Assessment of knowledge and attitude regarding infection control is crucial in creating a safer workplace for dental health care providers as well as patients visiting them. This is challenging for academic institutes which is responsible for education and training of undergraduates to knowledgeable and skilled professionals. Such challenge can be accomplished by consistent inculcation of good knowledge and positive attitude in them with consistent supervision. Various studies have been conducted to assess knowledge, attitude, and practice of infection control policies amongst health care workers in Nepal. However, only few have been recorded among undergraduate dental students which entailed the conduction of the present study.
In the present study, majority of undergraduate dental students in BPKIHS (78.7%), had adequate knowledge regarding infection control which is almost like the findings of the study conducted by Embrahimpour et. al and Halboub et al. among undergraduate dental students which showed satisfactory level of knowledge.1,11 However, there are studies which report inadequate knowledge regarding infection control among undergraduate dental students.5,6 The reason for adequate knowledge in our study is the incorporation of infection control training in the curriculum which is routinely conducted both via theory and practical sessions as early as third year.
Regarding the association of level of knowledge with respect to gender, age, and academic years, there was no significant difference in level of knowledge between males and females though it was higher among the participants with higher mean age and among students of higher academic level. This is in accordance with the results of the study conducted at Kantipur Dental College and Hospital, Nepal among undergraduate dental students and interns.5 This significant difference is highly plausible in the sense that with increasing age and increasing level of education, knowledge is ought to upgrade. It is notable that, regarding Hepatitis B Virus (HBV)-vaccination status, 89% were vaccinated against HBV while 7.4% did not remember their status and 3.7% reported to be unvaccinated. This finding agrees with 86.50% vaccinated and 13.50 % unvaccinated status of the students of BPKIHS itself which was reported in a cross-sectional study done by Bhattarai et al. This study included medical, dental as well as nursing students and particularly for dental students, the vaccinated status was 80.2%, which was slightly lesser compared to our study result.12 Another cross-sectional study done in Nepal including medical and dental students reported that 73.5% were vaccinated while 4.5% had no idea about their vaccination status.13 Such increase in percentage of vaccinated students in our study indicates increased awareness among the students with due course of time in Nepal which is a positive finding. On the contrary, much higher rate of vaccinated status has been reported by other studies in UAE (95.8%), Brazil (90.8%), and Canada (100%).14–16
A couple of striking findings were noted despite good knowledge among majority of the students. Few students were unaware regarding the protocol of changing mask between patients. This could be attributed to the limited supply of such requirements in the institute because of which good clinical practice is being compromised. In addition, few students were found to lack the knowledge regarding post-exposure prophylaxis regimen when an unvaccinated dentist encounters a needle prick injury while treating Hepatitis B surface Antigen positive (HBsAg) patient. It is a serious concern though an occasionally encountered incidence during clinical practice, which calls for conduction of additional lectures and demonstrations to improve their knowledge.
In response to attitude questionnaire, majority of participants (74.3%) showed ‘positive’ attitude regarding infection control. This finding again is in congruence with the study done by Alharbi et al.9 Similarly, there are various other studies which report positive attitude among the dental students.4,17 But there are studies reporting negative attitude as well.6,18 Regarding the attitude of different academic year students, it was found that majority of fourth year students showed the most positive attitude. This statistically significant difference may be attributed to the fact that attitude is a subjective domain and hence a result of discrepancy in an individual’s beliefs, notions, and behavior. However, there was no difference in attitude noted among different age group and gender.
In the present study, it was appreciable to note that 100% of the students showed positive attitude regarding the need of all dental practitioners to get vaccinated against HBV, importance of enquiring and recording the medical history of the patients before starting any intra-oral procedures, and the necessity of disposal of used needles and sharp objects into designated sharps container. Such attitude is the reflection of good knowledge reported in the present study which in turn will contribute in strict adherence to infection control guidelines among the naive dental students.
Still, 0.7% of the participants disagreed to the statement regarding: effectiveness of wearing two pairs of gloves during any intra-oral surgical procedures to prevent disease transmission and offering face mask to coughing person as they enter the dental setting. However, wearing of double gloves can be incorporated into practice as it has been considered based upon several studies that, double gloving provide protection from occupational blood contact maintaining optimum manual dexterity as well as tactile sensitivity. In addition, the practice of offering mask to coughing persons in the vicinity of clinical set-up has also been recommended by CDC.4 Furthermore, few students revealed uncertainty to the CDC guidelines like washing hands before wearing gloves and instructing patients to use pre-procedural mouth rinse before commencement of any treatment procedure. This is of serious issue, which could be implemented in their practice if not supervised strictly. Despite the paucity of existing data which recommend preprocedural mouth rinse to prevent clinical infection among patients or DHCPs, it is advisable to use such rinse prior to aerosol generating procedures (AGPs) because, there are studies that have demonstrated reduction in the level of microorganisms with its use.19,20 In relation to washing of hands before wearing gloves, it has been recommended with an explanation that, the integrity of gloves may be compromised via presence of small, unnoticeable defects or even can be torn during use which can contaminate hands during glove removal. Hence, hands should be washed thoroughly before wearing gloves.4 Also, there were students though very few, who showed uncertainty as per CDC recommendation according to which responsibilities for disinfection and sterilization of dental instruments and other equipment should be assigned to a trained staff.4 Such attitude if not improvised will subsequently produce incompetent professionals who might jeopardize the health system in toto.
Study limitations: One of the major domains of education i.e., practice was not incorporated in the questionnaire because clinical assessment was not feasible as the students were only virtually accessible due to COVID-19 pandemic. Hence, with a view that subjective response would not reflect the true practice of the students, only knowledge and attitude were taken into consideration. Also, the present study did not include dental students from other parts of Nepal, hence making the sample size relatively small.
Despite the limitations, the data obtained from the study will help derive information pertaining to existing lacunae regarding knowledge and attitude towards infection control among the undergraduate students. This will trigger the need for further upgradation of current teaching-learning methods via conduction of continuous education programs, demonstrations regarding proper use of personal protective equipment (PPE), disinfection methods at more frequent intervals. Formal assessments and feedbacks during their clinical postings will also improve their knowledge, attitude and practice. Moreover, the results of this study will add to the existing literature and in turn impel conduction of similar studies amongst other group of staffs/ health care personnel in this institute. The result is expected to contribute in strengthening a cautious treatment strategy in the institute in future.