The impact of AIDS and the dread of acquiring HIV infection from patients
have led to the resurgence in infection-control practices among health care
workers. Recent reports of blood-borne pathogen transmission in health care
settings, including oral health, have caused considerable public health
concern. Transmission has been reported from patient to patient, patient to
health care workers, but rarely from health care worker to patient. The risks of
dental clinicians acquiring serious infections have been well documented but
the risk to dental assistants has received less attention, especially in South
Africa.
Aim: To assess infection-control practices of dental assistants and their level
of adherence to universal precautions in public health care facilities in
Limpopo Province.
Objectives: To establish the prevalence and the type of occupational
exposures among dental assistants working in public health care facilities in
Limpopo Province.
Methods: A cross-sectional survey was conducted among dental assistants in
Limpopo Province in 2005. The study population comprised all 73 employees
who performed the functions of a dental assistant in public dental facilities. A
self-administered questionnaire was used to collect information regarding
work experiences and training, infection-control practice and knowledge, and
the nature, incidences and reporting of any occupational exposures they had
experienced. A follow-up telephone call was made to these dental assistants,
after they had received the questionnaire, to re-iterate the importance of the
survey and to request them to complete and return the questionnaire in the
prepaid envelope they had been given. The facilities were clustered according
to the six districts in Limpopo Province. Ethical approval was given by the
University of the Witwatersrand and the Department of Health and Welfare in
Limpopo Province.
Results: Fifty-nine dental assistants returned the completed questionnaire,
giving a response rate of 80.8%. Epi Info Version 3.3.2 programme was used
to analyze the data. The majority of respondents were female (95%), with a
mean age of 40.2 years (age range 23-54). More than 90% of the
respondents had no formal training for their occupation, half (49.1%) did not
have any health training, 22% were auxiliary nurses, 18.6% were
“correspondence-trained” assistants who had been trained via distance
learning and had no practical clinical training and only 10.2% of the
respondents had received training at a technikon or university . The majority
of the dental facilities (57.6%) had one dental assistant working alone,
followed by those with two or three assistants (39.5%). The number of
respondents assisting more than two oral clinicians in a day was 93.3%. The
mean number of clinicians assisted per day was 3.8. The total numbers of
dental assistants who experienced occupational exposures while working at
the various dental clinics were 26 (44.1%), with 11.5% experiencing multiple
injuries within the preceding six months. Auxiliary nurses and trained
assistants were significantly more likely than untrained assistants to be aware
of universal precautions, their protective effects, needle stick protocols, and of
the need for personal protective equipments to be worn for all procedures
(p=0.001).
Compliance with infection-control practices was low overall. More than twothirds
of the assistants routinely wore gloves during procedures. The lowest
compliance reported was the use of protective eye shields, whilst more than
62.7% were not vaccinated against hepatitis B virus. More than two-thirds of
the assistants were injured in the process of removing and or cleaning
instruments; 65.3% of the injuries were direct punctures. Twenty-three
percent did not report the injury. The risk of injury for the untrained assistants
was 9.9 times higher than that for auxiliary nurses, p=0.008.
A small percentage (23.8%) of those with sharp injuries was placed on
antiretroviral drugs. Surprisingly, a significant high percentage of respondents
were given wound cleaning only as treatment of their occupational exposures
(78.4%) and sharp injuries (83%).
Conclusion and recommendation
More than 90% of the respondents had no formal training for their occupation.
Dental assistants were understaffed and had increased workload. The
greatest incidence of injury was associated with the handling of sharp objects,
and this included recapping used needles. Occupational exposures to
infectious material were found to be relatively high whilst compliance to some
basic infection-control guidelines was low among dental assistants. The
training of dental assistants should be regulated. More suitably qualified
dental assistants should be appointed and existing ones should be given inservice
training on the importance of infection-control practices and
compliance with universal precautions.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/5798 |
| Date | 23 October 2008 |
| Creators | Nemutandani, Mbulaheni Simon |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf |
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