ORIGINAL ARTICLE
Patients’ Perception of Cross-infection Prevention in Dentistry in Jordan Nicola Barghouta/Rola Al Habashnehb/Soukaina T. Ryalatc/ Farah A. Asa‘add/Mousa Marashdehe Purpose: To explore the public perception of cross-infection prevention methods and their role in disease transmission, among patients attending Jordan University Hospital. Materials and Methods: A systemic random sample of 310 dental patients with a mean (SD) age of 35.1 (14.80) years was selected (42.6% males and 57.4% female). Patients were interviewed prior to dental appointments by a specially trained and calibrated dentist. Responses of the patients were recorded in the structured questionnaire, maintaining their privacy and confidentiality. The data were entered into a Microsoft Excel spreadsheet and analysed using the SPSS statistical package to obtain the prevalence rates of patients’ perceptions, which were then cross tabulated with gender, age and other variables. Significant differences were determined using the chi-square test, when appropriate. Results: Of the respondents, 83.5% found it necessary for the dentist to wear gloves, and 65.8% stated the reason was to prevent cross infection from one patient to another. About three-quarters (74.8%) found it necessary for the dentist to wear a mask; when asked about the reason, 52.3% stated prevention of cross infection from dentist to patient. Regarding wearing protective glasses, about three-quarters (73.9%) found it unnecessary for the dentist to do so. The majority (76.8%) stated the method of HIV transmission was by dentists using needles previously used for patients infected with AIDS; 71% knew there is no vaccine against HIV. Only half (49%) reported that hepatitis could be transmitted by blood transfusion. Approximately two-thirds (67.4%) knew there is a vaccine against hepatitis. About 53.5% claimed their knowledge regarding infection transmission was obtained through watching television programmes about cross infection. Conclusion: Dental patients in Jordan need to be equipped with adequate knowledge about cross-infection control, thus education reinforcement is imperative. Key words: cross-infection control, dentists, gloves, hepatitis, HIV, Jordan, public perception Oral Health Prev Dent 2012; 10: 9-16
C
ross infection may be defined as the transmission of infectious agents between patients and staff within a clinical environment. Transmission may result from person-to-person contact or via
a
Instructor, University of Jordan, Amman, Jordan.
b
Associate Professor, Jordan University of Science and Technology, Irbid, Jordan.
c
Assistant Professor, University of Jordan, Amman, Jordan.
d
Master’s Student, Jordan University of Science and Technology, Irbid, Jordan.
e
Assistant Professor, Jordan University of Science and Technology, Irbid, Jordan.
Correspondence: Dr Rola Alhabashneh, Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid 22110, Jordan. Tel: +962-79-606-4813. Fax:+ 962-2720-1064. Email:
[email protected]
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Submitted for publication: 22.10.10; accepted for publication: 04.03.11
contaminated objects. The mode of transmission can be through blood, droplets of saliva, instruments contaminated with blood, saliva and tissue debris. The route of transmission is either by inhalation, contact or inoculation (Samaranayake and Jones, 2006). Most exposures are accidental and can be avoided by using safe work practices and following infection control guidelines. However, because some exposures are not preventable, immunisation and appropriate post-exposure management are important measures (McCarthy and Britton, 2000). Of concern to both healthcare workers and the public is the risk of exposure to blood-borne pathogens, including hepatitis B and C viruses (HBV and HCV) and human immunodeficiency virus (HIV) (McCarthy and Britton, 2000). Cross-infection control meas-
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ures carried out by dentists and healthcare workers have been studied widely, and mainly focussed on wearing gloves, masks, safety glasses, proper attire, the sterilisation of instruments and surgery disinfection (CDC, 1993). Furthermore, several studies have been conducted to explore the public perception and knowledge of cross-infection control in dentistry (Borsum and Gjermo, 2004; Crossley, 2004; Mulligan et al, 2006). In a study conducted by Maguire et al (1989), 69% of the patients expected their dentists to wear gloves, 47% expected them to wear a protective mask and 25 % expected the use of protective eye wear by their dentists. Among UK and Hong Kong patients, over 50% of patients believed that they could contract HIV from an HIV-infected dentist. In addition, almost all patients expected dentists to wear protective gloves, but only 73% and 40% expected dental staff to wear protective face masks and spectacles, respectively. Most patients were aware that such measures were for the benefit of both dental staff and patients (Porter et al, 1993). Although this observation was consistent with a Nigerian study (Otuyemi et al, 2001), another study found that one-third of the patients thought that the gloves were for the dentists’ own protection (Samaranayake and McDonald, 1990). Grace and colleagues (1991) assessed the public’s attitude toward infection control techniques utilised in dentistry. 69.8% of the respondents preferred gloves to be worn by their dentist. Respondents received information about HIV from various sources, chiefly newspapers or magazines (29.0%) and television (27.3%), but 80.9% would read pamphlets on HIV if they were available in the dentist’s office. Humphris et al (1993) found that 13% of the patients claimed to be aware from the media of someone having been cross infected with HIV from a dental visit. Regarding HIV transmission, Tsang et al (1993) reported ignorance of the patients on this subject as one-third thought that insect bites could spread HIV infection. In a study conducted by Bowden et al (1989), most of the dental patients surveyed believed that gloves should be worn by the dentist. Patients receiving care in a dental hospital as opposed to general practice were more enthusiastic in the belief that dentists should wear gloves and/or a mask. Shulman and Brehm (2001) found that 77.4% of the respondents preferred dentists to wear masks when providing their care and they preferred the use of plastic barriers, which 63% said would make them feel confident that proper infection-control
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procedures were followed. In an Egyptian study (Mousa et al, 1997), 90% of the patients expected dentists to wear gloves, 73% expected them to wear face masks and 37% to wear spectacles. Interestingly, few patients (3.6%) reported having avoided or delayed dental visits due to their perception of the risk of cross infection (Thomson et al, 1997). Knowing patient perception of infection control methods will affect dental practice. Heightened awareness among patients will hopefully help them to ask and remind members of the dental team to take all necessary steps to prevent cross infection to protect both their patients and themselves. Therefore, our present study aimed to explore the perception among dental patients attending Jordan University Hospital of cross-infection prevention methods and their role in disease transmission.
MATERIALS AND METHODS After being approved by the ethics committee of Jordan University, this cross-sectional study was conducted over a period of two weeks in 2009 among patients attending Jordan University Hospital. Systematic random sampling of 50% of the total patients attending the dental clinics from May 10 to 25, 2009 was conducted. All patients attending the clinic with even numbers (2, 4, 6, 8, … ) were invited to participate by the research team. A total of 663 patients were present in the clinic on the days of the research team’s visit, bringing the total number of invited participants to 330. All invited patients agreed to participate, therefore, there were no non-respondents. Sex and age distribution of the obtained sample are given in the results section. During auditing of the completed structured questionnaire, twenty questionnaires were not filled out correctly and were thus excluded from the statistical analysis, bringing the total number of questionnaires ready for analysis down to 310.
Data collection All participants underwent a structured interview by a trained dentist after signing an informed consent form. A questionnaire designed for the purpose of this study sought data about sociodemographic and other relevant characteristics of the participants, including age, income, occupation and pat-
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terns of attendance at the dental clinic. The questionnaire also included ten questions which dealt with cross-infection barriers used by dentists, subjects’ knowledge about HIV and hepatitis and the methods of their transmission, the presence of vaccines against them, watching educational programmes on the transmission of diseases, dental visits and instrument sterilisation. After the preliminary construction of the questionnaire, it was presented to 10 dentists as arbitrators to test its validity. Their observations in terms of amendments, deletions and additions were taken into consideration. Subsequent to final construction of the questionnaire, it was distributed to 50 attendants (patients) in the waiting rooms at dental clinics in the Jordan University Hospital in order to determine clarity, relevance of questions and time needed to fill the questionnaire. This was carried out prior to the actual data collection. The 50 questionnaires were not included in the study sample, but were used to calculate the value of the coefficient of internal consistency (Cronbach’s alpha test), which reached 87%, indicating a high degree of internal consistency between the questionnaire questions. The Pearson correlation coefficient – split halves (odds, evens) – was extracted on some key questions; it ranged between 0.78% and 0.85%, indicating reliability and stability of the questionnaire. It took most of the participants 5 to 10 minutes to fill out the questionnaire.
Statistical analysis The Statistical Package for the Social Sciences software (SPSS, version 11.5) was used for data processing and analysis. Characteristics of subjects’ variables were described using frequency distribution for categorical variables, and mean and standard deviation for continuous variables. The chi-square test was used to assess significant differences between respondents in categorised variables. A P value of ≤ 0.05 was considered to be statistically significant.
RESULTS Among participants, 57.4% were females and 42.6% were males. The mean age was 35.1 ± 14.80 years. The largest group of participants was in the age group of 20 to 29 years, accounting for 32.3%. Students made up 22.3%, which corresponded
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Table 1 Sample description including socioeconomic variables Variable
No. (%)
