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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 98-103

Knowledge and perception regarding personal protection equipment and infection control measures against COVID-19 among dental practitioners of Saudi Arabia


1 Department of Endodontics, North of Riyadh Dental Center, MOH, Riyadh, Saudi Arabia
2 Department of Endodontics, Riyadh Specialized Dental Center, MOH, Riyadh, Saudi Arabia
3 Department of Dental, King Saud Medical City, MOH, Riyadh, Saudi Arabia
4 Department of Dental, Khamis Mushayt General Hospital, MOH, Khamis Mushyt, Saudi Arabia
5 Department of Restorative Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia

Date of Submission29-Aug-2020
Date of Decision31-Dec-2020
Date of Acceptance20-Jan-2021
Date of Web Publication21-Aug-2021

Correspondence Address:
Dr. Saeed Ali Alqahtani
Department of Endodontics, North of Riyadh Dental Center, MOH, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjos.SJOralSci_89_20

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  Abstract 


Introduction: The lack of interest and knowledge related to personal protection equipment (PPE) and infection control measures might have a detrimental effect on dental occupational workers.
Aim: The purpose of this study was to evaluate the knowledge and perception of dental practitioners about PPE to limit the spread of coronavirus disease 2019 (COVID-19).
Materials and Methods: This cross-sectional descriptive study was conducted between May and June 2020 among the dental practitioners working in public and private sectors of Saudi Arabia. An online questionnaire was distributed among dental practitioners across Saudi Arabia using E-mails or WhatsApp software. The questionnaire consisted of two parts: (1) basic demographic characteristics (gender, professional status, type of dental setup, and working experience) and (2) knowledge and attitude regarding the use of a face mask, gloves, gowns, and personal hygiene. Descriptive statistics were performed to summarize frequencies and percentages.
Results and Discussion: The total number of the responses received was 535 (68.8% – male and 31.2% – female). Only 17.8% knew that surgical masks are made of nonwoven fabric and that the middle layer acts as a barrier (39.8%). Regarding gloves, 57.4% of the participants agreed that latex/nitrile gloves are more reliable and durable. On the contrary, satisfactory knowledge regarding face shield, gown, hand hygiene, and infection control measures was observed.
Conclusions: This study showed a low level of certain PPE knowledge among dental practitioners. However, knowledge and perception about biosafety, face shield, gown, hand hygiene, and infection control measures were found to be higher and adequate among the participants.

Keywords: COVID-19, dental practitioner, knowledge, personal protection equipment


How to cite this article:
Alqahtani SA, Alshahrani MO, Alnefaie MO, Almofrej AM, Aldaghsh FH, Alamri NS, Alshamrani SS. Knowledge and perception regarding personal protection equipment and infection control measures against COVID-19 among dental practitioners of Saudi Arabia. Saudi J Oral Sci 2021;8:98-103

How to cite this URL:
Alqahtani SA, Alshahrani MO, Alnefaie MO, Almofrej AM, Aldaghsh FH, Alamri NS, Alshamrani SS. Knowledge and perception regarding personal protection equipment and infection control measures against COVID-19 among dental practitioners of Saudi Arabia. Saudi J Oral Sci [serial online] 2021 [cited 2021 Dec 1];8:98-103. Available from: https://www.saudijos.org/text.asp?2021/8/2/98/324191




  Introduction Top


Unparalleled measures and efforts have been adopted all around the world to control and combat the rapid spread of the ongoing coronavirus disease 2019 (COVID-19).[1] It is a novel respiratory disease that has emerged from a causative organism – the severe acute respiratory syndrome (SARS) coronavirus 2 belongs to the family Coronaviridae of the order Nidovirales.[2] COVID-19 pandemic was first detected in December 2019 in Wuhan, China, and rapidly, it spreads all over the world. It causes illness ranging from the common cold to SARS.[3],[4] It is highly contagious and transmittable that may spread during close person-to-person contact, small airborne droplets produced during talking, coughing, and sneezing, or by touching contaminated surfaces or objects and then touching their mouth, nose, or possibly their eyes.[5],[6] The virus has an incubation period of 4–14 days.[7]

The risk of getting severe COVID-19 is higher among health-care workers (HCWs). Since HCWs are primarily involved and are in close contact with various types of patients, protection of HCWs and prevention of intrahospital transmission of infection are very important aspects in an epidemic/pandemic response, and this requires that HCWs must have updated knowledge regarding the source, transmission, symptoms, and preventive measures. The latest figures show thousands of medical staff getting infected with a large percentage of them dying.[8] Dental staff are not exceptional for similar possibilities.[9] The available literature advocates dearth of knowledge, misinterpretations, and inadequate training for infection prevention and control among HCWs that leads to spread of disease and poor infection control practice.[10],[11],[12]

The dental clinic/hospital could be a riskier setting for spreading the virus because of the close contact with patients and the nature of the dental treatment, although COVID-19 patients are not supposed to receive dental treatments.[13] However, the fairly lengthy incubation period of this highly transmittable disease (up to 14 days in some cases)[14] before any manifestations could arise, is a serious challenge for dental staff to identify the existence of COVID-19 infection during the incubation period. Dental practitioners, thereby, need to be updated with a high level of knowledge and understanding to deal with the disease and be able to control and manage its spread.

Despite the provision of recommended preventive guidelines and recommendations on disease control, many dental practitioners take these mandatory preventive measures for granted in their clinical settings. This lack of interest and knowledge related to personal protection equipment (PPE) and infection control measures might have a detrimental effect on dental occupational workers. This situation is true to many settings, including dental clinics/hospitals of the Kingdom of Saudi Arabia, which is like many other countries, having a vast range of dental facilities. It is imperative to device sound prevention measures in dental clinics/hospitals and to increase the level of awareness among dental practitioners to safeguard their prevention. Hence, this survey-based study was aimed to assess the level of knowledge and perception regarding PPE and infection control measures among Saudi Arabia dental practitioners. The null hypothesis is that there would be no difference between the level of knowledge and perception regarding PPE and infection control measure among dental practitioners against COVID-19 concerning gender, professional status, and working experience.


  Methods Top


A cross-sectional study was conducted between May and June 2020 among dental practitioners working in Saudi Arabia according to the ethical principles mentioned in the Declaration of Helsinki (2013). Approval to conduct this study was obtained from the Institutional Review Board of Dental College in Riyadh (FRP/2020/245/181). Before the inception of the study, participants were outlined about the purpose and details of the research study. The participants had to express their willingness to involve in this study by giving written consent. No financial incentive of any kind was offered to the participants.

The study participants were the dental practitioners working either in public or private dental clinics/hospitals in Saudi Arabia. The sample size was calculated using an established formula. The minimum calculated sample size was 301 participants. An online structured questionnaire was developed using Google Forms. The authors of this paper shared the link of the questionnaire through E-mails, WhatsApp, and other social media to only those contacts of the investigators who are currently working as dental practitioners (convenience sampling method). The online questionnaire was designed so that without filling in the complete fields, it was impossible to submit the form. The participants were asked to roll out the questionnaire to their contacts in order to achieve maximal participation throughout Saudi Arabia.

The content validity of the questionnaire was assessed by two experts. A pilot study on 25 dental practitioners was conducted and an internal consistency/reliability was measured using Cronbach's which was found to be 0.80. The questionnaire consisted of two parts: (1) basic demographic characteristics (gender, professional status, type of dental setup, and working experience) and (2) knowledge and attitude regarding the use of a face mask and shield, gloves, and gowns to limit COVID-19 exposure. The second part of the questionnaire was consisting of 17 close-ended questions.

Statistical and data analysis

The data analysis included was the Shapiro–Wilk test (to check the normality of the data). Descriptive statistics were employed to analyze the mean and standard deviation values. The analysis was performed using IBM SPSS for Windows, version 23.0 (IBM Corp., Armonk, NY, USA).


  Results Top


Five hundred and thirty-five dental practitioners participated in this research. [Figure 1] presents the graphical representation of demographic information. The majority of the participating practitioners were male (68.8%) compared to female (31.2%). Among the participants, 52.7% were general practitioners and 70.3% were affiliated with public sector clinics. Out of 535 participants, the majority of them reported a working experience of 0–5 years (39.2%) and mostly reported practitioners were Saudis (91.0%). Since this study targeted practitioners from countrywide, the total number of responses received was divided according to the region. The highest percentages of the participants were from the central region (37.7%) of Saudi Arabia followed by the southern region (30.1%). The response rate from the northern region was the least (9.3%).
Figure 1: Demographic details of the participating dental practitioners

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[Table 1] depicts the assessment of knowledge regarding biosafety. A good number of the participants were familiar with biosafety (62.1%). The majority of the practitioners knew the importance of biosafety in a dental setting (75.9%); consequently, the majority of them wanted to include biosafety in the dental curriculum (78.1%).
Table 1: Knowledge about biosafety among working dental practitioners

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[Table 2] shows the level of knowledge about surgical masks among the participants. Significant knowledge gaps were identified among the participants. Only 17.8% knew that surgical masks are made of nonwoven fabric. However, only 19.1% responded correctly that surgical masks could be made of polyester, polyethylene, polypropylene, polystyrene, or any nonwoven material. More than half of the respondents (54.4%) answered correctly that a surgical mask consisted of three layers. However, only 39.8% were aware that the middle layer acts as a filter barrier. On the contrary, 89.2% responded correctly that the purpose of the metal strip on a surgical mask is to fit on the nose. To our surprise, 87.1% knew that N95 mask/respirator is the best choice against COVID-19 protection. However, 55.5% were not sure about the number of layers present in N95 mask/respirator. On asking, “to which extent the surgical mask should cover the face?”, 82.1% responded correctly.
Table 2: Knowledge about face mask among working dental practitioners

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[Table 3] presents respondents' knowledge on inquiring questions related to gloves, face shields, eye protection, and gown among working dental practitioners. 57.4% of the participants agreed that latex/nitrile gloves are more reliable and durable, while almost all the participants (96.3%) were aware of the importance of eye/face shield along with the mask. A total of 73.3% of the participants believed that face shield along with headcover is necessary, whereas 71.8% believed that face shield is adequate compared to goggles or safety glasses. As many as 87.7% rightly knew that long-sleeved water-resistant gown is mandatory against COVID-19 protection.
Table 3: Knowledge about gloves, face shields, eye protection, and gown among working dental practitioners

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[Table 4] focuses on inquiring the level of knowledge of dental practitioners related to personal hygiene and sanitization. We interpret that the dental practitioners were acutely aware and hence showed an overall good knowledge. As many as 97.9% believed that proper hand hygiene is necessary and that the time duration for handwash should be 20–40 s. Again, hand hygiene needs to be performed after removing the PPEs (95%). A majority of the participants (95%) concluded that after every patient, disinfection of dental chair and devices need to be sterilized considering the COVID-19.
Table 4: Knowledge about hygiene and sanitization among the working dental practitioners

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  Discussion Top


This is the first study to report and provide a detailed insight into the level of knowledge and perception of dental practitioners relating to PPE use for personal protection against COVID-19. Biosafety measures lessen the risk of cross-contamination in clinical practice.[15] In this study, we evaluated the viewpoint related to biosafety and its importance in dental practice. Most of the participants agreed that biosafety measures be implemented in dental practice and that it should be part of the dental curriculum. The risks to health professionals and patients are issues of ongoing discussion. In this context, to promote biosafety measures would create a safe environment.

Face masks are one of the effective forms of PPEs and believed to prevent the transmission of contagious respiratory droplets by infected individuals.[16] However, for effective protection, the practitioner must have an intimate knowledge of wearing. Unfortunately, only 17.8% knew correctly that surgical masks are made of nonwoven material, and a large number of participants were not aware of the material used, the number of layers present, and the filtering barrier layer of the surgical mask. The reason might be because majority of the participants were having graduate degree with only 0-5 years of working experience. These findings were expected from the participants. The poor knowledge suggests that the dental practitioners of Saudi Arabia need to improve their knowledge. However, on inquiring the purpose of the metal strip, the extent to which the surgical mask covering the face, and the most effective mask against COVID-19 protection, 89.2%, 82.1%, and 87.1%, respectively, answered correctly. This high knowledge maybe because of recently circulating posts and messages on social media claiming the proper way to wear the surgical mask and the types of protective masks and their effectiveness. On the contrary, 55.5% of the participants were not sure about the number of layers present in the N95 mask. This strongly suggests that the dental practitioners of Saudi Arabia are not interested in improving knowledge through conferences, formal courses, workshops, and symposiums. In addition, the longer clinical experience increases the likelihood of participants being involved with medical emergencies, and hence, these previous experiences likely impact the retention of knowledge. Continuing medical education is an established method that can facilitate lifelong learning.[17]

On the other hand, knowledge related to gloves, face shields, eye protection, and gown among working dental practitioners was noticed to be higher. The reason might be that these tools are strongly advised for personal protection during surgeries. Furthermore, in the dental curriculum, the importance of these tools is highlighted in every surgical procedure. Another reason could be the previously available data suggesting that lack of PPE knowledge contributed to the higher cross-infection rates.[18],[19] A vital aspect of this study is that responses were collected on a national scale, and such high knowledge scores on Likert scale among dental practitioners of Saudi Arabia are promising regarding the ability of dentists in controlling the spread of the COVID-19.

Similarly, knowledge about hygiene and sanitization among the working dental practitioners was also noticed to be higher. Most of the dental practitioners were well trained, and they have ample knowledge on hand hygiene maintenance and its importance. From the data represented in [Table 4], we can say that knowledge about hygiene and sanitization largely agreed among the participants, irrespective of gender, working experience, or professional status.

This study has some strengths. The nationwide survey of the dental practitioners led us to assess their knowledge and perception regarding PPE and infection control measures against COVID-19. Hence, the study may represent the actual status of knowledge and perception among the practitioners of Saudi Arabia using random sampling method to avoid bias. Among limitations, we can say that we adopted a convenience sampling method that may not help in claiming generalizability of the findings. Instead, simple random sampling or systematic sampling would have been more appropriate in finding the level of knowledge and perception. In the future, a study particularly targeting graduates of different educational institutes of Saudi Arabia would be helpful in analyzing the difference in level of knowledge and perception among the graduates of different institutes.


  Conclusions Top


In the present study, dental practitioners had overall limited knowledge regarding the face masks used against COVID-19 protection. However, knowledge and perception of biosafety and other PPE were found to be higher and adequate among the participants. In addition, dental practitioners were well informed about hygiene practice and sanitization of the clinics to fight against COVID-19.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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