Attitudes toward HIV-infected individuals and infection control practices among a group of dentists in Mexico City--a 1999 update of the 1992 survey

Implications of HIV Disease for Oral Health Services

This paper, by means of a quality framework, reviews health services research in relation to people with HIV infection. The relevance of oral health care services to people’s needs is considered in terms of the goal of health services to reduce the burden of disease on the everyday life of the population. Dental services may therefore have a role in primary prevention in the HIV epidemic, passing on information about HIV and promoting health through the early diagnosis and treatment of oral disease. Effectiveness research of oral health care in HIV assesses the usefulness of oral diagnosis, whether care is safe, and whether treatment is clinically effective. Few data are available on the efficiency of services. People with HIV still have problems accessing dental care, due to the volume of care available in relation to their need and acceptability of care. Access problems in the US are compounded by social inequality. Health services research data are particularly sparse in resource-poor countries, and there is a need to translate the available information into treatment guidelines appropriate to these settings. The research community and funding agencies should place greater emphasis on the quality of oral health services for people with HIV.

(A1) Identification of Oral Health Care Needs in Children and Adults, Management of Oral Diseases

The workshop considered five questions reviewing the identification of international oral health care needs of children and adults, and the management of oral diseases in resource-poor countries: (1) What is the role of the dental profession in the management of the HIV-infected individual? (2) Identifying health care needs-What are the epidemiology and disparities of HIV-associated oral lesions in children from different continents? (3) How effective is HIV treatment in controlling oral diseases? (4) Could we develop basic inexpensive oral and dental care protocols for economically deprived HIV-infected patients? and (5) What is the best method of arranging resources to meet the oral health care needs of people with HIV disease? The consensus of the workshop participants was that there is a need to re-target research efforts to non-established market economy countries and prioritize research in these regions to children with HIV disease. It will be important to assess commonalities and variations in oral health needs across geographical and cultural boundaries, and research efforts should be centralized in resource-poor countries to support multi-center longitudinal standardized studies. It is essential that oral health research be integrated into other health care research programs, to make these research priorities and public health initiatives feasible.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Dentists' awareness toward vaccine preventable diseases

Effective infection control in dentistry is unfeasible without an adequate immunization program for dental health care providers (DHCPs). Such an assumption is demonstrated for some vaccine preventable infectious diseases (VPIDs), such as Hepatitis B, Influenza and Varicella. However, excluding Hepatitis B vaccine, immunization programs for DHCPs are few and often unclear about which vaccinations are recommended, thus leading to generally low awareness and consequent low vaccination rates. This survey investigated dentists' awareness toward VPIDs. At the moment of registration to a dental congress, a questionnaire regarding the immunization status toward VPIDs was anonymously filled in by 379 Italian dentists (86% of the contacted dentists), with at least fifteen years of activity. DHCP specific awareness was considered high if dentists reported to have controlled the serum level of anti-HBs during the last ten years and have received seasonal influenza vaccine annually. Awareness toward VPIDs was classified high if dentists reported to be immune against six or seven of the following VIPDs, Hepatitis B, Influenza, Varicella, Measles, Mumps, Rubella and Tetanus. DHCP specific awareness resulted high for 32.5% of subjects and low for 31.1%. None of the subjects reported high awareness toward VPIDs, while for 60% of them, such awareness was low (immunization status reported for none or one of the seven VPIDs). Low dentists' awareness stresses the need for a transparent immunization program which is effective in controlling VPID transmission in the dental health care settings and focuses on those VPIDs which pose a true risk of infection for DHCPs and patients.

Biossegurança e odontologia: crenças e atitudes de graduandos sobre o controle da infecção cruzada

Este estudo teve o objetivo de investigar as percepções de graduandos de Odontologia sobre a fidelidade às diretrizes de biossegurança e acerca do preservar-se. Nove questões abertas, que abordaram aspectos de interesse para o tema, foram aplicadas em entrevista com 14 acadêmicos, que realizavam atendimento odontológico de pacientes da Faculdade de Odontologia de Araraquara da Unesp. Utilizou-se a metodologia de pesquisa qualitativa e a estratégia metodológica para análise das entrevistas foi a Discurso do Sujeito Coletivo (DSC). Três figuras metodológicas foram obtidas, sendo ideias-centrais, expressões-chave e o DSC propriamente dito. A análise dos discursos permitiu avaliar a fala natural da coletividade. Verificou-se a adesão dos entrevistados aos protocolos de biossegurança, embora houvesse a queixa de que, na rotina diária, as precauções fossem negligenciadas por não serem muito práticas. Entre as medidas de proteção individual e coletiva, rotineiramente utilizadas, foram apontados o uso de Equipamento de Proteção Individual (EPI) e as barreiras protetoras, bem como as atividades de desinfecção e esterilização. O risco de contágio foi visto por alguns com pavor e por outros com total indiferença porque acreditavam ser algo do qual é possível de se ter controle por meio da adesão às precauções padrão. Entre as doenças de maior preocupação, a aids e as hepatites B e C foram as mais temidas. Diante do discurso obtido, salienta-se a necessidade de se aperfeiçoar as estratégias educacionais, com intuito de motivar a fiel adesão às normas de biossegurança, essenciais no trato de pacientes odontológicos.

Hepatitis B virus infection in dentistry: a forgotten topic

More than two billion people have been infected with hepatitis B virus (HBV). Globally, 350-400 million suffer from chronic HBV infection. It is postulated that dentists and dental staff are infected and transmit the virus to their patients more than any other occupation. The aim of this article is to review the HBV incidence in dental society, the points of view of dentists and their patients regarding transmission of the virus during dental procedures, the occurrence of HBV outbreaks in dental clinics and the importance of methods of preventing HBV infection in dentistry.

Dental Infection Control in India at the Turn of the Century

The purpose of this study was to assess the status of Dental Infection Control and Occupational Safety in India. 456 respondents (dentists) used this self-administered survey instrument containing about 96 variables. Over 95% of respondents felt that HIV and Hepatitis were infectious disease risks of concern and that infectious diseases were on the rise in India. Education and training in Dental Safety were lacking and that the latter are made mandatory in dental school curricula. Availability and access to safety materials and equipment were lacking in India and affordability was an issue. While respondents had adequate knowledge in the subject of infectious diseases, attitude (Stigma) towards treating infected patients was a negative factor with a significant number stating that double gloving was necessary, medical history dictated additional precautions and finally that care providers had the right to refuse care to Infectious patients. Although standards in Dental Safety are in place, implementation of educational (both didactic in schools and continuing education for practitioners) is a priority. Dental industry from within and outside India must play a role in this effort. In conclusion, significant structural and educational support activities are indicated with improvements in access and availability of materials and equipment to improve dental safety in India. Further, stigma of infectious diseases must be eradicated if not reduced towards infectious patients.

Infection Control: A Survey of UK Special Care Dentists and Dental Care Professionals

Aim

To determine attitudes to and practice of infection control among practitioners involved in special care dentistry.

Methods

A questionnaire on the issues of decontamination and infection control was sent to all 680 members of the British Society for Disability and Oral Health.

Results

The response rate was 63.5%. Almost all respondents (95%) reported having a local infection-control policy; most (97%) had local protocols for the management of inoculation injuries; most (81%) gave new staff training in infection-control procedures and most (74%) provided updates for established staff. Most respondents ‘usually’ or ‘always’ provided eye protection for patients (95%) and themselves (93%). Virtually all routinely wore gloves, and nearly all (94%) ‘always’ changed gloves between patients. The majority ‘usually’ or ‘always’ disinfected or disposed of surface coverings between patients (98%), sterilised all non-disposable instruments that had been set out for the patient (99%), and disinfected laboratory work (96%).

Conclusions

There was high awareness of infection-control issues, and good reported compliance among these dental workers.

A survey of knowledge, attitudes, and behavior of Italian dentists toward immunization

This study assessed the knowledge, attitude, and compliance to immunization guidelines among dental health-care professionals in Italy. A questionnaire was mailed to a random sample of 1000 dentists on demographic and professional characteristics; knowledge regarding infectious diseases that can be acquired/transmitted by the dentist and the vaccinations recommended; attitudes regarding the vaccinations; self-assessed information about previous vaccinations. A total of 369 dentists responded. Only 44.1 and 32.4% correctly indicated all infections that can be acquired or transmitted during their activity. Half of the dentists knew that they should be vaccinated against hepatitis B and influenza and this knowledge was significantly higher in those older, who correctly indicated that hepatitis B and influenza can be acquired and transmitted during their activity, and in those with a positive attitude towards vaccinations. Those younger, involved in specialties with low blood contact, and who did not know that hepatitis B and influenza are vaccinations recommended, were more likely to believe that is important for them to receive vaccinations. A large proportion (85.7%) reported receiving the hepatitis B vaccine, but only 56.2% the three doses. Those with a lower number of years of activity, those who knew that hepatitis B can be acquired by the dentist, those who did not need information, and those who were informed from guidelines, educational courses, and dental associations were more likely to have received the three doses or to be natural immunizated. Training and educational interventions are needed to improve knowledge and immunization coverage.

Evaluating infection control practices among dentists in Vâlcea, Romania, in 1998

OBJECTIVES

To evaluate infection control knowledge and practices, provide training on universal-standard precautions (USP), and improve infection control knowledge and practices among dentists.

SETTING

Private and public dental offices in Vâlcea, Romania.

METHODS

Information about the use of hepatitis B vaccine, knowledge of and training in USP, perceived risks of disease transmission, and infection control practices was gathered from a sample of dentists through interviews, direct observations, and a survey administered during a training session.

RESULTS

Interviews among dentists and direct observations of infection control practices revealed that resources were often scarce in public clinics; however, availability of supplies in private or public clinics often did not correlate with adherence to proper infection control. Of 125 registered dentists, 46 (37%) attended the session and completed the survey. Of these, 75% worked in public clinics, 40% in private practices, and a few in both. More than 50% believed that the prevalence of hepatitis B virus (HBV) was low in their patients compared with the Romanian population. Only 26% of dentists had received hepatitis B vaccine. Dentists reported a mean of six percutaneous injuries a year. Most (89%) reported that gloves were effective in preventing HBV transmission; 24% wore them for every patient. Most used dry heat sterilization; however, chemical disinfectants were also used.

CONCLUSIONS

Resources were limited, receipt of hepatitis vaccine was low, and infection control knowledge and practices varied. Training and education are needed regarding the importance of USP, hepatitis B vaccination, and alternative practices when resources are insufficient.

Attitudes of a group of Mexico City residents toward HIV/AIDS in the dental office

OBJECTIVE

To ascertain the intention of the public to undergo dental treatment at dental clinics where other patients or a dentist are infected with HIV/AIDS.

STUDY DESIGN

A cross-sectional design was used to interview a stratified sample of persons 18 years and older in Mexico City with use of a standardized questionnaire. Questions included the type of dental service used, the perception of risk for HIV/AIDS contagion in the dental environment, and the reported intention to continue treatment in a dental office where patients or a dentist were affected by HIV/AIDS.

RESULTS

Of the 490 participants, 74.9% were concerned about HIV/AIDS transmission in the dental office. Only 21.2% intended to continue treatment at a dental office where HIV/AIDS patients were treated, and only 20.0% intended to continue treatment when the dentist was HIV-positive. The degree of concern about HIV/AIDS contagion and the modality of dental service used were associated with the stated intention to continue dental treatment.

CONCLUSIONS

There is a need to have good infection control standards in dental practice; to increase public trust in such standards by making them more apparent; and/or to establish educational programs to improve public knowledge and attitudes toward HIV/AIDS risks in dental practice.

An audit of the hepatitis B vaccination status of staff in general dental practices in Lancashire

PURPOSE OF THE STUDY

To audit compliance, by general dental practitioners working in two health authorities in Lancashire, with the British Dental Association recommendations on vaccination against hepatitis B.

BASIC PROCEDURE

A postal questionnaire to dental practices.

MAIN FINDINGS

Replies were received from 85% of practices. The respondents consisted of 187 dentists, 270 dental nurses and 132 non-clinical staff. Totals of 98.9% of dentists, 96.7% of nurses and 72.7% of the non-clinicians reported that they had been vaccinated but fewer had undergone a blood test in the past five years. The poorest compliance was in having written evidence of immune status, with only 46.5% of dentists, 51.0% of nurses and 62.5% of non-clinical staff having this.

PRINCIPAL CONCLUSIONS

Greater publicity about the BDA recommendations is needed to improve compliance. An extension of the occupational health services currently being set up for general medical practitioners and their staff to dental practices would also help.