Article Info
Year: 1999
Month: October
Issue: 4
Reference: Al-Rabeah A., Mohammed A., .Saudi Epidemiology Bulletin. 1999;6(4):.
Currently no standard instruction or protocols for infection control practicing in dental private clinics in Riyadh City. We assume that dentists are practicing the infection control according to their training and knowledge.
Dentists working in private dental clinics in Saudi Arabia come from different countries and faculty with different standards of infection control.
Although there were many studies on infection control practices conducted in King Saud University, Dental College and in dental clinics at Primary Health Care Centers (PHCC) in Riyadh City, we did not find any single study conducted to assess the infection control practice of the dental units in the private sector.
A cross sectional survey confined to private dental units was conducted in March and April 1999. A total sample size amounted to 130 dental units was chosen using the proportional allocation method. Three hospitals, 45 clinics and 39 centers were selected randomly. A self-administered questionnaire was completed. Odd Ratio (OR) and 95% Confidence Interval (95%CI) were used to calculate the likelihood of compliance among the studied dentists.
Of the 206 questionnaire, 203 (98.5%) were completed. The mean age of the responding dentists was 36.8 + 6.7 years. Dentists working in the private dental clinics were from different nationalities mostly non-Saudi. About two thirds 139(68.5%) of dentists were general practitioners and 64(31.5%) were specialists in different dental subjects.
The experience of around two thirds of the studied dentists ranged from 6 to 15 years with mean of 13.2 + 6.1 years. More than one half of the studied dentists examined 6 to 10 patients daily. A total of 137 (67.5%) reported that they had a history of a needle stick during treatment of patients. A total of 144 (70.9%) of dentists stated that they had been vaccinated against hepatitis B virus. A total of 189 (93.1%) of dentists mentioned that they always took a medical history of each patient before treatment. All the studied dentists stated that they always use gloves for each patient during dental treatment.
More than 90% of dentists always wear a facemask during dental treatment. More than half of those wear facemask change it after each patient. Protective glasses (eye glasses or eye protector or single face shield) were always worn by more than 70% of dentists. Only 13 (6.4%) of dentists in this study were always using rubber darn during dental treatment. More than 96% of dentists said that the Hepatitis virus and AIDS are the more important infectious diseases in dental clinic. The primary source of infection control information for the studied dentists were collages 78%.
Of the studied dentists, 166 (82%) said that they refused to treat AIDS patients and 68 (33%) to treat hepatitis patients. Only 37.9% of the dentists sterilize hand pieces by autoclaving, other 53.7% wipe it with disinfectant. About 44% of dentists disposed the used needle and sharp instruments in a special safety container.
Dentists working in clinics were more than three times likely to be compliant, to infection control practice, than others working in other places, and this was found statistically significant (OR=3.23, CI= 1.07 €“ 10).
The probability of compliance among dentists of age < 40 years was one tenth of those dentists > 40 years of age, and this difference was also found to be statistically significant (OR=0.11, CI= 0.03 €“ 0.36).
Arabs were one fourth likely to be compliant than non-Arab, and this found statistically significant (OR=0.26, CI= 0.08 €“ 0.88). Dentist with <15 years€™ experience were one fifth likely to be compliant than those with more than 15 years€™ experience, and this found statistically significant (OR=0.2, CI= 0.06 €“ 0.63). (table 1).
Editorial note:
Infection control has become one of the most discussed topics in dentistry. Cross infection control is an integral part of dentistry and many dental health workers no longer question its necessity. The observation that very few respondents have followed the full requirements of infection control practice developed by ADA and CDC is significant. The compliance with internationally recommended procedures was weak for a number of procedures.
Universal cross infection control procedures are to be implemented when treating each patient. Most hospital in developing countries has no infection control programs due to the lack of awareness of the problem or absence of trained personnel in infection control [1].
Dental care professionals are at an increased risk of cross infection while treating patients. This occupational potential for disease transmission becomes evident initially when one realizes that most human microbial pathogens have been isolated from oral secretion [2].
Oral health care workers are known to be at increased risk of Hepatitis and Human Immunodeficiency Virus (HIV) infection. HBV is the most important infectious occupational hazard in the dental profession [3] and many studies have shown that dental personnel have five to ten fold greater chance of acquiring this infection than the general population.[4]
The most practical method of avoiding Hepatitis B infection for all dental personnel to receive the Hepatitis B vaccine , Vaccination against infectious diseases is essential for both dentists and their assistants. The CDC theorizes that "the limited number of reports of HBV transmission from health care workers to patients in recent years may reflect the adoption of universal precautions and in-creased use of HBV vaccine [5].
Protection for operator and patient can be gained by the use of both sterile instruments and a sterile mechanical barrier worn on the operator's hand and face [6].
Control of cross infection is the responsibility of the dentist, and all members of the dental team have a duty to ensure that necessary steps are taken to prevent cross infection
This study indicates an overall compliance with the infection control procedures only 17 (8.4%) among dental practitioners in private dental clinic. Continuous follow up for private dental sector is very important, to evaluate and check the facilities for sterilization, disinfection and universal precautions.
The Ministry of Health have to be provide formal infection control courses manual to the dental professionals with mandatory attendance for continued licensing, all staff should carry out internationally recommended infection control procedures.
Specific educational effort should be carried out to increase the information of the oral health care workers on the risks and concerns of treating HIV and Hepatitis patients and to increase the confidence of the practitioner to treat these patients.
References
- Sobayo El. Nursing aspects of infection control in developing countries. Journal of Hospital Infection 1991 June; 18 Suppl A: 388-91.
- Cottone JA, Terezhalmy GT, Molinari JA. Practical infection control in dentistry. Second edition. Baltimore: Williams and Wilkins 1996
- Martin MV. New concepts in cross infection control in dentistry. Postgraduate dentist 1990 June : 8-11.
- Kane MA, Lettau LA. Transmission of HBV from dental personnel to patients. JADA 1985;110: 634-6.
- Runnells RR. Countering the concerns: how to reinforce dental practice safety. JADA 1993;124 Jan: 65-73.
- Shalhoub SY, Al Bagieh NH. Cross infection in the dental profession, dental instruments sterilization: assessment part €”1.0donto-Stomatologie Tropicale 1991(June): 13-4.
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Tables 1. The studied variables and compliance among dentists in dental private sector, Riyadh, 1999
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Variable
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Infection control practices
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OR*
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95%CI**
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Complaint (%)
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Non complaint(%)
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Setting
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Clinic
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10 (14.9)
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57 (85.1)
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3.23
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1.07- 10
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Other
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7 (5.1)
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129 (94.9)
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Age group
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<40
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6 (3.8)
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154 (96.3)
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0.11
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0.03- 0.36
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>40
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11 (25.6)
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32(74.4)
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Sex
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Male
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13(11.5)
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100 (88.5)
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2.79
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0.81- 10.59
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Female
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4(4.4)
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86 (95.6)
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Nationality
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Arab
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11 (6.3)
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163 (93.7)
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0.26
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0.08- 0.88
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Non-Arab
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6 (20.7)
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23 (79.3)
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Degree
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General practice
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10(7.2)
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129 (92.8)
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0.63
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0.21- 1.95
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Specialist
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7(10.9)
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57 (89.1)
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Daily load of work
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<=10 patients
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9 (6.4)
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131 (93.6)
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0.47
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0.16-1.43
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>10 patients
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8 (12.7)
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55 (87.3)
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Source of knowledge
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College
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15(9.4)
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144 (90.6)
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2.19
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0.45- 14.45
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Other
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2 (4.2)
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42 (95.5)
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Experience (years)
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<=15
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6 (4.2)
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136(95.8)
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0.2
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0.06- 0.63
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>15
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11 (18)
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50 (82)
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*OR=Odd ratio.
**95%CI=95% confidence interval.
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