Behavioural video to navigate predoctoral dental students toward safer practice (revision of EJE-21-4739)

INTRODUCTION

Local anaesthesia is considered essential knowledge within the dental profession as it helps to address pain management. Operator percutaneous needlestick injuries associated with the delivery of dental anaesthesia are common for dental healthcare providers. The study proposes a supplemental technique to reduce self-inducing novice operator needlestick injury to complement existing pedagogies for the preclinical local anaesthesia curriculum. The purpose of the study is to evaluate whether a local anaesthesia behavioural video can navigate students to safer clinical practice. Further, a supplemental technique is proposed in whether assessing instrument retraction technique in clinical patient care leads to decreased self-inducing intraoral needle stick injury for novice predoctoral dental operator.

MATERIALS AND METHODS

Beginning in 2011, predoctoral dental students were asked to view a "what not to do" video within a summative assessment and identify at least five behaviours that were unacceptable errors for delivering local anaesthesia. Operator intraoral needlestick injury was also tracked per the bloodborne exposure reports within predoctoral patient clinics.

RESULTS

Data from the learners' responses identified progression in recognising unacceptable errors from behavioural video. Intraoral needlestick injury, 8 and 9 years prior and after the introduction of video showed significance with a low correlation coefficient.

CONCLUSION

More data need to be gathered and evaluated in other dental school settings to determine whether this supplemental educational video decreases needlestick injury in novice operators. Results suggest this behavioural video may guide novice operators to overall safer clinical practice.

Prevalence and characteristics of needlestick injuries among dental interns during their first-year clinical training: an observational study

BACKGROUND

Dental interns are vulnerable to needlestick injuries (NSI). The objectives of this study were to examine the prevalence and characteristics of NSI exposures among dental interns during their first-year clinical training, assess risk factors, and evaluate reporting behaviours.

METHODS

An online survey was conducted among dental interns of Class 2011-2017 at Peking University School and Hospital of Stomatology (PKUSS), China. The self-administrated questionnaire consisted of information on demographic profiles, NSI characteristics, and reporting practices. The outcomes were presented by descriptive statistics. A multivariate regression analysis was performed to assess NSI sources using a forward step-wise approach.

RESULTS

A total of 407 dental interns completed the survey (response rate 91.9%, 407/443), and 23.8% sustained at least one NSI. The mean number of NSIs per intern was 0.28 during the first clinical year. More occupation exposures occurred from October to December, between 13:00-15:00. Syringe needles were the most frequent sources, followed by dental burs, suture needles, and ultrasonic chips. The risk of peer-inflicted NSIs in the department of Paediatric Dentistry was 12.1 times higher than that in Oral Surgery (OR 12.1, 95% CI: 1.4-101.4). Appropriately 64.9% NSIs occurred when chairside assistants were absent. Compared to working alone, the risk of peer-inflicted NSIs was 32.3 times higher when providing chairside assistance (OR 32.3, 95% CI: 7.2-145.4). The left-hand index finger was the most commonly injured site. About 71.4% of exposures were reported in paperwork.

CONCLUSIONS

Dental interns are susceptible to NSIs during their first-year clinical training. Extra attention should be paid to syringe needles, dental burs, suture needles, and ultrasonic chips. The lack of chairside assistance is hazardous regarding NSIs. The training of chairside assistance of the first-year dental interns should be enhanced. First-year dental interns are required to increase their awareness of ignored behaviors related to NSI exposures.

Global prevalence, risk factors and reporting practice of needlestick and sharps injuries among dental students: A systematic review and Meta-analysis

BACKGROUND

Dental students are vulnerable to needlestick injuries (NSI) due to their inadequate training. However, the global prevalence of NSI among dental students is unknown.

AIM

To determine the pooled prevalence among dental students, epidemiological profile, and risk factors for NSI.

METHODS

A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The review protocol was registered at the International Prospective Register of Systematic Reviews (CRD 42022312778). Eligible studies were identified from PubMed, Scopus, Web of Science, Embase, OVID, and EBSCO databases. A meta-analysis with a random effects model was performed to estimate the pooled prevalence, and meta-regression was conducted to explore heterogeneity among studies.

FINDINGS

A total of 25 studies from 15 countries met the inclusion criteria. The estimated pooled prevalence of NSI among dental students was 44% (95% CI: 38-51%). Local anesthesia, tooth cleaning or scaling, and waste disposal were associated with highest risk for NSI. Most studies observed under-reporting of NSI. Dental students had inadequate knowledge regarding post-exposure management.

CONCLUSION

Dental students had a high prevalence and low reporting rate of NSI exposure. Inadequate knowledge might increase the probability of NSI exposure.

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.

A Retrospective Analysis of Non-Sharps-Related Injuries in a Dental School

OBJECTIVES

Workplace non-sharps injuries are a common occurrence in a dental school setting. In dentistry, the importance of preventing non-sharps injuries is often overlooked due to emphasis on sharps-related injuries. The aim of this research was to analyse the incidences of non-sharps injuries over an 11-year period in a dental school to identify trends and the possible causative factors for these injuries.

METHODS

Injury reports lodged with the University of Queensland Workplace Health and Safety databases between 2009 and 2019 were categorised and analysed.

RESULTS

Of 1156 incidents reported, 35.7% (n = 413) were non-sharps injuries, and the most common type of non-sharps injury was general incidents (48.4%, n = 200). The most common body site for injury was the hands (19.4%, n = 80), and the most common location where an injury occurred was in clinical patient care (53.8%, n = 222). The personnel type most at risk of a non-sharps injury fluctuated between students and staff throughout the study period.

CONCLUSIONS

All personnel, including students and staff, are at similar risk of experiencing a non-sharps injury within a dental school setting. The equipment and facilities of a dental clinic as well as the level of adherence to safe working procedures are contributing factors. Continuous quality improvement is essential for minimising these injuries.

Occupational percutaneous injuries and exposures in a dental teaching environment: A 10-year report

PURPOSE

Percutaneous injuries (PIs) are woefully underreported and the risk at dental academic institutions is higher due to lack of knowledge and experience of students. The aims of this study are to (1) present data on the prevalence of PIs and exposures over a 10-year period in a dental teaching institution; (2) provide information on areas with increased risk as it relates to personnel and instruments; and (3) improve the awareness of the risk of occupational PIs and exposures in dentistry.

METHODS

Data presented were collected as a part of an infection control program. A description of the incident reporting and collecting methodology is provided. Distribution tables and confidence intervals for injuries by year were calculated. Overall associations were produced using either Fisher's exact or Chi-square test.

RESULTS

Between 2009 and 2019, a total of 342 PIs (338) and mucosal exposures (4) were reported. A significant number of injuries occurred while reaching for an instrument (15.2%), injecting local anesthetic (13.2%), and cleaning an instrument (11.7%). About 31% of the injuries were caused by needlesticks followed by burs (22.8%). There was a statistically significant association between work practice controls and activity type (p < 0.001) and position (p = 0.01). PIs and compliance issues were higher among the third-year dental students.

CONCLUSIONS

There was a declining trend in incidents over the years, which could be attributed to the extra-protective measures that were implemented. Uncovered dental burs and needlesticks continue to be the predominant cause of PIs in academia. We found that collection of data on such occupation-related injuries to be useful in observing any trends and implementation of corrective actions.

Identifying Trends of Percutaneous Injuries at an Australian Dental School

Objectives

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

Methods

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

Results

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

Conclusions

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

Self-reported percutaneous injuries of students and interns at the School of Dentistry in Trinidad: A follow up study of an updated sharps protocol

Objective To report the results of a survey of all percutaneous injuries that occurred between 2009 – 2014 among students and interns at the dental school in Trinidad and to evaluate compliance with the protocol for the management of percutaneous injuries. Methods Data was collected via questionnaires administered to 186 clinical students and interns in 2012 and 2014. Data were analysed using SPSS® 17.0 Statistical software. Results A 90% response rate was obtained. Forty-eight persons (29%) reported one or more sharps injuries at the dental school. Of the 76 sharps injuries reported, 55 were percutaneous. Needle sticks and burs accounted for the majority of injuries and mostly occurred while working on patients. There were no significant relationships (p>0.05) between sex nor student year with the occurrence of injuries. 76% of the respondents described their concern for contracting blood borne injuries from sharps injuries as “high.” After injury, 41% of the respondents followed the school’s protocol for sharps injuries. Conclusion The prevalence of percutaneous injuries among students and interns at the UWI dental school in Trinidad is 23% and occur most commonly while working on patients. Compliance with the protocol for percutaneous injuries needs to be improved. The protocol needs to be audited to improve efficiency and reinforced to the students, interns and clinical supervisors during their clinical years.

Preliminary Evidence Supports Modification of Retraction Technique to Prevent Needlestick Injuries

A modified retraction technique was introduced into the DDS degree preclinical anesthesia course in 2011 with the goal of reducing needlestick exposure incidents. In numerous studies of dental exposures, injuries from dental anesthetic needles account for the highest proportion of all exposures. The purpose of this study was to assess the preliminary impact of a modified retraction technique on the incidence of blood and body fluids (BBF) exposure incidents associated with needles during injection. Data from evaluations of students from 2014 and 2015 were obtained and tracked to determine whether the modified retraction technique was "excellent," "clinically acceptable," or "clinically unacceptable." Data were collected to determine if the patient perceived the modified retraction technique as "comfortable" or "correctable when addressed" to help improve student technique for future injections. Likewise, data from the blood-borne exposure database where all information related to BBF exposures is recorded were reviewed and the information separated by year and class. This study presents preliminary data only and because of the small sample size does not lend itself to validation by statistical analysis. However, the technique effectively removes the operator's hand from the field during injection, reducing the risk of accidental intraoral needlestick to the nondominant hand of the operator.

Percutaneous self-injury to the femoral region caused by bur breakage during surgical extraction of a patient's impacted third molar

Extraction of an impacted third molar is one of the most frequently performed techniques in oral and maxillofacial surgery. Surgeons can suffer numerous external injuries while extracting a tooth, with percutaneous injuries to the hand being the most commonly reported. In this article, we present a case involving a percutaneous injury of the surgeon's femoral region caused by breakage of the fissure bur connected to the handpiece during extraction of the third molar. We also propose precautions to prevent such injuries and steps to be undertaken when they occur.

Occupational exposure to blood and body fluids in a department of oral sciences: results of a thirteen-year surveillance study

Objectives. Aim of this analysis was to identify trends that will aid in the prevention of injury. Methods. Our data were collected from 1999 to 2011 during a surveillance program of occupational exposures to blood or other potentially infectious materials in a Dental School by using a standard coded protocol. Results. 63 exposures were reported. 56/63 (89%) percutaneous and 7/63 (11%) mucosal, involving a splash to the eye of the dental care workers (DCW). 25/63 (40%) involved students, 23/63 (36%) DCW attending masters and doctorate, 13/63 (21%) DCW attending as tutors and 2/63 (3%) staff. 45/63 (71%) and 18/63 (29%) occurred respectively during and after the use of the device; of last ones, 1/18 (0.05%) were related to instrument clean-up and 1/18 (0.05%) to laboratory activity, 12/18 (67%) occurred when a DCW collided with a sharp object during the setting, and 4/18 (22%) during other activities. The instrument and the body part most likely involved were needle and finger respectively. The overall exposure rate was 4.78 per 10,000 patient visits. Conclusions Our results may serve as benchmark that Dental Schools can employ to assess their frequency of injury.

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.

Accidents in the context of study among university students--a multicentre cross-sectional study in North Rhine-Westphalia, Germany

Knowledge about prevalence and patterns of accidents among university students is scarce. The aims of the present health survey were to assess the general prevalence of accidents among university students, to describe the specific kinds of accidents, and to analyse associated factors. A multicentre cross-sectional health survey was conducted at 12 universities and 4 universities of applied sciences in North Rhine-Westphalia (NRW), Germany. The response rate was 88%. The self-administered questionnaire covered multiple areas of health, behaviours and a specific module for accidents. In total, 252 (8.8%) out of 2855 students (aged 17-26 years) had experienced an accident in the context of their studies. Contusions, compressions and strains constituted more than 50% of all kinds of injuries, while fractures, irritations, burns or acid burns were reported less frequently. The cumulative risk of experiencing an accident was increasing linearly with the study duration, indicating an absence of a specific vulnerable period. Nearly 60% of all accidents took place during study-related sports activities, and about a quarter of all accidents occurred on the way to or from university. Only few accidents occurred on university floors, in lecture rooms or on stairways. Further studies are needed to assess more in depth the causes of accidents and the situation immediately preceding the event before making specific recommendations for prevention.

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.