Hindawi

BioMed Research International

Volume 2020, Article ID 3413087, 5 pages
https://doi.org/10.1155/2020/3413087

Research Article
What Do the Dental Students Know about Infection Control? A
Cross-Sectional Study in a Teaching Hospital,
Rawalpindi, Pakistan

Mariam Khan Qamar,1 Babar Tasneem Shaikh ,2 and Aamir Afzal3

1
Department of Pathology, Foundation University Medical College, Rawalpindi, Pakistan
2
Health Services Academy, Islamabad, Pakistan
3
Foundation University Medical College, Rawalpindi, Pakistan

Correspondence should be addressed to Babar Tasneem Shaikh; shaikh.babar@gmail.com

Received 23 January 2020; Revised 7 April 2020; Accepted 9 May 2020; Published 1 June 2020

Academic Editor: Vance W Berger

Copyright © 2020 Mariam Khan Qamar et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Background. Dental students are exposed to various infections and infective sources during their training, and on this aspect, their
level of knowledge is suboptimal and practices are risky. Therefore, improving their knowledge and practices would contribute
significantly to infection control. Objective. To ascertain the level of understanding of senior dental students regarding the
infection control in the dental practice. Methods. A cross-sectional study was conducted among dental students (3rd year and
4th year) of the Foundation University Dental College, Pakistan. The sample consisted of 100 third year dental students and 88
fourth year students. A self-administrated questionnaire was used for data collection which consisted of fourteen close-ended
items. Frequencies of knowledge, attitudes, and practice were calculated separately by using SPSS 21.0 software. Results. Almost
half of the students would not use any antiseptic for sterilizing their hands, and only two-third would ask their patient to use an
oral mouth rinse before starting the treatment. Many students did not the optimal temperature of the autoclave for sterilization
of the instruments. Only one-third would wear the personal protective equipment during a procedure. Around one-third of the
study participants reported that ineffective sterilization during clinical practice can transmit infection from one patient to
another. Conclusion. Knowledge on infection control among the dental students is though weak, practices are not as per
standards but attitudes are positive and encouraging for taking steps and complying with measures on infection control.

1. Background viruses [2]. Moreover, they are also at a risk of percutaneous

occupational injuries and eye exposure while treating the
Dental students are one of the dental health care profes- patients [3]. Only through strict safety precautions and
sionals who are at a high risk of exposure to infections implementation of guidelines for infection control, we can
because of their direct contact with the patients, infected prevent these mishaps from happening. The Center for
instruments, and hospital environment. Cross infection is a Disease Control and Prevention (CDC) in the United States
major concern to all the dental health care professionals. It has updated its guidelines on infection control in dental
is defined as the transmission of infection between the staff settings. The aim of these guidelines is to ensure a safe
and the patient within the hospital environment [1]. Among working environment to prevent the transmission of nosoco-
these, the most serious oral infections are caused by bacteria mial and occupational infections among the dental health
that colonize in the oral cavity including mycobacterium professionals [4, 5].
tuberculosis, influenza virus, and streptococci. Students are Dental colleges are responsible for providing proper
equally vulnerable to cross infections that are caused by the training to their students to ensure safety of the patients,
hepatitis B virus (HBV), hepatitis C virus (HCV), and other implementing infection control measures, and establishing
 2738, 2020, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2020/3413087 by Cochrane Colombia, Wiley Online Library on [09/09/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
2 BioMed Research International

a safe working environment [6]. Several studies have been Table 1: Gender distribution and average score of knowledge,
conducted to assess the practices and knowledge of dental attitude, and practice of dental students in each group.
students and have demonstrated poor compliance of the stu- Gender 3rd year 4th year P value
dents to infection control measures. A study conducted in
India to assess the infection control practices among dental Male (28 (14.9%)) 12 (12.0%) 16 (18.2%)
0.235
students showed that only one-tenth of the respondents Female (160 (85.1%)) 88 (88.0%) 72 (81.8%)
adhere to the infection control measures [1]. Similar studies Knowledge 10:80 ± 2:50 10:07 ± 1:81 0.024
have been conducted worldwide to investigate the knowledge Attitude 4:70 ± 1:32 4:45 ± 1:36 0.212
and practices of dental students on infection control [6–14],
Practice 5:32 ± 1:22 5:86 ± 1:20 0.003
and a general consensus is that students need awareness
and must be protected in the unsafe environment.
Fauji Foundation Hospital in Rawalpindi city houses a
huge number of medical and dental students for educational
and training purposes. This hospital is a busy tertiary health in silence without discussing with each other. They were
facility catering to mostly ex-army servicemen and their not asked to put their names on the forms, hence keeping
families. It has a fully equipped dental outdoor clinic the anonymity intact. Data was entered and analyzed on
where the dental undergraduate students come on daily SPSS v.21. Descriptive statistics was done in terms of mean
basis for observations, education, hands-on training, or and standard deviation. Frequency and percentage were cal-
apprenticeship. Nevertheless, there is paucity of data with culated for qualitative variables. Independent sample t-test
regard to infection control practices among dental students was used to compare the mean score of knowledge, attitude,
within the hospital environment in Pakistan. For this and practice among both groups. P value ≤ 0.05 was taken as
purpose, it is imperative to ascertain the understanding of a level of significance. Written verbal consent was obtained
the senior dental students who have attended the module of from all the respondents. Study received approval from the
infection prevention and control during their study course. Ethics and Research Committee of the Foundation Univer-
This study will help better understand the gaps and deficien- sity, Rawalpindi, dated January 2, 2019.
cies in the dental college curriculum and will sensitize and
educate the future dental surgeons in adopting the necessary 3. Results
infection prevention practices.
A total of 188 dental students responded to our questionnaire
2. Methods completely and hence included in the study results. Hence,
the study population comprised of 28 male and 168 female
A cross-sectional study was conducted among dental students. Table 1 shows the analysis of cross tabs between
students (3rd year and 4th year) attending the Foundation the independent (gender and class of study) and dependent
University Dental College, Pakistan. The duration of study variables which yielded no significant statistical association
was two months from 14th July 2019 to 14th September (i.e., P > 0:05).
2019. The sample size (n = 188) was calculated by using Table 2 shows that although a majority (94%) reported
the WHO sample size calculator with the following washing their hands before and after examination of the
parameters: confidence level = 95%, anticipated population patient, yet only half of them (49%) would use an antiseptic
proportion = 95:5% [6], and absolute precision required = solution for washing their hands. There were 64% partici-
3%. A total of 228 dental students studying in the college pants who preferred patients to have an oral mouth rinse
included 121 third year and 107 fourth year students. Out before commencement of any treatment procedure. The
of these approaches, 82.6% (n = 100) students from the majority (98%) of the students considered isolation as an
third year and 82.2% (n = 88) students from the fourth important measure for the infection control. With regard to
year gave a complete response and therefore were included vaccination, 85% got vaccinated for hepatitis B, 45% for
in the study. As per the exclusion criteria, the students of tetanus, and only 15% of the students were vaccinated for
first and second year were excluded from the study tuberculosis, but surprisingly, 18% have not received any
because training in infection control is provided in the vaccine at all.
dentistry curriculum of third year and fourth year. Written On the subject of sterilization of instruments, 95%
informed consent was taken from all the participants of reported use of autoclave for the purpose and only 68%
the study. The Institutional Review Board of the hospital reported using the same for 15 minutes (optimal time) and
granted the requisite permission to conduct the study. A only 60% thought that 120 degrees is the required tempera-
total of 188 dental students completed the questionnaire ture on which the autoclave should be used. Around 80%
comprising of 14 items. There were 6 questions related study participants considered that hepatitis B has the highest
to “knowledge,” 5 questions related to practice, and 3 rate of transmission via saliva. In case of direct blood contact
questions were based on “attitude.” A self-administered with a HIV patient, 62% would opt for anti-HIV immuno-
questionnaire developed by Singh et al. [6] was distributed globulins. During the work at a dental surgery, the use of face
to the dental students. The consistency of the question- mask and gloves as an infection control measure was
naire was assessed using Cronbach’s alpha (α = 381). Each practiced by 38% while 32% would wear an eye protector,
student was given fifteen minutes to fill the questionnaire and only one-third of them (29%) would wear all of them.
 2738, 2020, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2020/3413087 by Cochrane Colombia, Wiley Online Library on [09/09/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
BioMed Research International 3

Table 2: Student knowledge, attitudes, and practice on infection control measures.

n = 188 %
1 Do you wash your hands before and after patient examination? Yes 176 93.6
Plain soap 88 46.8
2 With what do you wash your hands? Detergent 8 43
Antiseptic solution 92 48.9
Do you prefer oral mouth rinse before commencement of any
3 120 63.8
treatment procedure?
4 Do you think isolation is important in infection control? 184 97.9
Hepatitis B 160 85.1
Tetanus 84 44.7
5 With which of the following vaccines have you been vaccinated?
Tuberculosis 28 14.9
None 34 18.1
Autoclave 178 94.7
Which of the following do you use to sterilize
6 Boiling 8 4.3
instruments in dental clinic?
Washing 2 1.1
5 min 44 23.4
7 Minimum time required for sterilization in autoclave? 10 min 16 8.5
15 min 128 68.1
100 degree 62 33
8 Temperature for sterilization in autoclave? 120 degree 112 59.6
150 degree 14 7.4
Hepatitis B 150 79.8
Which of the following has the highest rate AIDS 12 6.4
9
of transmission via saliva? Tuberculosis 14 7.4
Do not know 12 6.4
Anti-HIV immunoglobulins 116 61.7
What immediate action should be taken in case of direct Anti-HIV drugs 22 11.7
10
blood contact with HIV patient? Blood test to be carried out 48 25.5
Do not know 2 1.1
Face mask and gloves 72 38.3
What protective measures do you take to prevent Eyewear 60 31.9
11
yourself from injury? Protective clothing 2 1.1
All the above 54 28.7
Dispose them 108 57.4
12 After use of gloves for a patient, what do you do with them? Reuse them after wash 80 42.6
Reuse them after sterilization 0 0
Ineffective sterilization during clinical practice can
13 70 37.2
transmit infection from one patient to another.
Apart from instrument sterilization, disinfection of Yes 184 97.9
14
dental chair, clinic, and dental office is required? Do not know 2 1.1

After using a pair of gloves on the patient, 57% would dis- believe that besides instruments, disinfecting the dental
pose them off but 43% think that they can reuse them chair, clinic, and doctor’s office is necessary. In Table 3,
after washing. Only 37% reported that ineffective steriliza- it has been observed that there is a significant positive
tion during clinical practice can transmit infection from correlation between the mean score of knowledge and atti-
one patient to another, although a large majority (98%) tude r = 0:781, P ≤ 0:05; however, there was no differences
 2738, 2020, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2020/3413087 by Cochrane Colombia, Wiley Online Library on [09/09/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
4 BioMed Research International

Table 3: Correlation among knowledge, attitudes, and practice hepatitis B, which should be mandatory for all medical
scores. and dental students prior to their admission.
The strength of this study is that it was conducted with a
Variables Correlation coefficient (r) P value senior group of dental students (3rd and 4th year) who have
Knowledge-attitude 0.781 0.000 studied the module on infection prevention and control.
Attitude-practice -0.157 0.031 The use of a self-administered questionnaire itself is one of
Knowledge-practice -0.045 0.539 the limitations of this study; therefore, objectivity in respond-
ing to certain questions might have been compromised.
Results could be generalized with caution because similar
noted between the mean score of attitude-practice and group of students in a private hospital setting with better
knowledge-practice scores. infection control and prevention standard operating proce-
dures might exhibit different behaviors and practices.
4. Discussion
5. Conclusion
Hands are the foremost significant reservoir for many patho-
gens. Handwashing is therefore considered as an effective We concluded that there was lack of correct knowledge on
method of prevention of infection [15]. In the current study, infection control among the dental students, yet they showed
the majority of the students described that hands should be a positive attitude towards infection control measures. How-
washed and the students described plain soap and antiseptic ever, a greater compliance and supervision would be needed.
solution before and after the examination as a preferred Further studies in similar settings and utilizing the mix
method. Similar results were seen in a study conducted in methods with qualitative enquiry would be beneficial to
Germany where most of the trainee dentists washed their understand certain careless attitudes and behaviors among
hands before and after the procedure [8]. Nonetheless, there dental students.
are studies that show poor compliance of the students with
handwashing [9]. A study conducted in Yemen reported only Data Availability
43% of the students adhere to handwashing [9]. In the pres-
ent study, most of the dental students were vaccinated with Available with first author.
hepatitis B vaccine which was in concurrence with the other
studies [12–14]. This rate is much higher than the study con- Conflicts of Interest
ducted in India showing that only 38% of the students were
vaccinated against hepatitis B [6]. The dental students had The authors declare that they are no conflict of interests.
good knowledge of autoclaving and sterilization similar to
other studies [6, 9]. Wearing of face mask and eye protection Authors’ Contributions
was observed in only one-third of the students. Similar
results were recorded in other studies [9]. However, a good MKQ, BTS, and AA were all responsible for defining the ini-
majority of the dental students in our study thought that hep- tial research question and developing the protocol and study
atitis B infection and not tuberculosis is transmitted through design. MKQ and AA were involved in the collection of data
saliva, which was quite surprising. Another surprising find- and took lead in writing the manuscript. BTS contributed to
ing in our study was that two-thirds of the students consid- the completion of the manuscript and has critically revised it.
ered that ineffective sterilization during clinical practice All authors read and approved the final manuscript.
cannot transmit infection from one patient to another.
This highlights the lack of awareness of the concept of Acknowledgments
cross infection. The majority of the students did believe
that disinfection of dental chairs and the office of the den- Appreciation is hereby extended to the students of Foun-
tist is also required. This concurs with the findings of dation Medical and Dental University for participating in
other studies included in our literature review [2, 3]. our study.
Importance of continuous-based infection control lectures
and training could help in raising the level of knowledge References
regarding the subject [16]. We recommend that every hospi-
[1] M. A. Al-Omari and Z. N. Al-Dwairi, “Compliance with infec-
tal needs to set up infection control measures in accordance
tion control programs in private dental clinics in Jordan,”
with the guidelines. For both the students and faculty of Journal of Dental Education, vol. 69, no. 6, pp. 693–698, 2005.
a hospital to improve their practice and knowledge of [2] B. Rahman, S. B. Abraham, A. M. Alsalami, F. E. Alkhaja, and
infection control, hospitals need to address the need for S. I. Najem, “Attitudes and practices of infection control
quality assurance and implementation of infection control among senior dental students at college of dentistry, Univer-
measures. It is highly recommended that reinforcement sity of Sharjah in the United Arab Emirates,” European Journal
training of the students through periodic workshops on of Dentistry, vol. 7, no. S 01, pp. S015–S019, 2019.
infection precaution and control should be planned to [3] S. A. Al-Maweri, B. Tarakji, B. Shugaa-Addin, H. M. Al-Sha-
highlight the significance of infection control [17]. miri, N. A. Ahmed Alaizari, and O. AlMasri, “Infection con-
Another recommendation is that of vaccination, especially trol: knowledge and compliance among Saudi undergraduate
 2738, 2020, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1155/2020/3413087 by Cochrane Colombia, Wiley Online Library on [09/09/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
BioMed Research International 5

dental students,” GMS Hygiene and Infection Control, vol. 10, [17] A. P. Erdem, K. Peker, S. Kuru, and E. Sepet, “Evaluation of
2015. Final-Year Turkish Dental Students’ Knowledge, Attitude,
[4] S. D. Holmberg, A. Suryaprasad, and J. W. Ward, “Updated and Self-Perceived Competency towards Preventive Den-
CDC recommendations for the management of hepatitis B tistry,” BioMed Research International, vol. 2019, 11 pages,
virus–infected health-care providers and students,” MMWR 2019.
Recommendations and Reports, vol. 61, no. 3, pp. 1-2, 2012.
[5] W. G. Kohn, A. S. Collins, J. L. Cleveland et al., “Guidelines for
infection control in dental health-care settings–2003,” MMWR
Recommendations and Reports, vol. 52, no. RR-17, pp. 1–61,
2003.
[6] A. Singh, B. M. Purohit, A. Bhambal, S. Saxena, A. Singh, and
A. Gupta, “Knowledge, attitudes, and practice regarding infec-
tion control measures among dental students in Central
India,” Journal of Dental Education, vol. 75, no. 3, pp. 421–
427, 2011.
[7] I. A. Razak and O. P. Lind, “Cross-infection control in Malay-
sian dental practice,” Singapore Dental Journal, vol. 20, no. 1,
pp. 11–15, 1995.
[8] M. B. de Amorim-Finzi, M. V. Cury, C. R. Costa, A. C. Dos
Santos, and G. B. de Melo, “Rate of compliance with hand
hygiene by dental healthcare personnel (DHCP) within a
dentistry healthcare first aid facility,” European Journal of
Dentistry, vol. 4, no. 3, pp. 233–237, 2010.
[9] E. S. Halboub, S. A. al-Maweri, A. A. al-Jamaei, B. Tarakji, and
W. A. al-Soneidar, “Knowledge, attitudes, and practice of
infection control among dental students at Sana'a University,
Yemen,” Journal of International Oral Health, vol. 7, no. 5,
pp. 15–19, 2015.
[10] V. Malhotra, S. Kaura, and H. Sharma, “Knowledge, attitude
and practices about hepatitis B and infection control measures
among dental students in Patiala,” Journal of Dental and Allied
Sciences, vol. 6, no. 2, pp. 65–69, 2017.
[11] J. Dagher, C. Sfeir, A. Abdallah, and Z. Majzoub, “Infection
control measures in private dental clinics in Lebanon,” Inter-
national Journal of Dentistry, vol. 5057248, 2017.
[12] V. K. Pavithran, R. Murali, M. Krishna, A. Shamala,
M. Yalamalli, and A. V. Kumar, “Knowledge, attitude, and
practice of needle stick and sharps injuries among dental pro-
fessionals of Bangalore, India,” Journal of International Society
of Preventive and Community Dentistry, vol. 5, no. 5, pp. 406–
412, 2015.
[13] M. A. Baseer, J. Ahlawat, S. H. Ansari, A. R. Alakras,
R. Mahrous, and A. M. Alenazi, “Awareness of droplet and air-
borne isolation precautions among dental health professionals
during the outbreak of corona virus infection in Riyadh city,
Saudi Arabia,” Journal of Clinical and Experimental Dentistry,
vol. 8, no. 4, pp. e379–e387, 2016.
[14] S. Mohiuddin and N. Dawani, “Knowledge, attitude and prac-
tice of infection control measures among dental practitioners
in public setup of Karachi, Pakistan: cross-sectional survey,”
Journal of Dow University of Health Sciences, vol. 9, no. 1,
pp. 3–8, 2015.
[15] N. T. Mutters, U. Hägele, D. Hagenfeld, E. Hellwig, and
U. Frank, “Compliance with infection control practices in a
university hospital dental clinic,” GMS Hygiene and Infection
Control, vol. 9, no. 3, pp. 1–5, 2014.
[16] G. Alharbi, N. Shono, L. Alballaa, and A. Aloufi, “Knowledge,
attitude and compliance of infection control guidelines among
dental faculty members and students in KSU,” BMC Oral
Health, vol. 19, no. 1, p. 7, 2019.