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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 2  |  Page : 65-69

Knowledge, attitude and practices about hepatitis B and Infection Control Measures among dental students in Patiala


1 Department of Community Medicine, Government Medical College, Patiala, Punjab, India
2 Department of Prosthodontics, Laxmi Bai Dental College, Patiala, Punjab, India
3 Department of Periodontics, Government Dental College, Patiala, Punjab, India

Date of Web Publication6-Dec-2017

Correspondence Address:
Dr. Vishal Malhotra
195-B, Sewak Colony, Patiala - 147 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-4696.219977

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  Abstract 


Background: Hepatitis B is highly infectious, but preventable diseases and dentists are at increased risk of exposure to saliva and blood of patients during their clinical practice, and so it is of utmost importance that they follow standard guidelines for infection control. Aims: To assess knowledge, attitude, and practices regarding infection control measures among dental students of Government Dental College in Punjab. Materials and Methods: A cross-sectional survey using a self-administered pretested questionnaire to dental students and responses were statistically analyzed. The analysis of variance was used to compare means of knowledge, attitude, and practice scores between four groups of study subjects and P < 0.05 is considered statistically significant. Results: Although the students have sufficient knowledge regarding hepatitis B, still there are gaps in putting their knowledge into practice. Third and final year students have significantly less mean knowledge and practice scores compared to interns and postgraduate students. The majority of students have a positive attitude and were willing to perform any procedure on hepatitis B-infected patients. Conclusions: Dental students have adequate knowledge and good attitude but still there are some misconceptions. There is poor implementation of standard infection control measures in their practice. Rigorous training programs on preventive practices and regular workshops must be organized on an annual basis in dental colleges. Moreover, hepatitis B vaccination must be made mandatory for students before they start their clinical practice.

Keywords: Dental students, exposure, hepatitis B, infection


How to cite this article:
Malhotra V, Kaura S, Sharma H. Knowledge, attitude and practices about hepatitis B and Infection Control Measures among dental students in Patiala. J Dent Allied Sci 2017;6:65-9

How to cite this URL:
Malhotra V, Kaura S, Sharma H. Knowledge, attitude and practices about hepatitis B and Infection Control Measures among dental students in Patiala. J Dent Allied Sci [serial online] 2017 [cited 2017 Dec 17];6:65-9. Available from: http://www.jdas.in/text.asp?2017/6/2/65/219977




  Introduction Top


Dental professionals are exposed to infection during their work because of many potential sources of infection in dental practice, such as wide variety of microorganisms in the blood and saliva of patients such as Mycobacterium tuberculosis, hepatitis B virus (HBV) and hepatitis C virus, staphylococci, streptococci, herpes simplex virus Types 1, human immunodeficiency virus (HIV), mumps, influenza, and rubella. The infection could be a direct infection, contact infection, smear infection, droplet infection, or cross infection.[1] Studies have shown that risk of exposure for general dentists is about three to four times greater, and for nonimmunized surgical specialists about six times greater than that of the general population.[2],[3] It is of utmost importance that effective infection control measures and sterilization procedures be followed by all dental health professionals to prevent cross infection. The incidence of hepatitis B and the prevalence of the carrier state are increasing.[1]

Hepatitis B is highly infectious, and the risk of infection following a needlestick injury with needle from an infected source patient is ~0.3% for HIV, 3% for hepatitis C, and 6%–30% for hepatitis B. Most blood exposures in health settings are preventable. Strategies to protect health workers include implementation of universal precautions, immunization against hepatitis B, provision of personal protection and the management of exposure and are recommended by WHO.[4] Despite having standardized guidelines by the WHO and Centers for Disease Control (CDC) for universal precautions and postexposure prophylaxis (PEP), fewer dentists and dental clinics and even dental colleges where future dentist are trained, adhere to these guidelines and strictly implement them in their clinical practice.[5],[6]

Dental education plays very important role in helping future dentists to acquire adequate knowledge and attitude for infection control measures. The present study was conducted to assess the knowledge, attitude, and practices regarding Hepatitis B infection and other infection control measures among dental students of Government Dental College Patiala.


  Materials and Methods Top


A cross-sectional survey was conducted among dental students (3rd year, final year, interns, and postgraduate) of Government Dental College, Patiala from September 1, 2015, to October 28, 2015. A prestructured questionnaire which consists of 29 questions on knowledge, attitude, practices, and vaccination status was designed and to check the validity, practicability, and rendition of responses it was pretested on random sample of dental students of other private dental college in Patiala. There were 10 questions to check knowledge, 3 questions on attitude, and 16 questions on preventive and protective practices of dental students. Each correct response was allotted one mark since few questions were having multiple options so, maximum marks were 40. There are total of 131 students enrolled, which include postgraduates (21), Interns (30), 4th year (39), and 3rd year (41) in Government Dental College. Of these 117 students gave verbal informed consent and participated in the study which consists of eighteen postgraduate students, 26 interns, 32 final year students, and 41 3rd year students. Dental students of 3rd and 4th year were given questionnaire in the classroom and were asked to fill the questionnaire in 15 min without discussing with each other and in the present of senior faculty of dental college. The interns and postgraduate students were given questionnaire in their respective Departments of Posting and were made to fill the questionnaire in the presence of senior faculty of respective departments. The study was conducted after getting approval from Institutional Ethical Committee. Data were analyzed using Microsoft Excel software, percentage, mean, standard deviation, Chi-square for categorical variables, analysis of variance to compare means of knowledge, attitude, and practices between four groups of students and P < 0.05 was considered significant for all statistical analysis. The overall level of knowledge, attitude, and practices of the study participants were assessed using the sum score of each outcome based on Bloom's cut-off point (60%–80%):[7],[8],[9]

  • (>80%–100%) high levels
  • (60%–80%) moderate levels
  • (<59%) low levels.


Having a score above the cutoff point was equated with having high levels of knowledge, attitude, and good practice.


  Results Top


Of the 117 dental students' male constitute just 21% and females 79% [Table 1]. All the students were aware of hepatitis B, and they have fair knowledge about hepatitis B, but there are some gaps and misconceptions also. Most students were aware about jaundice as a presenting symptom of hepatitis B but fever can also occur in hepatitis was known to just 35% of students and 10% do not know the right laboratory test required for detection of hepatitis B. Most students were well aware about the common modes of spread of hepatitis B, but there are misconceptions also, as 18% students believed that it spreads by hugging and kissing and 17% responded water-borne and mosquito bite as mode of spread, 10% consider animal bite, toilet seats, hair cutting, and sharing towels as mode of spread. Just 55% students responded correctly to ideal age of hepatitis B vaccination. Odds of hepatitis B transmission after single needle stick injury were responded correctly by just 23% dental students. Cirrhosis as a complication of hepatitis B was known to 81% of students, but liver cancer was known to just 45%. Just 10% students have correct knowledge about PEP of hepatitis B. Books and dental study course is source of information of 90% of dental students [Table 2].
Table 1: Distribution of dental students according to gender and class

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Table 2: Knowledge of dental students regarding hepatitis B

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Regarding preventive and protective practices, all students inquire about medical history of patients for any communicable and noncommunicable diseases and washed their hands before and after examination, though only 54% used antiseptic solution and 44% used plain soap for hand washing. Face mask and gloves are used by all the dental students as a standard protective measure, but eye shield is used by just 7.6% and protective clothing by just 30% of students. For instrument sterilization autoclave is used by 61.5%, boiling by 30%, and there are students who used autoclave or boiling depending on the availability of mode of sterilization at that time. The majority of students responded that they sterilized instruments for 15 min. 67.5% dental students have completed their three dose schedule of Hepatitis B vaccination and there is a significant difference between vaccination statuses from 2nd year to postgraduate students. New saliva ejector is used by 70% of the students, and 75% disinfect impression cast, dentures, and wax. Eighty-eight percent students disinfect dental chair. All students used color coded containers for biomedical waste disposal [Table 3] and [Table 4].
Table 3: Preventive and protective practices of respondents

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Table 4: Vaccination status of study subjects (n=117)

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Overall, there was statistically significant difference between means of groups (3rd year, 4th year, interns, and postgraduate) for knowledge and practice scores but not for attitude. Postgraduates have significantly higher knowledge and practice score [Table 5], [Table 6] and [Graph 1]. Blooms cut off point, showed that majority of dental students have moderate level of knowledge.
Table 5: Correlation of total score of positive response of knowledge, protective, and preventive measures adopted

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Table 6: Knowledge, attitude, and practice score of the students of Government Dental College Patiala (blooms cut off)

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  Discussion Top


Although the students have sufficient knowledge regarding hepatitis B still there are gaps in their knowledge about diagnosis, modes of transmission, its infectivity, complications, and PEP. Third and final year students have a significantly less mean knowledge score as compared to interns and postgraduate students, which is reflected in their clinical practice with significantly lower mean practice scores. Regarding vaccination status, 32.47% students did not complete their hepatitis B vaccination schedule in contrast to a study done in Bhopal where 61% students were not vaccinated for hepatitis B.[10] In the present study, significantly lesser number of the 3rd and 4th year students completed their vaccination schedule. The young and inexperienced dental students might underestimate the risk of exposure. Even if not performing invasive procedures, chance of mucocutaneous exposure while examining the patients physically still exists. This reduced perception of risk may translate into recklessness which can prove hazardous. Regarding PEP, just 10% students responded correctly in the present study, which is less than a study done in Nasik Maharashtra, where 31% responded correctly about PEP.[11] It indicates the need to further strengthen the knowledge base of these budding dentists so that they can incorporate these universal precautions in their clinical practice.

In the present study, 61.5% used autoclave, 26.65% students used boiling, 2.5% used washing, and another 10% used autoclave or boiling as method of sterilization depending on availability at that moment, this is in contrast to study[10] where 94.3% dental students are using autoclave to sterilize instruments. Boiling is not recommended method of sterilizations for dental instruments and studies have proved that boiling is ineffective in sterilizing instrument and can expose the patient to risk of cross-infection.[1],[12] Regarding protective measures, all students wear face masks and gloves but eyewear by just 7.6% and protective clothing by 30% of students, similar results are reported by study.[10] New saliva ejector was used by 70% of students; although it is recommended that on every patient new saliva ejector is to be used, this is, in contrast, to study done in Pakistan where just 5.7% dentists do not use new saliva ejector.[13] Disinfection of impression casts, dentures, and wax is done by 75% of students in the current study compared to another study where 37% dentists disinfect them.[13] Most of the dental students disinfect dental chair similar to results reported by study done in Bhopal.[10]

The majority of students have a positive attitude, and 91% were willing to perform any procedure on hepatitis B-infected patients, a study done in Andhra Pradesh reported 65% willingness for treating hepatitis B-infected patients.[14]

Recommendations

Standard PEP protocol for accidental exposure must be in place for timely action and reporting. Counseling of the dental students regarding hepatitis B vaccination at the time of the admission should be done by the dental colleges. Workshops for free HBV vaccination and Continuing medical education (CME) to raise the awareness of the dental students should be organized by dental institutes on an annual basis.

Limitations

One of the limitations of this study was dental students have given their subjective self-assessment and their practice was not supervised by us. Therefore, their responses might not have accurately reflected true level of their knowledge, attitude, and practices.


  Conclusions Top


There are gaps in the knowledge and practices of the dental students, despite having standard guidelines by the WHO and CDC for infection control measures; these are not being implemented rigorously due to lack of resources in government institute which expose the patients to risk of cross infection. The students feel that there should be more free availability of gloves, distilled water, eye shields in the government institute. Factors both administrative and personal must be found out for compliance and strict implementation of infection control guidelines.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Jamani F, Rababah T, Qsous R, Ababneh H, Daameh D. Testing of several methods of sterilization in dental practice. World Health Organization. East Mediterr Health J 1995;1: 80-6. Available from: http://www.emro.who.int/emhj-volume-1-1995/volume-1-issue-1/article9.html. [Last accessed on 2015 Oct 29].  Back to cited text no. 1
    
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Cottone JA, Molinari JA. Hepatitis B vaccines: An update. J Calif Dent Assoc 1989;17:11-4.  Back to cited text no. 3
    
4.
Health Care Worker Safety. Secretariat of the Safe Injection Global Network. Department of Essential Health Technologies, World Health Organization. Available from: http://www.who.int/injection_safety/toolbox/docs/en/AM_HCW_Safety.pdf. [Last accessed on 2015 Oct 29].  Back to cited text no. 4
    
5.
Freire DN, Pordeus IA, Paixão HH. Observing the behavior of senior dental students in relation to infection control practices. J Dent Educ 2000;64:352-6.  Back to cited text no. 5
    
6.
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Nandakumar A, Anantha N, Venugopal TC. Incidence, mortality and survival in cancer of the cervix in Bangalore, India. Br J Cancer 1995;71:1348-52.  Back to cited text no. 7
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Gizaw Z, Gebrehiwot M, Teka Z. Food safety practice and associated factors of food handlers working in substandard food establishments in Gondar Town, Northwest Ethiopia. Int J Food Sci Nutr Diet 2014;3:138-46.  Back to cited text no. 8
    
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Singh A, Purohit BM, Bhambal A, Saxena S, Singh A, Gupta A. Knowledge, attitudes, and practice regarding infection control measures among dental students in Central India. J Dent Educ 2011;75:421-7.  Back to cited text no. 10
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Pandharbale AA, Gadgil RM, Bhoosreddy AR, Ahire BS, Kunte VR, Shinde MR. An epidemiological study to assess the awareness of hepatitis B infection in the dental students, college staff, practitioners, and auxiliary staff in city of Maharashtra. J Indian Assoc Public Health Dent 2015;13:179-82.  Back to cited text no. 11
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Martin MV, Bartzokas CA. The boiling of instruments in general dental practice: A misnomer for sterilisation. Br Dent J 1985;159:18-20.  Back to cited text no. 12
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Batool A, Sherwani M, Bano K, Aasim M. Knowledge, attitude and practices of dentists about hepatitis B and C infection in Lahore. Pak J Med Res 2012;51:93-6.  Back to cited text no. 13
    
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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