Self-reported percutaneous injuries in dentists: implications for HBV, HIV, transmission risk

Occupational bloodborne exposure incident survey & management of exposure incidents in a dental teaching environment

OBJECTIVES

The purpose of this study was to investigate the prevalence of occupational exposure incidents among undergraduate dental students and the factors associated with it in the educational dental clinics at Pharos University in Alexandria - Egypt, and to measure the commitment with applying infection control policy in the form of compliance with post-exposure management protocol and reporting exposure incidents.

MATERIALS AND METHODS

An anonymous self-administered questionnaire consisting of thirteen multiple-choice questions was distributed among 350 undergraduate dental students in mid-senior and senior levels during lectures at the end of the second semester of 2011, with a response rate of 90.00%.

RESULTS

About 62.00% of the senior students reported that exposures occurred outside the patient's mouth. A high percentage of both the mid-senior and senior students (74.70% and 70.70%, respectively) reported that they were exposed to multiple sources of incidents. The vast majority of studied groups stated that they didn't follow Infection Control Protocol after Incident Exposure.

CONCLUSION

The findings of this study confirm that dental students experience exposure incidents but are not likely to report them, thus it is important that the principles of infection control training and reporting of all exposure incidents continue to be emphasized throughout undergraduate dental education.

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.

Occupational health hazards in a prosthodontic practice: review of risk factors and management strategies

The intent of this article was to analyze the potential hazards and risks involved in persons exposed to prosthodontic practice. These risks include exposure to physical and chemical hazards, dental materials, infectious environment, inappropriate working pattern and psychosocial stress. The potential harm of these hazards and its prevention is highlighted. Prosthodontists, students, dental technicians, and others working in the prosthodontic clinics and laboratory should be aware of the specific risk factors and take measures to prevent and overcome these hazards.

Needle stick injuries among dental students: risk factors and recommendations for prevention

Aim

To evaluate the risk factors of needle stick injuries (NSIs) sustained by undergraduate dental students and nurse students at the King's College London (KCL) Dental Institute.

Materials and methods

A retrospective study evaluated the incident reports relating to NSIs reported over a period of 2 years. Factors including the dental department, study year, and when the injury took place during administration of local anaesthesia (LA) and recapping conventional syringe or clearing work surface or during disposal.

Results

This report showed that students are at the highest risk of NSIs at the fourth year of their 5-year BDS course. About one-third of injuries were reported among this group of students followed by year 5 students (25%). Oral surgery clinics were the major source of incident reporting when compared with other specialised dental clinics within the institute. The left hands of the students were the most frequently affected by such injuries and then the right hands of student dental nurses. The attempt of needle recapping of conventional syringes was the least reported mechanism of injuries and constituted only 15% of the total injuries and mainly occurred in third year students. The most frequent injuries among student nurses were during disposal of the needle.

Conclusion

Less NSIs occur when using safety syringes. A non-recapping policy with immediate disposal of either the conventional or safety syringe systems after injection would prevent all clearance-related NSIs sustained by nurses. To avoid NSIs, education plays a vital role particularly with effective implementation of the change to safety syringes with appropriate training.

Health care-associated transmission of hepatitis B & C viruses in dental care (dentistry)

Hepatitis B virus (HBV) infection rates are declining, but infection with this virus or hepatitis C virus (HCV) remains a risk for dental health care personnel (DHCP). This article describes the epidemiology of HBV and HCV and their particular risks to DHCP. Hepatitis B vaccination is discussed, as is postexposure management recommendations for both HBV and HCV.

Occupational hazards in orthodontics: A review of risks and associated pathology

The purpose of this article was to review the occupational hazards related to the practice of orthodontics. A systematic approach was used to include all risks involved in an orthodontic practice. The classification of hazards was based on major sources of risks by system or tissue and by orthodontic office area (dental chair, laboratory, sterilization area, x-ray developing area). Potentially hazardous factors relate to the general practice setting; to specific materials and tools that expose the operator to vision and hearing risks; to chemical substances with known allergenic, toxic, or irritating actions; to increased microbial counts and silica particles of the aerosols produced during debonding; to ergonomic considerations that might have an impact on the provider's muscoleskeletal system; and to psychological stress with proven undesirable sequelae. The identification and elimination of these risk factors should be incorporated into a standard practice management program as an integral part of orthodontic education. Professional organizations can also assist in informing practitioners of potential hazards and methods to deal with them.

Percutaneous injuries of dental personnel at the University of the West Indies, School of Dentistry

AIM

To report the results of a survey of all percutaneous injuries occurring in 2003-2004 to staff and students at the dental school in Trinidad.

METHOD

Data were collected via 163 questionnaires administered to all dental surgery assistants, the current clinical students (years 3, 4 & 5), the interns, part-time and full-time academic staff.

RESULTS

A 71% response rate was obtained. The number of persons reporting one or more sharps injuries at the dental school was 42 (37%). Of these, 17 (40%) were percutaneous. Needlesticks and periodontal scaler injuries were the most common. There was no significant correlation (p>0.05) between injury and gender, age group, dominant hand or needle recapping technique. 75% of respondents described their concern of contracting a blood-borne disease from a sharps injury as "high" and 59% of the respondents followed the school's recommended protocol following the injury. 50% of the injuries among the students and interns were not reported.

CONCLUSIONS

A more rigorous programme of risk management with respect to sharps injuries needs to be designed and implemented at the school. There is also a need to improve surveillance of and reduce the underreporting of these injuries.

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.

Transmission of HIV in the dental clinic and elsewhere

This review focuses on the risk of transmission of HIV in dental practice in developed and developing countries; and as a result of oral sex, perinatal transmission and breast feeding. Postexposure prophylaxis (PEP) and practical measures to control cross-infection with TB are also discussed. There are few data from resource-poor countries where prevalence of HIV and risk of infection are higher--issues that deserve priority. Available information indicates that the risk of HIV transmission in the dental office is very low. Transmission of HIV from three healthcare workers to patients has been confirmed, including a dentist who infected six patients. There are >300 reports (102 confirmed) of occupational transmission to healthcare workers, including nine dental workers (unconfirmed). Exposure to HIV has been reported by 0.5% dentists/year. The risk of HIV infection after percutaneous exposure (0.3%) can be reduced by 81% with zidovudine PEP. However, risk assessment is required to assess the need and appropriate regimen. The risk of HIV transmission associated with orogenital sex exists, but is considered extremely low: barrier protection is recommended. Conversely, the proportion of babies who acquire HIV from untreated HIV-seropositive mothers is 15-25% in developed countries and 25-45% in developing countries. The frequency of HIV transmission attributable to breastfeeding is 16%. Airborne transmission of TB can be avoided by the prompt referral of known/suspected cases of active TB for chemotherapy, deferral of elective procedures until patients are not infectious, and the use of appropriate standard/isolation precautions including adequate ventilation of treatment areas.

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.

Do people with HIV/AIDS disclose their HIV-positivity to dentists?

This study documents behaviours of people with HIV/AIDS regarding the disclosure of their HIV-positivity when seeking dental care. An anonymous survey was conducted in Québec, Canada, from 1993 to 1995, using a sample of 463 people with HIV/AIDS recruited from different sources. Over 80% of respondents reported having sought dental care since becoming aware of their positivity. Of these, 54% reported having always disclosed their HIV-positivity to dentists, while 25% reported never having disclosed this information to dentists. However, 83% of all respondents preferred that the dentist be aware of their HIV status. Respondents gave reasons related to the sociopathological impact of HIV infection to explain their behaviours. The predictors of disclosure of HIV-positivity to the dentist were: gender, main source of payment for dental care, prior disclosure of HIV status to family members, prior disclosure of HIV status to co-workers, and trust in the maintenance of confidentiality by the dentist. These results emphasize the need to use universal precautions in the dental office and to promote dentist-patient relations free of discrimination, so that people with HIV/AIDS are not reluctant to disclose their health status and are confident that such disclosure will lead to care best adapted to their condition.

Prospective survey of percutaneous injuries in orthodontic assistants

This prospective diary survey provides documentation concerning the occurrence of percutaneous injury among orthodontic chairside assistants in the United States and Canada. A 20-day period was used to collect data regarding exposure to injuries; 693 valid responses were received from orthodontic assistants. Most chairside assistants in this sample work in a solo practice and average 33 hours per week treating patients for 49 weeks per year. The study identified a percutaneous injury rate of 0.11 for chairside assistants during this period, a rate than can be extrapolated to 1.4 episodes of percutaneous injury per year per chairside assistant. The majority of these injuries occurred outside the mouth. Those assistants with longer orthodontic experience had a lower injury rate than those with less experience. The rate of percutaneous injury to dental assistants was slightly higher than the annual rate (0.99) for orthodontists monitored by means of a companion survey and slightly lower than the rate (1.9) for a smaller sample of orthodontists from the American Dental Association survey of 1995. The annual rate of percutaneous injury for orthodontic chairside assistants is less than half of that observed for dentists in general practice.

A prospective survey of percutaneous injuries in orthodontists

This national survey provides documentation regarding typical orthodontic practice patterns in the United States, including the prevalence of percutaneous injuries. The sample reflects a similar geographic distribution of the population as a whole, with more practitioners located in areas with higher populations. Most practitioners in this sample were in solo full-time practice, averaging 35 hours per week, and treating patients for 47 weeks per year. A 20-day prospective period was used to collect data regarding exposure to percutaneous injuries. The study identified a mean percutaneous injury rate of 0.085 during a 20-day period for practicing orthodontists, a value that can be extrapolated to slightly less than one (0.99) percutaneous injury per orthodontist per year. The majority of these injuries (84%) occurred outside the mouth. This rate is approximately one third the rate reported for dentists in general practice.

Occupational blood exposure and HIV infection among oral and maxillofacial surgeons

OBJECTIVE

The purpose of this study was to examine occupational blood exposure and the seroprevalence of HIV infection among oral and maxillofacial surgeons.

STUDY DESIGN

Three hundred twenty-one oral and maxillofacial surgeons attending an annual meeting voluntarily and anonymously participated in an HIV serosurvey and completed a questionnaire assessing practice and demographic factors. Statistical tests included the Wilcoxon rank-sum test and the chi-squared test.

RESULTS

Eighty percent of those who completed the survey reported one or more blood-skin contacts within the previous month. The mean number of percutaneous injuries within the previous year was 2.36 +/- 0.2. Wire was most commonly associated with percutaneous injuries. Oral maxillofacial surgeons who reported three or more percutaneous injuries performed more fracture reductions than oral and maxillofacial surgeons reporting no percutaneous injuries (p < 0.01). No participant was HIV-positive; the upper limit of the 95% confidence interval was 1.15%.

CONCLUSION

The findings suggest that the occupational risk for HIV infection in oral surgery is very low even though most oral and maxillofacial surgeons experienced blood contact. Associations of percutaneous injuries with fracture reductions and wire may assist in the development of new techniques and equipment to minimize blood exposures.

National survey of endodontists and selected patient samples: infectious diseases and attitudes toward infection control

A survey was conducted of 591 patients from endodontic practices located in six large municipalities in the United States. A comparison was made between the self-reported incidence of transmissible diseases from patients medical histories to national statistics for the incidence of hepatitis B, herpes, tuberculosis, and HIV/AIDS. A national survey of 422 endodontists was also conducted. This survey was used to determine the beliefs and attitudes of practicing endodontists toward infection control techniques and infectious diseases. Compared with previous surveys, a trend toward increasing use of the hepatitis B vaccine, gloves, and greater acceptance of medically compromised patients was found.