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ORIGINAL ARTICLE
Year : 2018  |  Volume : 21  |  Issue : 5  |  Page : 553-559

Awareness, knowledge, and attitude of dental students toward infection control in prosthodontic clinic of a dental school in India


Department of Prosthodontics and Crown and Bridge, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India

Date of Acceptance31-Aug-2017
Date of Web Publication4-May-2018

Correspondence Address:
Dr. S C Deogade
Flat No-502, Block-d, Apsara Apartment, South Civil Lines, Pachpedi Road, Jabalpur - 482 001, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_81_17

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   Abstract 


Background: Infection control practices are crucial and important elements in clinical dentistry as there is an increase in the prevalence of infectious diseases among dental patients. This necessitates the application of recommended procedures for infection control in dental schools and clinics. Objectives: The aim is to evaluate the awareness, knowledge, and attitude of the undergraduate dental students toward infection control measures in the prosthodontic clinic and to assess their satisfaction toward applying these measures during prosthodontic treatment. Materials and Methods: A questionnaire-based study was conducted among 180 third, fourth and fifth year dental students (119 females and 61 males) in November 2015 in a private dental school of Rani Durgawati University, Jabalpur (Madhya Pradesh), India. It included 25 close-ended questions related to vaccination status and previous sharp injuries, awareness, knowledge, and attitude toward infection control in the prosthodontic clinic, previous education about infection control, and subjects' satisfaction with their knowledge and attitude. The questionnaire was distributed among 3rd, 4th, and 5th year students and informed consent were obtained before commencing the questionnaire. Results: A total of 180 participants responded to the questionnaire. Their perception toward infection control practices in the prosthodontic clinic varied from 14.4% to 100%, where former were regularly disinfecting dental cast before sending it to the laboratory and later ones were regularly using gloves while attending the patient. Most of the subjects responded “good” or “fair” to the questions related to the evaluation of their knowledge and policy implementation of infection control in prosthodontic clinic (P < 0.0001). Around 47.8% were almost satisfied, and 28.9% were fairly satisfied with their knowledge and performance. Conclusions: The study findings showed inadequate attitude and awareness of subjects toward infection control in prosthodontic practice. Their self-assessment and satisfaction reflect their performance toward infection control policy.

Keywords: Awareness, dental students, infection control, prosthodontic


How to cite this article:
Deogade S C, Suresan V, Galav A, Rathod J, Mantri S S, Patil S M. Awareness, knowledge, and attitude of dental students toward infection control in prosthodontic clinic of a dental school in India. Niger J Clin Pract 2018;21:553-9

How to cite this URL:
Deogade S C, Suresan V, Galav A, Rathod J, Mantri S S, Patil S M. Awareness, knowledge, and attitude of dental students toward infection control in prosthodontic clinic of a dental school in India. Niger J Clin Pract [serial online] 2018 [cited 2018 Aug 16];21:553-9. Available from: http://www.njcponline.com/text.asp?2018/21/5/553/231902




   Introduction Top


The human mouth is a fertile environment for the transmission, inoculation, and growth of various infectious and detrimental microorganisms.[1],[2] Blood and saliva are the common routes for transmission of such microbial agents in the dental operatory.[1],[3] Transmission can be through direct contact with blood, saliva, and other secretions or indirect contact with contaminated instruments, equipment, and environmental surfaces or contact with airborne contaminants. In dental clinics, dentists are often exposed to patient's blood and blood-contaminated saliva during dental procedures increasing the chances of transmission of micro-organisms between members of the dental team and the patients.[4],[5] This necessitates the implementation of infection control measures as an integral part in dental clinical practice.

A considerable emphasis has been placed on standardized infection control measures, but unfortunately, only a few dentists seem to implement these procedures in their clinical practice.[1],[6],[7],[8],[9],[10],[11],[12] The other unfortunate thing is that in dental schools, future dentists have not adequately adhered to these protocols and hence, cross-contamination is more probable in them than the more experienced members of the dental team.[13],[14],[15],[16],[17],[18],[19] Several studies [6],[13],[14] have revealed that knowledge on infection control is higher than that implemented in dental clinical practice. This matter of worry necessitates a high-level of medical training, clinical skills, and knowledge in dental education worldwide.[20] The importance of infection control should be taught meticulously to students in their undergraduate training so that they adopt their learned attitudes and behaviors when they become professionals.[21] The next unfortunate thing is the absence of a comprehensive and well-planned institutional effort to teach infection control during undergraduate program. A lack of adequately structured programs to train the dental faculty contributes a poor implementation of infection control measures. Educational interventions are crucially important to create high standards in infection control so that comprehension and compliance with infection control principles and development of positive attitude can prove a significant benefit in controlling cross-contamination.[19]

Prosthetic treatment involves various stages in the construction of removable and fixed prostheses. Therefore, prosthodontic clinic requires a high degree of concern regarding cross-contamination between the clinic and laboratory. Dental impressions, maxillomandibular registration bases and apparatus, trial and final prostheses are all exposed to contamination in the patient's mouth which can spread infectious agents to the clinician, other patients and the dental technicians.[22],[23],[24] There are previous studies conducted on infection control, in general, dental clinic.[2],[3],[4],[16],[19],[21],[22] However, these studies did not cover some of the important infection control procedures in the prosthodontic clinic. The aim of this study was to evaluate the awareness, knowledge, and attitude of the dental students toward infection control measures in the prosthodontic clinics. It also aimed to assess their satisfaction toward applying these measures in their prosthodontic clinic.


   Materials and Methods Top


A questionnaire-based study was conducted among 3rd, 4th, and 5th year dental students of a private dental school of Rani Durgawati University (RDU), Jabalpur (Madhya Pradesh), India in November 2015. The decision evaluating 3rd year and 4th year dental students was because the former ones are just entering the clinical postings and the latter ones are in the last year of their under-graduation and should, therefore, have a more complete theoretical and practical background regarding infection control to become good professionals. Even, 5th year dental students are in internship phase before completion of their degree course. Furthermore, assessments at this phase of undergraduate program may indicate the adequacy of the dental curriculum in incorporating essential behavior toward infection control among future dentists. The sample comprised of 180 participants: seventy from 3rd year, 58 from 4th year, and 52 from 5th year dental students. The study was approved by the ethical committee of RDU, Jabalpur (Madhya Pradesh), India. It was a self-administered questionnaire including 25 close-ended questions related to the demographic data, hepatitis B virus (HBV) vaccination status, attitude, and awareness toward infection control in the prosthodontic clinic, previous education in infection control during the graduate training, and subjects' satisfaction with their knowledge and attitude. Informed consent was obtained from each student before responding the questionnaire. It was pretested on a random sample of 20 dental students to ensure practicability, validity, and interpretation of responses. Data were statistically analyzed using SPSS version 21.0 for windows (SPSS Inc, Chicago, USA). Descriptive statistics (mean, standard deviation and percentages) were used to describe the quantitative and categorical variables. Student's t-test for independent samples and one-way analysis of variance was used to compare the mean values of quantitative outcome variable (attitude score) in relation to the categorical study variables. Post hoc test (Tukey) was used to observe the significance of pairwise comparison. A P < 0.05 was used to report the statistical significance of the results.


   Results Top


A total of 180 study subjects participated in this study: 70 (38.8%) 3rd year students, 58 (32.2%) 4th year students, and 52 (29.0%) 5th year students [Figure 1]. The total number of females was 119 (68.6%), and males were 61 (31.4%) as shown in [Figure 2]. Among them, 93.4% were vaccinated for HBV, 2.8% were not vaccinated, and 3.8% were not sure whether they had it or not. In prosthodontic clinics, eye injury is more common because of foreign bodies, splatter and aerosols, arising during the use of rotary instruments. Almost 28.9% of the participants reported that they had a sharp injury at least once and nearly 18.3% reported about eye splashing injury [Figure 3].
Figure 1: Distribution of participants according to their year of academic education (in percentage)

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Figure 2: Gender-wise distribution of participants (in percentage)

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Figure 3: Distribution of participants according to types of vaccinations and types of injuries

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[Table 1] demonstrates the distribution of responses of participant's awareness and attitudes toward infection control practices in the prosthodontic clinic. It varies between 14.4% (those were regularly disinfecting dental casts before sending it to the dental laboratory) and 100% (those were regularly using gloves when attending patients). Almost 87.2% of respondents agreed that they sterilize (or autoclave) the stock metal impression trays before making impressions of the patient. Majority of respondents (95.6%) informed that they rinse the impression under running water immediately after being removed from patient's mouth. In response to the two questions related to the education in infection control practices during the under-graduation academics, about 84.4% of the participants responded positively for having only a few lectures during their undergraduate program. On the other hand, 52.8% responded positively for attending only one clinical demonstration or hands-on workshop about infection control during undergraduate program [Table 2]. Approximately 6.6% of study subjects had evaluated their knowledge as “very good” toward infection control in the prosthodontic clinic, 62.8% of them as “good” and 26.7% as “fair” and 3.9% as “poor.” Toward implementation of infection control policy in their prosthodontic clinical practice, only 4.4% had evaluated it as very good, 52.8% as “good,” 40.6% as “fair,” and 2.2% as “poor.” About 6.6% of them were totally satisfied, 47.8% were almost satisfied, 28.9% were fairly satisfied and 12.8% were little satisfied with their knowledge and performance in infection control in the prosthodontic clinic practice [Table 3]. When comparing the mean values of attitude scores toward infection control across five-point nominal scale responses of having didactic (theory) lectures during undergraduate or internship program questions, it showed higher statistical significant for the subjects who responded positively to having only a few lectures during their undergraduate program comparing to the study subjects who had responded to other options (F = 8.26, P < 0.0001). However, there was no statistical significance across the four-point nominal scale responses toward the question related to attending a clinical demonstration/hands-on workshop about infection control during their undergraduate program (F = 2.08; P = 0.67). The comparison of mean values of attitudes scores toward infection control across the five-point ordinal scale responses of three satisfaction questions of infection control shows a statistical significant difference in the responses to all the three questions. The mean attitudes scores was highly significant in study subjects who had responded as “very good” to the two questions related to the evaluation of their knowledge and related to policy implementation of infection control in prosthodontic clinic (F = 9.12; P < 0.0001; F = 21.11; P < 0.0001), when compared with participants who had responded as “good,” “fair,” and “poor” to these two questions. For the mean value of subject's attitude scores related to their satisfaction with their knowledge and performance toward infection control in the prosthodontic clinic, there was a higher significance for the subjects who had responded as “totally satisfied” comparing other subject's responses (F = 9.06; P < 0.0001).
Table 1: Distribution of responses of participant's awareness and attitude towards infection control practices in prosthodontic clinic

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Table 2: Distribution of responses of participant's knowledge toward infection control and comparison of mean values of their attitude scores in relation to their knowledge responses

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Table 3: Distribution of responses to questions related to satisfaction of respondents with their knowledge and behavior toward infection control, and comparison of mean values of their attitude scores in relation to their responses of their satisfaction with their knowledge and behavior

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   Discussion Top


The results of the present investigation reveal student's awareness, knowledge, attitude, and behavior toward infection control at a dental school in RDU, Madhya Pradesh (India). This is a survey with internal validity, which means these data cannot be applied to the entire country and/or other countries. Not all infection control procedures were investigated because of concerns that increased the number of questions would reduce the accuracy of response and response rate.

This questionnaire-based survey evaluated the awareness, knowledge, and attitudes of dental students toward infection control measures in the prosthodontic clinic. It also assessed student's implementation of infection control practices in the prosthodontic clinic. Nearly two-thirds of the participants were females. HBV immunization among the respondents was 93.4%, whereas only 2.8% of subjects were not vaccinated, and 3.8% of subjects were not sure if they had it before. This drastic awareness of HBV immunization among students can be credited to the strong encouragement and recommendation of the dental school. This result was almost similar to those conducted in the dental schools of other countries. de Souza et al.[16] showed that almost 90.8% of senior students were immunized against HBV in six dental schools in Rio de Janeiro state, Brazil. In their study, McCarthy and Britton [25] reported 100% immunization among final year dental, medical, and nursing undergraduates at the University of Western Ontario, Canada. Rahman et al.[26] reported that almost 95.8% of senior dental students were immunized against HBV at College of Dentistry, University of Sharjah in the United Arab Emirates. Moradi Khanghahi et al.[27] reported 89.9% of vaccination for HBV among dental students at Mashhad Dental School in Iran. Ahmad et al.[28] reported that about 80% of the dental students received an HBV vaccination in Riyadh College of Dentistry and Pharmacy, Riyadh. Alshiddi [29] showed 94.2% of immunization against HBV among dental students at College of Dentistry, King Saud University, Riyadh, Saudi Arabia.

Previous research data had shown that 20% of the incidences of HBV developed after needlestick injuries.[30] The occurrence of sharp injuries among dental care providers is likely to be more compared to other health-care professionals.[31] The reason for such injuries may be due to small operatory fields and dealing with a variety of sharp dental instruments. McCarthy and Britton [25] and de Souza et al.[16] reported 82% and 31% of accidental injuries, respectively, among dental students in their studies. Rahman et al.[26] showed that almost 53.8% of the undergraduates reported about accidental injuries. Alshiddi [29] in his study found that almost 57% and 30.2% of the dental students had sharp injury and eye splashing, respectively. In the present study, almost 28.9% of respondents had sharp injuries, whereas, 18.3% of respondents had eye splashing injuries.

When evaluated their attitudes toward infection control in the prosthodontic clinic, the majority of the undergraduates (96.6%–100%) care about protective barriers such as gloves, face mask and head cap. However, a less concern was observed regarding the use of other protective barriers such as protective eyeglasses (37.2%) and protective gowns (21.1%). These results support the previous studies [13],[26],[28],[29] where the similar disconcert was noted for other protective barriers among dental students. Almost, 48.3%–62.2% of the respondents were aware of disinfecting important items used commonly in the prosthodontic clinic such as rubber bowl, alginate mixing spatula, face bow and shade guide. This result was almost similar to the findings of Alshiddi [29] who carried study in College of Dentistry, Saudi Arabia.

Cross-contamination control between dental offices and prosthetic laboratories is very crucial and important to maintain the health of patients and dental office staff. The risk of cross-infection of laboratory personnel by saliva or blood-borne infections has been reported.[32],[33],[34] The items such as impressions, dental cast, denture prosthesis, cast metal framework, bite registration or wax rim should be properly disinfected before sending to the laboratory.[35] The Centers for Disease Control and Prevention Guideline for infection control in dental health-care settings in 2003 recommended certain definite strategies to control cross-contamination in the dental clinic and dental laboratory.[36] For infection control between the prosthodontic clinic and dental laboratory, few questions were asked to disinfecting items sent or received by the dental laboratory. In this study, 95.6% of the participants rinse the impression, and 60% apply disinfectant before sending it to the laboratory. In his survey, Alshiddi [29] reported that almost 96.5% of the dental students and interns rinse and disinfect the impression before sending directly to the laboratory. Ahmad et al.[28] documented around 87% of the undergraduates disinfects impression before it was sent to the laboratory. Yengopal et al.[37] and Al-Omari and Al-Dwairi [38] reported less than that, 53.7% and 18.1%, respectively. Nearly, 14.4%–87.2% of respondents disinfects other dental items such as dental cast, denture prosthesis, metal framework, bite registration or wax rim and face bow and fork before sending them to technicians. These findings suggest that an additional education is required to promote routine disinfection of impressions and prostheses.

When asked regarding their experience of previous education in infection control during the under-graduation program, almost 84.9% of them had only a few lectures about infection control measures. However, 40.6% of the respondents had not attended clinical demonstration/hands-on workshop about infection control during their academic program. These findings are in agreement with the previous studies reported by Askarian et al.,[39] Abreu et al.[2] and Alshiddi [29] on dental students in Iran, Brazil and Saudi Arabia, respectively. Lack of knowledge or interest may be one of the reasons that should have lead the students not to attend such educational programs. Even lack of opportunities for students from dental school in analyzing their own experiences in the clinics from the perspective of infection control could have contributed in their demotivation. Self-assessment is important parameter in evaluating self-satisfaction by students in regards to their attitude toward infection control practices in the prosthodontic clinic. Most of the subjects evaluated their knowledge and their implementation of infection control policy as “fair” or “good,” and most of them were fairly satisfied (28.9%) or almost satisfied (47.8%) with their knowledge and their performance toward infection control policy. These results indicate undergraduates' responses toward infection control and suggest the need of additional educational efforts to improve their awareness and attitudes. The certain definite strategies to motivate students during their under graduation program may help them motivating to implement adequate infection control measures with their routine clinical and laboratory work. Furthermore, dental schools could offer opportunities for students to analyze their own experiences in the dental clinic from the perspective of infection control. Machado-Carvalhais et al.'s [17] approach can be applied sensitizing students to their attitudes to change their behavior and consequently improve their quality of life. This survey was carried in only one dental school; hence, the results cannot be generalized to the undergraduates of other dental schools. However, the findings would be useful for planning and implementation of right strategies and interventions, including a national-based survey of dental schools across the country.


   Conclusions Top


The findings of this study reveal inadequate awareness, knowledge, and attitude of dental undergraduates toward infection control, especially for the procedure related to prosthodontic practice. Students' responses indicated deficiency of proper education to support infection control measures, and their self-assessment and satisfaction reflect their performance toward infection control policy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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