Staff Knowledge and Attitudes Towards COVID-19 New Biosafety Practices at a Brazilian Dental School

Ana Carolina  Marques-Medeiros; Renata Castro  Martins; Maria Elisa  Souza e Silva; Ênio Lacerda  Vilaça; Leandro Napier de  Souza; Maria Auxiliadora Parreiras  Martins; Ricardo Santiago  Gomez; Mauro Henrique Nogueira Guimarães de  Abreu

Authors

Ana Carolina Marques-Medeiros
Renata Castro Martins
Maria Elisa Souza e Silva
Ênio Lacerda Vilaça
Leandro Napier de Souza
Maria Auxiliadora Parreiras Martins
Ricardo Santiago Gomez
Mauro Henrique Nogueira Guimarães de Abreu

Keywords:

COVID-19, Education, Dental, Infection Control, Dental

Abstract

Objective: To evaluate knowledge and attitudes towards biosafety recommendations during the COVID-19 pandemic at a Brazilian dental school. Material and Methods: A cross-sectional study was performed in 2020 with the clinical staff of a Brazilian dental school. The whole clinical staff was sent pre-tested self-administered online questionnaires about knowledge and attitudes towards the recommendations for biosafety in dental settings in the context of the COVID-19 pandemic. Descriptive statistical analyses were carried out for proportion calculation. Results: Disposable head covering caps, isolation gowns, and gloves were the most frequently reported personal protective equipment (PPE). The rates ranged from 52.9% to 88.5% for N95 respirators, from 68.6% to 92.6% for face shields, from 47.4% to 67.5% for conventional eye protection shields, and 45.1% to 77.4% for eye protection with solid side shields. Chlorhexidine gluconate was the most frequent mouthwash indicated before clinical dental care. The percentage of agreement to provide clinical care to patients with suspected COVID-19 varied from 23.5% to 50.0%. The percentage of respondents who agreed that bioaerosol-generating procedures should be avoided was higher than 74.5%. Less than 50% knew the correct sequence for doffing of PPE. Conclusion: This study revealed important gaps in knowledge and attitudes towards prevention and control measures against infection in dental environments in the context of COVID-19, indicating the need for improvements.

References

Sabino-Silva R, Carolina A, Jardim G, Siqueira WL. Coronavirus COVID-19 impacts to dentistry and potential salivary diagnosis. Clin Oral Investig 2020; 24(4):1619-21. https://doi.org/10.1007/s00784-020-03248-x

Spagnuolo G, De Vito D, Rengo S, Tatullo M. COVID-19 outbreak: an overview on dentistry. Int J Environ Res Public Health 2020; 17(6):3-5. https://doi.org/10.3390/ijerph17062094

Checchi V, Bellini P, Bencivenni D, Consolo U. COVID-19 Dentistry-related aspects: a literature overview. Int Dent J 2020; 71(1):21-6. https://doi.org/10.1111/idj.12601

Fallahi HR, Keyhan SO, Zandian D, Kim S-G, Cheshmi B. Being a front-line dentist during the Covid-19 pandemic: a literature review. Maxillofac Plast Reconstr Surg 2020; 42(1):12. https://doi.org/10.1186/s40902-020-00256-5

Wu DT, Wu KY, Nguyen TT, Tran SD. The impact of COVID-19 on dental education in North America — Where do we go next? Eur J Dent Educ 2020; 24(4):825-7. https://doi.org/10.1111/eje.12561

Villani FA, Aiuto R, Paglia L, Re D. Covid-19 and dentistry: Prevention in dental practice: a literature review. Int J Environ Res Public Health 2020; 17(12):1-12. https://doi.org/10.3390/ijerph17124609

Brasil. Agência Nacional de Vigilância Sanitária. Nota técnica GVIMS/GGTES/ ANVISA no 04/2020 atualizada em 25.02.2021. Orientações para serviços de saúde: Medidas de prevenção e controle que devem ser adotadas durante a assistência aos casos suspeitos ou confirmados pelo novo coronavírus (SARSCoV-2). 2020. Available from: http://portal.anvisa.gov.br/documents/33852/271858/Nota+Técnica+n+04-2020+GVIMS-GGTES-ANVISA/ab598660-3de4-4f14-8e6fb9341c196b28. [Accessed on February 26, 2021]. [In Portuguese].

Centers for Disesase Control and Prevention. Guidance for Dental Settings. Interim Infection Prevention and Control Guidance for Dental Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic. 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html. [Accessed on December 4, 2020].

World Health Organization. WHO Director-General’s statement on IHR Emergency Committee on Novel Coronavirus (2019-nCoV) [Internet]. WHO. 2020. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-statement-on-ihr-emergency-committee-on-novel-coronavirus-(2019-ncov). [Accessed on December 4, 2020].

Elangovan S, Mahrous A, Marchini L. Disruptions during a pandemic: gaps identified and lessons learned. J Dent Educ 2020; 84(11):1270-4. https://doi.org/10.1002/jdd.12236

Quinn B, Field J, Gorter R, Akota I, Manzanares MC, Paganelli C, et al. COVID-19: The immediate response of European academic dental institutions and future implications for dental education. Eur J Dent Educ 2020; 24(4):811-4. https://doi.org/10.1111/eje.12542

Sukumar S, Dracopoulos SA, Martin FE. Dental education in the time of SARS-CoV-2. Eur J Dent Educ 2021; 25(2):325-31. https://doi.org/10.1111/eje.12608

Jum’ah AA, Elsalem L, Loch C, Schwass D, Brunton PA. Perception of health and educational risks amongst dental students and educators in the era of COVID-19. Eur J Dent Educ 2021; 25(3):506-15. https://doi.org/10.1111/eje.12626

Landis R., Koch G. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 1977; 33(2):363-74. https://doi.org/10.2307/2529786

Ataş O, Yildirim TT. Evaluation of knowledge, attitudes, and clinical education of dental students about COVID-19 pandemic. PeerJ 2020; 8:e9575. https://doi.org/10.7717/peerj.9575

Arora S, Saquib SA, Attar N, Pimpale S, Zafar KS, Saluja P, et al. Evaluation of knowledge and preparedness among indian dentists during the current Covid-19 pandemic: a cross-sectional study. J Multidiscip Healthc 2020; 13:841-54. https://doi.org/10.2147/JMDH.S268891

de Abreu MHNG, Lopes-Terra MC, Braz LF, Rímulo AL, Paiva SM, Pordeus IA. Attitudes and behavior of dental students concerning infection control rules: a study with a10-year interval. Braz Dent J 2009; 20(3):221-5. https://doi.org/10.1590/S0103-64402009000300009

Hoernke K, Djellouli N, Andrews L, Lewis-Jackson S, Manby L, Martin S, et al. Frontline healthcare workers’ experiences with personal protective equipment during the COVID-19 pandemic in the UK: a rapid qualitative appraisal. BMJ Open 2021; 11(1):e046199. https://doi.org/10.1136/bmjopen-2020-046199

Houghton C, Meskell P, Delaney H, Smalle M, Glenton C, Booth A, et al. Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis (Review). Cochrane Database Syst Rev 2020; (4):CD013582. https://doi.org/10.1002/14651858.CD013582

Meng L, Hua F, Bian Z. Coronavirus Disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine. J Dent Res 2020; 99(5):481-7. https://doi.org/10.1177/0022034520914246

Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci 2020; 12(1):1-6. https://doi.org/10.1038/s41368-020-0075-9

Cavalcante-Leão B, de Araujo C, Basso I, Schroder A, Guariza-Filho O, Ravazzi G, et al. Is there scientific evidence of the mouthwashes effectiveness in reducing viral load in Covid-19? a systematic review. J Clin Exp Dent 2021; 13(2):e179-89. https://doi.org/10.4317/jced.57406

Ortega. K.L., Rech BO, Haje GLCE, Gallo CB, Pérez-Sayáns M, Braz-Silva PH. Do hydrogen peroxide mouthwashes have a virucidal effect? a systematic review. J Hosp Infect 2020; 106(4):657-62. https://doi.org/10.1016/j.jhin.2020.10.003

Vergara-Buenaventura A, Castro-Ruiz C. Use of mouthwashes against COVID-19 in dentistry. Br Jounal Oral Maxillofac Surg 2020; 58(8):924-7. https://doi.org/10.1016/j.bjoms.2020.08.016

Loch C, Kuan IBJ, Elsalem L, Schwass D, Brunton PA, Jum’ah A. COVID-19 and dental clinical practice: Students and clinical staff perceptions of health risks and educational impact. J Dent Educ 2021; 85(1):44-52. https://doi.org/10.1002/jdd.12402

Umeizudike KA, Isiekwe IG, Fadeju AD, Akinboboye BO, Aladenika ET. Nigerian undergraduate dental students’ knowledge, perception, and attitude to COVID-19 and infection control practices. J Dent Educ 2021; 85(2):187-96. https://doi.org/10.1002/jdd.12423

Zemouri C, De Soet H, Crielaard W, Laheij A. A scoping review on bio-Aerosols in healthcare & the dental environment. PLoS One 2017; 12(5):1-26. https://doi.org/10.1371/journal.pone.0178007

Ge Z, Yang L, Xia J, Fu X, Zhang Y. Possible aerosol transmission of COVID-19 and special precautions in dentistry. 2020; 21(5):361-8. https://doi.org/10.1631/jzus.B2010010

World Health Organization. Transmission of SARS-CoV-2: implications for infection prevention precautions Available from: https://www.who.int/publications/i/item/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations. [Accessed on December 4, 2020].

Gandolfi MG, Zamparini F, Spinelli A, Sambri V, Prati C. Risks of aerosol contamination in dental procedures during the second wave of COVID-19 — experience and proposals of innovative IPC in dental practice. Int J Environ Res Public Health 2020; 17(23):1-12. https://doi.org/10.3390/ijerph17238954

Chaudhary FA, Ahmad B, Ahmad P, Khalid MD, Butt DQ, Khan SQ. Concerns, perceived impact, and preparedness of oral healthcare workers in their working environment during COVID-19 pandemic. J Occup Health 2020; 62(1):1-7. https://doi.org/10.1002/1348-9585.12168

Khader Y, Al Nsour M, Al-Batayneh OB, Saadeh R, Bashier H, Alfaqih M, et al. Dentists’ awareness, perception, and attitude regarding COVID-19 and infection control: cross-sectional study among Jordanian dentists. JMIR Public Heal Surveill 2020; 6(2):1-11. https://doi.org/10.2196/18798

Mustafa RM, Alshali RZ, Bukhary DM. Dentists’ knowledge, attitudes, and awareness of infection control measures during COVID-19 outbreak: A cross-sectional study in Saudi Arabia. Int J Environ Res Public Health 2020; 17(23):1-14. https://doi.org/10.3390/ijerph17239016

Hegde S. Which type of personal protective equipment (PPE) and which method of donning or doffing PPE carries the least risk of infection for healthcare workers? Evid Based Dent 2020; 21(2):74-6. https://doi.org/10.1038/s41432-020-0097-3

European Center for Disease Prevention and Control. Guidance for wearing and removing personal protective equipment in healthcare settings for the care of patients with suspected or confirmed COVID-19. 2020. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-guidance-wearing-and-removing-personal-protective-equipment-healthcare-settings-updated.pdf. [Accessed on December 4, 2020].

Verbeek JH, Rajamaki B, Ijaz S, Sauni R, Toomey E, Blackwood B, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Emergencias 2021; 33(1):59-61. https://doi.org/10.1002/14651858.CD011621.pub4

Ahmed MA, Jouhar R, Adnan S, Ahmed N, Ghazal T, Adanir N. Evaluation of Patient’s Knowledge, Attitude, and Practice of Cross-Infection Control in Dentistry during COVID-19 Pandemic. Eur J Dent 2020; 14(Suppl 1):S1-S6. https://doi.org/10.1055/s-0040-1721295

Ahmed N, Shakoor M, Vohra F, Abduljabbar T, Mariam Q, Rehman MA. Knowledge, awareness and practice of health care professionals amid sars-cov-2, corona virus disease outbreak. Pakistan J Med Sci 2020; 36(COVID19-S4):S49-S56. https://doi.org/10.12669/pjms.36.COVID19-S4.2704

Duruk G, Gumusboga ZŞ, ÇolaK C. Investigation of Turkish dentists’ clinical attitudes and behaviors towards the COVID-19 pandemic: a survey study. Braz Oral Res 2020; 34:e054.

https://doi.org/10.1590/1807-3107bor-2020.vol34.0054

Singh Gambhir R, Singh Dhaliwal J, Aggarwal A, Anand S, Anand V, Kaur Bhangu A. Covid-19: a survey on knowledge, awareness and hygiene practices among dental health professionals in an Indian scenario. Rocz Panstw Zakl Hig 2020; 71(2):223-9. https://doi.org/10.32394/rpzh.2020.0115

Qudeimat MA, Farrah RY, Owais AI. Infection control knowledge and practices among dentists and dental nurses at a Jordanian university teaching center. Am J Infect Control 2006; 34(4):218-22. https://doi.org/10.1016/j.ajic.2005.06.012