ORIGINAL ARTICLE

https://doi.org/10.5005/jp-journals-10063-0150
CODS Journal of Dentistry
Volume 15 | Issue 1 | Year 2023

Knowledge, Attitude, and Practice Related to Infection Control Procedures Followed by Dental (Undergraduates) in Davangere City: A Cross-sectional Study

Shree Rashmi¹, Lilly BK², Sushanth V H³, Allama PC R⁴, Vivek H P⁵, Srinidhi PB⁶

^1–6Department of Public Health Dentistry, College of Dental Sciences, Davangere, Karnataka, India

Corresponding Author: Lilly BK, Department of Public Health Dentistry, College of Dental Sciences, Davangere, Karnataka, India, Phone: +91 9591099124, e-mail: lillybk8@gmail.com

Received: 01 March 2024; Accepted: 29 March 2024; Published on: 25 April 2024

ABSTRACT

Introduction: Transmission of infectious agents among patients and dental healthcare personnel in dental settings has been an issue of concern. Reports highlight the need for a recommendation of strict infection control practices that have to be met for disease transmission.

Aims and objectives: To assess the knowledge, attitude, and practices related to Infection control procedures followed by dental students in Davangere. A cross-sectional study.

Materials and methods: A cross-sectional descriptive questionnaire-based study was carried out with a sample of 123 students among dental students (third year, final year, internship) in Davangere, Karnataka, India, through the convenience sample method. A questionnaire was designed regarding infection control procedures, and the data was collected using an Excel sheet and analyzed using the frequency distribution Pearson Chi-squared test using SPSS (software version 22.0). Before the commencement of the survey, a pilot study was carried out on Cronbach’s α = 0.81.

Results: A total of 150 students took part in the study with a response rate of 81.3% (n = 123), out of which third year, 55 (44.71%), 48 (39%) were final year, and interns 20 (16.26%). All the students (100%) responded positively about the need for sterilization and infection control; >80.5% of students have reported that they consider screening for human immunodeficiency virus (HIV) in every patient.

Conclusion: Dental undergraduate students at private dental colleges in India reported reasonably good infection control practices. However, to enable students to follow strict infection control procedures, certain upgrades should be made in the institution.

Key message: Dental practitioners should be aware of the spread of infectious diseases and the need to control these diseases.

How to cite this article: Rashmi S, BK L, VH S, et al. Knowledge, Attitude, and Practice Related to Infection Control Procedures Followed by Dental (Undergraduates) in Davangere City: A Cross-sectional Study. CODS J Dent 2023;15(1):9–15.

Source of support: Nil

Conflict of interest: None

Keywords: Dental students, Infection control, Infectious diseases

INTRODUCTION

A growing concern in dentistry is infection management. Dentists and dental assistants are highly susceptible to contracting and spreading infectious illnesses. Cross-contamination and disease transmission from patient to patient has drawn equal attention.¹

Low knowledge regarding concepts such as universal precautions and hand hygiene has been reported.² Hospital-acquired infections can result in reduced life expectancy of infected persons.²^,³ Major outbreaks are primarily caused by the spread of infections in hospital settings and dental clinics.⁴ There is an increased risk of contracting infectious diseases like COVID-19, hepatitis, and human immunodeficiency virus (HIV) not only by the front-line workers but also by visiting patients and healthcare workers by cross-contamination.⁵

OBJECTIVES

To assess the knowledge, attitude, and practices related to infection control procedures followed by dental students in Davangere. A cross-sectional study.

MATERIALS AND METHODS

Study Design

The present study was a cross-sectional survey performed during the period between December 2022 and January 2022.

Study Participants and Study Location

The study was conducted among dental undergraduates (third year, final year, and interns) at two colleges (College of Dental Sciences and Bapuji Dental College and Hospital) in Davangere, Karnataka, India. Out of a total of 150 students, the total number of students who took part in the study was 123 students.

Pretesting of the Questionnaire

A close-ended structured questionnaire related to knowledge, attitude, and practices related to infection control practices among dental undergraduates containing 17 questions was prepared. A pilot study was conducted before the administration of the questionnaire among 10 participants whose results were not included in the study.

Sample Size Determination

Thus, on calculating,

Here,

Z = 1.96 constant a 95% confidence level

σ = 0.6 observed standard deviation

n = sample size

e= 0.1 instrumental error.

Sampling Method and Administrative Procedure

A convenience sampling strategy was employed in this investigation. We approached undergraduate students at the aforementioned colleges to distribute 150 questionnaires. We gave them sufficient time to complete the survey and then collect it.

The close-ended, structured questionnaire was created in English. The participants were administered a structured questionnaire consisting of two parts. The first part consisted of general information such as the name, age, gender, year of studying, college name, and contact number. The second part was the questionnaire, which consisted of 17 questions related to knowledge, attitude, and practice related to infection control practices by dental students, out of which seven questions were related to knowledge, five were related to attitude, and five were related to practices.

Statistical Analysis

The data was recorded and tabulated onto the Microsoft Excel sheet. The recorded data were subjected to frequency distribution and person Chi-squared statistical tests using the IBM SPSS (SPSS, software version 22.0) (p ≤ 0.05).

Ethics Statement

Ethics approval: This study was approved by the Institutional Ethics Committee (IEC) at the College of Dental Sciences, Davangere.

Informed Consent

The survey tool was sent to potential participants along with a cover letter outlining the components of informed consent. This letter explained the purpose of the research study, its possible benefits and risks, and that participation was entirely voluntary with no repercussions for declining to participate, including academic penalties. The IEC removed the need for signed written consent in order to protect participant anonymity; instead, participation in the survey was taken to indicate informed consent.

RESULTS

A total of 150 students took part in the study with a response rate of 82% (n = 123), out of which there were 55 (44.71%) third year, 48 (39%) final year, and 20 (16.26%) interns. The average age-group was between 20 and 24 years.

Figure 1 represents the number of male and female students who participated in the survey.

Fig. 1: Represents the number of male and female students who participated in the survey

Table 1 represents the frequency of responses for each question, as well as the results of the Chi-squared test.

**Table 1:** Frequency distribution of responses of the Chi-squared distribution
Questions	Response	N	%	p-value
Do you think sterilization is important for infection control?	Yes No	123	100%	–
Is it necessary to handle sharp instruments safely?	Yes No	123	100%	–
Is it necessary to dispose of the used syringes and needles?	Yes No	121 2	98.4% 1.6%	0.328
Is there any need to undertake precautions to prevent nosocomial infections?	Yes No	123	100%	–
Is it necessary to wear scrubs and gloves while dealing with patients?	Yes No	121 2	98.4% 1.6%	0.816
Should the blood-stained equipment be disposed of properly?	Yes No	123	100%	–
Is it necessary to screen all patients for HIV infection?	Yes No	99 24	80.5% 19.5%	0.104
Is there a need to use standard precautions for infection control regardless of diagnosis or infection status?	Yes No	121 2	98.4% 1.6%	0.816
Have you taken immunization against hepatitis B virus?	Yes No	74 47	61.2% 38.8%	0.055
Is it necessary to wash hands when contaminated with body fluids?	Yes No	123	100%	–
Do you use protective eyewear while treating patients?	Yes No	113 10	91.9% 8.1%	0.246
Do you use double gloves while performing invasive procedures?	Yes No	95 28	77.7% 22.8%	0.634
Do you take the medical history of all the patients in their first appointment?	Yes No	123	100%	–
Do you use PPE kit while treating patients with COVID-19?	Yes No	122 1	99.2% 0.8%	0.455
Do you use alcohol-based handrubs before and after treating patients?	Yes No	116 7	94.3% 5.7%	0.399
Is it necessary to maintain an isolated room for TB patients?	Yes No	121 2	98.4% 1.6%	0.290
Do you sterilize the hospital environment after the visit of HIV-infected patients?	Yes No	118 5	95.9% 4.1%	0.566

All the students responded positively when questioned about the need for sterilization for infection control (100%). (Figure 2 represents the opinion of undergraduate students regarding the necessity for sterilization for infection control). All the students had the knowledge of handling sharp instruments safely and responded yes (100%) (Figure 3 represents the opinion of undergraduate students regarding safety while handling sharp instruments).

Fig. 2: Represents the opinion of undergraduate students regarding the necessity for sterilization for infection control

Fig. 3: Represents the opinion of undergraduate students regarding safety while handling sharp instruments

About 98.4% of students responded yes when questioned about the need for disposal of used syringes (Figure 4 displays undergraduate students’ opinion regarding the need for disposal of sharp instruments).

Fig. 4: Represents undergraduate students’ opinions regarding the need for disposal of sharp instruments

When students were questioned about nosocomial infection, all the students responded yes, and we’re well aware of nosocomial infection and the necessary precautions to be taken (Figure 5 represents the opinion of undergraduate students regarding the need for prevention of nosocomial infections).

Fig. 5: Represents the opinion of undergraduate students regarding the need for prevention of nosocomial infections

When asked about the use of gloves and scrubs while dealing with patients, 98.4% agreed, and 1.6% disagreed (Figure 6 conveys the undergraduate students’ opinions about the usage of gloves and scrubs while dealing with patients).

Fig. 6: Represents the undergraduate students’ opinion about the usage of gloves and scrubs while dealing with patients

All the students responded yes when asked if stained equipment should be disposed of properly (Figure 7 illustrates the undergraduate students’ opinion about the need for disposal of blood-stained equipment).

Fig. 7: Represents the undergraduate students’ opinion about the need for the disposal of blood-stained equipment

When questioned about screening all patients for HIV, 80.5% responded yes, and 19.5% disagreed (Figure 8 suggests the undergraduate students’ opinion on screening all patients for HIV infection).

Fig. 8: Represents the undergraduate students’ opinion on screening all patients for HIV infection

A total of 98.4% of students have confidently agreed to the need for standard precautions regardless of diagnosis of infection (Figure 9 portrays the undergraduate students’ opinion regarding the use of standard precautions for infection control regardless of diagnosis or infection status). When questioned about being vaccinated against hepatitis B, only 61.4% of students responded yes, among which 38.1% were interns and final year students (Figure 10 represents the attitude of undergraduates regarding the need for hepatitis immunization). All students responded yes when questioned about the practice of washing hands after contamination with body fluids (Figure 11 illustrates the undergraduate students’ opinion regarding the need for washing hands when contaminated with body fluids). When asked about the use of protective eyewear, 91.9% responded yes, and 8.1% disagreed (Figure 12 portrays the undergraduate students’ practice of using protective eyewear while treating patients). When questioned about the use of double gloves while doing invasive procedures, 77.2% responded yes, and 22.8% responded no (Figure 13 describes undergraduate student’s practice of using gloves while performing invasive procedures). When asked for the medical history of every patient during their first visit, all students responded yes (Figure 14 represents undergraduate students’ practice of taking the medical history of all patients in their first appointment).

Fig. 9: Represents the undergraduate students’ opinion regarding the use of standard precautions for infection control regardless of diagnosis or infection status

Fig. 10: Represents the attitude of undergraduates regarding the need for hepatitis immunization

Fig. 11: Represents the undergraduate students’ opinion regarding the need for washing hands when contaminated with body fluids

Fig. 12: Represents the undergraduate students’ practice of using protective eyewear while treating patients

Fig. 13: Represents undergraduate students’ practice of using gloves while performing invasive procedures

Fig. 14: Represents undergraduate students’ practice of taking medical history of all patients in their first appointment

When asked about the use of a personal protective equipment (PPE) kit during the COVID-19 pandemic, 99.2% said yes, and 0.8% disagreed (Figure 15 depicts undergraduate students regarding the use of a PPE kit during the COVID-19 pandemic). About 94.3% of students responded yes when questioned about the use of alcohol-based handrubs for cleaning hands, and 5.7% disagreed (Figure 16 describes the undergraduate students’ knowledge about the use of alcohol-based handrubs while treating patients). When questioned about the need for an isolated room for tuberculosis (TB) patients, 98.4% of students responded yes, and 1.6% disagreed (Figure 17 denotes undergraduate students’ opinion on the need for a separate room for TB patients). A total of 95.9% of students responded yes when questioned if they sterilized the dental chair and surroundings after treating HIV patients, and 4.1% disagreed (Figure 18 denotes the undergraduate students’ opinion of the need for sterilization of the hospital environment after the visit of an HIV-infected patient).

Fig. 15: Represents undergraduate students’ opinions regarding the use of PPE kits during COVID-19 pandemic

Fig. 16: Represents the undergraduate students’ knowledge about the use of alcohol-based handrub while treating patients

Fig. 17: Represents undergraduate students’ opinions on the need for separate rooms for TB patients

Fig. 18: Represents the undergraduate students’ opinion on the need for sterilization of the hospital environment after the visit of an HIV-infected patient

DISCUSSION

Healthcare professionals are at higher risk of acquiring infectious diseases.¹ Dental professionals who are frequently exposed to saliva and blood have a higher susceptibility to infection compared to other general population.¹^,² Dental patients are also at risk of acquiring and spreading infection. Multiple ways exist for an infection to spread in a dental operatory, including direct contact with blood, oral fluids, indirect contact with contaminated tools and surfaces, contact with conjunctival, nasal, and oral mucosa from droplets carried by coughing, sneezing, talking, inhalation of airborne microscopic particles.³ Formal programs in ”infection control and safety” should be strictly implemented by dental healthcare professionals.³^,⁴ The dentist and his assistant must take precautions to minimize the spread of infectious diseases like COVID-19 among themselves and the patient.⁴ Dental students should be extra careful while treating patients with immunocompromised conditions such as AIDS, diabetes, and asthmatic patients who are at high risk of acquiring infectious diseases during invasive procedures like extraction, placing implants, and minor surgeries like frenectomy and gingivectomy. Dental students who become future dental professionals serve the needy. They tend to practice the protocols they have been practicing in their training years as dental students. This survey aims to check if the necessary precautions and protocols have been implemented and practiced among the dental undergraduates of a private dental college.

The present study was conducted to assess the knowledge, attitude, and practices related to infection control practices among dental (undergraduate) students in Davangere. Among the 150 participants, the final-year students and interns showed to have more knowledge regarding infection control practices.

When questioned about sterilization, the dental students of this study followed the protocols with 100% frequency when compared with students in a private dental college at Udaipur, Rajasthan, India, which had a frequency of 20.6%.⁵^,⁶ The usage of gloves by the students was 98.4% in this survey, which is similar to the frequency of the usage of gloves at Udaipur (99.3%).⁶^,⁷ All students took their medical history. Only 61.4% of the students are vaccinated against hepatitis B, and this vaccination rate is quite alarming compared to the vaccination rate reported among students in the United States of America, which is 95%.⁸^,⁹ All the students followed safe disposal of sharp objects 100%, which is a higher percentage when compared to studies done at Pune by Tartari et al. in which 72.3% were only aware of proper disposal of sharp wastes.⁹

A greater percentage of students have reported the need for separate rooms for TB patients. 91.9% of students used protective eyewear, which is a higher percentage when compared to students of Sharjah, United Arab Emirates (26.5%). A total of 47.9% of United Arab Emirates reported positive for washing hands before and after treating patients, while students of this survey have reported 100% frequency.¹⁰

The study suggests that the participants, particularly interns, fourth-year, and third-year students, demonstrated awareness of Infection control procedures. The advantage of this study is that it is cost-effective and administered remotely online and by mail. The finding aligns with the hypotheses of the study, indicating that the knowledge, attitudes, and practices (KAP) of undergraduates and interns regarding Infection control procedures may have limitations. The emergence of COVID-19 has pressurized the higher authorities to put forth strict protocols such as maintaining separation of 2 m between patients, strictly keeping 70% alcohol-based handrubs, using N-95 masks in public places, triage screening that included—triage negative (asymptomatic), triage positive (temperature screening positive) and confirmed COVID-19.¹¹ Lack of knowledge, difference of opinion, superstitions regarding the infectious diseases, and the protocols to be followed in situations like pandemic among the people makes it difficult to draw a definitive conclusion.

Since there were no similar studies available for comparison, the significance of the findings may be interpreted within the context of being the first study of its kind. The lack of comparative studies makes it challenging to make direct comparisons or draw definitive conclusions about the broader community. However, the results provide initial insights into the participants’ KAP and indicate a potential need for further research in this area.

Risks

If infection control protocol is not followed, there can be sudden outbreaks, an increase in the number of multidrug-resistant bacteria, and an increase in the number of casualties.

Study Limitations

The survey was solely based on the respondent’s self-assessment. Since the students were not supervised during their routine practice, the responses do not accurately reflect their knowledge and attitude.¹¹ Therefore, there may be a discrepancy between the actual practice and the reported response. Another limitation is that the survey was restricted to two colleges. Thus, the study’s outcome was insufficient to detect statistical differences with respect to the reports. Despite the high response rate, sampling bias still exists. Hence, future studies must aim to examine a broader range of demographic factors for authentication.

CONCLUSION

In conclusion, the dental undergraduate students at this private dental college in India reported reasonably good infection control practices. For the patient and the dental staff, there is a life-threatening risk associated with inadequate infection management. All dental offices, hospitals, and other institutions have to adhere to appropriate infection control procedures. However, the institution needs to make a few adjustments and improvements to allow students to adhere to stringent infection control protocols. The entire dental healthcare workforce needs to create and closely adhere to formal programs in infection control and safety in order to improve and maintain a hygienic condition. The dental curriculum and grade system can be revised to evaluate the overall quality of care.

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