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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 81-89

Effects of the outbreak of COVID-19 on oral health-care workers (HCWs) at the regional dental center in Qassim, Saudi Arabia


1 Department of Periodontics, Regional Dental Center in Qassim, Dammam, Saudi Arabia
2 Department of Endodontics, Regional Dental Center in Qassim, Dammam, Saudi Arabia
3 Department of Pediatric Dentistry, Regional Dental Center in Qassim, Dammam, Saudi Arabia
4 Department of Preventive Dental Sciences, Imam Abdulrahman Bin Faisal University, College of Dentistry, Dammam, Saudi Arabia

Date of Submission01-Aug-2020
Date of Decision12-Oct-2020
Date of Acceptance28-Oct-2020
Date of Web Publication19-Jul-2021

Correspondence Address:
Dr. Wesam Talal Alsalman
Qassim Regional Dental Center, 7722 King Saud Road, Al Akhdar 2872 Buraydah, Qassim
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjos.SJOralSci_60_20

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  Abstract 


Introduction: Since the emergence of the 2019 novel coronavirus (COVID-19), the pandemic has rapidly spread all over the globe, affecting millions of people and resulted in over 1,900,000 deaths. During the outbreak of COVID-19 situation, health-care workers in general and dental team specifically are at risk of developing psychological distress and other mental health symptoms.
Aim: The study was conducted to investigate the effects of outbreak of coronavirus (COVID-19) on oral health-care workers (HCWs) at the Regional Dental Center in Qassim and how it affects their practice and daily life in terms of psychological, mental, behavioral manner, and social well-being.
Materials and Methods: This is a cross-sectional, single dental care facility-based study. A bilingual questionnaire was distributed to a convenience sample of 150 HCWs. The questionnaire contained 26 questions covering the following domains: (a) demographic data, (b) knowledge testing and sources of information, (c) personal precautions and infection control measures, and (d) behavioral and psychological aspects. The questionnaire was distributed through the social media platform. Data were analyzed using SPSS version 22. Descriptive statistics were used for data summarization and presentation.
Results and discussion: The response rate was 72% , with the age range from 18 to 54 years, with female 60% to male 40% distribution. A very high level of awareness about the COVID-19 ranging from 60% to 100% was found among participants. The main sources of information regarding coronavirus were Ministry of Health (MoH), social media, followed by the World Health Organization website. Almost 90% started regular hand hygiene and paying attention to the proper use of personal protective equipment. Almost 70% agreed to stop treating patients due to their perception of the risk of contamination. Almost 90% of them felt afraid of transferring the infection to their families. Majority of them spent their time on social media, while nearly 50% on reading and sleeping. Almost two-third of the participants do highly trust the precautions which have been taken by the MoH and the Regional Dental Center in Qassim.
Conclusions: It is concluded that the HCWs had good knowledge and awareness about COVID-19. They are concerned about their safety and possibility of spread of infection to their families and considered to stop regular dental treatment. Their satisfaction is moderate about the safety measures provided by MoH and the center. Future research should be carried out at multicenter, primary, secondary, and tertiary care centers to generalize the findings.

Keywords: COVID-19, dental professionals, infection control, oral health care workers, prevention


How to cite this article:
Alsalman WT, Alharbi SM, Albattah AH, Almas K. Effects of the outbreak of COVID-19 on oral health-care workers (HCWs) at the regional dental center in Qassim, Saudi Arabia. Saudi J Oral Sci 2021;8:81-9

How to cite this URL:
Alsalman WT, Alharbi SM, Albattah AH, Almas K. Effects of the outbreak of COVID-19 on oral health-care workers (HCWs) at the regional dental center in Qassim, Saudi Arabia. Saudi J Oral Sci [serial online] 2021 [cited 2021 Dec 1];8:81-9. Available from: https://www.saudijos.org/text.asp?2021/8/2/81/321884




  Introduction Top


Coronaviruses (CoVs) are a large family of single-stranded RNA viruses which may affect human and animals.[1]

It was officially announced on January 8, 2020, a novel coronavirus as the causative pathogen of COVID-19 by the Chinese Center for Disease Control and Prevention and on January 30, 2020, the World Health Organization (WHO) announced that this outbreak had constituted a public health emergency of international concern.[1],[3] The International Committee on Taxonomy of Viruses has determined that SARS-CoV-2 is the same species as SARS-CoV but a different strain.[2] Coronaviruses have been traditionally considered nonlethal pathogens to humans and causing approximately 15% of common colds.[5] In addition, SARS-CoV-2 is considered with lower severity and mortality than SARS-CoV-1 but is much more transmissive and affects more elderly individuals than youth and more men than women.[5]

Since the emergence of the 2019 novel coronavirus (COVID-19), it has rapidly spread across China and the rest of the world, leaving behind millions of infected people and tens of thousands of deaths.[4]

Clinical presentation of COVID-19 diseased patients includes acute respiratory illness at least with one of the following: fever or recent history of fever (85%), cough (50%–80%), dyspnea (20%–40%) (shortness of breath), fatigue (70%), upper respiratory tract infection symptoms (15%), and gastrointestinal tract (GI) symptoms (10%).[2],[3],[4],[5],[11]

Modes of transmission can be through respiratory droplets sized > 5–10 μm in diameter and through direct contact with infected people and indirect contact with surfaces in the immediate environment or with objects used on the infected person.[6] Air mode of transmission means that the virus can remain in the air for long periods of time and be transmitted to others over distances >1 m and usually occurs when droplet size is <5 μm in diameter.[6] In an analysis of 75,465 COVID-19 cases in China, airborne transmission was not reported.[7] However, airborne transmission may be possible in specific circumstances and settings, in which procedures or support treatments that generate aerosols are performed.[6]

The incubation period of COVID-19 has been estimated at 5–6 days on average; however, there is evidence that it could be as long as 14 days.[3],[9]

Several countries around the globe tried to defend the pandemic of COVID-19 by applying different policies including curfew, postponing social and commercial activities and celebrations, closing airports, schools, and restriction in transportations inter- and intracities and counties, all of which to prevent and to control the spread of the infection. Currently, the government of Saudi Arabia applied the curfew for a certain period during day and night in most regions where some regions are further subjected to 24 h of curfew. For dental services, Saudi Ministry of Health (MoH) stopped all dental elective procedure during the pandemic and restricted dental services to emergencies. These circumstances lead to substantial effects on the daily practice of health-care providers including dentists.

Due to the characteristics of dental settings, the risk of cross-infection may be high between dental team and patients. In countries/regions that are potentially affected with COVID-19, dental clinics should apply strict and effective infection control protocols.[8]

During the outbreak of COVID-19 situation, health-care workers in general and dental team specifically are at risk of developing psychological distress and other mental health symptoms. The ever-increasing number of confirmed and suspected cases, depletion of personal protective equipment (PPE); media coverage; fear of contagion and infection of family, friends, and colleagues; the curfew; feeling of uncertainty and stigmatization, all may lead to high levels of stress, anxiety, and depression symptoms, which could have long-term psychological implications to health-care provider.[10] To the extent of our knowledge, there is no specific study testing the psychological, mental, and behavioral outcomes of the outbreak of COVID-19 on staff in dental facilities.

In the Regional Dental Center in Qassim, Saudi Arabia, where this study was conducted, sorting station was established for patients/employees, examining them clinically prior entering the facility. Examination includes taking body temperature and asking the individual certain related questions. When dealt with suspected COVID-19 cases (patient with respiratory symptoms of cough, fever, shortness of breath, or GI symptoms) and those who communicated with confirmed cases during the past 2 weeks and those who traveled to area where there is an outbreak of the disease, in such cases, extra precaution measures will be considered. Precautions measures include restriction of movement of the patient within the facility, using clinics with opened window to the outside environment, and dental team should apply restricted use of PPE: (N95 mask, surgical gown, face shield, head and foot cover, and surgical gloves). Clinics should be left unused for 2 h postoperatively followed by strict disinfection protocol. Half of the staff was attending the facility with half of the duty to prevent crowding. Patient waiting rooms and reception were designed to allow 1.5 m of minimum separation between individuals to observe the recommendation of social distancing.

The aim of this study is to investigate the effects of outbreak of coronavirus (COVID-19) on staff at the Regional Dental Center in Qassim and how it affects their practice and daily life in terms of psychological, mental, behavioral manner, and social well-being.


  Methods Top


Study design

This is a cross-sectional, dental facility-based survey. The study followed the American Association for Public Opinion Research reporting guideline. Approval from the Clinical Research Ethics Committee at the Regional Dental Center in Qassim and from the Regional Research Ethics Committee in Qassim Province was received before the initiation of this study. An electronic generated questionnaire was used and sent to employees of the Regional Dental Center in Qassim in convenience sampling method that allows one-time participation for each user. Electronic informed consent was provided by all survey participants prior to their enrollment. Participants could terminate the survey at any time they desired. The survey was anonymous, and confidentiality of information was assured. The survey was conducted from March 30, 2020, to the end of April 2, 2020.

Study participants

A total of 108 individuals participated in the study. All participants were staff at the Regional Dental Center in Qassim, located in Buraidah, Saudi Arabia. The center is a public health-care facility with 50 dental clinics that occupies multi dental specialties, digital three-dimensional radiology department, dental prosthetic laboratory, infection control department, public health unit, central sterilization services department, and medical engineering department. Residents of different dental specialties and dental interns are also practicing within the different scope of service in the facility. In addition to clinical departments, different administrative units are present to support the work process within the facility.

Distribution of age, gender, jobs, nationalities, and qualifications of participants was collected. Participants in this survey represent 72% (108 out of 150) of the total number of current staff working in the center. The response rate was 72%.

The pretested questionnaire was bilingual, in English and Arabic. The questionnaire contained 26 questions covering the following domains: (1) demographic data, (2) knowledge testing regarding coronavirus (COVID-19) disease, (3) awareness regarding coronavirus (COVID-19) disease, (4) source of information regarding coronavirus (COVID-19) disease, (5) opinions and suggestions regarding dental procedures during the pandemic situation, (6) infection control measures during current pandemic situation, (7) fears and risk management during pandemic situation, (8) psychological and behavioral changes during pandemic situation (using Yes-No-Don't Know scale),[12] and (9) degree of trust of employees to the precautionary measures in the center during the pandemic.

The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY, USA). Descriptive statistics was used for the data analysis.


  Results Top


Demographic results

Out of the 150 employees in the Regional Dental Center in Qassim, a total of 108 individuals (72%) participated in this study with a 95% confidence level and 5% margin of error. The sample is composed of 65 females (60.19%) and 43 males (39.81%). The age of participants was ranged between 18 and 54 year and distributed, as shown in [Table 1]. Participants were from multinationalities [Table 1]: Saudi Arabia, Philippine, India, Yemen, Egypt, Jordan, and Sudan. The level of education was with a wide range starting from high school to doctorate degree [Figure 1]. Participants were either clinical (91: [84.26%]): dental consultants/specialists (40: [37.04%]), general practitioner dentist (3: [2.78%]), dental assistants (35: [32.41%]), dental interns (5: [4.63%]), dental hygienists (6: [5.56%]), and maxillofacial radiologists (2: [1.85%]) or nonclinical (17: [15.74%]) divided into dental laboratory technicians (3: [2.78%]) and administrative staffs (14: [12.96%]) (e.g., human resources and receptionists).
Table 1: Age groups and nationalities within the sample

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Figure 1: Education level of participants

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Table 2: Questions and answers

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Table 3: Changes in food habits

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Figure 2: The main source of information regarding COVID-19

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Figure 3: Extra precautions taken since COVID-19 pandemic

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Figure 4: People at highest risk from spread of infection in dental treatment

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Figure 5: Psychological changes: (a) Constant suspicion that you have the virus (n = 35), (b) Speed in discomfort and feeling annoyed (n = 19), (c) Boredom (n = 68), (d) Isolation (n = 33), (e) Loss of appetite (n = 6), (f) Increased appetite (n = 17), (g) Difficulty in concentrating (n = 12), (h) Having trouble getting to sleep (n = 19), (i) Sleep more than normal (n = 16), (j) Feeling sad (n = 33), (k) Stay tuned for the unknown (n = 32), (l) Self-neglect (n = 7), (m) Losing enthusiasm for doing anything (n = 14), (n) Difficulty relaxing (n = 16), (o) Tachycardia (n = 8), (p) Taking psychological medication not used previously (n = 1)

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  Discussion Top


The cross-sectional, single-center, survey conducted at the Regional Dental Center in Qassim, Saudi Arabia, provides an appraisal of the effects of outbreak of coronavirus (COVID-19) on health care workers (HCWs, staff) in various dimensions including clinical practice and their daily routine life in terms of psychological, mental, behavioral manners, and social well-being. The response rate of the survey was 72% which is quite acceptable. The female respondents were almost 60% and male 40%. The survey was conducted at the end or during the month of March–April (2020), which may reflect the awareness at moderate level. Eighty-five percent of the respondents HCWs were clinical staff and the remaining 15% were among the nonclinical staff.

In Saudi Arabia, several studies addressed the awareness of health-care worker and medical students about MERS coronavirus. The studies showed that awareness among health-care workers varies between institutions, gender, and among different professions.[13],[14],[15] In our study, there was a high level of awareness and knowledge about the COVID-19 among the HCWs. A majority of them were aware of its origin known so far, its incubation period, and mode of spread and prevention.

The estimated incubation period of COVID-19 is 5–6 days on average up to 14 days.[9],[16] Surprisingly, almost 100% of surveyed HCWs were aware of the incubation period of the coronavirus.

As we know, it is essential to know the incubation period because of its role in determining the safe period to treat suspected patients.[17] It is important for HCWs to be aware of modes of transmission and preventive measures to protect themselves and their patients, all the time. Dentists' knowledge about respiratory disease contagion was noticed in other studies to be lower among dentists,[18] than among health-care providers,[19] but in our study, it is very encouraging that almost 100% of HCWs were aware and knowledgeable about the same. The sources of awareness of our HCWs were variable, MoH, social media, and WHO which were three major players. It reflects the alertness of our HCWs and their eagerness to update themselves with the knowledge about the current challenge of COVID-19 to our profession.

Interestingly, there was no effect on the eating habits of our HCWs, but at the same time, they started using extra precautionary measures as far as the infection control and personal hand hygiene was concerned. This reflects their awareness to the current recommendations in addition to the existing universal precautions for infection control in clinical settings.

Though their awareness and response to prevention measures, almost 70% of the HCWs responded that the routine dental treatment should be stopped. In addition, 95% felt better with personal protective equipment and disinfection/sanitation procedures. As far the effect on future of dental practice, almost 60% believed and expressed that it would change.

Currently, there is no evidence-based specific treatment for COVID-19, and there is no vaccine available. So far, the management of COVID-19 has been largely supportive or symptomatic.[20] The current approach to COVID-19 is to control the source of infection; use of infection prevention and control (IPC) measures to lower the risk of transmission; and provide early diagnosis, isolation, and supportive care for affected patients.[21] Almost 60% of the HCWs reflected their confidence on the current precautionary measures for self-protection in the clinics, also worried about being at high risk while staying in the center. A very high number, almost 90%, were worried about transmission of the coronavirus infection to their families that has a psychological impact on their personalities.

As far as the behavioral and psychological impact was concerned, it was interesting to see that majority of the respondents were under the perceptions of being exposed to the virus, feeling of boredom, isolation, feeling sad, and having a feel of uncertainty. Certainly, this would effect on their daily performance and interest. Avoiding handshake was the highest impact on interpersonal contact and greetings. The time spent during isolation and curfew was skewed toward the excessive use of social media, sleeping, reading, watching TV, exercise, and cooking. The other effect on daily behavior was avoiding food from outside and extra washing of food products and trends toward eating healthy food. All these behavioral changes and impact on daily life reflect toward some healthy attitudes and lifestyle. It is not clear how long this effect will stay as the stressful environment has forced them to rethink about their choice of food.

It is interesting to know that MoH issued guidelines for infection control and categories of the dental procedures to be considered for elective or emergency care. It is hoped that the concerns of the HCWs will be leveled at lowering the perceived risk from coronavirus pandemic with increased information and upgrading of the infection control measures for routine clinical dental practice.

In this time of COVID 19 pandemic, hospitals are flooded with infected symptomatic and asymptomatic patients. HCWs are at the forefront of the treatment and management of COVID-19 infections, working in close proximity to the infectious virus. In addition, the unpreparedness of the health-care system and the novelty of the COVID-19 infections have made the HCWs a common and easy target for these infections. There is increased reporting of global health-care mortality in recent months due to the current pandemic. Reports from the early viral spread in the Chinese city of Wuhan have suggested that a high number of HCWs, who were unaware of the transmissibility and severity of COVID 19, got infected while treating the infected patients.[22] A recent study reported that Jordanian dentists were aware of COVID-19 symptoms, mode of transmission, infection control, and measures in dental clinic. However, dentists had limited comprehension of the extra precautionary measures that protect the dental staff and other patients from COVID-19.[23]

Another study assessed the anxiety and fear of getting infected among dentists while working during the current novel coronavirus disease (COVID-19) outbreak. Despite having a high standard of knowledge and practice, dental practitioners around the globe are in a state of anxiety and fear while working in their respective fields due to the COVID-19 pandemic impact on humanity.[24]

In general, it is recommended that to protect the HCWs and their families, staff should undergo routine medical checks, including temperature checks and real-time polymerase chain reaction test. In addition, HCWs should isolate themselves in hospitals provided residence and maintain social distancing from family members and other staff. To prevent psychological distress and manage stressful conditions, psychological evaluations and counseling sessions should be available for vulnerable staff. To preserve mental well-being, HCWs should practice healthy eating, physical activity, minimum 6–8 h of sleep, and communication with family and friends.[25] Interestingly, most of those recommendations are already in practice by our HCWs, which reflects their high alert and awareness to the current trends of the COVID-19 and its effects on HCWs and how to manage the various stressors leading to their behavioral changes.

It has been recommended recently that the following measures must be taken to ensure the safety of frontline health-care workers: (1) duty of care including to inform, protect, and support health-care workers, (2) easy availability and accessibility of standard personal protective equipment (PPE), (3) train, remind, and insist the healthcare workers on the use of PPE, (4) the fear of being infected can be overcome by proper training, (5) providing psychosocial support both by the mental health workers and social workers using different platforms, (6) family, friends, and coworkers support, (7) supportive and updated supervision and networking with coworkers, (8) installing physical barriers, standard infection-control measures related to PPE, environmental engineering, and social distancing from patients and coworkers could minimize the risk of infection, and (9) provision of risk allowance to motivate health-care workers.[26]

A recent meta-analysis by Cochrane group concluded that health-care workers point to several factors that influence their ability and willingness to follow IPC guidelines when managing respiratory infectious diseases. These include factors tied to the guideline itself and how it is communicated, support from managers, workplace culture, training, physical space, access to and trust in personal protective equipment, and a desire to deliver good patient care. The review also highlighted the importance of including all facility staff, including support staff, when implementing IPC guidelines.[27]

The limitation of the study is that it is a single center (health-care facility) and it is conducted at a time of the pandemic when the coronavirus Cov-2 awareness is at the initial level. The proper understanding of the COVID-19 is still evolving. There are daily evolutionary information, understanding, and recommendations being flooded. There is no vaccine or evidence-based clinically proven treatment available. There was no time for the training and practice of all those precautionary guidelines which needs time to be implemented as far as full compliance is concerned. The cross-sectional survey provides a time point information. In our study, a convenience sampling approach was adopted in which the respondents were approached on ease of accessibility. As the number of HCWs in this study was small, therefore, the results cannot be generalized to Saudi Arabia, and additional cross-sectional multicenter studies with a representative sample of both genders that reflect cultural characteristics from other Saudi Arabian regions are needed.


  Conclusions Top


It is concluded that the HCWs had good knowledge and awareness about COVID-19. They are concerned about their safety and possibility of spread of infection to their families and considered to stop regular dental treatment. Their satisfaction is moderate about the safety measures provided by MoH and the center.

Future surveys should be conducted on regular intervals to evaluate progress on compliance, alleviation of fear, restoration of confidence, and psychological and social well-being of the HCWs not only at tertiary or secondary care facilities but also at the primary health-care level that would help to generalize the findings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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