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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 31  |  Issue : 1  |  Page : 4-10

Knowledge, attitudes, and practices regarding sterilization protocol among undergraduate dental students in Faridabad City: A questionnaire-based study


1 Department of Oral Medicine and Radiology, Manav Rachna Dental College, Faridabad, Haryana, India
2 Department of Public Health Dentistry, Inderprastha Dental College, Sahibabad, Uttar Pradesh, India

Date of Submission13-Nov-2018
Date of Acceptance15-Feb-2019
Date of Web Publication23-Apr-2019

Correspondence Address:
Dr. Sumit Bhateja
Department of Oral Medicine and Radiology, Manav Rachna Dental College, Faridabad, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_186_18

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   Abstract 


Aim: To assess the level of knowledge, attitudes, and practices regarding sterilization/infection control measures among undergraduate dental students. Materials and Methods: A total of 300 dental students from Manav Rachna Dental College, Faridabad, Haryana participated in this study. A questionnaire survey comprising 24 questions regarding knowledge, attitudes, and practices was completed by the participants. Results: It was observed that a majority of the students were highly concerned regarding the sterilization and infection control protocol. 96.9% students dispose of their gloves after use. About 89% are aware of the exact specifications of sterilization via autoclave. Use of mouth masks and head caps as effective infection control measures was practiced among 82.4% students. A large fraction of students comprising about 85% believed that proper sterilization could not be achieved by simple boiling of instruments. Conclusion: The level of knowledge and attitude of sterilization measures were acceptable, although compliance and practice of the same needs to be more worked upon.

Keywords: Attitude, dental students, infection control, knowledge, practice, sterilization


How to cite this article:
Sachdeva A, Sharma A, Bhateja S, Arora G. Knowledge, attitudes, and practices regarding sterilization protocol among undergraduate dental students in Faridabad City: A questionnaire-based study. J Indian Acad Oral Med Radiol 2019;31:4-10

How to cite this URL:
Sachdeva A, Sharma A, Bhateja S, Arora G. Knowledge, attitudes, and practices regarding sterilization protocol among undergraduate dental students in Faridabad City: A questionnaire-based study. J Indian Acad Oral Med Radiol [serial online] 2019 [cited 2019 Dec 15];31:4-10. Available from: http://www.jiaomr.in/text.asp?2019/31/1/4/256895




   Introduction Top


Sterilization is defined as the process by which an article, surface, or medium is made free of all microorganisms either in the vegetative or spore state.[1] Disinfection means the destruction or removal of all pathogens or organisms capable of producing infections.[1] Barrier protection of personnel using masks, protective eyewear, gloves and gowns, instrument sterilization, and methods of avoiding direct contact with various surfaces are mandatory.[2] Dental health personnel is at high risk of exposure to cross-infection with blood-borne pathogens such as hepatitis B virus, other viruses, and bacteria that colonize the oral cavity and the upper respiratory tract.[3] As most instruments directly contact mucosa or penetrate oral tissues, it is essential that contaminated reusable instruments be cleaned and sterilized thoroughly by using accepted methods that can be tested and monitored routinely.[2] Rotary instrumentation can expose personnel to heavy spatter of >50 mm particles and mists. Aerosol particles of <5 mm remain suspended and can reach the alveoli if not stopped by a barrier.[2] According to the Centers for Disease Control, dental instruments are classified into three categories depending on the risk of transmitting infection, that is, critical, semi-critical, and noncritical, based on the following criteria:[4]

  1. Critical instruments are those used to penetrate soft tissue or bone, or enter into or contact the bloodstream or other normally sterile tissue. They should be sterilized after each use. Sterilization is achieved by steam under pressure (autoclaving), dry heat, or heat/chemical vapor. Critical instruments include forceps, scalpels, bone chisels, scalers, and surgical burs
  2. Semi-critical instruments are those that do not penetrate soft tissues or bone but contact mucous membranes or non-intact skin, such as mirrors, reusable impression trays, and amalgam condensers. These devices also should be sterilized after each use. In some cases, however, sterilization is not feasible and, therefore, high-level disinfection is appropriate
  3. Noncritical instruments are those that come into contact only with intact skin such as external components of x-ray heads, blood pressure cuffs, and pulse oximeters. Such devices have a relatively low risk of transmitting infection; and, therefore, may be reprocessed between patients by intermediate-level or low-level disinfection.


Various methods of sterilization[1] have been summarized in [Table 1].
Table 1: Showing different methods of sterilization

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The most commonly employed method of sterilization in the dental office is by autoclave. The principle of an autoclave is similar to that of a pressure cooker. It is designed to sterilize materials by the use of steam under pressure, in which steam is the sterilizing factor while pressure is used only to raise the temperature of the steam.[5] This apparatus provides the most effective method of sterilization and can be used successfully in the dental office. An autoclave can be used to sterilize culture media, gowns, dressings, gloves, etc.

Sterilization specifications[1] are 121°C temperature, 15 lbs pressure, and holding time of 15 min.

Dental health personnel including dental students are at high risk of exposure to cross-infection with blood-borne pathogens as they are continually exposed to blood and saliva mixed with blood, and may even suffer needle punctures.[6] There is a lack of awareness and knowledge regarding sterilization protocols among dental students. The students of today are practitioners of tomorrow. To our surprise, even many practicing dentists are ignorant about the importance of following sterilization protocols in their practice. So in our opinion, it is time for dentistry to recognize the importance of maintaining sterilization protocols at the highest level that will yield the greatest public benefit.

With this background, the current study was carried out to assess the knowledge, attitudes, and practice regarding infection control measures among undergraduate dental students and interns.


   Materials and Methods Top


A self-administered questionnaire survey comprising 24 questions was formulated by an oral medicine specialist and two dental surgeons. The survey was conducted among 300 undergraduate dental students (including the third year, final year, and interns) of Manav Rachna Dental College, Faridabad, Haryana. The dental students were given the questionnaire in their respective classrooms and were asked to fill it on their own. The interns were given the same questionnaire in their respective clinical posting departments. The questions were designed to assess the knowledge, attitude, and practice of infection control. The study was approved by the Institutional Ethical Committee.


   Results Top


It was observed that 96.9% of students dispose of their gloves after use. About 89% are aware of the exact specifications of sterilization via autoclave. Use of mouth masks and head caps as effective infection control measures were practiced among 82.4% students. A large fraction of students comprising about 85% believed that proper sterilization could not be achieved by simple boiling of instruments. Almost 68% do not sterilize their air rotors and burs after repeated use. Also, 76% do not sterilize their patient drapes which could act as a potent source of infection via saliva or blood. It has been seen that a majority of students do not wear protective eyewear to prevent them from droplet infection. The results of the study have been tabulated in [Table 2]. Question-wise analysis has been represented in [Chart 1],[Chart 2],[Chart 3],[Chart 4],[Chart 5],[Chart 6],[Chart 7],[Chart 8],[Chart 9],[Chart 10],[Chart 11],[Chart 12],[Chart 13],[Chart 14],[Chart 15],[Chart 16],[Chart 17],[Chart 18],[Chart 19],[Chart 20],[Chart 21],[Chart 22],[Chart 23],[Chart 24].
Table 2: Showing responses of participants regarding knowledge, attitudes, and practices among dental students

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   Discussion Top


It is of utmost importance for any healthcare center to set up and govern its own measures to prevent the spread of infectious and communicable diseases. To achieve this, it is important that health care professionals be aware of the protocols and risks involved in the practice. The aim of this study was to assess the level of knowledge, attitudes, and practices of dental students regarding sterilization and infection control protocols. In this study, the level of practice and compliance with infection control measures was unsatisfactory among the students. Acceptable reasons for this could be inadequate training for infection control measures and negligence among the students. Similar studies were also conducted earlier by Askarian and Assadian,[7] Henrique et al.,[8] Taiwo and Aderinokun,[9] and Ogden et al.[10] in Iran, Brazil, Nigeria, and the UK. Henrique et al.[8] earlier conducted a 10-year study to assess attitudes and behavior of dental students concerning infection control rules. In 1995, most students used an autoclave to sterilize instruments (83.8%), and this percentage subsequently rose in the year 2005 (95.9%). No student could describe the correct temperature and sterilization time in either 1995 or 2005. However, in our study, 89.6% of the students answered correctly about temperature and sterilization time. The high percentage of correct answers to questions about sterilization procedure revealed good knowledge. The study carried out by Razak and Linda in Malaysia[11] concluded that about 83.0% of dentists wear a face mask. This was nearing the results of our study where 90.7% wear a face mask while examining any patient. Almost 94% of students believed in the importance of isolation in infection control. With respect to attitudes towards adherence to infection control measures, the majority of the respondents believed infection control measures to be necessary. In one study conducted in the year 2001, 55.5% of the students advised an oral mouth rinse before the commencement of any treatment procedure.[12] This was in accordance with our findings in which almost 59.8% advice oral mouth rinse. It was surprising to note that despite being aware of the importance of sterilization in the dental profession, certain drawbacks regarding practices of the same were observed. The attitude towards infectious control measures was positive, but greater compliance with clinical practice was needed. Rigorous infection control training for students before graduation is also highly recommended. The findings in this study should also act as alarm bells for dental educators in various dental colleges about the importance of educating their students clearly and comprehensively about infection control measures which should be strictly followed.

One of the limitations that we found to our study was the method for assessment. We could not supervise the responders' actual practice and, therefore, had to rely on their self-assessment. Therefore, the responses might have not accurately reflected the true knowledge and attitude in practice. Students are more likely to comply with an infection control programme only if they understand the basic motive behind it.


   Conclusion Top


Dental students in this study displayed a positive level of knowledge regarding sterilization and infection control practices. However, the knowledge acquired must be practically administered into daily practice. Compliance can be improved by upgrading students' knowledge through educational programmes and making them aware of the various health hazards that can occur following malpractice of sterilization and infection control measures. So through this study, we sincerely appeal to the Dental Council of India that dental schools in India should expand subjects like “STERILIZATION PROTOCOLS” in the curriculum for BDS students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ananthanarayan and Paniker's Textbook of Microbiology, Seventh Edition, Chapter - 3: Sterilization and Disinfection.  Back to cited text no. 1
    
2.
Sturdevant's Art & Science of Operative Dentistry, South Asian Edition, Chapter - 5: Infection Control.  Back to cited text no. 2
    
3.
Rahman B, Abraham SB, Alsalami AM, Alkhaja FE, Najem SI. Attitudes and practices of infection control among senior dental students at college of dentistry, university of Sharjah in the United Arab Emirates. Eur J Dent 2013;7(Suppl 1):S15-9.  Back to cited text no. 3
    
4.
American Dental Association. Available from: https://www.ada.org/. [Last updated on 2009 Jul 09].  Back to cited text no. 4
    
5.
Frobisher, Martin Jr. Fundamentals of Bacteriology. Philadelphia and London: W. B. Saunders Company; 1949. p. 70-2, 99-120.  Back to cited text no. 5
    
6.
Su J, Deng XH, Sun Z. A 10-year survey of compliance with recommended procedures for infection control by dentists in Beijing. Int Dent J 2012;62:148-53.  Back to cited text no. 6
    
7.
Askarian M, Assadian O. Infection control practices among dental professionals in Shiraz Dentistry School, Iran. Arch Iranian Med 2009;12:48-51.  Back to cited text no. 7
    
8.
Henrique M, Claudia T, Braz F, Lúcia A, Martins S, Almeida I. Attitudes and behavior of dental students concerning infection control rules: A study with a 10-year interval. Braz Dent J 2009;20:221-5.  Back to cited text no. 8
    
9.
Taiwo JO, Aderinokun GA. Assessing cross infection prevention measures at the dental clinic, University College Hospital, Ibadan. Afr J Med Sci 2002;31:213-7.  Back to cited text no. 9
    
10.
Ogden GR, Bahrami M, Sivarajasingam V, Phillips G. Dental students' knowledge and compliance in cross-infection control procedures at a UK dental hospital. Oral Dis 1997;3:25-30.  Back to cited text no. 10
    
11.
Razak IA, Linda OP. Cross infection control in Malaysian dental practice. Singapore Dent J 1995;20:11-5.  Back to cited text no. 11
    
12.
Leggat PA, Kedjarune U. Bacterial aerosols in the dental clinic: A review. Int Dent J 2001;51:39-44.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2]



 

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