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...attitudes and/or practices the respondents.
Methods. 49-item survey consisting of eight demographic, nine attitudinal, and 32 practice questions was used for this study. A stratified sampling method was used, in which the United States was divided into four regions. Three states were selected from each region according to geographic location and population. Five percent of registered dental hygienists within each selected state were randomly selected for inclusion in the study. All analyses were conducted using the Statistical Package for Social Scientists (SPSS v.10, Chicago, IL).
Results. Of the 2,009 surveys mailed, 104 were undeliverable. A total of 856 completed surveys were returned from practicing dental hygienists for a response rate of 44.9%. Overall, this study found an increased use of barriers and personal protective equipment in comparison to previous studies. A majority of respondents (53.9%) felt that treating patients with HIV or AIDS increased their personal risk for contracting the disease. The majority of respondents also reported always using extra precautions with HIV/AIDS patients (63.5%) and hepatitis patients (60.1%). In addition, most respondents reported they would not use an ultrasonic scaler when treating HIV/AIDS (65.8%) or hepatitis (58.9%) patients, indicating an alteration in clinical practice habits.
Conclusion. The majority of dental hygienists surveyed reported altering infection control practices and treatment techniques when treating HIV/AIDS or hepatitis patients. While there has been an improvement in compliance with recommended infection control guidelines, practitioners still have misconceptions, and possibly fear, regarding infectious diseases and disease transmission.
Keywords: Infection control, disease transmission, universal precautions, aerosols, personal protective equipment, attitude of health professional, practices, dental hygienist
Introduction
Over the last two decades, attitudes of health care providers towards infection control and treatment of patients with infectious diseases have changed dramatically. (1-20) Most oral health care professionals have realized the importance of infection control and have incorporated Occupational Safety and Health Administration (OSHA) guidelines into their practices to prevent disease transmission. (1) Due to the media, public awareness of the possibility of disease transmission within the dental office has forced even more compliance with OSHA standards in order to assure apprehensive patients.
A key element of infection control is the concept of universal precautions. This concept was introduced by the Centers for Disease Control and Prevention (CDC) as a means to reduce the risk of transmission of blood-borne pathogens in health care settings. The primary principle behind this concept is based upon the premise that clinicians cannot rely definitively on the medical history and examination of a patient to determine the absence or presence of infectious diseases.
Therefore, the same infection control procedures should be used for all patients. (21-23) In 1996, the CDC expanded this concept and changed the term to standard precautions. The 2003 guidelines state: "Standard precautions integrate and expand the elements of universal precautions into a standard of care designed to protect health care personnel and patients from pathogens that can be spread by blood or any other body fluid." (21)
The emergence of the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) has also been correlated with compliance with infection control guidelines. However, oral health care workers continue to indicate a reluctance to treat patients with HIV/AIDS or those in high-risk groups. (1-17) Although dentistry has come a long way in infection control practices, patients with infectious diseases continue to be treated with different infection control methods. (1)
Review of the Literature
Previous studies have investigated the knowledge, attitudes, and practices associated with infection control and the treatment of patients with infectious diseases. These studies, which date as far back as the early 1980s, have been conducted with a variety of oral health care workers, including dental assistants, dental hygienists, and dentists.
Several studies have been conducted to investigate the infection control knowledge, practices, and attitudes of dentists. (2-9) In 1998, Gershon et al. reported that 98% of Maryland dentists surveyed believed that following recommended infection control procedures (ICP) would protect them from exposure to HIV. (2) Although 69% of the respondents indicated a tolerance for and acceptance of treating patients with AIDS, 43% reported that they would rather refer HIV patients elsewhere, and 56% felt that they should have the right to refuse to treat HIV patients. HIV was believed to be transmitted through saliva by 44% of the respondents, and 67% felt that it could be transmitted by a splash to the eyes or mouth. (2)
A national survey of endodontists regarding infectious diseases and attitudes toward infection control was conducted by Cohen et al. (3) Ninety-five percent of endodontists reported receiving a hepatitis B vaccine during the period from 1982 to 1995, and 99% reported wearing gloves during every patient contact. In general, most respondents felt that infection control measures protected them from transmissible diseases. The majority of respondents also reported that they were willing to treat patients with transmissible diseases. (3)
Verrusio et al. compared the results of two national surveys of infection control practices conducted by the American Dental Association (ADA) during 1986 and 1988. (4) Results from these surveys indicated an increase in hepatitis B vaccination and in following ICP. Verrusio et al. attributed education, the media, and the AIDS epidemic to the increase in knowledge of infectious diseases. However, results from these surveys suggest that education and understanding of HIV infection have not eradicated irrational fears about this disease. (4)
Other studies also report a reluctance of dentists to treat patients with HIV. (5-7) Moretti and colleagues found that 30% of respondents would not treat patients suspected of having HIV, even if the patients had no clinical signs or symptoms of AIDS or AIDS Related Complex (ARC). (5) Survey results from Gerbert's study revealed that while California dentists were reluctant to treat patients with AIDS, 70% felt the responsibility to do so.6 Forty-seven percent of the respondents also believed that AIDS was transmitted through saliva. (6)
Differences in infection control practices and attitudes of dentists, dental hygienists, and dental assistants were reported in two different studies. (10,11) Both studies reported that dental hygienists were more likely to use recommended ICP than dentists or dental assistants....
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