Infection control practices in MOH dental clinics, Jazan, 2006

This study was conducted to assess infection control practices in MOH dental units in Jazan, Saudi Arabia. It was accomplished using a cross-sectional survey confined to Ministry of Health (MOH) dental practices in Jazan region.

Dental care in Jazan is delivered at 3 levels: Primary Health Care Centers (PHCC), General hospitals, and the Dental Care Center. All dentists working at these health facilities were selected, and completed a self-administered questionnaire. The response rate was 100%.

There were 78 respondent dentists, of mean age 33.9 years (Standard Deviation SD ±7.8) with almost half (47.4%) in the age group 31-40 years. Males constituted 63 (80.8%) and females 15 (19.2%); 13 (16.7%) were Saudis and 65 (83.3%) non-Saudis; 58 (74.4%) were married and 20 (25.6%) single; 70 (89.7%) were general practitioners and 8 (10.3%) were specialists. Almost half 34 (43.6%), were working at PHCCs, 29 (37.2%) in hospitals and 15 (19.2%) in the dental care center. Their mean experience was 11.8 years (SD ±6.7), and 24 (30.8%) had experience ranging from 6-10 years. On average, a dentist examined 19 patients per day, most 52 (66.7%) examined more than 15 patients daily.

A total of 20 (25.6%) dentists reported a history of needle stick injury during treatment of patients, and 6 (7.7%) reported they had one or more cut wounds on their hands at the time of this survey. Of the total, 80.7% stated that they had been vaccinated against Hepatitis B virus (HBV), and 50 (64.1%) mentioned that they always took each patient€™s medical history before treatment

Of the studied dentists, 68 (87.2%) stated that they always used high volume suction besides saliva ejectors during dental treatment; all (100%) reported always washing their hands before starting treatment; all (100%) always used gloves and all (100%) wore a face mask for each patient during dental treatment; 76 (97.4%) of those wearing a facemask changed it after each patient. Protective glasses (eye glasses, eye protector, or single face shield) were always worn by 46.2%. All the dentists always wore uniform coat during dental treatment, 42 (53.8%) changed it daily and 4 (5.1%) changed it if dirty. Only half of the dentists in this study 43 (55%) always used a rubber dam during dental treatment. More than half 42 (53.8%) always gave their patients a mouthwash before starting dental treatment.

All stated that hepatitis and AIDS viruses are the most important infectious diseases in a dental clinic, 89.7% said they refused to treat AIDS patients and 46.2% refused to treat hepatitis patients.

All participant dentists sterilized hand pieces by autoclaving; 76.9% disposed of the used needle and sharp instruments in a special safety container. Five (38.5%) of the dentists who reported examining or treating 10 patients or under daily were compliant to infection control precautions, whereas among those examining more than 10 patients daily, 7 (10.8%) were compliant to infection control precautions. Those who examined 10 or less patients daily were about five times more likely to be compliant than those who examined more than 10 patients daily; which was statistically significant (OR=5.12, CI= 1.32-20.28). The primary source of infection control information for 93.6% were dental colleges. Dentists who had received their knowledge from dental colleges were more compliant to infection control practices, compared to those who received their knowledge from other sources, eg. journals, conferences, etc, and this was also statistically significant (OR=0.10, CI= 0.014 €“ 0.640). Only 15.4% of respondents were found to follow the full requirements of infection control practices.

With the rise in the number of people infected with hepatitis B and the AIDS viruses, cross infection has become of paramount concern. Dental care professionals are at an increased risk of cross infection while treating patients. In this study, 100% of participant dentists wore masks and 97.4% changed it during treatment and between patients. These results are much higher than previously reported in other countries, 75% in Kuwait, [1] and 64.8% in New Zealand. [2]

Recently, there have been several reports about transmission of infection as a result of inadequate sterilization of hand pieces.[3,4] In our study, all respondents sterilized hand pieces.

If the recommended Infection Control practices are used, the risk of occupationally acquired infection with bloodborne pathogens is limited to sharp injuries, which can be minimized if puncture-proof

containers for sharps disposal are used. About 76.9% of respondents in this study maintained special containers for sharps disposal, 55.1% used rubber dams in their restorative procedures, and 15.4% were fully compliant with infection control procedures. In a previous study among private dental clinics in Riyadh, special containers for sharps disposal were maintained by only 8.4%, only 6.4% used rubber dams, and only 8.4% were fully compliant with the list of infection control procedures.[5]

This study investigated a limited range of items on infection control and has focused on barrier methods, HBV vaccination, and sterilization. More research is needed to provide comprehensive data on compliance with all recommended infection control programs by general dentists and specialists. New methodological techniques need to be introduced for the assessment of compliance of the dental team with Infection Control Practices. It is also recommended to include a larger observational element within the study design in order to reduce socially desirable responses.