|Year : 2022 | Volume
| Issue : 3 | Page : 64-69
Knowledge, attitude, and practice about infection control protocols among pediatric dentists in India during COVID-19 pandemic: An online cross-sectional survey
S Vijai, Kumar R Krishna, Joby Peter, Anaswara Mahima Sathish, Avani V Sudhakar
Department of Pediatric and Preventive Dentistry, Malabar Dental College and Research Centre, Malappuram, Kerala, India
|Date of Submission||13-Aug-2022|
|Date of Acceptance||03-Sep-2022|
|Date of Web Publication||29-Sep-2022|
Dr. Avani V Sudhakar
Malabar Dental College and Research Centre, Near Velampullikkav Temple, Kandanakam, Kalady. P.O, Malappuram, Kerala
Source of Support: None, Conflict of Interest: None
Introduction: The aim of this study was to assess the knowledge, attitude, and practice of infection control protocols among pediatric dentists in India during the COVID-19 pandemic. Materials and Methods: An online cross-sectional survey using a semi-structured questionnaire was conducted in the Department of Pediatric and Preventive Dentistry, Malabar Dental College and Research Centre, Manoor, Kerala, and a link for Google Forms was shared with pediatric dentists on social media (i.e., Facebook and WhatsApp). Results: A total of 205 respondents were included in the final analysis, of which 91.22% were following the current WHO/DCI/IDA/CDC Guidelines regarding cross-infection control of COVID-19 in their practice. Majority of the participants had to modify their clinic setup to follow the WHO/DCI/IDA/CDC guidelines to practice during the COVID-19 pandemic. Most of the participants reported that these infection control protocols affected the income-expenditure of their clinics. Conclusion: The findings of the study revealed that most of the subjects had adequate knowledge regarding infection control protocol and are practicing it resulting in few cases of COVID-19 infection among the dentists.
Keywords: Dental clinic infection control, Indian scenario, pediatric dentists and COVID-19
|How to cite this article:|
Vijai S, Krishna KR, Peter J, Sathish AM, Sudhakar AV. Knowledge, attitude, and practice about infection control protocols among pediatric dentists in India during COVID-19 pandemic: An online cross-sectional survey. Int J Oral Care Res 2022;10:64-9
|How to cite this URL:|
Vijai S, Krishna KR, Peter J, Sathish AM, Sudhakar AV. Knowledge, attitude, and practice about infection control protocols among pediatric dentists in India during COVID-19 pandemic: An online cross-sectional survey. Int J Oral Care Res [serial online] 2022 [cited 2022 Dec 6];10:64-9. Available from: https://www.ijocr.org/text.asp?2022/10/3/64/357314
| Introduction|| |
COVID-19 is a fatal respiratory infection caused by a novel coronavirus, now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV), which was first discovered in December 2019 in Wuhan city, Hubei Province, China. On January 30, 2020, the World Health Organization (WHO) declared COVID-19 as a public health emergency of international concern and categorized as a pandemic on March 11, 2020. In India, the first confirmed case was reported on January 30, 2020 in Kerala.
SARS-CoV-2 causes infections, from the common cold, to more serious diseases such as Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV). The main symptoms of COVID-19 have been identified as fever, dry cough, fatigue, myalgia, shortness of breath, and dyspnea. The virus is transmitted through droplets and the spread occurs through coughing, sneezing, and salivary contamination.
The viral load contained in the human saliva is very high and acts as a potential source of infection. Dental office seems to be at high risk for this nosocomial infection because of the nature of dental procedures and dental practitioner are considered to be at high risk. Dentists are in close contact with patients and are the first-line diagnosticians for oral diseases. The Center for Disease Control (CDC) and American Dental Association (ADA) have suggested several interim guidelines to be followed in dental practice. WHO has also published instructions for the dentists to take several personal protection measures as a step to curb the spread of infection. American Academy of Pediatric Dentists (AAPD) has also recommended guidelines for the pediatric dentists as a part of the protocol for practice during the COVID-19 pandemic.
In India, the current method of disease control is based on containment measures including the implementation of a lockdown approach for Movement Control Order (MCO) to prevent the virus spread and break the chain of rapid transmission from persons to persons. The dentist may practice cautiously by following the interim guidelines by health authorities and dental associations and to implement sound prevention measures in dental clinics and optimize their clinical practice to the changing trends to ensure safe and risk-free practice. Hence, this study aimed to assess the knowledge, attitude, and practice of infection control protocols among pediatric dentists in India during the COVID-19 pandemic.
| Materials and Methods|| |
Participation and procedure
An online cross-sectional survey was conducted in the Department of Pediatric and Preventive Dentistry, Malabar Dental College and Research Centre, Manoor, Kerala. A semi-structured questionnaire was designed for the Google survey tool (Google Forms), and the generated link was shared with pediatric dentists on social media (i.e., Facebook and WhatsApp). The questionnaire was designed to be anonymous. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. The study proposal was submitted for approval and clearance was obtained from the ethical committee of our institution. A written informed consent was obtained from each participant. The data were kept confidential and the results did not identify the respondents personally.
The final questionnaire consisted of 5 questions related to demographic data and 22 questions related to infection control protocol. The link was also shared personally to the contact list of investigators and research assistants. The investigator's decision to collect the data using online approaches was predicated on maintaining social distance during the strict lockdown in India. Initially, 205 potential respondents provided written informed consent online and completed the entire survey. The inclusion criteria to participate in the study were being an Indian resident, a pediatric dentist having Internet access, and voluntary participation.
Study population and sample size
The cross-sectional study was conducted among pediatric dentists from different states of India. A pilot study was done on 30 subjects to check the study validity. The sample size required for the study calculated was 169.
| Result|| |
A total of 205 respondents were included in the final analysis, of which 74.63% were female and 25.37% were male. The majority were postgraduate, within the age group of 20–30 years (77.56%) having private practice (47.32%) and having 0–10 years of practice (96.1%).
The summary of the frequency and percentage of responses on regarding the knowledge and attitude about infection control protocols among pediatric dentists in India during the COVID19 pandemic is shown in [Table 1].
|Table 1: Frequency and percentage of responses regarding the knowledge and attitude about infection control protocols|
Click here to view
Various infection control devices installed in the clinic primarily includes high volume extra oral section (65.8%) followed by fumigation/fogging system (56.09%) [Figure 1].
|Figure 1: Percentage distribution of methods of infection control in dental clinic|
Click here to view
Approximately 40.9% of the dentists use surgical 3ply mask/N95 facemask, gloves, face shield, and protective gown during routine consultation during the COVID-19 pandemic [Figure 2].
|Figure 2: Percentage distribution of personal protective equipment used by general dentists: (A) with surgical 3ply facemask and gloves, (B) with surgical 3ply + N95 facemask and gloves, (C) with N95 facemask and gloves, (D) with surgical 3ply/N95 facemask, gloves, and face shield, (E) with surgical 3ply/N95 facemask, gloves, face shield, and protective gown, and (F) with PPE kit|
Click here to view
Approximately 31.7% of the participants disinfect the dental clinic before starting daily work, after every procedure and after finishing daily work, whereas 29.2%% of the participants disinfect the clinic only after finishing daily work [Figure 3].
|Figure 3: Percentage distribution of frequency of disinfect the dental clinic in current scenario of COVID-19|
Click here to view
Approximately 54.15% of the participants fumigate their clinic daily, whereas 31.22% fumigate weekly once only. At the same time, 4.8% fumigate their clinic monthly once and 9.76% never fumigated their clinic [Figure 4].
|Figure 4: Percentage distribution of frequency of fogging/fumigation of the dental clinic in current scenario of COVID-19|
Click here to view
Approximately 90.24% of the participants prefer autoclave for sterilization of the instruments, whereas 7.8% prefer UV sterilizer [Figure 5].
|Figure 5: Percentage distribution of preferred sterilization method for instruments in dental clinic|
Click here to view
Approximately 52.69.% of the participants store sterilized instruments in sterilization pouches, 23.9% in instrument cassette, and 19.51% in a UV chamber [Figure 6].
|Figure 6: Percentage distribution of methods used to store sterilized instruments in dental clinic|
Click here to view
Approximately 45.37% of the participants manage the extra expenditure during COVID-19 by maintaining the treatment charge same but additional charge for maintaining protocol;18.54% following the practice with the same treatment charge before the COVID-19 pandemic, whereas 26.83% increased their treatment charge [Figure 7].
|Figure 7: Percentage distribution of method of managing the extra expenditure during COVID-19 pandemic|
Click here to view
| Discussion|| |
COVID -19 pandemic outbreak has a cascade effect on the world and has also affected India in the worst manner. Health professionals which include doctors, dental surgeons, and specialists are at greater risk of transmission from patients and infection control is vital. Dentists who are at the frontline for providing treatment for oral diseases are considered as one of the highest risk categories to get COVID-19 infection. Hence, CDC and ADA along with local governing authorities have issued several interim guidelines and protocols to prevent the spread of COVID-19 in dental setup and instructed only to provide emergency treatment and all aerosol-generating procedures need to be avoided.
The majority of the participants were aware of the protocols issued by CDC/ADA/WHO/DCI/IDA in the prevention of disease transmission. On analyzing the result, it shows that majority of the participants (91.2%) were following these guidelines in their clinics and most of the pediatric dentists (81.46%) had to modify their clinic setup in order to follow the CDC/ADA/WHO/DCI/IDA guidelines.
Along with the infection control protocols, 93.66% of the participants are following the universal protocol for each patient. Approximately 88.29% of the pediatric dentists had also trained their clinical staff regarding the application of CDC/ADA/WHO/DCI/IDA guidelines in their practice. It is observed that the majority of the dentists had started pre-appointment screening and telephone triage of the patients during the COVID-19 pandemic.
It is observed that 93.17% of the total participants started giving emergency care for pediatric patients during the COVID-19 pandemic. Approximately 66.83% of the Pediatric dentists in our study have a play area in their clinics. It is clearly noticed that 48.78% of the participants had to modify the clinic’s play area according to CDC/ADA/WHO/DCI/IDA guidelines during the COVID-19 pandemic. Due to the pandemic, a number of professional bodies have advised not to conduct routine dentistry including aerosol-generating procedures, and deliver dental care only in acute, emergency situations.But on analyzing the result it is evident that 69.76% of participants had started treating patients with aerosol-generating procedures.
Only 49.27% of pediatric dentists had used personal protective equipment (PPE) prior to the COVID-19 outbreak. But now 68.29% reported that they have arranged a separate area for donning and doffing of PPE after the COVID-19 outbreak which indicates the influence of the COVID-19 pandemic on the field of dentistry.
It is reported that 82.4% of the participants were confident in treating patients with all the precautions during COVID-19 pandemic. But at the same time, 91.2% of the pediatric dentists admitted that the application of infection control protocols affected the income-expenditure of the clinics.
Approximately 65.8% of the subjects had selected volume extra oral suction in their clinics and followed by fogging/fumigation as the infection control device. According to the CDC guidelines, dentists need to perform procedures in an adequately ventilated room, that is, a minimum of 6–12 air changes per hour in facilities with a mechanically ventilated room and at least 60 liters/second/ patient in facilities with natural ventilation.
According to the result analysis, 40.9% of the participants use a surgical 3ply mask/ N95 face mask, gloves, face shield, and protective gown for the routine consultation of the patients. According to a study conducted by Veena et al., maximum contamination was found on the right arm of the operator and left arm of the assistant. Contamination was also found on the head, chest, and inner surface of the face mask of the operator and of the assistant. Hence, PPE must be worn to provide an effective and efficient barrier against the aerosol-generated hazards from the operative site.
According to CDC COVID-19 Guidance for Dental Services, disinfection of dental clinics must be done before starting daily work, after every procedure, and after finishing daily work. But it is observed that only 31.7% of the participants follow this protocol properly. Similarly, only 54.15% of the participants fumigated their clinic daily according to the infection control protocol.
Application of infection control protocols for COVID-19 had adversely affected the income-expenditure of dental clinics. 45.37% of the participants reported that they manage the extra expenditure during COVID-19 by maintaining the treatment charge same but additional charge for maintaining protocol and 26.83% have increased their treatment charge. Approximately 18.4% followed the practice with the same treatment charge before the COVID-19 pandemic.
Even though the study observed that majority of the pediatric dentists were aware of the infection control protocol for COVID 19, there are some lacunae in the knowledge about the use of Personal Protective Equipment(PPE) kits, HEPA filters, and frequency of disinfection of dental clinic.
| Conclusion|| |
In conclusion, Indian pediatric dentists seem adequately prepared for the provision of patient care either during or after the COVID-19 pandemic. The findings of the study revealed that most of the subjects had adequate knowledge regarding infection control protocol and are practicing it resulting in few cases of COVID -19 infection among the dentists. The need of the hour is to update ourselves with the constantly changing situations and reorganize our methods of practice to combat new infections.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wu F, Zhao S, Yu B, Chen YM, Wang W, Song ZG, et al
. A new coronavirus associated with human respiratory disease in china. Nature 2020;579:265-9.
Eurosurveillance Editorial Team. World Health Organization declares novel coronavirus (2019-nCoV) sixth public health emergency of international concern. Eurosurveillance 2020;25:200131e.
Lloyd-Smith JO, Schreiber SJ, Kopp PE, Getz WM Superspreading and the effect of individual variation on disease emergence. Nature 2005;438:355-9.
Zhu N, Zhang D, Wang W, Li X, Yang B. A novel corona virus from patients with pneumonia in China. 2019. New Engl J Med2020;382:727-33.
Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al
. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: A study of a family cluster. Lancet 2020;395:514-23.
Park CL, Russell BS, Fendrich M, Finkelstein-Fox L, Hutchison M, Becker J American’s COVID-19 stress, coping and adherence to CDC guidelines. J Gen Intern Med 2020;35:2296-303.
Kanaparthi A, Dukkireddy D, Gopalaiah H, Kesary SPR, Katne T, Gantala R Awareness of COVID-19 pandemic among dental practioners of Telangana state, India: A cross-sectional survey. J Oral Biol Craniofac Res 2020;10:484-9.
Imai N, Gaythorpe KAM, Abbott S, Bhatia S, van Elsland S, Prem K, et al
. Adoption and impact of non-pharmaceutical interventions for COVID-19. Wellcome Open Res 2020;5:59.
Indian Dental Association. Indian Dental Association’s Preventive Guidelines for Dental Professionals on the Coronavirus Threat. Maharashtra, India: Indian Dental Association; 2019.
Rajput R, Chouhan Z, Suthar P, Chouhan RR, Mathur S, Purohit P MERS-CoV (middle east respiratory syndrome corona virus): A dental surgeon perspective. Int J Contemp Med 2015;2:1228-30.
Jamal M, Shah M, Almarzooqi SH, Aber H, Khawaja S, El Abed R, et al
. Overview of transnational recommendations for COVID-19 transmission control in dental care settings. Oral Dis 2021;27:655-64.
Veena HR, Mahantesha S, Joseph PA, Patil SR, Patil SH Dissemination of aerosol and splatter during ultrasonic scaling: A pilot study. J Infect Public Health 2015;8:260-5.
Kinariwala N, Perera Samaranayake L, Perera I, Patel Z Concerns and fears of Indian dentists on professional practice during the coronavirus disease-2019 (COVID-19) pandemic. Oral Dis 2020;20:1-3.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]