Evaluating Infection Control Practice among Dental Professionals in Private Dental Clinics in Douala during Covid-19 Pandemic
Evaluating Infection Control Practice among Dental Professionals in Private Dental Clinics in Douala during Covid-19 Pandemic
Lingondo Simon Mwambo 1, Dr Forcham Emmanuel Duna*
1) BDSC, M.A, MSc., MPS (Oral Surgery), CAIE, CDS, PGCERT (Applied and Computational Mathematics).
*Correspondence to: Dr Forcham Emmanuel Duna Senior Lecturer, researcher and HND Exam Coordinator. Address : Catholic University of Cameroon, Bamenda, school of health and medical sciences and university of Buea, department of microbiology and parasitology.
Copyright.
© 2025 Dr Forcham Emmanuel Duna This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 03 Feb 2025
Published: 14 Feb 2025
ABSTRACT
BACKGROUND: Infection control measures refer to policies and procedures use to minimize the risk of spreading infection especially in hospital and human or animal health care facilities. Although there is evidence that many private dental clinics suffer from cross infection that can occur during dental procedure, there is still insufficient literature on it control measure in Douala. Aim: The purpose of this study was to assess infection control practice among private dental professionals (PDPs) in Douala during COVID-19 pandemic.
MATERIAL AND METHOD: A retrospective study was conducted and private dental professionals were approached through a convenient sampling technique in health structure in Douala from the 11th MAY to the 10th JUNE 2022. 154 dental professionals in private dental clinics gave consent to participate in this study. Data was collected using close-ended questionnaires that was translated in French to facilitate easy understanding since we are in the French-speaking zone and was analyzed using EPI infos version 3.5.1
Result: Infection control practices among dental professionals in Douala1 during COVID-19 pandemic was up to standard. 105(81.5%) participants tell patients to used hand sanitizer before getting into the dental clinic, 110(85.2%) wear examination gloves when consulting, 98(75.9%) wear face shield and face mask before any dental procedure. 64(49.61%) changed face mask after each patient ,80(60%) give mouth wash to their patient before any dental procedure, 112(87.0%) clean and disinfect ultrasonic scalar and hand pieces ,105(81.5%) clean and disinfect dental chair after each patient, 117 (90.7%) ventilate the clinic during any procedure by opening windows 65(50.4%) to ventilate, 91(70.4%) wear PPE, disinfected surfaces, sterilized instruments to avoid cross infection before and after each patients, 80(60%) changed their lab coat after two days, 122(94.3%) had safety box for sharp instruments disposal, 105(81.5%) used dry heat as sterilization method.
Conclusion: Infection control measures during COVID -19 pandemic among dental professionals was respecting the CDC guidelines and Practice of infection control was up to standard as guideline for dental settings in Douala.
Key words: Practice, infection control measures, coronavirus 19, private dental professionals
Evaluating Infection Control Practice among Dental Professionals in Private Dental Clinics in Douala during Covid-19 Pandemic
INTRODUCTION
1.1 BACKGROUND
Dental care has become challenging with the emergence of new diseases that are very contagious and fatal. From tuberculosis to hepatitis, HIV/AIDS and new corona virus infection control measure cannot be over emphasized. The oral health care givers is expected to exposed themselves to harm and at same time not to harm the patient. Many communicable diseases have been part of global emergency and re-emergency. Globally, 99.7% of oral health care workers implement infection control procedures, most commonly disinfection, sterilisation, COVID-19 screening, social distancing, and wearing face masks. Most practicing dentists (72.8%) used personal protective equipment (Estrich et al., 2020). According to interim guidance from the Centers for Disease Control and Prevention oral health-care workers (HCWs) and dental patients had already been reported to have contracted diseases including Mycobacterium tuberculosis, hepatitis B and C virus (HBV and HCV), Legionella pneumophila, human immunodeficiency virus, and other microorganisms originating from the oral and respiratory (Benedict Odhiambo Otieno1, Eunice Njeri Kihara and Bernard Nzioka Mua1, 2020).
Cross-infection control has always been a prime importance in the hospital, it is considered as gold standard not only for patient safety but also for dentist and their staff. In the light of current COVID-19 pandemic, ADC and CDC guidelines for cross-infection control have changed (source: ADA-COVID-19 Resources for Dentists) (Bizzoca ME, Campisi G, Muzio LL, 2020). Cross-infection transmission occurs during dental treatment (66%) involving blood, saliva, and procedures generating aerosols. These aerosols remain suspended in air for a quite reasonable time and could possibly be a substantial source of infection in case of treating infected patient. (Bizzoca ME, Campisi G, Muzio LL, 2020). COVID-19 has the potential to cause severe acute respiratory tract infection among infected humans and is commonly transmitted from person to person via hands, saliva, nasal droplets, and surface contacts (Ahmed et al., 2020).
The dental professionals and practices have the potential to spread the disease to the population unknowingly, if the precautions are not being strictly followed (Sarfaraz et al., 2020). SARS-CoV-2 transmission during dental procedures can therefore happen through inhalation of aerosol/droplets from infected individuals or direct contact with mucous membranes, oral fluids, contaminated instruments and surfaces. Given the exposure risk for different working categories, dental professionals are the workers facing the greatest coronavirus risk (R EZZERTI, 2020). In the beginning of this COVID-19 outbreak, mostly dental services were closed or restricted to emergency treatment only because of lack of proper guidelines for COVID-19 infection control, fear and anxiety among dental professionals. By the passage of time, people have realized that they have to live with coronavirus disease until COVID-19 vaccine is available; therefore, life is resuming to normal with certain modification such as social distancing, wearing facemask, avoiding gatherings, and caring of hand hygiene through frequent washing or sanitization. (Bizzoca ME, Campisi G, Muzio LL, 2020). Hence, in Cameroun, little is still known about infection control practice among private dental professionals during COVID-19 pandemic in Douala.
The purpose of this study is to evaluate infection control practice among private dental professionals during COVID-19 pandemic in Douala, assess their knowledge with respect to COVID-19 guideline, evaluate their practice of infection control, determine the level of exposure of dental professionals, nosocomial infection and assess the role dentist in Douala play to stop the spread of the disease using infection control measures.
1.2 STATEMENT OF THE PROBLEM
Private dental clinics have a profit-making approach toward practice rather than humanitarian only. They always want to make profit over cost and this may influence less investment they make in infection control measures, especially as COVID-19 infection demands more than usual, therefore it could be shortcoming or laxity in compliance to standard of infection control by health care personnel in private dental clinics in Douala. For this purpose, acquiring updated knowledge regarding infection control measure and disinfection during the current pandemic is necessary for every dental professional.
There is a general tendency for patient to avoid health facilities during the outbreak of a very virulent and fatal disease for fear of nosocomial infection. This is the case during COVID-19 pandemic in Douala, identifying the shortcoming of infection and correcting them will reassure patient and general public in Douala about the safety of dental practice as COVID-19 is yet to be eradicated.
The purpose of the study was to evaluate the practice of infection control in private dental clinics in Douala with respect to COVID-19 guidelines as prescribe by Centre of Disease Control
- To assess if the practice of infection control during COVID-19 pandemic was up to standard in private dental clinics in Douala.
- To assess the application of COVID-19 infection control recommended guidelines in private dental clinics in Douala.
1.4.1 General Research Question
How did private dental clinics in Douala practice infection control during COVID-19 pandemic?
1.4.2 Specific Research Question
- To evaluate if the practice of infection control during COVID-19 pandemic was up to standard in private dental clinics in Douala?
- Are dental clinics practicing infection control guideline for dental setting in Douala?
1.5 RESEARCH HYPOTHESIS
Could insufficient infection control practice in private dental clinics in Douala be a deterrent to dental visits and treatment during COVID -19 out break?
1.6 SIGNIFICANCE OF THE STUDY
There is a general tendency for patient to avoid health facilities during the outbreak of a very virulent and fatal disease for fear of nosocomial infection. This is the case during COVID-19 pandemic in Douala, identifying the shortcoming of infection and correcting them will reassure patient and general public in Douala about the safety of dental practice as COVID-19 is yet to be eradicated.
1.7 DEFINITION OF TERMS AND CONCEPT
Infection control: Refers to measure practiced by health care personnel to reduce the risk of transmission of infectious agents to patient and employers or the preventives measures that aim to ensure the protection of those who might be vulnerable to acquire an infection both in the general community and while receiving care due to health issue.
Practice: Is a method, procedure, process or rule use in particular field or profession or action rather than though or idea.
Coronavirus: Also known as COVID-19 is an ss-RNA, enveloped virus with a size of ~350 kilo base-pair (kbp) is contagious disease that causes a severe acute respiratory syndrome 2 ( SARS-CoV-2).
Dental professionals: This are health care personnel who are qualify to treat the disease and condition affecting the mouth, jaw, teeth and gums.
1.8 LIMITATIONS
Time period in which this study was done was a very clear limitation as it prevented certain participants from participating in this study. The sensitive nature of this study caused some potential participants to turn down their consent to participate.
This study was carried out in Douala which is the largest city in Cameroon and its economical capital. It covers an area of 41 000 ha = 410 km2 and has a population of 3 793 000 inhabitants. The city of Douala is divided into seven districts (Akwa, Bassa, Bonabéri, Bonapriso, Bonanjo, Deïdo and New Bell) and it has more than 120 neighborhoods. The climate is mostly hot and humid there than cold.
A Retrospective study design was used to carry out the research study because it easy, cost effective to perform and can be done within a short time interval, study variables can be obtained or collected at once.
The study concern dental professionals in private clinics in Douala.
All private dental clinics in Douala that was willing to participate in the study.
All private dental clinics who was present within the study time
The private dental clinics who withdraw before the end of the study.
All Public dental facility in Douala.
All private dental clinics that was not present within the study time.
Following a study carried out by (Karimi, S. D.) In Pakistan on infection control practice, his number of participant was 140. The sample size was calculated using Slovin’s formula
n= N/1(1+N (e) ²)
Where,
n= estimated sample size
e= error margin
N= population size = 100-95= 5
Therefore 5% = 5/1= 0.05%
n= 140/1(1+140(0.05)²)
=154
However, we could not meet up with the sample size which were 154 but we have the sample size of 129 participant. This is because the duration of the study was for 1 month and also many participants refused to participate within the study time
Non-probabilistic sampling method was used, participants was chosen using convenient sampling techniques because the study was carried out on available private dental professionals in Douala.
2.6 DATA COLLECTION PROCEDURE
Infection control practices
Data was obtained by giving out questionnaire, data collection form was used for the study and distributed to the participant.
Pretesting of data collection tools
Sample questionnaire was given to participants reflecting the study population to evaluate the understanding of questions.
2.7 DATA COLLECTION PROCEDURE
Clearance was be obtained from the regional delegation of public health littoral. The school administration. The various hospital where the research was carried out.
Pretesting of questionnaire was done on participant reflecting the study population in other to evaluate understanding of questions and determine the time needed to answer the questionnaire. After final modification, the self-administered questionnaires were distributed to participants by the principal investigator (PI).
The principal investigator was data collector of this study and was trained by his supervisor.
The principal investigator was moving to the various hospital, introduce her selves to each participant, explain the goal of the study and they could come in.
Few minutes was accorded to potential participant in case they have questions or need clarification in regard to this study. When this was done, the participant signed the consent form to demonstrate his or her willingness to participate in the study.
The questionnaire was strictly confidential and the answer questionnaire was kept cautiously to be analyse for result.
2.8 DATA MANAGEMENT
Training was done in other to understand the concept
Generate tools for data management
Collect the data
Data was checked for completeness, analyzed, coded and saved in Microsoft word 2007 and in a USB flash drive.
2.9 DATA ANALYSIS
Data was input in Microsoft word 2007 and analyzed using EPI Infos.
The results obtained was presented in form of tables and charts.
2.10 ETHICAL CONSIDERATION
Ethical clearance and approval were obtained from school authority of Havard Higher University Institute of Science and Technology, Bamenda. An authorization was obtained from the Districts enrolled for this study and a participant’s consent was given to sign as an agreement outlining their roles and responsibilities to participate in the study.
2.11 EXPECTED OUTCOME
To assess if the practice of infection control during COVID-19 pandemic was up to standard in private dental clinics in Douala and if they actually followed the Centre of Disease Control guidelines.
A total of 129 Oral health care givers from 42 dental clinics or structures in the city of Douala participated in this study. They responded to self-administered questionnaires.
3.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS
Table 1 shows the demographic presentation of study respondents sex, qualification and work experience
|
Variables |
Frequency(n=) |
Percentage % |
|
SEX; Male Female |
57 72 |
44.4 55.6 |
|
Qualification; Dental surgeon Dental therapist/technician Dental assistant |
39 64 26 |
30.5 49.5 20 |
|
Work experience 1-5yrs 6-10yrs 11-20yrs 21-30yrs Above 30yrs |
64 37 18 7 2 |
49.5 28.5 14.3 5.7 2.0 |
From the results of this table above, majority 72(55.6%) of participants were female against minority 57(44.4%) who were male. 64 (49.5%) were dental therapist/technician while 26 (20%) were dental assistant. Majority of participant had work experience 1-5 year 64 (49.5%) while 2 (2%) were above 30 years.
3.2 TRIAGE AND SCREENING
Table 2 shows triage and screening of everyone entering the dental clinic
|
Variables |
|
Frequency(n=) |
Percentage% |
|
Obligatory hand sanitization before getting into the clinic? |
No Yes |
24 105 |
18.5 81.5 |
|
When consulting do you wear examination gloves?
offer mouthwash before procedures |
No
Yes
Yes No |
19
110
80 49
|
14.8
85.2
62 38 |
|
Do you wear face shield and face mask before any dental procedure? |
No
Yes |
31
98 |
24.1
75.9 |
|
How often do you change your face mask? |
At the end of the day
When I get dirty
At the end of the week
After each patient |
17
22
26
64 |
13.1
17.2
20.1
49.6
|
|
How do you handle hand piece and ultrasonic scalar? |
Disinfect after each patient
Clean after each patient
Clean and disinfect after each patient at the end of the day |
10
5
11 2 |
7.4
3.7
87.0 1.9 |
|
How do you handle dental chair? |
Disinfect after each patient
Clean after each patient
Clean and disinfect after each patient
Clean and disinfect at the end of the day |
14
20.5
105
2 |
11.1
5.6
81.5
1.9 |
From the results of table 2 above, 105(81.5%) of participants tell patients to used hand sanitizer before getting into the dental clinic, majority 110(85.2%) wear examination gloves when consulting. Majority 80(62%) offered mouth wash before procedure. Majority of participants 98(75.9%) wear face shield and face mask before any dental procedure. Majority of participants 64(49.61%) changed face mask after each patient against minority 17(13.19%) who changed when it at the end of the day. Majority of participants 112(87.0) clean and disinfect ultrasonic scalar and hand pieces while minority 2(1.9%) clean at the end of the day. Majority of participants 105(81.5%) clean and disinfect dental chair after each patient while minority 2(1.9%) clean and disinfect at the end of the day.
3.3 INFECTION CONTROL MEASURES IN DENTAL SETTINGS
Table 3 shows infection control measures among study participants in dental settings
|
Variables |
Frequency (n=) |
Percentage% |
|
|
Do you ventilate the clinic during any procedure? |
No
Yes |
12
117 |
9.3
90.7 |
|
What do you use to ventilate? |
Fan open windows air conditioner |
12 65 52 |
9.3 50.4 40.3 |
|
What do you do to avoid cross infection before and after each patient? |
disinfect surfaces dental chairs disinfection and use of PPE wearing PPE, surfaces disinfection, sterilization of instruments |
26 12
91 |
20.4 9.2
70.4 |
|
How often do you change your lab coat? |
After two days when it gets dirty at the end of the week |
80 19 30 |
60 15 25 |
|
Are there special containers for waste disposal in your clinic? |
No
Yes |
12
117 |
8.4
92.6 |
|
How do you manage sharp instruments after a procedure? |
safety box
in a plastic bag |
122
7 |
94.3
5.7 |
|
What type of sterilization method do you use? |
dry heat
steam |
105
24 |
81.5
18.5 |
From the results of the table 3 above, majority of participants 117 (90.7%) ventilate the clinic during any procedure. Majority of participants open windows 65(50.4%) to ventilate while 12(9.3%) used fan to ventilate. Majority of participants 91(70.4%) wear PPE, disinfected surfaces, sterilized instruments to avoid cross infection before and after each patients while minority 12 (9.2%) used PPE and disinfect dental chair. Majority of participants 80(60%) changed their lab coat after two days while minority 19(15%) changed when it get dirty. Majority of participants 122(94.3%) had safety box for sharp instruments disposal while minority 4(7.4%) were using plastic bag. Majority of participants 105(81.5%) used dry heat as sterilization method against 24(18.5%) who used Steam as sterilization methods.
3.4 INFECTION CONTROL MEASURE
3.4 a) Infection control measure remark
Figure 1: Infection control remark
Figure above shows the general infection control measures and it shows that 126(98%) do take adequate control measures while 3 (2%) do not.
4.4.b) Infection control practice remark
Figure 2: Infection control practice remark
From the above figure, it shows 126 (98%) of the population do have a good practice for infection control in dental clinics and 3 (2%) has poor practicing styles.
3.4 ASSOCIATION BETWEEN INFECTION CONTROL MEASURES AND SOCIO-DEMOGRAPHIC CHARACTERISTICS
Table 4: Associations between infection control measures and socio-demographic characteristics
|
Variables |
Infection control measures N= |
||
|
|
Adequate control measures |
Inadequate control measures |
P value |
|
qualification dental surgeon dental therapist dental technician dental assistant |
22 7 16 8 |
1 - - - |
.712 |
|
years of experience 1-5 6-10 11-20 21-30 30 and above |
26 11 10 5 1 |
- - - 1 - |
.086 |
|
Infection control practice remark Good practice Poor practice |
53 0 |
0 1 |
.019 |
From table 4 above, there is no association between demographic characteristics and infection control measures as there is no P value >0.05. Still on the same table above there is a significant association between the infection control practice and the infection control measures, P=0.019
With respect to the practice of infection control during covid-19 pandemic as according to CDC guidelines, it was found that 105(81.5%) of participants tell patients to used hand sanitizer before getting into the dental clinic. This may be due to the fact they were no hand washing point available and also that hand sanitizer kills certain germs. Most participant 110(85.2%) wear examination gloves when consulting, 98(75.9%) wear face shield and face mask. Majority of participants 64(49.61%) changed face mask after each patient. This might be because they had good knowledge about the new corona virus that is very contagious and fatal. Talking about infection control measures in dental setting, majority of participants 117 (90.7%) ventilate the clinic during any procedure by open windows 65(50.4%) to ventilate may be due to fact that facilitate airflow. Majority of participants 91(70.4%) wear PPE, disinfected surfaces, sterilized instruments and 80(60%) changed their lab coat after each patients. This is to limit cross infection in dental setting. Majority of participants 122(94.3%) had safety box for sharp instruments disposal. Majority of participants 105(81.5%) used dry heat as sterilization method. This may be due to the fact that dry heat was the sterilization method available in their dental setting. These results were in accordance with the recommendations set by the CDC guidelines, (2016) who reported that used of hand sanitizer, wearing examination gloves, ventilated the clinic, wearing PPE, disinfect surfaces, sterilized instruments and changing lab coat after each patients represents the minimum infection prevention expectations to limit the spread of covid-19 in dental settings and with that of R EZZERTI, (2020).
Talking about practice of infection control measures, 126(98%) of participants had good practice about infection control measures. This might be because they care about both patient and their own well-being. Tis is in accordance with the study carried out by Estrich et al., (2020) in United State who reported that infection control procedures were implemented in 99.7% of dentists’ primary practices, most commonly disinfection, COVID-19 screening and wearing face masks also most practicing dentists (72.8%) used personal protective equipment according to interim guidance from the Centers for Disease Control and Prevention. This study was in contrary with a study carried out by Askarian & Assadian, (2009) in Iran who reported that, practice of infection control was poor among DHCPs.
4.2. CONCLUSION
Results from this study indicated that, infection control measures during COVID -19 pandemic dental professionals respected the CDC guidelines and Practice of infection control was up to standard for dental settings in Douala. This work highlights that many dental professionals were adhering to good infection control practice during the COVID-19 outbreak.
4.3. RECOMMENDATIONS
1. The ministry of public health should continuously emphasize on the education, training and recycling of dental health care personnel on infection control.
2. Dental practitioners should organize conferences and debates in order to discuss about the importance of infection control.
3. For researchers, further studies on infection control practices would be of great value in increasing our knowledge and better understanding measures of prevention to be taken.
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