Knowledge, Practice and Attitude of Dental Students Regarding Infection Control During the COVID-19 Pandemic - A Cross Sectional Study

Introduction

In Wuhan, China, a pneumonia outbreak with an undetermined origin occurred in December 2019. One month later, SARS-CoV-2, a novel coronavirus that causes a severe acute respiratory syndrome was discovered by researchers.¹ The disease produced, known as the 2019 Coronavirus disease, or COVID-19 was caused by the pathogen, which was discovered to be the seventh member of the coronavirus family to infect humans. China and the rest of the world were both affected by the public health issue brought on by. After the infection expanded significantly more, WHO updated the situation on March 12, 2020, and COVID-19 was declared as a pandemic.¹

Dental/oral and other healthcare personnel should be very careful in protecting against spread of the disease, as COVID-19 has been found in the saliva of infected individuals. Similar to other respiratory disorders, it can spread through aerosols used in medical procedures as well as droplets released during speaking, coughing, or sneezing (respiratory system activity) .²

Coronavirus 2 which causes severe acute respiratory syndrome is the source of the viral disease COVID-19 (SARS-CoV-2). On March 11, 2020, World Health Organization (WHO) proclaimed the novel coronavirus (COVID-19) outbreak a worldwide pandemic. Global public health is being threatened by COVID-19. Every nation experienced a public health emergency as a result of COVID-19 pandemic. The primary focus of the healthcare systems of all the nations was reducing COVID-19-related morbidity and mortality rates.

The pathogenesis of the Coronavirus in humans is influenced by the virus’s virulence as well as the host’s immunity and general health. The most crucial point is that COVID-19 can affect and kill healthy individuals depending on the virus’s aggressiveness and the patient’s haste in getting treatment.³

Compared to other respiratory illnesses with similar transmission pattern, such as severe acute respiratory syndrome, COVID-19 has a higher rate of transmission.

Although a specific mode of transmission for SARSCoV-2 has not been established, droplets and aerosols appear to be two of the main mechanisms for its dissemination. Protocols must be implemented to restrict the spread of COVID-19.

The American Dental Association (ADA) and the Center for Disease Control and Prevention (CDC) modified their cross-infection control guidelines in light of the current COVID-19 pandemic. S per this amended guidelines, dentists are to follow updated infection control procedures anywhere they practice.⁴

These practices include keeping an eye on public areas, donning safety gear, applying sanitizers, and following social distancing.

The knowledge and attitude of dental students is crucial in preventing COVID-19 transmission among themselves, patients, and hospital staff because there is a close connection between patients, students, clinicians, and doctors.

Materials and Methods

A survey on dental students’ knowledge, attitude, and practices regarding the management of COVID-19 infection was planned. An extensive literature review of questionnaires on the knowledge, behavior, and attitude of dental students about COVID-19 infection prevention was used to evaluate the content validity. Participants in this descriptive, cross-sectional study included students willing to participate from three dental colleges in Bangalore - M.R. Ambedkar Dental College and Hospital, Sri Rajiv Gandhi College of Dental Sciences, and Krishna Devaraya College of Dental Sciences and Hospital.

Questionnaire

Knowledge of infection control

1) Have you attended any training on programs for preventing the spread of SARS COV 2 virus infection?

2) Are you aware of Center for disease control (CDC) guidelines for the prevention of COVID-19 infection?

3) Do you perform COVID-19 screening for the patient when he/she visits your dental college/hospital?

4) Which tests do you advise before performing a surgical procedure?

5) Do you think that performing aerosol procedures pose more risk than other dental procedures?

Clinical practice

6) Which disinfection protocol do you follow between two appointments?

7) Are you aware of the protocol to be followed during donning and doffing of personal protective equipment?

8) Which type of protective gear will be more appropriate while performing dental procedures?

9) How are you following the patient triage for consultation appointments during this COVID-19 pandemic?

10) Have you made any changes in your treatment protocol for the patient in this COVID-19 pandemic?

Attitude towards infection control

11) Have you treated any COVID-19 recovered patients in this pandemic?

12) Do you think fear of COVID-19 infection transmission will harm the patient’s attitude towards dental treatment?

13) Did you feel any changes in the behavior of patients towards non-emergency dental procedures?

14) Are you worried about yourself and your family’s health while treating the patients?

15) Do you find new practice protocols physically and psychologically taxing?

Statistical analysis

Chi square test was used to compare the distribution of responses to knowledge, attitude & clinical practice based questions. The significance was set at p≤0.05.

Results

A total of 314 copies of questionnaires were sent online to dental students participating in the survey. Questionnaire used in this study was planned based on three main domains- knowledge, attitude and practices of dental students towards the control of COVID-19 infection.

Domain-Knowledge

Table 1 strongly describes that students were aware of Real-Time Reverse Transcription–Polymerase Chain (RTPCR) test before performing any surgical procedure, and were also aware of CDC guidelines for prevention of COVID-19 infection. 97.9% opined that RTPCR or Rapid antigen test should be done before performing any surgical procedure. See table 1 and figure 2.

Domain-Attitude (Table 2)

Over 93% of the students think fear of COVID-19 infection transmission will have a negative impact on the patient’s attitude towards dental treatment. 33.2% were concerned about the efficacy of COVID-19 vaccine. 91.2% felt that only emergency cases to be treated which was statistically significant and also reported that adapting to new practice protocols is physically and psychologically taxing. See table 2 and figure 3. 

Domain-Practices (Table 3)

About 96.6% opined that N95 protective gear will be more appropriate while performing dental procedures. 96.3% practitioners agreed to have made changes in their treatment protocol for patients during COVID-19 pandemic. 94.5% responded affirmatively of being aware of protocol to be followed during donning and doffing of personal protective equipment. See table 3 and figure 4.

Discussion

The current study found that a significant number of students had good knowledge regarding COVID-19- infection and its prevention protocol. Majority of the study sample had expressed positive attitude towards infection control practices to prevent COVID-19 in the dental office.

In this study, most students were aware of need of RT-PCR or rapid antigen testing before undergoing surgical procedures and CDC guidelines for preventing COVID-19 infection. We need more educational programs to prevent the spread of the SARS-COV-2 virus.

In a similar study by Mohammad Esmaeelinejad et al.,¹ the mean knowledge score was 9.55±1.94 (59.7%). The mean set point was 7.26±1.79 (66%). The current study recorded a result of about 95.02% for knowledge, but a value of 78.06% was recorded for attitude.

In a similar study by Basim Almulhim⁴ and his two colleagues in Saudi Arabia, 388 dental students participated in the study. 68% of the respondents that they were well informed about COVID-19. The average knowledge score of the participants was 5.84 out of 7. Females (6.24) scored significantly higher than males (5.55, p <=0.001). The average attitude score was 6.34, 9. 93% used personal protective equipment (PPE) model and 95% maintained social distancing. Of all dental students attending, only 16% were willing to treat patients during the pandemic, while 28% did not want to treat patients, and 28% preferred remote dentistry. Majority of dental students (44%) were happy to treat only emergencies. In the current study, 80.05% students treated patients recovered from COVID-19 infection.

A study by Osman Atas et al.,⁵ had a correlated response. Both clinical and preclinical students feared infecting themselves and others with COVID-19, and the difference was statistically significant. Three-quarters (74.9%) of the participants agreed when asked if they thought their experiences related to COVID-19 were affecting them psychologically. Differences between gender and clinical status were statistically significant.

Kehinde Adesola et al., conducted a study involving 102 undergraduate clinical dental students.⁶ Males accounted for 54.9%, and the mean age was 25.3±2.4 years. Around 50% of students had good knowledge on COVID-19. The male final-year students (58.1%) demonstrated better knowledge of COVID-19 than female final-year student (28.6%, p =0.008). Most respondents (95.1%) expressed positive attitude towards infection control practices for COVID-19. At the current study site, graduates responded better to treatment protocols than undergraduates.

In a similar study on 324 study participants who completed a questionnaire had response rate of 40.5%. Majority of respondents were males (59.8%) and their age ranged between 25-30 years (32.7%), followed by 31-35 years (31.2%). Only 28.4% reported of participating in infection prevention and control (IPC) activities.⁷ Mean value of 41.60±6.26 indicates that the study participants expressed positive attitude towards COVID-19 IPC. Subscale scores for subjective norms and perceived behavioral control were low, with mean scores of 28.95±5.44 and 34.89±6.49, respectively. The attitude to behavior (p <0.001) and subjective norm (p <0.001) components significantly predicted Dental Health Care Worker (DHCW) intention to practice COVID-19 IPC behavior, accounting for 44.3% of the variance. The study recommended implementing a comprehensive infection control education and training program on COVID-19 among DHCWs in Saudi Arabia to strengthen infection prevention attitudes and behaviors.

A correlative cross-sectional study was conducted on 622 dental students were observed during clinical sessions to assess adherence to infection control protocols. ⁸ The compliance checklist used was adapted from the Center for Disease Control and Prevention dental facility infection control checklist. Observations were made for two consecutive years. Once in 2019, before COVID-19 outbreak, and once in 2020 during the pandemic. Adherence to infection control measures among dental students improved during the COVID-19 pandemic compared to before the pandemic. Adherence to personal protective equipment standards was higher than hand hygiene practices.

Conclusion

Dental students demonstrated good knowledge and practice towards the COVID-19 infection control; however, their attitude towards the COVID-19 infection control varied depending on their educational qualification and experiences. The level of awareness for infection control in undergraduate level students was less when compared to postgraduate level students. Further studies are required to assess the knowledge and practice of the students after holding appropriate training courses.

Conflicts of Interest

None