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International Journal of Dentistry and Oral Science (IJDOS)  /  IJDOS-2377-8075-08-6060

Knowledge Attitude And Practice Of Dentists Towards Prophylaxis After Exposure To Blood And Body Fluids


Abhishek Naram1, Balakrishna.R.N2*, Deepak.S3

1 Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai - 600 077, India.
2 Senior Lecturer, Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai - 600 077, India.
3 Senior Lecturer, Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai - 600 077, India.


*Corresponding Author

Balakrishna.R.N,
Senior Lecturer, Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai - 600 077, India.
E-mail: balakrishnarn.sdc@saveetha.com

Received: May 08, 2021; Accepted: June 16, 2021; Published: June 25, 2021

Citation: Abhishek Naram, Balakrishna.R.N, Deepak.S. Knowledge Attitude And Practice Of Dentists Towards Prophylaxis After Exposure To Blood And Body Fluids. Int J Dentistry Oral Sci. 2021;8(6):2873-2878.doi: dx.doi.org/10.19070/2377-8075-21000583

Copyright: Balakrishna.R.N©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.



Abstract

Post-exposure prophylaxis plays an important role in prevention of blood and borne diseases after occupational exposures. This study was aimed at assessing the level of knowledge, attitude and practice of dental students on prophylaxis after exposure to blood and body fluids. A self administered questionnaire consisting of 10 questions regarding knowledge attitude and practice regarding prophylaxis after exposure to blood and body fluids. Data was collected through google forms. responses were analysed and statistical data is represented as pie charts. In the present study 48% of the participants know the duration of PEP to be taken. 96% of the students agree to the fact that PEP reduces the likelihood of being HIV positive. 68% of the participants did not attend any training program regarding PEP. Knowledge, attitude and practice of dentists working in Saveetha dental college towards prophylaxis after exposure to blood and body fluids is adequate but there are knowledge gaps. Interventions to raise their knowledge are therefore recommended.


Full Text -HTML

1.Keywords
2.Introduction
6.Conclusion
8.References

Keywords

Anterior Teeth; Gingival Recession; Malocclusion; Recession; Types Of Malocclusion.


Introduction

Occupational exposure is defined as contamination of a health care worker (HCW) with patient's blood or body fluids during his/her professional practice.These exposures, which are common among HCWs, include sharp injuries, mucocutaneous contamination, and bites.These exposures are an important hazard for HCWs because they can result in the transmission of bloodborne pathogens such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) Although avoiding exposures is very important for preventing transmission of the pathogens, post-exposure prophylaxis (PEP) is also an essential element of programs to stop infection and is vital for HCWs' safety. [1]

PEP includes procedures that have to be done after exposure to patients' blood and body fluids to stop probable microorganism transmission.[1] These procedures include immediate washing of the exposed area; determination of risk associated with exposure; evaluation of the source patient for acquired immune deficiency syndrome (AIDS), HBV and HCV; injection of hepatitis B vaccine and immunoglobulin; consumption of antiretroviral drugs; and evaluation and follow from the exposed HCW. [2] Each of those procedures is indicated under a particular circumstance and a number of other studies have shown their efficacy. [3] The study of Cardo, et al, showed that consuming zidovudine after injury with a needle contaminated by HIV-positive patient's blood reduced the risk of HIV transmission by approximately 80%. [3] After exposure to HBs-Ag+ blood, injecting either hepatitis B vaccine or immunoglobulin alone can reduce the risk of HBV infection by nearly 70%, according to the Center for Disease Control and Prevention (CDC) guidelines. [1]

Dentists are more prone to occupational exposure because of close contact with the patients' oral cavity, using sharp instruments and operating with high speed rotary instruments, which produce infectious aerosols. [4, 5] According to a previous study, 73% of dental students at Shiraz University of Medical Sciences had been injured with a sharp instrument a minimum of once during their clinical practice.[6] In London, only 76% of junior doctors were aware that PEP would reduce HIV transmission. [7] In Scotland, 16% of HCWs had not been immunized against HBV, although they were in danger of blood and body fluids exposures. In Brazil, 44% of dentists after sharp injury and 14% of them after mucosal contamination with potentially infectious fluids investigated whether the source patient was carrier of bloodborne viruses or not, and only 11% of them sought medical aid after occupational exposure. [8]

Recently, there's an increasing attention towards occupational hazards in HCWs and so as to reduce the hazards, several protocols and guidelines are established in developed countries. However, to the best of our knowledge, there's no precise information on the dentists' behavior after blood and body fluids exposure in Iran. To enhance the HCWs safety and establish local guidelines, more information is important . Previously our team has a rich experience in working on various research projects across multiple disciplines The [9-23]. The Aim of the study is to assess the knowledge, attitude, and practice of dentists working in saveetha dental dental college regarding prophylaxis after exposure to blood and body fluids.


Materials And Methods

This was a cross-sectional study conducted among dental students undergoing training in saveetha dental college and hospitals. Data were collected by means of a self-administered questionnaire consisting of 10 closed ended questions. The survey was prepared in the form of google forms and was sent to potential responders. 100 people have responded to the survey.The questionnaire consisted of questions regarding knowledge about prophylaxis after exposure to blood and body fluids Convenient sampling method was used for data collection. The responses were presented as percentages. Data was tabulated and statistical analysis was done using spss software.


Results And Discussion

From the results [fig1] 96% of the students said they evaluate general health and medical history before dental care. [fig2] When asked if they wear protective equipment while treating patient 92% of the participants wear protective gear while treating patients. [fig3] 79% of the students were aware of the PEP whereas 21% of the students aren't aware of the PEP. [fig 4]72% of the study participants know when PEP is indicated whereas the other 28% of the participants do not know about it. [fig 7] 36% of the study population does not know the preferable time to take PEP. however [fig 9 ]70% of the participants know the duration to which PEP to be taken and 30% of the participants doesn't know the duration of the pep to be taken. [fig 5] 59% of the participants know the guidelines for taking pep whereas other 41% do not know about it.[fig 6] 97% of the participants agree with the fact that PEP reduces the likelihood of being HIV positive. [fig 8] when asked regarding maximum delay for taking PEP majority of the participants responded as 72 hours. [fig 10] 68% of the participants did not attend any training regarding post exposure prophylaxis whereas 32% have attended.

HIV and HBV constitute a serious public health concern, and occupational exposure of HCWs to these viruses poses a threat to healthcare delivery systems in resource-limited settings. Standard precautions have been advocated by the Centre for Disease Control (CDC, USA) as a means to reduce occupational exposures to HIV and other blood-borne pathogens. [24] In spite of the precautions, occupational exposure still occurs. Therefore, studies relating to knowledge, attitude and practices of HCWs are vital as they help to inform policy formulations on occupational PEPs against blood-borne pathogens, such as HIV and HBV. This study shows that 77% of the participants have heard about PEP for HIV. This finding is higher than similar studies conducted in India. In the institution where the present study was done, there is an infection control unit where incidences of occupational exposures are reported and PEP Instituted. But, updates or seminars on standard precautions and PEP aren't routinely finished the HCWs.

In this study, 73% of respondents had knowledge of the best time for the initiation of PEP, which is higher compared to that to HIV and other blood-borne pathogens. [24] In spite of the precautions, occupational exposure still occurs. Therefore, studies relating to knowledge, attitude and practices of HCWs are vital as they help to inform policy formulations on occupational PEPs against blood-borne pathogens, such as HIV and HBV. This study shows that 77% of the participants have heard about PEP for HIV. This finding is higher than similar studies conducted in India. In the institution where the present study was done, there is an infection control unit where incidences of occupational exposures are reported and PEP Instituted. But, updates or seminars on standard precautions and PEP aren't routinely finished the HCWs.

In this study, 73% of respondents had knowledge of the best time for the initiation of PEP, which is higher compared to that nars on PEP and standard precautions aren't frequently administered for the HCWs within the institution. This is less than the Mathewos et al. [25], but higher than the report by Shivaprakash et al.,[28] among dental surgeons in India. The majority of the dental surgeons in the present study had adequate knowledge about PEP for blood-borne viral infections, which is higher than the finding of Tebeje and Hailu [29] in south-west Ethiopia, but slightly higher than what is reported in a Zimbabwean study [30]. The dental surgeons exhibited a good attitude towards PEP for HIV/HBV. Over 95% of the participants agreed on the importance of PEP for HIV/HBV and the availability of PEP guidelines in work place. This finding was similar to that reported by Mathewos et al.,[25].

The available medical literature does not adequately address the issue of the HCW’s knowledge-base on modes of transmission and PEP for HBV and HCV. [31] Some of the reasons cited by the respondentsin study by sivaprakash et al for not taking of the PEP service included: fear of stigmatisation and discrimination; lack of awareness of the existence of the PEP service and protocol; and, lack of understanding of the value of reporting exposures. Comparatively, an alarmingly high proportion of Nigerian surgeons in another centre took no action once they were exposed. [32] A study of European medical students found that few students did not report needlestick injuries, [33] and only 18% of London, England, doctors sought advice regarding PEP despite over three-quarters of doctor reporting occupational injury. [7] the rationale for the discontinuation of PEP was found to be fear of adverse effects among the respondents. This finding was in agreement with another study conducted in Dar es Salaam, in which they showed that many respondents failed to use PEP for the full length of the time prescribed [34]. Our institution is passionate about high quality evidence based research and has excelled in various fields [35-45]. One of the limitations of our study was that in evaluating the dentists' practice, we trusted their personal statements, which might be different from their real practice. Moreover, this research was a cross sectional study and thus suffered from all limitations of this type of the study.


Figure 1. Bar graph shows the percentage distribution of patients with recession and malocclusion. X axis shows the age group of patients and Y axis shows the percentage of recession patients with malocclusion. 18-25 years age group 20.75% (blue), 26-30 years age group 22.64% (green), 31-35 years age group 39.62% (beige), 36-40 years 16.98% (yellow). From the graph we can infer that the most common age group with recession and malocclusion was 31-35 years by 39.62%.

Figure 2. Bar graph shows the percentage distribution of patients with recession and malocclusion. X axis shows gender and Y axis shows percentage of recession patients with malocclusion. 67.92% of patients with recession and malocclusion were male (blue) and 32.08% of patients were female (green). From the graph we can infer that the most common gender with recession and malocclusion was male by 67.92%.

Figure 3. Bar graph shows the percentage distribution of malocclusion in patients with recession. X axis shows the malocclusion types and Y axis shows percentage of recession patients with malocclusion. Majority of patients with recession had class II div 1 malocclusion by 56.60% (beige) and the least number of patients with recession had class II malocclusion by 1.887% (green). From the figure we can infer that the common type of malocclusion that is prevalent in recession patients is angle’s class II div 1 by 56.60%.

Figure 4. Pie chart shows the percentage distribution of sites at which recession is more prevalent in patients with malocclusion. From the pie chart it is evident that 86.79% of patients with malocclusion had recession in the anterior teeth (blue) and 13.21% patients with malocclusion had recession in the posterior teeth (green). From the graph we can infer that the most common site for recession is anterior teeth (86.79%).

Figure 5. Bar graph shows the association between malocclusion classification with sites affected. X axis shows the types of malocclusion and Y axis shows the number of recession patients with malocclusion. Anterior teeth (blue) and posterior teeth (green). From the graph we can infer that class II div 1 (50.94%) was the type of malocclusion that was prevalent in patients with recession in the anterior teeth. However chi square test shows p value .444 (p >0.05) was statistically not significant.

Figure 6. Bar graph shows the association between the site of recession with gender of the study population. X axis shows the gender of the study population and Y axis shows the number of recession patients with malocclusion. Anterior teeth (blue ) and posterior teeth (green).From the figure we can infer that male patients had maximum recession in the anterior teeth (54.72%). Chi square test shows p value .051 (p <0.05) was statistically significant.

Figure 7. Bar graph shows the association between the site of recession with gender of the study population. X axis shows the gender of the study population and Y axis shows the number of recession patients with malocclusion. Anterior teeth (blue ) and posterior teeth (green).From the figure we can infer that male patients had maximum recession in the anterior teeth (54.72%). Chi square test shows p value .051 (p <0.05) was statistically significant.

Figure 8. Bar graph shows the association between the site of recession with gender of the study population. X axis shows the gender of the study population and Y axis shows the number of recession patients with malocclusion. Anterior teeth (blue ) and posterior teeth (green).From the figure we can infer that male patients had maximum recession in the anterior teeth (54.72%). Chi square test shows p value .051 (p <0.05) was statistically significant.

Figure 9. Bar graph shows the association between the site of recession with gender of the study population. X axis shows the gender of the study population and Y axis shows the number of recession patients with malocclusion. Anterior teeth (blue ) and posterior teeth (green).From the figure we can infer that male patients had maximum recession in the anterior teeth (54.72%). Chi square test shows p value .051 (p <0.05) was statistically significant.

Figure 10. Bar graph shows the association between the site of recession with gender of the study population. X axis shows the gender of the study population and Y axis shows the number of recession patients with malocclusion. Anterior teeth (blue ) and posterior teeth (green).From the figure we can infer that male patients had maximum recession in the anterior teeth (54.72%). Chi square test shows p value .051 (p <0.05) was statistically significant.

Conclusion

In conclusion, the study revealed that the knowledge and practice of dental surgeons prophylaxis after exposure to blood and body fluids is Availability of a formal PEP training centre with proper guidelines is recommended to enhance the knowledge attitude and practice amongst dental surgeons regarding prophylaxis after exposure to blood and body fluids.


Acknowledgment

With sincere gratitude, we acknowledge the staff members of the department of oral and maxillofacial surgery, department of conservative dentistry and endodontics and saveetha dental college and study participants for their extended support towards the completion of research.


Authors Contribution

Abhishek - carried out the survey and writing of the manuscript
Dr. Balakrishnan- corresponding author and guided the study
Dr.Deepak - review of the article.


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