CLINICAL DENTISTRY AND RESEARCH 2011; 35(2): 21-27
KNOWLEDGE, ATTITUDE AND BEHAVIOUR REGARDING HEPATITIS B AND INFECTION CONTROL IN DENTAL CLINICAL STUDENTS Nihat Akbulut, DDS
ABSTRACT
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University,
Background and Aim: Nowadays infections formed by virus
Ankara, Turkey
of hepatitis are the most important part of infectious disease
Bengi Öztaş, DDS, PhD
in dentistry because of working in close contact with patients.
Department of Oral and Maxillofacial Radiology,
The aim of this study is to determine the level of knowledge,
Faculty of Dentistry, Ankara University,
attitude and behaviour among dental clinic students regarding
Ankara, Turkey
Hepatitis B disease and standard isolation precautions in
Şebnem Kurşun, DDS
Ankara University Dentistry Faculty.
Department of Oral and Maxillofacial Radiology,
Subjects and Methods: This study is a cross-sectional
Faculty of Dentistry, Ankara University,
survey which was conducted on clinical students (4th and 5th
Ankara, Turkey
year). A self-administered questionnaire which had three parts
Gülümser Çölok, DDS, PhD Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, Turkey
(knowledge, attitude and behaviour) was administered to the participants. The results were evaluated statistically by using “t-test” and “Chi- Square test”. Results: The results of the study indicated that students’ responses given to the knowledge part of the questionnaire have seventy seven percent success rates (77%). The results of the research showed that infection control measures were learned primarily by means of faculty lessons (99% of students) and then also by independent research on the Internet (60% of students). In addition general success rate of female students was higher (71.6%) than male students’ (46.9%), which was statistically significant (p≤ 0.05).
Correspondence
Conclusions: Present study showed that dental clinical students showed moderate adherence to standard infection
Şebnem Kurşun, DDS
control precautions among dental clinical students. The
Department Oral and Maxillofacial Radiology, Faculty of Dentistry, Ankara University, Beşevler, Ankara, Turkey Phone: +90 312 2965634 Fax: +90 312 2123954 E-mail:
[email protected]
level of knowledge was high and attitude was acceptable,
Submitted for Publication: 01.13.2011 Accepted for Publication : 06.20.2011
however, the daily practice, i.e. the clinical behavior of students was moderate. Dental clinical students and also the other dental professions should apply all standard procedures and conventions in their daily practice. Key words: Behavioral Research, Dental Student, Hepatitis B, Infection Control.
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CLINICAL DENTISTRY AND RESEARCH INTRODUCTION Nowadays, viral hepatitis occupies a very important place among health problems. Hepatitis B, which is caused by Hepatitis B Virus, is an even more common serious disease in Turkey and across the world.1-6 Infection preventions and controls are the most important components for providing a safe environment for patients and staff within a dental practice.2,5,6 In the dental setting, there are special circumstances and opportunities able to lead to the transmission of such organisms to dental healthcare professionals and to dental clinical students.2,6 For example, high-speed dental instruments can create an airborne mist of fluid, saliva, blood and possible infectious driblets through the irrigation systems, which are usually required in dental clinical practices. Health care workers like dental clinical students are trained to practice standard hygiene measures such as frequent hand washing, using face masks and gloves; and wearing protective clothes when treating their patients.2,4 In 2003, the Center for Disease Control and Prevention of the United States of America (CDC) updated their guidelines for infection control in dental settings. This includes, but is not limited to, wearing a facemask, eye protection, protective clothing, and other cautionary materials which can be laundered in an in-house laundry or other suitable services.1,4 Awareness and compliance with these recommendations are very important for the prevention of occupational and contagious infections in healthcare workers and also for protecting dental healthcare workers.6 The aim of this study is to determine the level of knowledge, attitude and practice of safety measures among dental clinical students regarding the Hepatitis B disease and standard isolation precautions in the Ankara University Faculty of Dentistry in Turkey. General opinion in Turkey is that there is distrust as to sterilization and disinfection of the dental tools used in dentistry. As we, the academicians are responsible for training the future dentists; we considered planning this study to determine how careful the dentistry students are in the sterilization and disinfection of the dental tools. Theoretical and practical knowledge of cross infection should be given a considerable importance during the 5-year-dentist training period. Students to graduate should be equipped with a full knowledge and skills in this. SUBJECTS AND METHODS Theoretical basic education, including medical microbiology, is given in the last four semesters and is followed by
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theoretical and beside clinical education for a further four semesters. However, the curriculum does not include specific infection control training. This study is a crosssectional survey conducted on 4th and 5th year clinical students at the Ankara University Faculty of Dentistry between March and May 2009. A descriptive multiplechoice questionnaire was prepared by an infection control expert and two research assistants, one of whom works in the Oral and Maxillofacial Surgery Clinic and the other in the Oral Diagnosis and Radiology Clinic. A self-administered questionnaire (Table 1) composed of three parts (knowledge, attitude and practice), as well as a key question and demographic information survey were administered to the participants.1 This questionnaire was carried out on 173 students. Signed consent form was taken from each student attended to the study. The first part of the questionnaire consists of 15 questions which measure the level of knowledge, the second part of the questionnaire consists of 10 questions which determine the attitude and the last part of the questionnaire consists of 10 questions which determine the behavior of clinical students. Possible responses to the “knowledge” questions were “correct,” “incorrect” and “have no idea;” attitude questions had four possible responses, which were “all important,” “important,” “it doesn’t matter” and “insignificant;” and finally, possible answers for the behavior questions were “always,” “often,” “sometimes,” “rarely” and “never.” In addition to the questions in questionnaire, participants were asked questions about demographic information (class, sex, age, income level of the family and whether there are any health workers in the family). We categorized all answers as “correct” or “incorrect.” Data was then collected and analyzed with SPSS 15.0 (Statistical Package for the Social Sciences) package programme. Statistical analyses for knowledge, attitude, and behaviour, frequencies together with means were evaluated. In this research we used the “Student t-test” and “Pearson’s Chi- Square Test” (p0.05) parts of the questionnaire. Eighty-five (85%) percent of the respondents believed that Hepatitis B virus (HBV) is more contagious than Human Immunodeficiency Virus (HIV) (p0.05). The results also indicated that students having higher income level exhibited higher success ratio (p>0.05). Finally, after assessing all the answers, we saw that the general success rate of the knowledge part of questionnaire was seventy seven percent (77%) (Figure 1).
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DISCUSSION The emergence of the blood-borne pathogens and the increasing number of infected patients who are the increasing interest in dental health care compel the dental professions to have thorough knowledge about contagious diseases and the dental management of the care of health workers presenting with HBV patients.7-13 And also we thought to determine the level of knowledge, attitude and behavior of the dental clinical students especially about Hepatitis B. For this purpose, we wanted to encourage the dental clinical students to increase the level of knowledge and obey the infection control measures. The present study showed moderate adherence to standard infection control precautions among the dental clinical students of Ankara University, Faculty of Dentistry. Their level of success in the knowledge and attitude sections was higher, however, the clinical students’ success in naming and using the correct daily practices was only moderate These results were also found in other studies.1,2,4 Contrary to Singh et al.14, we did not find any statistically linear positive correlation between the knowledge, attitude and behavior parts of the questionnaire. Askarian et al.1 state that their study showed a generally poor adherence to standard isolation precautions among dental healthcare professionals in Shiraz. The literature knowledge emphasize that only having knowledge of infection control measures and a positive attitude towards them does not ensure adherence to the guidelines.1-11 We also reached the same conclusion. In our study, contrary to various other studies, we found that although the knowledge level was seventy percent (70%), the general success rate (the cumulative result of knowledge, was higher, reaching at seventy seven percent (77%).2,4 Breda-Albuquerque et al.15 reported that female clinicians were found to make more frequent use of equipment such as lab coats, scrub caps and masks. In line with this study, our results were noteworthy as we carried out objective assessments and comparisons regarding the male and female dental clinical students’ knowledge, attitude and behavior. The general success rate of female students was higher (71.6%) than male students (46.9%). These results are not coherent with the literature knowledge.1,2,4,5 To elucidate the reason for this discrepancy requires more detailed research on this topic. Askarian et al.1 was found no correlation between levels of knowledge and practice. We had the same result in this topic, too. Yalcın et al.13 wrote that results of recent studies about the rate of carriers of HBV vary in different countries. This rate was 0.1% in Scandinavian countries and the United
"Hepatitis B and Infection Control" Table 2. Sample questions of the questionnaire and percentage of answers assessing students’ knowledge levels regarding Hepatitis B and standard infection control measures. Correct Q2: Hepatitis B is observed frequently in our country ( Turkey )
Q4: Blood, sexual contact, body fluids and secretions are the most important means of contamination by HBV and HIV
Q5: Incubation period of HBV is about 5080 days.
Q6: HBV is an RNA virus.
Q7: There is no difference between a Hepatatis B patient and a person infected with hepatitis B.
Q12: HBV doesn't contaminate the body by means of saliva
Incorrect
Have no idea
Total
83%
16%
1%
100%
143
27
3
173
98%
1%
1%
100%
171
1
1
173
15%
45%
40%
100%
26
77
70
173
24%
60%
16%
100%
42
102
29
173
72%
23%
5%
100%
125
38
10
173
80%
16%
4%
100%
1138
28
7
173
Figure 1. General success rate of dental clinical students regarding the knowledge part of the questionnaire.
Kingdom, 0.1-0.5% in West European countries and 1-5% in East Europe countries. Additionally, this rate was found to be less than 1% in North America and 5-18% in China. Also, the rate of carriers of HBV was found to be 5.4% in Turkey.13 Komerik et al.5 investigated the knowledge of viral hepatitis among preclinical and clinical dental students and stated that with increasing grade level, the level of knowledge also increases. These results are in line with our study.
The findings of the present study marked the importance of training university lecturers about disease contamination. The present study showed that the students mainly learned infection control measures from faculty lessons rather than internet and visual media. We highlight that control and precaution of Hepatitis B and other contagious diseases, and the disinfection of instruments and the environment of the dental clinic in dental practices require a reviewing of guidelines. In addition, by teaching our students about viral contagious diseases and prevention of viral infections, we can raise their sensibility regarding transmission of other infectious and communicable diseases. For example, we must encourage our students and colleagues to use protective equipment such as gloves, facemasks, lab coats, protective eye glasses, etc.12 Furthermore, we should follow and obey the Universal Guidelines for “Standard infection control and precautions” such as “American Dental Association Recommendations”, “Universal Precautions” and “Body Substance Isolation” refined by Lynch and colleagues; there is also a more common guideline set out by the Center for Disease Control and Prevention.4,5,7,8,13
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CLINICAL DENTISTRY AND RESEARCH Table 3. Sample questions of questionnaire and percentage of answers assessing students’ attitudes and behaviors towards Hepatitis B and standard infection control measures. Very important Q18: Patient contaminated with HBV must be called as the last patient.
Q21: Dental instruments must be disinfected and sterilized.
Q23: Every patient must be assumed to be a contagious disease risk; therefore, we must obey standard infection control measures.
Q26: I wear gloves before touching membranes and nonintact skin of patient.
Q28: I wear goggles during treatment procedures of patients.
Q32: I bend needles after injections and discard them into a medical waste container.
Q33: I check patients’ blood tests for contagious diseases before a procedure.
Q34: I check indicator showing whether or not instruments have been sterilized before using them in a procedure.
Not important
89%
10%
1%
0%
154
17
2
0
97%
2%
1%
0%
168
4
2
0
77%
20%
3%
0%
134
35
4
0
Always
Frequently
Sometimes
Rarely
Never
98%
2%
0%
0%
0%
170
3
0
0
0
12%
32%
42%
12%
2%
20
55
72
20
6
19%
10%
17%
12%
42%
33
18
30
20
72
31%
51%
14%
2%
0%
55
89
26
3
0
14%
20%
20%
20%
26%
24
35
35
35
44
CONCLUSIONS It is essential that all barrier techniques become protocol and a norm in students’ future daily practice as clinicians. In addition to obeying standard infection control measures, we should encourage students and our colleagues, as well as patients, to be vaccinated against Hepatitis B and other contagious diseases. Finally, these results suggest that viral infections such as Hepatitis B and other contagious diseases should be carefully considered by our society as a whole, as well as those instructing the new generation of professional and
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It doesn’t matter
Important
dental healthcare workers; if these are disregarded, our healthcare workers may face a serious challenge against their own health when they step into their clinics. Hence, we must educate the students in order to learn all infection control measurements. ACKNOWLEDGEMENTS This study was submitted as a ‘Poster Presentation’ in ‘14th Congress of Bass and the 9th Scientific Congress of BgDA’ in Varna, Bulgaria in May 2009.
"Hepatitis B and Infection Control" Table 4. General success rate of participants, showing the correlation between male and female students. General Succes Rate
Gender F
M Total
Total
0
1
Count
31
78
109
% within gender
28,40%
71,60%
100,00%
Count
34
30
64
% within gender
53,10%
46,90%
100,00
Count
65
108
173
% within gender
37,60
62,40%
100,00%
* F: Female M: Male 1: Correct answer 0: Incorrect answer.
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