Changes in compliance with recommended infection control practices and affecting factors among dentists in Taiwan

Compliance with recommended infection control practices in East Asia has not been clearly documented. To investigate changes in compliance with recommended infection control practices over a eleven-year period and to identify affecting factors, two nationwide cross-sectional surveys of dentists in Taiwan were conducted in 1999 and 2010. An anonymous questionnaire that assessed characteristics of dentists and practices of recommended infection control guidelines was mailed. Results showed that all infection control practices surveyed had improved in 2010. Factors affecting compliance with wearing basic protective barriers in 2010 were being female (odds ratio [OR]=3.631, p<0.001), aged forty-one to fifty years (OR=3.991, p<0.05), treating twenty-one to thirty patients per day (OR=2.690, p<0.05), and having information sources from seminars and conferences (OR=2.659, p<0.05). Although infection control practices have improved over time, there is still much room to increase rates of wearing a head cap, protective eyewear, and a face mask and disinfecting impression materials. Providing correct information about disinfection and sterilization processes through the Internet might be effective in improving compliance.

Preventive attitudes towards infection transmission in dental offices in North-East Romania

AIM

The aim of this study was to evaluate the level of knowledge and the current attitudes towards infection control in the dental offices in the Northeast Romania.

MATERIAL AND METHODS

Questionnaire-based study conducted on 152 dentists aged between 25-65 years practicing in 6 Northeast Romania counties. The questionnaire included questions related to current infection control procedures and attitudes. Data were statistically analyzed using SPSS 14.0 and chi-square test (p<0.05).

RESULTS

The majority of the dentists (83.6%) consider that universities should provide a substantial education regarding infection control through postgraduate courses, but 7.2% of the respondents are not sure about their usefulness. The clinical decision related to patient's treatment is influenced by his infectious status for 67.8% of the dentists. Of these, 19.1% have over 20 years of practice and 48.0% are females. Almost all dentists (93.4%), regardless of gender (96.4% females and 87.8% males) undergo periodic testing for blood-borne viral infections (hepatitis B, C and HIV). Full protective equipment is used for all the patients by 86.2% of the dentists, while 12.5% use it only for the infectious ones. 65.2% of the dentists use steam sterilization equipment (autoclave), and 80,8% use dry heat. The majority of the dentists (82.6%) believe that the patient must always be informed about the adopted infection control measures, but 21.7% declare to do so only in some particular cases.

CONCLUSIONS

Dentists knowledge and attitudes towards infection control must be improved by educational interventions in order to adhere to the European standards.

[Assessment of decontamination processes: cleaning, disinfection and sterilization in dental practice in Poland in the years 2011-2012]

OBJECTIVE

Effective decontamination of instruments is a key element of infection control and the provision of high quality in dental care. The aim of the study was to evaluate the efficiency of decontamination procedures including cleaning, disinfection and sterilization of re-usable instruments in dental practices in Poland.

MATERIAL AND METHODS

The efficiency of disinfection and sterilization processes have been evaluated on the results of the questionnaires. The following information were taken into account: setting where disinfection and sterilization had been performed, preparation of dental equipment for sterilization (disinfection, washing and cleaning, packaging), the types of autoclaves and used types of sterilization cycles, routine monitoring and documentation of sterilization processes, treatment of handpieces and the frequency of surface decontamination.

RESULTS

Data were collected from 43 dental practices (35 dental offices and 8 clinics). Disinfection and cleaning processes were performed manually in 63% of dental offices and ultrasonic baths were used in 53% of settings. Washer disinfectors were used in 23% of dental practices: in every researched clinic and in a few dental offices. All sterilization processes were performed in steam autoclaves, mainly in small steam sterilizers (81%). Dental handpieces were sterilized in 72% of practices, but only 33% of them performed sterilization in recommended cycle B. Sterilization processes were monitored with chemical indicators in 33% of practices. Biological monitoring of the processes was carried out at different intervals. Incorrect documentation of instruments and surfaces decontamination was recorded in several settings.

CONCLUSIONS

There is still a need for improvement of decontamination processes in dental practice in Poland. Areas for improvement include: replacement of manual cleaning and disinfection processes with automatic processes, sterilization of dental handpieces after each patient, monitoring of a sterilization process with chemical and biological indicators. Reported incorrect procedures in decontamination of medical devices performed by questioned dentists and lack or inadequate response to asked questions indicate the lack of adequate knowledge about decontamination. Personnel who performs decontamination processes should be continuously trained.

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 chi2 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.

[Assessment of disinfection and sterilization processes in dental practice as an important factors in prevention of infections]

The dental health-care settings is an environment where disease transmission occurs easily. Prevention of cross infection is therefore a crucial aspect of dental practice and dental clinic stuffmust adopt certain basic routines while practicing. Infections may be transmitted in the dental operatory through direct contact with blood, oral fluids or other secretions; via indirect contact with contaminated instruments, equipment or environmental surfaces; or by contact with airborne contaminants present in either droplet splatter or aerosols of oral and respiratory fluids. Strategies to prevent dental patient infections have focused on disinfection and sterilization. This study evaluates basic routines in prevention of cross-infection in the dentistry. The sample comprised 100 dentists, who completed questionnaires. Based on inquires the conditions for disinfection and sterilization of medical devices were assessed. The following issues were taken into consideration: the way of disinfection and preparation of the disinfectants, the localization of disinfection, preparing to disinfection, washing and packing of dental devices, the frequency of disinfection, methods of sterilization and the monitoring system, type of sterilizers and the available cycles. The dental practices are well equiped to proceed the steam sterilization, but 33% of dentists don't know the available cycles in their autoclaves. Only 35% of them made sterilization process protocols. Very common are three failures of instruments disinfections: multiple use of disinfectant, adding of disinfectant, adding new instruments. There is still need for improvement in disinfection and sterilization in dental practice, especially including: monitoring and documentation of sterilization process, proper use of disinfectants according to manufactures instructions, frequent disinfection of surfaces which contact with patients. Dental stuff should take part in advanced training courses about disinfection and sterilization.

The impact of clinical information systems in dental schools

Although Clinical Information Systems (CIS) are gaining widespread acceptance in dental schools, their impact on users is not well understood. We conducted separate qualitative studies of the impact of CIS on users in two dental schools and then compared our results. We found five themes in common. By understanding the factors that impact CIS implementation we believe that dental schools will be better prepared to manage them.

Influence of clinicians' socio-demographic, professional and educational variables on their compliance with preventive measures against hepatitis B and C

PURPOSE

To investigate the influence of a number of variables regarding clinicians' gender, social class, length of time since graduation and the level of knowledge on their use of available preventive measures against hepatitis B and C.

MATERIALS AND METHODS

A cross-sectional questionnaire-based survey was carried out involving a random and representative sample (n = 319) of the clinicians working in Recife, Pernambuco, North-East Brazil. The participants were interviewed by means of a questionnaire, prepared and pretested by the researchers. Pearson's chi-square and Fisher's exact tests were used in the statistical analyses (significance level: 5%).

RESULTS

Female clinicians were found to make more frequent use of equipment such as lab coats, scrub caps and masks (P = 0.0357). With regard to lab coat use in relation to social class, it was seen that clinicians from social class B used it less (P = 0.0077). The length of time since graduation was seen to be connected with the use of scrub caps (P = 0.0003), coating of equipment with polyvinyl chloride plastic film (P = 0.037), use of alcohol for cleaning equipment (P = 0.0012), two-handed recapping of needles (P < 0.0001) and immunisation (P = 0.003), showing that those who graduated most recently were more likely to take adequate infection control steps. The fact that clinicians had been informed about hepatitis B and C, and also their knowledge about its contagion, was positively associated with their levels of vaccination against HBV (P = 0.0313 and 0.0108, respectively).

CONCLUSIONS

The adherence to preventive practices against hepatitis B and C was shown to be connected with the clinicians' socio-demographic, professional and educational variables.

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.

Hygiene und Infektionsprävention in Zahnarztpraxen

Recommendations for prevention of infection in dentistry have been published in many countries and in Germany as well. In a pilot project in collaboration with the Public Health Service of the City of Frankfurt and the chamber of dentists in Hesse, compliance with these recommendations was studied in dental practices in Frankfurt/M in 2005. After being informed about the recommendations, more than 50% of the 560 Frankfurt dentists agreed to participate in this project, and 127 of these practitioners were visited by experts of the dentist chamber. Hygienic standards in the practices were examined using a checklist. A proper hygiene schedule was observed in 84% of the practices. Facilities for hand hygiene such as dispensers for soap, disinfectant and towels were available in 98, 93 and 92% of the practices, and personal protective equipment such as gloves, masks, eye wear and gowns was found in 98, 100, 98 and 88% of the practices, respectively. Reprocessing of dental instruments was done either manually (52%), manually in combination with ultrasonic cleaning (48%) or by using special reprocessing machines (32%). Steam sterilization was used in all practices; in some practices gravity displacement sterilizers were used (14%), whereas in most of the practices (61%) a high-speed prevacuum sterilizer was available -- especially in dental surgeon practices (77%). Monitoring and documentation of the sterilization process was done automatically (33%) or by hand (55%). In 80% of the practices, pressure, temperature, time and person responsible were documented. Documents of routine maintenance and regular biological testing of the sterilizers could be shown in 93 and 84% of the practices. The Frankfurt pilot project based on information and advice in combination with control has proven to be successful in the majority of practices enrolled. Encouraged by this experience, the chamber of dentists wants to implement this project all over the state of Hesse. The intention is to inform and to visit all 4,500 dental practices in agreement with the local public health services, which in turn could reduce their own control visits in dental practices. Thus, hygiene control visits of the public health services could focus on other practices such as ambulatory surgery or endoscopy.

Hygiene in dental practices

AIM

The aim of this study was to investigate the hygienic quality of dental practices on the basis of the self-awareness expressed by dentists respondents to a self-reported questionnaire about the health/hygiene characteristics of practice, the knowledge of biologic/toxicological risks and the preventive procedures and devices improvements in professional practice.

MATERIALS AND METHODS

Of the 127 practitioners contacted, 108 (85%) agreed to participate. The knowledge of infective risks was self- evaluated as good only in 24%: even if vaccinated, most of the dentists (57%) considered HBV the main infective agent to fear, not giving the same importance to the air-borne transmission of diseases. The presence of a single dental unit per surgery (90%) was considered an index of good health/hygiene education but, in spite of the use of disposable gloves, caps and masks, the dentists do not always change their coats or wash their hands between patients yet. The management of dental instruments can be considered efficient as long as they are sterilised in an autoclave (97%) and undergo periodic sterilization efficacy tests (76%). RESULTS AND CONCLUSION The results indicate a good structural and organisational status, but there is the need for continuous education concerning the prevention of cross-infections.

Desigualdades nas condições de controle de infecção em consultórios odontológicos em município brasileiro

Analisar as condições de controle de infecção dos estabelecimentos de assistência odontológica do Município de Cariacica, Espírito Santo, Brasil. Dados relativos ao respondente, localização e tipo de estabelecimento, bem como às condições do ambiente, equipamentos e materiais, foram recolhidos mediante observação direta em todos os serviços odontológicos e em vinte estabelecimentos operados por "dentistas práticos". Para efetuar a análise, foi construído Índice de Controle de Infecção (ICI) composto de 19 variáveis, e quanto menor o seu valor, melhores as condições de controle. Foram observados 113 estabelecimentos. A condição nos estabelecimentos mantidos por dentistas não licenciados (médiaICI = 23,05, dp = 11,86) foi quatro vezes pior em relação ao melhor valor observado nos estabelecimentos particulares. Em condição intermediária, localizaram-se os serviços públicos (médiaICI = 16,27; dp = 6,96). Os serviços localizados nas regiões periféricas apresentaram condição quatro vezes pior. Observou-se profunda divisão nas condições sanitárias da assistência odontológica. Uma parcela significativa da população, que depende de assistência odontológica oferecida por estabelecimentos operados por "dentistas práticos", estava exposta a condições sanitárias de elevado risco à infecção cruzada.

Compliance with infection control programs in private dental clinics in Jordan

The aim of this study was to assess the compliance of general dental practitioners (GDPs) in the private sector in North Jordan with infection control measures. A pilot-tested questionnaire about infection control measures was distributed in March 2004 to 120 private practices. The response rate was 91.66 percent. About 77 percent of dentists usually ask their patients about medical history, 36 percent were vaccinated against hepatitis B, 81.8 percent wear and change gloves during treatment and between patients, and 54.5 percent wear and change masks during treatment and between patients. Most dental practitioners (95.4 percent) reported that they changed extraction instruments and burs between patients. All dental practitioners reported that they changed saliva ejectors between patients, but only 41.8 percent changed handpieces between patients. Approximately 63 percent (69/110) used autoclaves for sterilization, 47.3 percent (52/110) used plastic bags to wrap sterilized instruments, and only 18 percent (20/110) disinfected impressions before sending them to dental labs. Fourteen percent used rubber dams in their clinics, and only 31.8 percent had special containers for sharps disposal. Based on these responses, approximately 14 percent of general dentists in this sample were considered to be compliant with an inventory of recommended infection control measures. In Jordan, there is a great need to provide formal and obligatory infection control courses and guidelines for private dentists by the Ministry of Health and the dental association in addition to distribution of standard infection control manuals that incorporate current infection control recommendations.

[Asepsis and antisepsis in dental offices in Dakar]

To evaluate hygiene in dental offices in Dakar, the authors questioned 64 public, private and semi-private dentists. From 62 practitioners who completed their questionnaire, it appeared that the dry-heated sterilizer (poupinel) was 5 times more used than the autoclave; The almost practitioners sayed respecting the sterilisation process and 66% of them said wearing gloves, masks and glasses during interventions. In spite of the hope these results give, this study is limited because it doesn't take into account many aspects of asepsis and antisepsis in dental office which require a rigorous application next to a personal who needs to be better trained.

Evaluation of infection-control practices by orthodontists in Turkey

The aim of this study was to investigate the cross-infection control procedures used by Turkish orthodontists. A questionnaire was mailed to 268 orthodontists to determine the attitude toward infection-control procedures. Responses were received from 194 orthodontists, and the reply data were analyzed. Of the 194 orthodontists who completed and returned the questionnaire, 77.3% had been vaccinated for hepatitis B, and 24.2% always wear a mask when treating their patients. While 48.5% of the respondent orthodontists always wear gloves, 4.1% never wear gloves.

Changes in dentists' attitudes and practice in paediatric dentistry

AIM

The purpose of the study was to determine if there had been any changes in the clinical practice and attitudes to the care of children by general dental practitioners over a ten year period from 1986 to 1996, following the introduction of a system of capitation payments in the United Kingdom.

METHODS

A questionnaire was mailed to 1,290 general dental practitioners practicing in Yorkshire (UK) in an identical way to a previous survey ten years before. Practitioners were asked questions concerning their practice of dental caries prevention, behaviour management, restoration of primary teeth and pulp therapy. Responses were compared with the results of the 1986 survey.

RESULTS

Of the total of 687 replies (53.2% response) 61% practiced, or said they practiced, diet evaluation and gave dietary advice. Oral hygiene instruction was reported by 87% and 57% used fissure sealants. The routine use of amalgam, previously 80%, had declined to 35% in favour of glass ionomer cements (57%). There had been a significant improvement in the use of pulp therapy for primary teeth at 35% compared with previous 3%. The use of rubber dam also increased, but only from 0% before to 9% in the present study. The usage of stainless steel crowns had changed from 2% over ten years to 8% and strip crowns from 1% to 5%.

CONCLUSION

The use of paediatric dental techniques by general dental practitioners had generally increased, particularly in preventive measures and pulp treatment. Restorative techniques had marginally changed, but a dramatic shift away from amalgam had occurred. There was still a very low usage of stainless steel crowns and rubber dam was also not used to the extent that it should be.

Knowledge, attitudes, behaviour and prevalence of TB infection among dentists in the western Cape

Tuberculosis (TB) remains the most important communicable disease in the world and in South Africa it accounts for 80% of all notifiable diseases. The impact of HIV on the TB epidemic is potentially catastrophic. HIV increases the susceptibility of the HIV-positive person to TB. The resurgence of TB as a public health problem has rekindled interest in this disease among oral health workers. The major concern is the risk of transmission in the dental setting. The aim of this study was to determine the prevalence of TB among dental practitioners and to assess their knowledge, attitudes and practices pertaining to TB. A cross-sectional survey was carried out. A structured questionnaire was used to obtain information on demography, infection control, TB status, behaviour, knowledge and perceived risk. In addition, Mantoux and multipuncture tests were performed to assess prevalence. The response rate was 78%. The sample consisted of 78 dentists, 80% male, with a mean age of 40 years. Ninety-two per cent reported always using gloves, 78% masks (68% surgical masks and 18% paper masks) and 50% glasses when treating patients. Two-thirds reported that they sterilise suction and three-in-one tips. Only 11% reported use of a rubber dam. No practitioner reported the use of high-volume externally vented aspirators or ultraviolet germicidal irradiation. Five per cent reported ever being diagnosed with TB, all after having qualified as a dentist. Half of the sample reported having being vaccinated against TB. The prevalence of those who developed a positive reaction was 33%. Thirty-one per cent reported having referred a patient suspected of having TB for further diagnosis and management. Dentists have a duty to take appropriate precautions to protect themselves, their staff and their patients from the risk of cross-infection. The implementation of infection control policies is critical to the provision of such protection. In addition, a dental health facility provides the opportunity for TB screening which has not as yet been tapped into to its fullest extent in a developing country setting where TB is endemic. Referral and integration of TB screening in high HIV and TB prevalence areas will provide early diagnosis, treatment of TB and possibly prevention and reduced risk of nosocomial infection.

Policies and protocols for preventing transmission of HIV infection in oral health care in South Africa

Human immunodeficiency virus (HIV) infection constitutes an unparalleled public health challenge. The unique nature of most oral health procedures, instrumentation and patient-care settings requires specific strategies and protocols aimed at preventing the transmission of HIV/AIDS between oral health care providers and patients, as well as between patients themselves. The present study investigated the level of information and training about protocols and policies for preventing the transmission of HIV/AIDS in oral health care settings in South Africa. The data collection techniques utilised available information, in-depth interviews and an open-ended questionnaire. The respondents were 20 purposively selected key informants who were senior officers for HIV/AIDS programmes and/or oral health organisations. Sixteen (80%) of the respondents reported that there were no existing oral health policies on HIV/AIDS in their health care institutions or organisations. None of the interviewees knew of any specific protocols on HIV/AIDS in the oral health care setting that emanated from South Africa. In addition, none of the dental professional associations had established an infection control committee or a support system for members who might become infected with HIV and develop AIDS. Territorial boundaries existed between sectors within the medical disciplines, as well as between the medical and oral health disciplines. Numerous general impediments were identified, such as prejudice, denial and fear, inadequate training and/or information about the infection, lack of representation and resources for policy planning, a lack of interest from the business sector, and approaching HIV/AIDS in the workplace as a 'one-time issue' Other obstacles identified included unemployment, poverty, illiteracy, disempowerment of women and inadequate communication of policies to service providers. Additional issues raised included the migrant labour systeM, complexities of language and culture, the large unstructured sex industry, high prevalence of sexually transmitted infections and lack of funding. All of these have an impact on oral health. Future policy directions identified included 'increasing access to HIV information and postexposure prophylaxis' 'shift towards care and support for those living with HIV/AIDS with emphasis on community and home-based care' and 'improving intersectoral co-ordination and collaboration'. The study demonstrated gaps in availability and access to policies and protocols on HIV/AIDS by managers and health workers. Specific strategic recommendations are made for oral health.

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.

Efficacy of protection by latex gloves during orthodontic therapy

The wearing of gloves during orthodontic or dental treatment is generally indicated for reasons of hygiene and protection against infection. This study was aimed at determining the extent and localization of perforations caused by the various orthodontic treatment techniques and interrupting the infection barrier. The impermeability was tested by means of a water retention test according to European standard EN 455, Part 1, performed on 1600 Centramed (Centramed, Koblenz), Tekmedic and SafeEx non-sterile disposable latex gloves (both by Safe Med, Switzerland) and Safe Gan latex gloves with an additional acrylate coating (also by Safe Med). The perforation rate in unused gloves was between 0.5% and 7.5%, rising on average to 11% with increasing use. 36% of the total number of lesions resulted from handling removable appliances, and 57% from handling fixed appliances, especially when replacing arch wires and elastics. Most lesions were in the thumb, index finger and palm region. Only 18% of the defects were noticed by the dentists themselves. The gloves worn by beginners in their first year of postgraduate orthodontic training had about twice as many defects as those worn by qualified orthodontists. When patients with an increased risk of infection are to be treated, additional hand disinfection measures should be taken and 2 pairs of gloves worn in view of the relatively unreliable protection offered by commercially available latex gloves.

Survey on attitudes toward HIV-infected individuals and infection control practices among dentists in Mexico City

BACKGROUND

The teaching of infection control is gradually being introduced at dental schools in Mexico. However, most practicing dentists have limited access to current infection control standards. Deficiencies of knowledge with regard to blood-borne pathogens such as HIV and hepatitis B virus may influence attitudes toward infected individuals and reduce compliance with infection control recommendations.

OBJECTIVE

The purpose of this study was to assess (1) attitudes toward HIV-infected patients and hepatitis B virus-infected patients and (2) infection control knowledge and practices among dental practitioners in Mexico City.

METHOD

A total of 196 dentists were interviewed by means of a questionnaire with Likert-type scales and open-ended questions (response rate, 86.1%).

RESULTS

Most respondents had no previous social or professional contact with HIV-positive individuals. Nine percent indicated that they had knowingly treated HIV-positive patients. Perceived professional and moral obligations to treat HIV-positive patients were high. Thirty-five percent of the respondents perceived the risk of HIV infection as "considerable" to "very strong." The risk of hepatitis B infection was considered significantly higher than the risk of HIV infection (P <.01); however, 78% of the respondents had not been immunized against hepatitis B. Reported use of personal protective equipment was high. Most respondents used dry heat sterilization. The principal disinfectants used were quaternary ammonium compounds, bleach, and glutaraldehyde. Fifty-four percent of the respondents acknowledged that clinical precautions reduced occupational risks.

CONCLUSIONS

This survey revealed contradictory attitudes toward HIV-positive individuals and limited understanding of infection control recommendations. Educational and regulatory efforts are needed to promote better adherence to current infection control standards.

Infection control practices across Canada: do dentists follow the recommendations?

This study investigated provincial and territorial differences in dentists' compliance with recommended infection control practices in Canada (1995). Questionnaires were mailed to a stratified random sample of 6,444 dentists, of whom 66.4% responded. Weighted analyses included Pearson's chi-square test and multiple logistic regression. Significant provincial and territorial differences included testing for immune response after hepatitis B virus (HBV) vaccination, HBV vaccination for all clinical staff, use of infection control manuals and post-exposure protocols, biological monitoring of heat sterilizers, handwashing before treating patients, using gloves and changing them after each patient, heat-sterilizing handpieces between patients, and using masks and uniforms to protect against splatter of blood and saliva. Excellent compliance (compliance with a combination of 18 recommended infection control procedures) ranged from 0% to 10%; the best predictors were more hours of continuing education on infection control in the last two years, practice location in larger cities (> 500,000) and sex (female). Clearly, improvements in infection control are desirable for dentists in all provinces and territories. Extending mandatory continuing education initiatives to include infection control may promote better compliance with current recommendations.

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.

HIV infection, dental treatment demands and needs among patients seeking dental services at the Muhimbili Medical Centre in Dar-es-Salaam, Tanzania

The objectives of this cross-sectional study were to determine the frequency of HIV infection among dental patients attending the three dental facilities at Muhimbili Medical Centre (MMC) in Dar-es-Salaam, Tanzania, and to compare the dental treatment demands and needs of the patients found to be HIV-infected with those of their HIV-seronegative counterparts. The facilities were; the dental outpatient department (DOPD) clinic, the dental minor surgery department, and the dental ward. This study which was conducted between March and April, 1996 enrolled a total of 460 patients. The investigations involved detection of anti-HIV IgG antibodies in saliva, examination of oral and peri-oral tissues, and assessment of dental and periodontal status. The overall HIV frequency among the dental patients was 10.9 per cent. The frequencies of HIV infection among patients attending the dental OPD clinic, minor surgery, and those admitted in the dental ward were 9.4 per cent, 26.3 per cent, and 25.0 per cent, respectively. The dental treatment demands and needs of HIV-seropositive patients were not different from that of HIV-seronegative patients. The high frequency of HIV infection calls for institution of infection control measures in the dental clinics. However, such measures need to be tailored for the poor countries, with potentially high frequency of HIV infection and minimal resources, in order to make them relevant.

Disinfection/sterilization in U.S. dental practices--practice behavior and attitudes

In an era when we are experiencing an increased awareness of communicable infectious diseases such as tuberculosis and hepatitis B, and in which stories regarding the fear of the spread of the HIV virus receive almost nightly news coverage, all health care professionals are taking extra precautions when providing care to patients. The concern of occupational transmission of infectious diseases from the perspective of patient to health care worker is not new. However, the sensationalized singular instance of a dentist in Florida who reportedly transmitted the HIV virus to five of his patients raises questions about the possibility of health care worker to patient transmission and puts the spotlight on the dental community.

Comparison of handpiece asepsis among Ohio dentists: 1991 & 1992

In 1991, we found that 23 percent of Ohio dentists sterilized handpieces between patients and 67 percent flushed handpieces between patients. In this study, we chose to investigate the changes in handpiece asepsis within Ohio dental offices for the twelve-month period ending August, 1992. Sixty-two percent of the 730 offices polled responded to the questionnaire. Offices reporting sterilization of handpieces between patients in 1992 is 80 percent compared to 23 percent in 1991. Sixty-nine percent of offices in the 1992 survey reported that they have changed infection control protocol to include heat sterilization of handpieces between patients while 24 percent report disinfection between patients. Back order of equipment, inadequate number of handpieces and fear of damage is cited by the offices using disinfection as the reasons for not sterilizing handpieces. Flushing handpieces between patients is reported by 83 percent of the offices. Previously, only 67 percent flushed between patients. Anti-retraction valves are present in 69 percent of the water lines. Breakdown of handpieces attributed to sterilization was reported by 45 percent of the offices. Two-hundred and three offices (45 percent) report questions from patients regarding office infection control policies. Infection control awareness of the general population and implementation of these procedures by dental professionals is increasing in Ohio.

A comparison of infection control practices of different groups of oral specialists and general dental practitioners

OBJECTIVE

The purpose of this study was to compare the infection control practices of general dentists and dental specialty groups.

METHODS

A survey was mailed to 5997 dentists in 1994; the response rate was 70%. The data were analyzed with multiple logistic regression (reference group: general dentists).

RESULTS

When sociodemographic influences were taken into consideration, significant predictors of routine infection control practices included all of the following characteristics (odds ratios are in parentheses): 1. Gloves: being younger than 40 years of age (4.5) and being female (5.9). 2. Using gloves and changing gloves after each patient: being younger than 40 years of age (4.0), being female (3.0), being an oral surgeon (3.6), and being an orthodontist (0.2). 3. Using gloves, masks, and protective eyewear: being younger than 40 years of age (2.5), being female (2.3), and being an orthodontist, oral physician, or oral pathologist (0.2). 4. Hepatitis B vaccination for the practitioner: being younger than 40 years of age (5.1). 5. Hepatitis B vaccination for all clinical staff members: being younger than 40 years of age (1.2), being an oral surgeon (1.7), and being an orthodontist (0.6). 6. Heat sterilization of handpieces: being younger than 40 years of age (1.5), being an oral surgeon (5.4), and being an orthodontist (0.2). 7. Taking no additional precautions for patients with HIV: being younger than 40 years of age (1.7), being a periodontist (2.6), being a pedodontist (2.3), and being an oral physician/oral pathologist (4.3).

CONCLUSION

Improved compliance with recommended infection control procedures is required for all groups and is particularly necessary for orthodontists.

Infection control in the orthodontic office in Canada

Because of the difficulty of identifying infected persons, current recommendations for infection control are to treat all patients as if they are infected with blood-borne pathogens such as human immunodeficiency virus (HIV) and the hepatitis viruses. Dentists' compliance with these recommendations has been investigated previously, however, there are few data related to orthodontists. The objective of this study was to measure the proportion of orthodontists who report the use of recommended infection control procedures and to compare the infection control practices of orthodontists and general dentists. A mailed survey with three follow-up attempts was administered to all orthodontists and general dentists in Ontario (N = 5441) in 1994. There were significant differences in the routine use of gloves (orthodontists 85%, general dentists 92%); masks (orthodontists 38%, general dentists 75%); protective eyewear (orthodontists 60%, general dentists 84%); changing gloves after each patient (orthodontists 84%, general dentists 96%); and heat sterilization of handpieces (orthodontists 57%, general dentists 84%). Hepatitis B virus (HBV) vaccination of all clinical staff was reported by 46% of orthodontists, compared with 61% of general dentists (p < 0.001). Reports of HBV vaccination of orthodontists (94%) and general dentists (92%) were not significantly different. The use of additional precautions for patients with HIV was reported by 80% of orthodontists and 78% of general dentists. More education is required to promote the use of universal precautions by both general practitioners and orthodontists. Increased use of barrier methods, HBV vaccination of clinical staff, and heat sterilization of handpieces is required to reduce the potential for cross infection in the orthodontic practice. This is particularly important with the increasing number of microorganisms that are resistant to antibiotics.

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

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 > or = 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.

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.

Dentists and cross-infection

A structured questionnaire was administered to a random sample of general dental practitioners in Natal, South Africa in 1994, to ascertain the precautions they use against cross-infection and to gauge the attitudes and behaviour towards the treatment of HIV-infected individuals. An interview was conducted covering 5 broad topics: demographic details, personal barrier protection, instrument sterilization and disinfection, sharps disposal and incidence of needlestick injuries and the extent of the knowledge, attitude and behaviour of the practitioners toward the treatment of HIV-infected individuals. The key findings were: routine glove wearing, for all patients, was practised by 87 per cent. The most common heat sterilization method was by autoclave (68 per cent), although a dry heat sterilizer and water boiler were used by 22 per cent of the respondents. Of the 18 respondents reporting a needlestick injury in the past 6 months only one sought after-care. 42 per cent of the respondents would continue to treat carriers of HIV in their practices. This survey shows that a significant number of dentists are using unacceptable cross-infection control procedures. Educational efforts should be made to improve their knowledge and to alleviate anxiety of health workers to treat HIV-infected patients.

Nonresponse bias in a survey of Ontario dentists' infection control and attitudes concerning HIV

OBJECTIVE

This study investigated late response and nonresponse bias in an HIV-related survey of dentists.

METHODS

Questionnaires with ID numbers were mailed to all dentists in Ontario (N = 5,997) with additional mailings four and seven weeks later.

RESULTS

Proportionately more respondents who returned questionnaires less than four weeks after the first mailing reported that they knowingly treated (P < .05) or were willing to treat HIV-infected patients (P < .05); that they had an accurate perception of risk of HIV infection after a needlestick injury (P < .01), and preferred not to refer HIV-infected patients (P < .01). Linear extrapolation of cumulative percent responses indicated nonresponse bias in terms of attitude and knowledge items; however, the magnitude was low.

CONCLUSIONS

The effects of late response and nonresponse bias on the results of this study were small. However, these results cannot be generalized beyond the study population, and obtaining high response rates and testing for nonresponse bias in surveys of attitudes related to HIV are recommended.

Assessment of the risk of glove puncture during oral surgery procedures

PURPOSE

The purpose of this study was to examine the incidence of glove puncture during stages of oral surgery procedures.

METHOD

One surgeon was requested to wear one type of sterile operating gloves during the treatment of patients who required an oral surgery procedure under outpatient local anesthesia. Each surgical procedure was divided into three modules, namely, (I) administration of the anesthesia and raising of mucoperiosteal flap, (II) bone removal and delivery of the tooth or root, and, (3) soft tissue repair. A total of 450 gloves worn during these modules were examined for punctures with a water inflation method and 200 unused gloves were tested as controls.

RESULTS

The results were analyzed statistically with Fischer's exact test. A total of 12 punctures were recorded, indicating that a glove puncture occurred in 16% of the surgical procedures. Gloves from the left hand (the nonworking hand) in module III showed the highest incidence of punctures. One puncture was observed in the 200 gloves tested as controls. Statistical analysis indicated that glove puncture was significantly more likely to occur in gloves worn on the left (nonworking) hand overall as compared with gloves from the right hand (p = 0.02) and that glove puncture was significantly more likely to occur in gloves worn on the left hand in module III as compared with gloves from other modules (p = 0.01). Additional precautions may therefore be indicated during the soft tissue repair part of oral surgical procedures.

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 practices of Rhode Island dental hygienists and certified dental assistants

PURPOSE

Limited studies document the infection control practices of dental hygienists and dental assistants even though both groups play a vital role in the prevention of disease transmission in the dental office. The purpose of this study was to survey Rhode Island registered dental hygienists and certified dental assistants to (1) determine their current infection control practices; (2) to document attendance at an infection control course; and (3) to identify the need for additional infection control education.

METHODS

In October of 1993 a fixed-response survey was mailed to a random sample of 267 registered dental hygienists (RDHs) and 260 certified dental assistants (CDAs) in Rhode Island. Data were analyzed using descriptive statistics, cross-tabulations, and the chi-square statistic.

RESULTS

Responses were received from 171 RDHs and 153 CDAs for adjusted response rates of 64% and 59%, respectively. Most responding RDHs and CDAs were wearing gloves but substantially fewer were utilizing one of the two acceptable combinations of personal protective barriers. Other procedures that were not always practiced by a substantial number of respondents included the use of disposable barriers, following recommended handwashing protocol, utilizing appropriate procedures for disinfection and sterilization of dental instruments and handpieces, updating medical histories, and biological monitoring of sterilization equipment. Although the majority of both groups reported having attended an infection control course within the past year, having written infection control protocols in place, and being satisfied or very satisfied with the level of infection control, many recommended procedures were not practiced routinely.

CONCLUSIONS

These findings indicate that lack of compliance with infection control guidelines is multifactorial. Even though there is a need for continuing infection control education for dental hygienists and certified dental assistants, education alone is not the answer.

Cross-infection control in Malaysian dental practice

A questionnaire survey on cross-infection control was conducted among 1371 professionally trained dentists whose names appeared in the Malaysian Government Gazette of 1990. A 73.1 percent response rate was obtained. About 13 percent of the dentists routinely did not wear gloves during treatment of patients as opposed to 54 percent who routinely did. About 83 percent and 52 percent of dentists wore a mask and eyewear or glasses respectively when carrying out dental procedures. About 93 percent of dentists would use a new sterile needle for each patient and about 40 percent would wipe working surfaces with disinfectant after each patient. The practice of sterilizing handpieces was found to be uncommon as opposed to the sterilization of hand instruments. Variations were observed in some of the infection control measures by gender, seniority in service and employment status. More than one-third of the respondents had experienced puncture wounds during the last month prior to the survey.

Infection control in Mississippi dental practices: a comparison of Mississippi Dental Association members and non-members

In conclusion, the results of the survey were reassuring in many ways. The data indicate that the dental profession in Mississippi seems to have taken advantage of continuing education opportunities, paid increased attention to infection control, and in general, were using appropriate techniques before the OSHA mandate of 1992. Furthermore, members of the MDA not only demonstrated a greater understanding of infections diseases, but were also 20 percent more likely to report behavior known to reduce the risk of cross infection. It will be important to continue to identify the "gaps" and provide information, additional training, and encouragement to the dental profession and to dental auxiliaries to improve infection control procedures where improvement appears to be needed.