental treatment for that reason. Nearly three-fifths (56.7%) did not worry about contracting SARS from dental treatment. Fewer than 10% of the respondents thought that dentists ran a high risk of contracting SARS. From the patients' experiences, 85.2% and 21.7% of the dentists wore face masks and face shields, respectively, when delivering dental treatment. CONCLUSIONS: The majority of patients interviewed had confidence in their dentists, their treatment environments, and the infection control measures taken, and were not worried about contracting SARS in the dental setting. This perception is an improvement from that described in an earlier study, in which more than half of the patients were concerned about contracting an infection during dental treatment and perceived that the infection control measures undertaken by the dental profession to prevent infectious diseases were not satisfactory. Patients, however, demanded better infection control measures during the SARS outbreak.     

Hepatitis B prevalence and infection control among dental health care workers in a community in South Korea

OBJECTIVES: The objectives of this study were to investigate the prevalence of hepatitis B vaccine and use of infection control procedures by dental health care workers in Taegu, South Korea. METHODS: Information was obtained with a mailed questionnaire sent to 300 private dental practices. Surveys were received from 177 dentists, 104 dental hygienists, and 46 dental assistants. All dental health care workers were asked to donate a blood sample for analysis of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs). RESULTS: Vaccination against hepatitis B virus was reported by 63 percent of the respondents. About 40 percent of all participants answered that they were anti-HBs positive, while another 43 percent did not know their status. About 89 percent of dentists reported that they wore a mask with all patients, while hygienists (13.6%) and assistants (13.0%) were less likely to do so. Reported use of gloves (4.5%) and protective eyewear (14%) with all patients was extremely low in every group. Among the 56 dentists who were tested for HBV markers, 23 did not receive the vaccine against hepatitis B, and 13 percent (3 of 23) were positive for HBsAg as carriers. CONCLUSIONS: About 37 percent (120 of 327) of dental health care workers surveyed in this study in Korea did not receive the vaccine against HBV infection. Basic barrier techniques to prevent cross-contamination were not being used consistently. Nationwide guidelines for barrier techniques and hepatitis vaccinations should be developed and disseminated to dental personnel.     

Preventive Control of AIDS by the Dental Profession: A Survey of Practices in a Large Urban Area

The purpose of this study was threefold: (1) to report the proportion of dental practitioners adhering to the 1987 Centers for Disease Control (CDC) procedures for using infection control techniques (ICTs); (2) to identify attitudes toward infection control and disease; and (3) to establish whether certain practitioner characteristics or use of certain ICTs were related to willingness to treat HIV-positive patients, willingness to volunteer for an HIV specialty clinic outside of regular practice, vaccination against hepatitis B, and a felt need for a specialty clinic within the practice to treat HIV patients effectively. A survey of approximately 3,800 members of a major metropolitan dental society found that 89 percent of respondents regularly used at least one CDC ICT beyond routine medical histories. Ninety-one percent indicated a moderate to extreme change in attitude toward the risks of infectious diseases and the regular use of ICTs (80.2% identified AIDS as the major factor in this change). Twenty-seven percent indicated that they would knowingly treat HIV-positive patients. No differences were found among practitioners willing to treat HIV-infected patients and those unwilling to treat these patients in terms of adherence to the CDC ICT recommendations for dentists. Statistical association between ICT use and other practitioner response variables are discussed.     

A SURVEY OF CROSS-INFECTION CONTROL PROCEDURES: KNOWLEDGE AND ATTITUDES OF TURKISH DENTISTS

Objectives:

The objective of this study was to investigate the knowledge, attitudes and behavior of Turkish dentists in Samsun City regarding cross-infection control.

Material and methods:

A questionnaire was designed to obtain information about procedures used for the prevention of cross-infection in dental practices and determine the attitudes and perceptions of respondent dental practitioners to their procedures. The study population included all dentists in the city of Samsun, Turkey, in April 2005 (n=184). The questionnaire collected data on sociodemographic characteristics, knowledge and practice of infection control procedures, sterilization, wearing of gloves, mask, use of rubber dam, method of storing instruments and disposal methods of contaminated material, etc. Questionnaire data was entered into a computer and analyzed by SPSS statistical software.

Results:

From the 184 dentists to whom the questionnaires were submitted, 135 participated in the study (overall response rate of 73.36%). As much as 74.10% dentists expressed concern about the risk of cross-infection from patients to themselves and their dental assistants. Forty-three percent of the participants were able to define "cross-infection" correctly. The greatest majority of the respondents (95.60%) stated that all patients have to be considered as infectious and universal precautions must apply to all of them. The overall responses to the questionnaire showed that the dentists had moderate knowledge of infection control procedures.

Conclusions:

Improved compliance with recommended infection control procedures is required for all dentists evaluated in the present survey. Continuing education programs and short-time courses about cross-infection and infection control procedures are suitable to improve the knowledge of dentists.     

Factors that affect patient attitudes toward infection control measures.

This study examined how differences in infection control procedures and patients' perceived knowledge of infection control, and how AIDS and hepatitis might affect attitudes toward the use of such measures. Patients receiving treatment at two sites where the methods of infection control and the frequency of their use differed (dental school and private dental practices) were surveyed concerning their approval/acceptance of infection control measures and self-report of knowledge concerning infectious disease and possible transmission of infectious disease during dental treatment. Data were collected from 379 patients, 272 from the dental school and 107 from five private practices. A high percentage (95 percent) of both dental school and private patients felt they were adequately protected, while fewer than 2 percent expressed anxiety about infection control procedures being used in either setting. Factors such as gender, age, and years of formal education did not significantly affect attitudes toward infection control measures, but age and education were correlated with perceived knowledge of infectious diseases. Patients' reported knowledge of infectious disease had a significant effect on their decision to leave a practice if the dentist was HIV positive. A significantly higher percentage of dental school patients felt that barrier infection control techniques should be used routinely. Patients treated where such techniques were not routinely used nevertheless expressed satisfaction with that level of protection, implying that patients tend to accept the level of infection control being practiced where they receive treatment.     

Infection control practices among a cohort of Brazilian dentists

Objective : To evaluate infection control practices among dentists in private and public practice. Design : Survey and cross‐sectional analysis. Setting : Sertãozinho city, Brazil. Participants : All dentists who were currently working at the study city, and agreed to participate, resulting in a study population of 135 dentists. Methods : Participants were personally interviewed and variables were submitted to χ² or Fisher's exact test. Results : Hand washing before and after each patient was reported by 86.7% of dentists, but private practitioners used liquid soap and paper towels more often than their public colleagues (p<0.001). Most of the study population (97.8%) used gloves routinely during clinical sessions, but 8.2% reused them. Dry‐heat was the main method employed for sterilisation of heat‐stable devices by 80.0% of dentists, but adequate temperature and time of exposure was accomplished by only 32.1% of public and 70.0% of private professionals (p<0.001). Heat‐sensitive devices were disinfected with an adequate substance by 60.0% of both affiliation dentists (p=0.908). Conclusions : There is a large gap between infection control recommendations and practices observed among the study population, and the situation is worse in public services. To reverse that situation, infection control issues must be openly debated by professional associations, dental schools and health authorities.     

Infection control practices and compliance to national recommendations among dentists in Romania

The aim of this study was to measure dental office compliance with current Romanian infection control regulations. A questionnaire was completed and returned from 61 randomly selected offices (32 private and 29 public with 94 dentists), where the sterilizers were also biologically monitored. Results indicated that with few exceptions, infection control practices in public and private offices were the same, with compliance on sterilising reusable instruments. Private offices monitored their sterilizers more frequently and had much newer equipment. Gowns were universally worn, but use of gloves, masks and protective eye-wear showed non-compliance with less than 10 per cent of the offices using personal protective equipment for all patients. Cost was the deciding factor. Predominant environmental disinfectants were alcohol and bleach. Offices were in compliance as to the use of disposable anaesthetic needles and carpules. Dentists reported reluctance to be vaccinated against hepatitis B even when offered free immunizations (6.4 per cent) and only 18.1 per cent of dentists had received any infection control training in the last three years. Results indicate that offices were in compliance for most national regulations. However, there are no recently published standards for dentistry in Romania concerning disinfectants or continuing education. Comparison with the literature indicates comparable compliance with recommended national infection control procedures for Romanian dentists as for dentists in other countries.     

The dental safety net in Connecticut

BACKGROUND: Many poor, medically disabled and geographically isolated populations have difficulty accessing private-sector dental care and are considered underserved. To address this problem, public- and voluntary-sector organizations have established clinics and provide care to the underserved. Collectively, these clinics are known as "the dental safety net." The authors describe the dental safety net in Connecticut and examine the capacity and efficiency of this system to provide care to the noninstitutionalized underserved population of the state. METHODS: The authors describe Connecticut's dental safety net in terms of dentists, allied health staff members, operatories, patient visits and patients treated per dentist per year. The authors compare the productivity of safety-net dentists with that of private practitioners. They also estimate the capacity of the safety net to treat people enrolled in Medicaid and the State Children's Health Insurance Program. RESULTS: The safety net is made up of dental clinics in community health centers, hospitals, the dental school and public schools. One hundred eleven dentists, 38 hygienists and 95 dental assistants staff the clinics. Safety-net dentists have fewer patient visits and patients than do private practitioners. The Connecticut safety-net system has the capacity to treat about 28.2 percent of publicly insured patients. CONCLUSIONS: The dental safety net is an important community resource, and greater use of allied dental personnel could substantially improve the capacity of the system to care for the poor and other underserved populations.     

Dental clinical attire and infection-control procedures. Patients' attitudes

BACKGROUND: The authors surveyed adults in military and civilian dental practices about infection-control procedures and clinical attire to see if patients' attitudes had changed with the alteration of infection-control procedures over the last two decades. METHODS: The authors surveyed 1,500 adults, using a written questionnaire at two military hospital dental practices and at four civilian dental offices, which included two general practices, one periodontal practice and one orthodontic practice. RESULTS: The authors found that the use of name tags and patient safety glasses during treatment were preferred by 52.0 percent and 53.4 percent, respectively, of respondents in military facilities. Respondents had no preference about dentists' clothing, use of protective glasses for examinations or head cover use. A majority of respondents preferred that dentists wear glasses when performing treatment (54.1 percent), and 77.4 percent of respondents preferred that dentists wear masks when providing their care. Respondents preferred the use of plastic barriers, and 63.0 percent said it made them feel confident that proper infection-control procedures were followed. A majority of respondents (52.3 percent) said they would be concerned if barriers were not used. CONCLUSIONS: Military and civilian respondents had similar perceptions of infection-control procedures. Respondents said they preferred that dentists wear name tags in group practices and use masks and protective glasses when performing treatment. The use of plastic barriers made respondents feel confident that proper infection-control procedures were being followed. PRACTICE IMPLICATIONS: This study can be used by dental practices to review their infection-control procedures and how patients perceive them. Dentists may decide to implement some of these procedures, especially those that are not required, and that improve customer satisfaction.     

Geographic distribution of pediatric dentists in private practice in the United States

PURPOSE: The objectives of this study were to: (1) determine the geographic distribution of pediatric dentists in private practice across the United States; and (2) compare state-based pediatric dental practitioner-to-children ratios. METHODS: Enumeration of pediatric dental practitioners was derived from the American Academy of Pediatric Dentistry's 2000-01 Membership Directory by including all active and fellow members who were in private practice in the United States. Population information for the 50 states and District of Columbia was obtained from Census 2000 data available on the US Census Bureau's Web site. RESULTS: A total of 2,913 pediatric dentists were in private practice in the United States, with the largest number located in California (333), Texas (238), and New York (202), and the smallest number located in Maine (3) and North Dakota (4). There were 4.03 pediatric dental practitioners for every 100,000 US children younger than 18 years of age. Connecticut and Massachusetts had almost twice (7.7) as many pediatric dental practitioners per 100,000 children as the national average. On the other hand, Maine had only one fourth (1) the number of pediatric dental practitioners per 100,000 children as the national average. CONCLUSIONS: Marked differences exist between the various states in their pediatric dental practitioner-to-children ratio.     

Sample infection control needs assessment survey data from eight countries

Objectives : To compare knowledge, attitudes and practice of standard methods in infection control by dentists in eight countries using a standardised questionnaire. Methods : Self‐administered questionnaires on dental infection control and safety (IC&S) knowledge, attitudes and practice were distributed to a convenience sample of dentists in India, Pakistan, Thailand, Philippines, Taiwan, China, South Korea and the United States of America. Results : Knowledge and practice of infection control among the Asian dentists lagged behind the levels of US dentists. Availability and affordability of equipment and materials were some of the reasons for the practice of infection control and safety. Attitude towards universal/standard precautions in controlling bloodborne pathogens was comparable between groups surveyed. Tested knowledge and practice of infection control was acceptable but the attitude and understanding of universal/standard precautions was ambiguous among both Asian and USA dental practitioners. Education in dental infection control should focus on improving the attitudes of practitioners towards universal precautions. Conclusions : Knowledge and practice of dental IC&S was high among the USA respondents. Immunisation and IC & S should be stressed in Asia. Information obtained through this study could be used to plan and implement policies in improving dental infection control and occupational safety in individual countries.     

Patients' Perception of Cross-infection Prevention in Dentistry in Jordan

Purpose: To explore the public perception of cross-infection prevention methods and their role in disease transmission, among patients attending Jordan University Hospital. Materials and Methods: A systemic random sample of 310 dental patients with a mean (SD) age of 35.1 (14.80) years was selected (42.6% males and 57.4% female). Patients were interviewed prior to dental appointments by a specially trained and calibrated dentist. Responses of the patients were recorded in the structured questionnaire, maintaining their privacy and confidentiality. The data were entered into a Microsoft Excel spreadsheet and analysed using the SPSS statistical package to obtain the prevalence rates of patients' perceptions, which were then cross tabulated with gender, age and other variables. Significant differences were determined using the chi-square test, when appropriate. Results: Of the respondents, 83.5% found it necessary for the dentist to wear gloves, and 65.8% stated the reason was to prevent cross infection from one patient to another. About three-quarters (74.8%) found it necessary for the dentist to wear a mask; when asked about the reason, 52.3% stated prevention of cross infection from dentist to patient. Regarding wearing protective glasses, about three-quarters (73.9%) found it unnecessary for the dentist to do so. The majority (76.8%) stated the method of HIV transmission was by dentists using needles previously used for patients infected with AIDS; 71% knew there is no vaccine against HIV. Only half (49%) reported that hepatitis could be transmitted by blood transfusion. Approximately two-thirds (67.4%) knew there is a vaccine against hepatitis. About 53.5% claimed their knowledge regarding infection transmission was obtained through watching television programmes about cross infection. Conclusion: Dental patients in Jordan need to be equipped with adequate knowledge about cross-infection control, thus education reinforcement is imperative.     

Utilization of personal protective equipment in general dental practice

The principles of universal precautions are central to infection control. These principles form the basis of current guidelines for the use of personal protective equipment (PPE) in dental practice. This study, which examined the patterns of use of PPE in general dental practice, was based on a postal survey of 260 dentists in Brisbane (41 per cent of the total private general practitioners in the region). Routine use of PPE was commonplace (gloves, 84.6 per cent; masks, 55.7 per cent; eyewear, 77.6 per cent), but complete compliance with current recommendations for glove handling and hand care had not been achieved. Potential problem areas in terms of attitudes to PPE were identified, as were inconsistencies in the use of PPE in both clinical and non-clinical settings. These findings emphasize the need for further educational campaigns In practical infection control measures.     

Knowledge and practices of decontamination during root canal treatment by dentists in Jeddah

BackgroundThe periapical area is healed through disinfection of root canal system and reduction of microbial infection after root canal.PurposeTo assess the knowledge of dental practitioners about decontamination during root canal treatment and the techniques used in the government and private sectors of Jeddah, Saudi Arabia.Methods103 dental practitioners and interns from private and governmental sectors performing root canal treatment were included. To extract information, a questionnaire assessing knowledge and preferred techniques used in decontamination during root canals treatment was distributed. The association of variables was investigated using chi-square tests.ResultsThe findings reflected that 82.5% of subjects used rubber dam for isolation with significantly more practitioner in the governmental (95.2%) as compared to the private sector (27.8%). Chelating agents were used by 13.3% of the practitioners in government sector and 1% practitioners in private sector (1%). The most commonly used irrigant was sodium hypochlorite. Calcium hydroxide was used more frequently in the governmental sector (29.8%) than in the private sector (11.8%), as intracanal medicament. Mechanical irrigation devices were used by 2.4% of practitioners in the governmental sector only.ConclusionsThere is a significant difference in practicing root canal disinfection techniques among dentists in governmental and private sectors but no difference in degree of knowledge.     

Improvements in Dental Health and Dentists’ Workload in Norway, 1992 to 2015

ObjectivesThere has been a marked improvement in dental health in Norway during the last few decades. What effect has this had on provision of dental services, and how has private dental practitioners’ assessment of their workload changed?MethodsThe data were from 2 large surveys of private dental practitioners carried out in 1992 (n = 1056) and 2015 (n = 1237). An analysis of nonresponders showed that they were evenly distributed according to their age, gender, and the region in which their practice was located. Thus, the samples were representative of private dental practitioners. For 1 representative week in practice, the practitioners were asked to report the number of visits and the number of patients who received 1 or more of the following items of treatment: filling, crown, bridge, denture, root filling, extraction, and periodontal treatment. As a measure of patient supply, the responses from the following questions were used: “Based on an overall assessment of economy, workload, and other personal factors, is the number of regular patients adequate? If not, do you wish to have more patients or fewer patients?”ResultsFrom 1992 to 2015, the annual number of visits per practitioner decreased by 23%. The number of patients per practitioner who received fillings, crowns, bridges, dentures, root fillings, or extractions decreased by 50% or more. The decrease was largest for practitioners younger than 35 years and for men. The proportion of practitioners who reported a deficit of patients increased from 20% to 37%.ConclusionsMany dentists will have too few patients and a fall in income in the years to come is expected.