Knowledge, Attitude, and Practices Regarding the use of Hazmat Kitamong Dental Professionals

Keywords

Hazmat Kit; Accidental Spill Management; Emergency Care; Zone Of Hazard; Knowledge; Attitude; Practices; Dental Professionals.

Introduction

In a hospital, or any other healthcare setting, hazardous substances such as bodily fluids, drugs, cleaning fluids and other chemicals are in very close proximity to hundreds of people each day. Hospital spillages can occur at any time, which can be due to broken or faulty equipment or human error. If this happens, everyone in the area is at risk, from staff to visitors to patients. Some of these people, namely the hospital’s patients, may be extremely susceptible to infection, due to illness or recent surgery resulting in an open wound [1]. It may also mean that a department has to close temporarily, which means that vital services may be denied to those that need them. Because a hospital environment necessitates use of hazardous substances, it is vital that contact with them is kept to a minimum, even by those who are used to handling such chemicals [2]. For example, many medical instruments contain mercury, which is a powerful neurotoxin, and some drugs, particularly those used in the treatment of cancer, are cytotoxins, meaning they are toxic to cells [3, 4]. It is essential, therefore, that all hospital departments have the right equipment and well-trained staff on hand to deal with any hazardous spills immediately when they arise [5].

HAZMAT is a term used to describe incidents involving hazardous materials or specialized teams who deal with these incidents [6]. Hazardous materials are defined as substances that have the potential to harm a person or the environment upon contact [7]. These can be gases, liquids, or solids and include radioactive and chemical materials. Biological organisms, such as viruses and bacteria, are also included as hazardous materials. Hospitals are required to protect their employees from the exposure of these materials that may occur as a result of patient care [8]. The aim of the study is to evaluate the knowledge and attitudes of healthcare professionals regarding Hazmat kit and its use in healthcare settings.

Materials and Methods

A cross-sectional study was carried out using a self-prepared questionnaire. The questionnaire was designed to assess the knowledge, attitude and practices [KAP] regarding the use of Hazmat kit in routine dental practice among dental professionals. The healthcare professionals (Dental Doctors, post graduates and housekeeping staff and nurses) working in Thiruvallur and Kanchipuram (Tamil Nadu) during the study period were included. Only those who gave their consent to participate were included in the study.

By employing a convenience sampling method, 750 healthcare professionals were targeted for the study and it was conducted from September 2020 to June 2021. The healthcare professionals (Dental Doctors, post graduates and housekeeping staff and nurses) aged 18 years and above, with English familiarity were included in the study. This study was initiated after approval from the institutional review board. (SDC/SIHEC/2021/0619-0320).

Study Instrument

A self-administered, 19 item questionnaire comprising four sections was used for data collection. The questionnaire acquired the respondent’s gender and occupation. In addition to the demographic data, the data in respect to their knowledge, attitude and practice regarding Hazmat kit usage was collected using a questionnaire containing 13 multiple choice questions and 4 fill in the blanks. Out of the 17 questions, 6 questions were used to assess the knowledge about the Hazmat kit, 7 questions assessed the attitudes of its use and 4 questions on the practices of Hazmat kit in the profession.

Statistical Analysis

Descriptive statistics were used to illustrate respondents’ demographic characteristics. Categorical variables were measured as frequency and percentages, while continuous variables were expressed as mean ± standard deviation. The Kolmogrov-Smirnov test was applied to declare the nature of data distribution. Data collected was statistically analyzed and results obtained.

Results

A total of 750 questionnaires were distributed and 161 were received with a response rate of 21.46%. 589 denied participation due to lack of knowledge about the kit. The Kolmogrov-Smirnov test revealed a non-normal distribution of the data. The gender distribution showed female predilection with 102 (63.4%) female respondents. (Fig. 1)

59 (36.6%) were doctors [dental practitioners], 49 (30.4%) were undergraduates (including interns and final year BDS students). 46 (28.6%) were postgraduate students, followed by 5 (3.1%) assistants in clinics and 2 (1.2%) housekeeping staff in hospitals and clinics. (Fig. 2)

Out of the 750 only 161 were willing to participate. 25.5% of the population were aware of the Hazmat kit and 7.5% were partially aware about its use while 67.1% were unaware of it. (Fig. 3) 27.3% of the population agreed that it is a professional obligation and only 13.7% strongly recommend its use(Fig 4). While 22.4% agree to use it but not mandatorily due to lack of severity of infection rates. 62.7% of the population was not sure of its use and 1.3% disagree with the use attributing to lack of awareness. (Fig. 5)

22.4% participants agreed to mandatory use, only 13.7% are definitely likely to recommend its use in hospitals while the 62.7% is still unsure. (Fig. 5)

Also 67.1% of healthcare professionals want educational programs to be conducted for the use of Hazmat kit (Fig. 6) and 69.6% recommend specialized training to be given to the practicing doctor, assistants, nurse and housekeeping staff. (Fig. 7) Only 20.5% of the population recommends its use in hospitals and clinics while 76.4% is unsure if it can be recommended to use. (Fig. 8)

70.8% think that there is a need for strict policies towards the safety of health care providers (Fig. 9) and 38.5% of the population is convinced that the kit is an effective solution for the safety of healthcare professionals. (Fig. 10)

94.4% of the population is currently not using the Hazmat kit in their practice (Fig. 11) and only 15.5% are definitive about the use. (Fig. 12)

82.6% of healthcare workers attribute it to non-usage due to lack of awareness. (Fig. 13)

To assess the usage of Spill kits among 5.7% of the population, records of needle stick injury (Fig. 14) and records of incidence of infection rates were assessed where only 32.3% and 34.8% maintain the records respectively. (Fig. 15)

Discussion

The current study sought to evaluate KAP towards usage of HAZMAT kits. Results of the study revealed poor KAP towards HAZMAT kits. A small percentage of respondents actually knew about HAZMAT kits and their knowledge was poor among the study cohort. Lack of knowledge about HAZMAT kits can be attributed to the rise in the frequency of infection rates. Only 27.3% of the population believed that it is a professional obligation to use HAZMAT kits, which is again a major sign of concern. The primary source of infection was through needle stick injuries, mishandling of spills and lack of improper treatment before disposal. These results are in line with the findings from previous studies reported around the globe [9-18]. This study is first of its kind and the possible reasons that can be attributed to some differences in response are due to demographic variation of the study population, study location and as well as the study tool used for data collection.

In addition, the mean attitude was also found lower in the study participants. A higher degree of ambiguity was recorded in the attitude where the majority of the healthcare workers are unsure about the significance of HAZMAT kits in order to mandate its use on a daily basis [19]. Most of the participants however reported the need to conduct awareness programs in order to inculcate the need, significance and safety during hazardous spill exposures which is in accordance with previous studies conducted [20-22]. The target population included healthcare professionals at all levels from the doctors to the assistants, nurses and the housekeeping staff. It is imperative to note that there is an urgent need to impose strict policies on the hospitals towards the management of HAZMAT events which result in combating further deterioration of the condition and can prevent spread of infections.

Health Belief Model highlights individual’s attitudes and beliefs responsible for particular health behavior. These beliefs and barriers in health care also play a vital role in achieving success. Within this context, poverty, cultural beliefs and perceived severity of illness can be the reasons for multiple opinions and practices towards a certain health behaviour [23-26]. The majority of the participants perceived the HAZMAT kit as costly. It is important that the general population should be educated on all aspects of hazardous spill management rather than on a single or a few issues. It should also be addressed by social and medical researchers for the purpose of achieving a fuller understanding of the underlying issues while the outcome of such studies should be utilized in policy and decision-making by government officials and members of the health care team [27-30].

Participants of the current study showed poor practice towards HAZMAT kit use, recording incidences of needle stick injuries and infection rates. Majority of the participants were not concerned about the safety measures which definitely expose them to the danger of acquiring infection. The positive correlations between knowledge-attitude, knowledge-practice and attitudepractice in this study reaffirm the relationship between knowledge, attitude and practice with HAZMAT kits. It is concluded that adequate knowledge can lead to a positive attitude resulting in good practices.

Hence, there is an urgent need for hospitals to participate in community disaster planning for HAZMAT incidents. Stringent rules have to be imposed on hospitals to protect their employees from hazardous materials exposures, including exposure that may occur as a result of patient care. Patient decontamination ideally should be performed in the field [31]. Adequate personal protective equipment for healthcare providers in a hot zone includes a chemical-resistant suit, nitrile gloves, disposable boots, and fullface cartridge or supplied air respirator. This equipment is less expensive than most operating suits [32]. With respect to training Healthcare providers, they need education through workshops and drills in the management of hazardous materials. If a hospital is unprepared to handle a contaminated patient, one option is to call the local HAZMAT team. However, this should be worked out in advance and there still needs to be a plan if they are not available [33].

With a rich case bank established in our institution over the last decade, we have been able to conduct research and publish extensively in the KAP survey domain [34-39]. Drawbacks of this study consists of limited population being studied and inclusion of a smaller sample size. Since this study is first of its kind, more similar studies need to be carried out to analyze the population and extract the data regarding its usage. Future scope of the study is that a larger sample from diverse population must be assessed over a longer period of time for planning and implementing protocols for the usage of HAZMAT kits.

Conclusion

It can be concluded from the study that the knowledge and awareness towards the usage of HAZMAT kits is inadequate among dental professionals. Hence, they were lacking regarding the practices of HAZMAT kit in the profession. However, the population showed a positive attitude towards learning through educational programs which gives hope in the better management of HAZMAT incidence. There is a need for hospitals to participate in community disaster planning for HAZMAT incidents. Therefore, it is recommended that the hospitals and universities focus on conducting hazardous spill management programs to enhance the preparedness of management of such events.