Dental Infection Control Practices and Public Perception: A Cross-sectional Study

Background: The aims of this study was to determine the practice of infection control among the dental professionals practicing in private dental clinics in Ernakulam city, and public’s perception of infection control measures. Materials and Methods: This was a cross-sectional study conducted with a sample of 84 private dental clinics and 152 respondents from the general public in Ernakulam city. A 24 item self-administered close-ended questionnaire was used for the dentists and a 13 item semi-structured questionnaire with both open and closed ended questions administered to the general public. Data obtained from both populations were tabulated and analyzed using descriptive statistics and bivariate analyses using Chi-square test (α = 0.05). Results: The final sample consisted of 66 dental clinics. Most of the dentists complied with the use of barrier techniques (gloves and mouth mask) during patient care. Almost half of the dentists had no knowledge of their auxiliaries being vaccinated against hepatitis B. With regard to the general public, 58% of the people had concerns regarding the methods used by the dentists to sterilize dental instruments, yet most of them (77%) did not avoid the dental treatment due to perceived cross infection risk. Conclusion: Results of this study revealed that the level of infection control practices adopted by the private dental clinics in the city was inadequate in a few areas. It was found necessary to educate, raise awareness, and promote continuing dental education aimed at improving dental safety. Key Words: Dental practice, Ernakulam city, infection control, infectious diseases, private dental clinics, public opinion, public perception Introduction In dentistry there is constant exposure to various blood borne and upper respiratory tract pathogens or infectious agents through blood, saliva, and various other body fluids.1-4 Infections can spread in a dental setting either through touch, spatter, or flying debris from the oral cavity.1-3,5-7 Occupational exposure to blood borne pathogens can be from the human immunodeficiency virus, hepatitis B virus (HBV), hepatitis C virus, Mycobacterium tuberculosis, herpes simplex virus Type I and Type II, Staphylococci, and other potentially infectious agents.4 The primary route of occupational exposure to “blood borne pathogens,” being mostly unintentional percutaneous injuries. These types of injuries are more prevalent in dental settings than other healthcare fields, mainly because of the small operating field, frequent patient movements, and the variety of sharp instruments being used in dentistry.8 Literature has also shown that the dental team is significantly at higher risk of contracting infections when compared to the general public, where the source could be a patient or a member of the dental team.4,9-11 The ongoing surveillance by the United States Centers for Disease Control and Prevention (CDC) states that the occupational blood borne pathogen exposure remains an important public health concern.12 Infectious diseases and its likely spread through the dental hospitals or clinics is a mammoth predicament where only the tip of the iceberg is visible to the naked eye. AIDS epidemic in the past three decades has been the greatest public health issue having reached unforeseen levels and has prompted the health communities to re-evaluate many routines and norms in provision of health care services.13 A 2004 study has also shown that dentists working in private dental clinics are less likely to adhere to infection control protocols than dentists working in hospitals and dental schools because institutions usually have stricter occupational health policies related to infection control.14 Further in a similar analysis of infection control data from Indian dentists from two independent surveys (1999 and 2010) by Shetty et al., when the dentists were stratified by occupation, the private practitioners compared to faculty were more likely to be immunized and used heat sterilisable instruments. Overall, the private practitioners were less likely to adhere to the infection control practices than the faculty because they did not require any institutional oversight and updates on their infection control practice measures.15 Infection control practice in the 2010 survey was less stringent than in the 1999 sample and could be attributed to a the surveys being conducted in different parts of India on mutually independent samples.15 The use of heat sterilisable instruments and regular use of surface barriers, autoclave and rubber dam were a more common in the 1999 cohort that was predominantly in South India.15 The results broadly