Pak J Med Res Original Article Vol. 51, No. 3, 2012 Knowledge, Attitude and Practices of Dentists about Hepatitis B and C Infection in Lahore Asia Batool, Misbah Ul Islam Khan Sherwani, Khatoon Akhtar Bano, Muhammad Aasim PMRC Research Centre, Fatima Jinnah Medical College, Lahore. Abstract Objectives: To assess the knowledge, attitude and practices of dentists of public and private sector in Lahore about Hepatitis B and C infection. Study type and settings: This cross-sectional analytical study was conducted on private dental practitioners and public sector dental surgeons working in hospitals of Lahore. Subjects and Methods: Private sector dentists of Lahore working in Shahdara, Badami Bagh, Mughalpura, Baghbanpura, Gulberg, Shadman, Mozang, Feroz pur Road, Model Town, Multan Road, Johar Town and Tohkher Niaz Baig were selected for the study. In the public sector hospitals, dental surgeons were selected from Demont Morency Dental College and Hospital, Mayo Hospital, Services Hospital, Govt. Mozang Hospital, Jinnah Hospital, Lahore General Hospital, Mian Munshi Hospital, Sheikh Zaid Hospital, Railway Hospital, Wapda Hospital and Combined Military Hospital by using convenient sampling technique. A self-administered, close-ended questionnaire was used and information was gathered about their knowledge, attitude and practices for HBV/HCV infection and its prevention. Data was entered in the SPSS-13 computer program. Frequency and percentages were calculated for different segments and comparison between the two groups was performed by using z-test for proportion. p-value ≤0.05 was considered significant. Results: A total of 209 dentisits agreed to participate in the study (105 in private and 104 in public sector). The mean age of the respondents was 33+9.8. Although majority had good knowledge about these viruses, their spread and prevention but information was either lacking or was wrong in many dentists. Disease spread through close contact was thought by 35%, through mosquitoes by 15%, in closed environments by 8%. Sexual and perinatal transmission of these viruses was not known by 30% and 8% did not know that these can be transmitted by blood or unsterilized instruments. About 50% stated that B and C cases should be restricted from working in food industry. Vaccine for hepatitis B was not known in 7%, while 25% said that a vaccine is available for hepatitis C. Attitude evaluation highlighted that 98% dentitsts screened their patients for hepatitis-B and C prior to dental treatment and 80% gave virus positive patients the last appointment to prevent disease transmission. Alomost 52% agreed that virus infected health professionals should not be discouraged from treating patients. Deficiencies were observed in the dental practices, which were more common in public sector like not being vaccinated for hepatitis B, infrequent use of special containers to dispose sharps. Deficiencies more marked in private sector included infrequent hand washing, not using autoclave for sterilization, not using new forceps/handpiece or personel protective equipments (mask/eye face shield). Conclusions: There were deficiencies in the knowledge, attitude and practices about hepatitis B&C virus in dentists of both public and private sector which need to be addressed on priority basis to stop disease transmission from this very frequented site. Policy message: Provision of a continuous formal and obligatory education on hepatitis B and C regarding its nature, causative organisims, risk factors, diagnosis management and prevention to update in infection control practices. The Dental Association should be made partner in the infection control campaign. Key words: KAP study, dentists, public and private sector, hepatitis B&C virus. Introduction health care workers and their patients1. Dental care professionals are at an increased risk of cross infection as 2,3 ith the global rise in the number of people well as its transmission while treating patients . With W infected with hepatitis B and C viruses, cross the presence of people who are infected with hepatitis B infection has become a paramount concern to dental and C and the HIV viruses, cross infection has become a major concern both to the dentist and his patient2. Both Corresponding Author: viruses can be transmitted after needle stick injuries and Asia Batool contact with body secretions and also because many PMRC Research Centre infected patients are unaware of their status or not willing Fatima Jinnah Medical College to disclose their disease status to health care workers. Lahore. There have been several reports of HBV and HCV Email: [email protected] Pakistan Journal of Medical Research, 2012 (July - September) 93 Knowledge, Attitude and Practices of Dentists about Hepatitis B and C Infection in Lahore transmission to patients from surgeons despite the surgeons were selected from Demont Morency Dental development of the universal precautions4,5. College and Hospital, Mayo Hospital, Services Hospital, Thousands of people infected with the life- Govt. Mozang Hospital, Jinnah Hospital, Lahore General threatening hepatitis C virus may have caught it during Hospital. Mian Munshi Hospital, Sheikh Zaid Hospital, routine dental treatment. Health campaigners warned that Railway Hospital, Wapda Hospital and CMH. Dental current practices in dental surgery, including the way surgeons who were not practically involved in dental tools are sterilized, may not be rigorous enough to procedures were excluded. remove the risk of transmission of the highly infectious Respondents were given ten minutes briefing on virus between patients. The transmission of HCV can the objectives of the study followed by a self filling of a occur via improper handling and cleaning of dental questionnaire containing study variables (socio- instruments. Risk of HCV transmission in this way has demographic characteristics, knowledge, attitude and proven by the researchers6 . practice of infection control procedures). There were 29 To minimize the risk of cross infection in the questions and 1 point was given for each correct answer dental clinic, specific recommendations have been issued and for all other responses, zero points were assigned. by professional health agencies. These recommendations Therefore, the score for knowledge ranged between zero include routine use of barrier techniques (gloves, masks), (no correct answers) and twenty nine (all answers correct). heat sterilization of dental instruments, vaccination against HBV, and the universal precautions7. Dentist’s Results compliance with these recommendations and infection control programs has been recently studied in different A total of 240 dentists were selected and out of 8-11 parts of the world . These studies indicate that there are whom 209(87%) agreed to participate in the study. Of gaps in some dentist’s knowledge regarding modes of 209 dentists 105 were from private sector and 104 from transmission of infectious diseases, the risk of infection public sector, majority (122) were males. Most of the from needle stick injuries, and awareness about general dentists (153=73.2%) were working as general measures which protect against HBV and HCV practitioners, 17 in operative dentistry, 11 in prosthetic 7 transmission . department, 8 in orthodontics, 2 in periodentics and18 in While it is important to assess health care diagnostic department. Hospital (public or private) was personnel’s hepatitis C knowledge, it is equally important the working place for 137(65.5%) dentists while to evaluate health care personnel’s attitudes and self- 72(34.4%) had their own clinics. The dentists of public reported behavior toward people with hepatitis C and to sector examined more than 30 patients a day as compared determine the factors that influence their behavior. to 15 patients in private sector. About 60% of public Interactions between patients and health care personnel sector and 40% of private sector dentitsts had less than represent an opportunity for education; yet if health care five years experience in their field. Almost a quarter personnel’s lack knowledge and hold judgmental dentists in public sector and 17% in private sector had no attitudes towards people with hepatitis C, they may not trained technician. 12 provide optimal treatment and care . Though most of the dentist had good knowledge Since dental health care workers may have about the causative organisms for hepatitis B and C and regular contact with hepatitis infected patients, they their mode of transmission but some deficiencies and should be aware of the dangers of the condition and the misconceptions were also seen. Some dentists from both necessary precautions that need to be taken. Our study public and private sector did not know about the targeted this group of dentists of public and private sector availability of HBV vaccine and some said that there is a in Lahore, as their knowledge, attitudes and practices are vaccine for HCV. Misconceptions about disease spread crucial in the management and control of Hepatitis B and through personal contact, mosquito bite and air and C viral infection. restriction of infected persons to work in food industry were also noted (Table-1). Subjects and Methods Almost all dentist (98.5%) agreed on screening of patients for hepatitis-B and C prior to any treatment. It was a descriptive cross-sectional study where The misconceptions noted were that giving last non-probability convenient sampling technique was used. appointment to the infected patient will prevent spread