- Email: [email protected]
Survey on attitudes toward HIV-infected individuals and infection control practices among dentists in Mexico City
Survey on attitudes toward HIV-infected individuals and infection control practices among dentists in Mexico City Gerard0 Maupomk, CD, MSc, DDPH RCS(E), PhD” Enrique Acosta-Gio, CD, PhDb S. Aida Borges-Ybfiez, CD, MPHb F. Javier Diez-de-Bonilla, CDb Vancouver,
British Columbia,
and Mexico City, Mexico
Background: The teaching of infection control is gradually being introduced at dental schools in Mexico. However, most practicing dentists have limited access to current infection control standards. Deficiencies of knowledge with regard to blood-borne pathogens such as HIV and hepatitis B virus may influence attitudes toward infected individuals and reduce compliance with infection control recommendations. Objective: The purpose of this study was to assess (1) attitudes toward HIV-infected patients and hepatitis B virus-infected patients and (2) infection control knowledge and practices among dental practitioners in Mexico City. Method: A total of 196 dentists were interviewed by means of a questionnaire with Liiett-type scales and open-ended questions (response rate, 86.1%). Resufts: Most respondents had no previous social or professional contact with HIV-positive individuals. Nine percent indicated that they had knowingly treated HIV-positive patients. Perceived professional and moral obligations to treat HIV-positive patients were high. Thirty-five percent of the respondents perceived the risk of HIV infection as “considerable” to “very strong.” The risk of hepatitis B infection was considered significantly higher than the risk of HIV infection (P < .Ol); however, 78% of the respondents had not been immunized against hepatitis B. Reported use of personal protective equipment was high. Most respondents used dry heat sterilization. The principal disinfectants used were quaternary ammonium compounds, bleach, and glutaraldehyde. Fifty-four percent of the respondents acknowledged that clinical precautions reduced occupational risks. Conclusions: This survey revealed contradictory attitudes toward HIV-positive individuals and limited understanding of infection control recommendations. Educational and regulatory efforts are needed to promote better adherence to current infection control standards. (AJIC Am J Infect Control 2000;28:2 l-4)
In the United States’,2 and Canada,3 the collaboration of regulatory agencies, professional associations, and the academic establishment, as well as consumer awareness, have positively influenced professional compliance with recommended infection control (IC) practices. The introduction of infection control in curricula at dental schools in Mexico has been a gradual process. However, most practicing dentists seem to have limited access to current IC standards. Knowledge regarding blood-borne pathogens, such as HIV and hepatitis B (HB), may influence attitudes toward infected individuals and compliance with IC recommendations.’ The aim of this survey was to assess attitudes to HIV-positive individuals and knowledge and practices pertaining to infection control among dentists in Mexico City.
From the Faculty of Dentistry, the Dental School, National
University University
of British of Mexico.b
Reprint University BC V6T
requests: Dr Gerard0 of British Columbia, 123, Canada.
Copyright Infection
0 2000 by the Association Control and Epidemiology, Inc.
0196-6553/2000/$12.00
+ 0
Columbia,a
and
Maupome, Faculty of Dentistry, 2199 Wesbrook Mall, Vancouver,
f 7/46/l
for 01172
Professionals
in
MATERIALS
AND
METHODS
Questionnaire items and response scales were obtained from open-ended questions used in focus groups in which dentists discussed issues affecting their practice. Content analysis allowed the construction of questions that were subsequently reworded in closed format and tried again in another set of pilot studies. No dentist participating in the pilot studies took part in the final stage. Trained interviewers administered the questionnaire to a systematic sample of dentists attending the largest exhibition of dental products that takes place in Mexico City each year The November 1992 exhibition drew more than 2000 attendees. Every tenth dentist entering the exbibition hall was approached on a one-on-one basis. The questionnaire encompassed Likert-type scale evaluations of agreement or disagreement with statements. Some items included a list of reasons for the substantiation of opinions, an open-ended option always being allowed. The Likert-type scales were converted to numeric values (1 = strongest agreement, 6 = strongest disagreement) when necessary for statistical tests. Data were analyzed through use of the Student t test, Pearson’s x2 test, and l-way analysis of variance (P < .05 level of significance). 21
AJIC
22
Maupome’
et al
RESULTS
,
February
.
A total of 227 dentists were approached, and a response rate of 86.3% was achieved. Of the 196 respondents (47% female), 37% were 2 1 to 25 years old, 28% were 26 to 30 years old, and 35% were more than 30 years old. The number of years in practice varied from 1 to 36 (5.8 SD 4.9). Eighty-three percent of the participants had dental degrees only; 17% had dental specialty or graduate degrees as well. Most respondents (89%) indicated that they had no friends or relatives infected with HIV, and most (91%) had not treated HIV-positive patients. Most respondents acknowledged a professional (86%) or moral (89%) obligation to treat HIV-positive patients (Table 1). A minority (5%) objected to treating HIV-positive individuals and felt no moral duty to treat them. Reasons given for not wanting to treat HIV-positive individuals included (1) concerns that the dentist might lose staff or that other patients might be scared away, (2) the costs associated with implementing current IC standards, and (3) a fear that the dentist and his or her family might be exposed to HIV. Respondents considered the risk of being infected with HB significantly higher than the risk of being infected with HIV (P < .Ol). Most of the respondents (78%) had not been immunized against HB. Only 54% of the respondents recognized that clinical IC precautions reduce the risk of occupational exposure to HIV. As many as 64% had the perception that even if the IC recommendations were followed, the risk of HIV infection to themselves would be “considerable” or “very strong” (Table 2). Although the risk of patient-topatient transmission was perceived by 62% of respondents to be “null” or “weak,” 28% considered this risk “considerable” to “very strong.” The hazard posed to dentists was considered higher (Table 2; P < .Ol). Most respondents rated their knowledge of HIV as “considerable” to “very strong” (Table 3). Most dentists declared that they used gloves and face masks, oftentimes changing them between patients (Table 4). Use of protective eyewear and use of protective clothing were reported to be very common. Many respondents indicated they used dry heat sterilization (72%) and/or sterilization with steam under pressure (41%). Quaternary ammonium compounds and household bleach were the most widely used disinfectants (64% and 46%, respectively); these were followed by glutaraldehyde (3 1%). DISCUSSION The sampling framework and technique a mixture of systematic and convenience This is not an ideal way of undertaking
consisted of approaches. a survey, but
2000
there is no official roster of active, licensed dentists in Mexico. The present survey depicts the situation to the best of our ability to achieve what we assume to be a reasonably representative survey of opinions, albeit limited, among active dental clinicians in Mexico City. HIV infection was perceived to be a “considerable” to “very strong” occupational hazard by respondents who rated their knowledge of modes of infection as “medium” to “very strong.” Most participants declared that they felt they had professional and moral obligations to treat these patients, and gender, age, and years of practice did not seem to be associated with willingness to treat. A similar high level of declared willingness to treat HIVpositive persons among a separate sample of dentists in Mexico City was recently reported.J This “good disposition” has to be interpreted with caution, because many dentists in Mexico City have not faced the decision of whether to knowingly treat an HIV-positive person. Moreover, in contrast with this expressed “good disposition” with respect to treating patients, only one half of the respondents said that they would be willing to share their workplace with an HIV-positive person, at least 20% responding “no” or “difficult to accept” in regard to this possibility. The main reasons for not wanting to treat HIV-positive individuals appear to be consistent with those noted in previous reports.5.6 Dentists who believe that they “don’t have the necessary facilities,” who think that “someone else, such as government agencies, can take care of those patients,” or who “don’t want to expose themselves” might unknowingly be treating HIV-positive persons as well as patients infected with other blood-borne pathogens. Poor understanding of “universal precautions” was also observed by Irigoyen et alJ; 63% of their respondents had modified their clinical questionnaires in a probably futile attempt to detect “high risk” patients. Participants appear to be eager to implement IC measures but do not appear to fully trust their effectiveness: many perceived that even if the IC recommendations were followed, HIV cross-infection in the dental office was likely (Table 2). Most dentists had not been immunized against HB despite the common perception of this hazard (Table 2)-a fact that illustrates a contradiction between what they claim to know and how much concern they have on the one hand and what they do to protect themselves on the other. This state of affairs may be an ominous indication of the situation in the larger dental office environment, inasmuch as most dental office employees in Mexico are not specifically protected by occupational hazards legislation. It is commonplace for dentists to recruit untrained personnel or to upgrade clerical staff to work as dental assistants. If most dentists are not immunized against HB, one may expect that they are
AJIC Volume
Table
28, Number
1.
Maupome’
1
Opinions
on the position
of the profession
on dental
practice
et al 23
and HIV infection
How
strong is your personal worry about the risk of being infected by HIV? 33% 25% 21% 10% Very strong Strong Considerable Medium “Dentists have a professional duty to treat HIV infected patients. ” 83% 3% 4% 4% Of course Almost sure Probably Maybe “Dentists have a moral duty to treat H/V infected patients. ” 88% 1% 4% 4% Of course Almost sure Probably Maybe “Every patient must be considered potentially HIV positive. ” 60% 3% 13% 7% Of course Almost sure Probably Maybe “As a dental clinician, fear of H/V infection has forced me to elude high-risk patients (such frequent blood transfusions). ” (Extra answer option) “I have never been in that situation”: 46% 2% 3% 1% 2% Of course Almost sure Probably Maybe Would you willingly work in the same environment as a person infected with HIV? 41% 7% 14% 14% Of course Almost sure Probably Maybe Do you have objections to treating HIV infected patients? 6% 4% 12% 11% Very strong Strong Considerable Medium
of the risk of HIV and hepatitis
B contagion
In spite of the clinical precautions in the dental setting, the possibilities from dentist to patient are: 5% 9% 21% Very strong Strong Considerable .from patient to dentist are: 16% 21% 27% Very strong Strong Considerable from patient to patient are: 6% 7% 15% Very strong Strong Considerable The risk of a dentist getting hepatitis /3 in clinical practice is: 19% 33% 23% Very strong Strong Considerable
of contagion
Table
Table
2. Subjective
3. Opinions
estimates
on perceived
proficiency
How would you rate your level of know/edge the modes of infection? 17% 24% Very strong Strong the specific oral signs? 14% 21% Very strong Strong the specific systemic signs? 15% 25% Very strong Strong
of knowledge
on the HIV infection,
3% Weak
8% Null
Difficult
4% to accept
3% No
Difficult
2% to accept
1% No
8% to accept men and people
Difficult as homosexual
10% No who need
Difficult
5% to accept
42% No
Difficult
8% to accept
16% No
5% Weak
in the clinical
61% Null
setting
by HIV..
11% Medium
33% Weak
21% Null
13% Medium
16% Weak
6% Null
11% Medium
20% Weak
42% Null
9% Medium
11% Weak
6% Null
on HIV infection with regard
to the specific
aspects
of..
40% Considerable
15% Medium
3% Weak
0% Null
33% Considerable
24% Medium
6% Weak
2% Null
34% Considerable
19% Medium
5% Weak
2% Null
not protecting their employees either. Dental office employees would benefit if Labor and Health authorities in Mexico were to introduce updated regulations on occupational health. Reported use of personal protective equipment (Table 4) was as high as that found in surveys in the United States’ and Canada.zJ Of all of the IC recom-
mendations, those pertaining to the use of disposable gloves and face masks were the most frequently complied with, perhaps because dentists find such use to be affordable, highly visible, and expected by the patient. In agreement with the findings of the survey by Irigoyen et al,“ dry heat was the prevailing sterilization method. In Mexico, as in other nations,8.9 the use of
AJIC
24
MaupomC
et al
Table 4. Reported clinical setting
February
use of infection
barriers
daily clinical practice. do you a/ways No 7% Yes 93% Do you change gloves between patients? In your
No 13%
Yes 85% In your Do you In your glasses? Do you In your scrubs
daily
clinical
practice,
do you
Yes 95%
No 5%
change face masks Yes 68% daily clinical practice,
between
a/ways
use latex
gloves?
Sometimes 2% use face masks?
patients?
No 24% do you
in the .
Sometimes 8% always
use protective
No 21% Yes 79% wash protection glasses between patients? Yes 46% No 41% Sometimes 13% daily clinical practice, do you a/ways use clinical or coats? Yes 97% No 3%
boiling water, exposure of instruments to UV light, and other forms of “sterilization” may be associated with a lack of information about accepted sterilization techniques. The common use of quaternary ammonium compounds emphasizes the use of products without proven effectiveness. In this regard, Mexican health authorities have not updated regulations on the clinical use of disinfectants, and there are no official recommendations pertaining to the application of products with laboratory-tested activity against Mycobacterium tuberculosis. How appropriately disinfectants were actually used was not investigated. These results suggest that more Continuing Education and Dental Education efforts are necessary. In principle, such an effort could take the form of a cadre of qualified IC professionals who would promote, implement, and oversee an IC standard nationwide. A step in this direction was taken in early 1999, when the Ministry of Health published a Mexican National Standard (MNS) on Oral Health and Prevention, which
2000
outlined IC guidelines based on the 1993 IC recommendations made by the US Centers for Disease Control and Prevention.l” Government, professional associations, universities, and the dental industry could play a major role in helping to reach every practicing dentist in the nation to make this MNS known and see that it is complied with. Longitudinal evaluations of patterns of adherence to IC standards should be undertaken to determine the success of efforts to ensure that the MNS is adopted by the profession at large. References 1.
Gershon RRM, Curbow B. K&n G, Celantano D. Correlates of attitudes concerning human
D, Lears K, Vlahov immunodeficiency
2.
virus and acquired immunodeficiency syndrome among hospital workers. AJIC Am J Infect Control 1994;22:293-9. McCarthy GM, MacDonald JK. Improved compliance with rec-
3.
ommended infection control practices in the dental office between 1994 and 1995. AJIC Am J Infect Control 1998;26:24-8. Gibson GB. Mathias RG, Epstein JB. Compliance to recommend-
4.
ed infection control procedures: changes over six years among British Columbia dentists. Can Dent Assoc J 1995;61:526-32. Irigoyen M. Zepeda M, L6pez-Cdmara V. Factors associated with Mexico City dentists’ willingness to treat AIDS/HIV-positive patients. Oral Surg Oral Med Oral Pathol Oral Radio1 Endod 1998;86: 169-74.
5.
6.
McCarthy GM, MacDonald JK. Gender differences in characteristics, infection control practices, knowledge and attitudes related to HIV among Ontario dentists. Community Dent Oral Epidemiol 1996;24:412-5. Grace EG, Cohen LA. Attitudes of Maryland dentists and hepatitis patients. Am J Dent 1993:6:32-34.
toward
AIDS
7.
Gershon RRM, Karkashian C. Vlahov D, Grimes M, Spannhake E. Correlates of infection control practices in dentistry. AJIC Am J Infect Control 1998;26:29-34.
8.
Treasure P, Treasure ET. Suwey of infection control procedures New Zealand dental practices. Int Dent J 1994:44:342-g. Trieger N. Schlesinger N. Kaufman E. Mann J. Israeli dentists:
9.
10.
survey of infection control promised patients. Special Centers for Disease Control
practices and care of medically Care Dent 1993; 13: I 17-2 I. and Prevention. Recommended
tion control practices for dentistry, Wkly Rep 1993;41(RR-8):1-12.
1993. MMWR
Morb
in
cominfecMortal
a
British Columbia,
and Mexico City, Mexico
Background: The teaching of infection control is gradually being introduced at dental schools in Mexico. However, most practicing dentists have limited access to current infection control standards. Deficiencies of knowledge with regard to blood-borne pathogens such as HIV and hepatitis B virus may influence attitudes toward infected individuals and reduce compliance with infection control recommendations. Objective: The purpose of this study was to assess (1) attitudes toward HIV-infected patients and hepatitis B virus-infected patients and (2) infection control knowledge and practices among dental practitioners in Mexico City. Method: A total of 196 dentists were interviewed by means of a questionnaire with Liiett-type scales and open-ended questions (response rate, 86.1%). Resufts: Most respondents had no previous social or professional contact with HIV-positive individuals. Nine percent indicated that they had knowingly treated HIV-positive patients. Perceived professional and moral obligations to treat HIV-positive patients were high. Thirty-five percent of the respondents perceived the risk of HIV infection as “considerable” to “very strong.” The risk of hepatitis B infection was considered significantly higher than the risk of HIV infection (P < .Ol); however, 78% of the respondents had not been immunized against hepatitis B. Reported use of personal protective equipment was high. Most respondents used dry heat sterilization. The principal disinfectants used were quaternary ammonium compounds, bleach, and glutaraldehyde. Fifty-four percent of the respondents acknowledged that clinical precautions reduced occupational risks. Conclusions: This survey revealed contradictory attitudes toward HIV-positive individuals and limited understanding of infection control recommendations. Educational and regulatory efforts are needed to promote better adherence to current infection control standards. (AJIC Am J Infect Control 2000;28:2 l-4)
In the United States’,2 and Canada,3 the collaboration of regulatory agencies, professional associations, and the academic establishment, as well as consumer awareness, have positively influenced professional compliance with recommended infection control (IC) practices. The introduction of infection control in curricula at dental schools in Mexico has been a gradual process. However, most practicing dentists seem to have limited access to current IC standards. Knowledge regarding blood-borne pathogens, such as HIV and hepatitis B (HB), may influence attitudes toward infected individuals and compliance with IC recommendations.’ The aim of this survey was to assess attitudes to HIV-positive individuals and knowledge and practices pertaining to infection control among dentists in Mexico City.
From the Faculty of Dentistry, the Dental School, National
University University
of British of Mexico.b
Reprint University BC V6T
requests: Dr Gerard0 of British Columbia, 123, Canada.
Copyright Infection
0 2000 by the Association Control and Epidemiology, Inc.
0196-6553/2000/$12.00
+ 0
Columbia,a
and
Maupome, Faculty of Dentistry, 2199 Wesbrook Mall, Vancouver,
f 7/46/l
for 01172
Professionals
in
MATERIALS
AND
METHODS
Questionnaire items and response scales were obtained from open-ended questions used in focus groups in which dentists discussed issues affecting their practice. Content analysis allowed the construction of questions that were subsequently reworded in closed format and tried again in another set of pilot studies. No dentist participating in the pilot studies took part in the final stage. Trained interviewers administered the questionnaire to a systematic sample of dentists attending the largest exhibition of dental products that takes place in Mexico City each year The November 1992 exhibition drew more than 2000 attendees. Every tenth dentist entering the exbibition hall was approached on a one-on-one basis. The questionnaire encompassed Likert-type scale evaluations of agreement or disagreement with statements. Some items included a list of reasons for the substantiation of opinions, an open-ended option always being allowed. The Likert-type scales were converted to numeric values (1 = strongest agreement, 6 = strongest disagreement) when necessary for statistical tests. Data were analyzed through use of the Student t test, Pearson’s x2 test, and l-way analysis of variance (P < .05 level of significance). 21
AJIC
22
Maupome’
et al
RESULTS
,
February
.
A total of 227 dentists were approached, and a response rate of 86.3% was achieved. Of the 196 respondents (47% female), 37% were 2 1 to 25 years old, 28% were 26 to 30 years old, and 35% were more than 30 years old. The number of years in practice varied from 1 to 36 (5.8 SD 4.9). Eighty-three percent of the participants had dental degrees only; 17% had dental specialty or graduate degrees as well. Most respondents (89%) indicated that they had no friends or relatives infected with HIV, and most (91%) had not treated HIV-positive patients. Most respondents acknowledged a professional (86%) or moral (89%) obligation to treat HIV-positive patients (Table 1). A minority (5%) objected to treating HIV-positive individuals and felt no moral duty to treat them. Reasons given for not wanting to treat HIV-positive individuals included (1) concerns that the dentist might lose staff or that other patients might be scared away, (2) the costs associated with implementing current IC standards, and (3) a fear that the dentist and his or her family might be exposed to HIV. Respondents considered the risk of being infected with HB significantly higher than the risk of being infected with HIV (P < .Ol). Most of the respondents (78%) had not been immunized against HB. Only 54% of the respondents recognized that clinical IC precautions reduce the risk of occupational exposure to HIV. As many as 64% had the perception that even if the IC recommendations were followed, the risk of HIV infection to themselves would be “considerable” or “very strong” (Table 2). Although the risk of patient-topatient transmission was perceived by 62% of respondents to be “null” or “weak,” 28% considered this risk “considerable” to “very strong.” The hazard posed to dentists was considered higher (Table 2; P < .Ol). Most respondents rated their knowledge of HIV as “considerable” to “very strong” (Table 3). Most dentists declared that they used gloves and face masks, oftentimes changing them between patients (Table 4). Use of protective eyewear and use of protective clothing were reported to be very common. Many respondents indicated they used dry heat sterilization (72%) and/or sterilization with steam under pressure (41%). Quaternary ammonium compounds and household bleach were the most widely used disinfectants (64% and 46%, respectively); these were followed by glutaraldehyde (3 1%). DISCUSSION The sampling framework and technique a mixture of systematic and convenience This is not an ideal way of undertaking
consisted of approaches. a survey, but
2000
there is no official roster of active, licensed dentists in Mexico. The present survey depicts the situation to the best of our ability to achieve what we assume to be a reasonably representative survey of opinions, albeit limited, among active dental clinicians in Mexico City. HIV infection was perceived to be a “considerable” to “very strong” occupational hazard by respondents who rated their knowledge of modes of infection as “medium” to “very strong.” Most participants declared that they felt they had professional and moral obligations to treat these patients, and gender, age, and years of practice did not seem to be associated with willingness to treat. A similar high level of declared willingness to treat HIVpositive persons among a separate sample of dentists in Mexico City was recently reported.J This “good disposition” has to be interpreted with caution, because many dentists in Mexico City have not faced the decision of whether to knowingly treat an HIV-positive person. Moreover, in contrast with this expressed “good disposition” with respect to treating patients, only one half of the respondents said that they would be willing to share their workplace with an HIV-positive person, at least 20% responding “no” or “difficult to accept” in regard to this possibility. The main reasons for not wanting to treat HIV-positive individuals appear to be consistent with those noted in previous reports.5.6 Dentists who believe that they “don’t have the necessary facilities,” who think that “someone else, such as government agencies, can take care of those patients,” or who “don’t want to expose themselves” might unknowingly be treating HIV-positive persons as well as patients infected with other blood-borne pathogens. Poor understanding of “universal precautions” was also observed by Irigoyen et alJ; 63% of their respondents had modified their clinical questionnaires in a probably futile attempt to detect “high risk” patients. Participants appear to be eager to implement IC measures but do not appear to fully trust their effectiveness: many perceived that even if the IC recommendations were followed, HIV cross-infection in the dental office was likely (Table 2). Most dentists had not been immunized against HB despite the common perception of this hazard (Table 2)-a fact that illustrates a contradiction between what they claim to know and how much concern they have on the one hand and what they do to protect themselves on the other. This state of affairs may be an ominous indication of the situation in the larger dental office environment, inasmuch as most dental office employees in Mexico are not specifically protected by occupational hazards legislation. It is commonplace for dentists to recruit untrained personnel or to upgrade clerical staff to work as dental assistants. If most dentists are not immunized against HB, one may expect that they are
AJIC Volume
Table
28, Number
1.
Maupome’
1
Opinions
on the position
of the profession
on dental
practice
et al 23
and HIV infection
How
strong is your personal worry about the risk of being infected by HIV? 33% 25% 21% 10% Very strong Strong Considerable Medium “Dentists have a professional duty to treat HIV infected patients. ” 83% 3% 4% 4% Of course Almost sure Probably Maybe “Dentists have a moral duty to treat H/V infected patients. ” 88% 1% 4% 4% Of course Almost sure Probably Maybe “Every patient must be considered potentially HIV positive. ” 60% 3% 13% 7% Of course Almost sure Probably Maybe “As a dental clinician, fear of H/V infection has forced me to elude high-risk patients (such frequent blood transfusions). ” (Extra answer option) “I have never been in that situation”: 46% 2% 3% 1% 2% Of course Almost sure Probably Maybe Would you willingly work in the same environment as a person infected with HIV? 41% 7% 14% 14% Of course Almost sure Probably Maybe Do you have objections to treating HIV infected patients? 6% 4% 12% 11% Very strong Strong Considerable Medium
of the risk of HIV and hepatitis
B contagion
In spite of the clinical precautions in the dental setting, the possibilities from dentist to patient are: 5% 9% 21% Very strong Strong Considerable .from patient to dentist are: 16% 21% 27% Very strong Strong Considerable from patient to patient are: 6% 7% 15% Very strong Strong Considerable The risk of a dentist getting hepatitis /3 in clinical practice is: 19% 33% 23% Very strong Strong Considerable
of contagion
Table
Table
2. Subjective
3. Opinions
estimates
on perceived
proficiency
How would you rate your level of know/edge the modes of infection? 17% 24% Very strong Strong the specific oral signs? 14% 21% Very strong Strong the specific systemic signs? 15% 25% Very strong Strong
of knowledge
on the HIV infection,
3% Weak
8% Null
Difficult
4% to accept
3% No
Difficult
2% to accept
1% No
8% to accept men and people
Difficult as homosexual
10% No who need
Difficult
5% to accept
42% No
Difficult
8% to accept
16% No
5% Weak
in the clinical
61% Null
setting
by HIV..
11% Medium
33% Weak
21% Null
13% Medium
16% Weak
6% Null
11% Medium
20% Weak
42% Null
9% Medium
11% Weak
6% Null
on HIV infection with regard
to the specific
aspects
of..
40% Considerable
15% Medium
3% Weak
0% Null
33% Considerable
24% Medium
6% Weak
2% Null
34% Considerable
19% Medium
5% Weak
2% Null
not protecting their employees either. Dental office employees would benefit if Labor and Health authorities in Mexico were to introduce updated regulations on occupational health. Reported use of personal protective equipment (Table 4) was as high as that found in surveys in the United States’ and Canada.zJ Of all of the IC recom-
mendations, those pertaining to the use of disposable gloves and face masks were the most frequently complied with, perhaps because dentists find such use to be affordable, highly visible, and expected by the patient. In agreement with the findings of the survey by Irigoyen et al,“ dry heat was the prevailing sterilization method. In Mexico, as in other nations,8.9 the use of
AJIC
24
MaupomC
et al
Table 4. Reported clinical setting
February
use of infection
barriers
daily clinical practice. do you a/ways No 7% Yes 93% Do you change gloves between patients? In your
No 13%
Yes 85% In your Do you In your glasses? Do you In your scrubs
daily
clinical
practice,
do you
Yes 95%
No 5%
change face masks Yes 68% daily clinical practice,
between
a/ways
use latex
gloves?
Sometimes 2% use face masks?
patients?
No 24% do you
in the .
Sometimes 8% always
use protective
No 21% Yes 79% wash protection glasses between patients? Yes 46% No 41% Sometimes 13% daily clinical practice, do you a/ways use clinical or coats? Yes 97% No 3%
boiling water, exposure of instruments to UV light, and other forms of “sterilization” may be associated with a lack of information about accepted sterilization techniques. The common use of quaternary ammonium compounds emphasizes the use of products without proven effectiveness. In this regard, Mexican health authorities have not updated regulations on the clinical use of disinfectants, and there are no official recommendations pertaining to the application of products with laboratory-tested activity against Mycobacterium tuberculosis. How appropriately disinfectants were actually used was not investigated. These results suggest that more Continuing Education and Dental Education efforts are necessary. In principle, such an effort could take the form of a cadre of qualified IC professionals who would promote, implement, and oversee an IC standard nationwide. A step in this direction was taken in early 1999, when the Ministry of Health published a Mexican National Standard (MNS) on Oral Health and Prevention, which
2000
outlined IC guidelines based on the 1993 IC recommendations made by the US Centers for Disease Control and Prevention.l” Government, professional associations, universities, and the dental industry could play a major role in helping to reach every practicing dentist in the nation to make this MNS known and see that it is complied with. Longitudinal evaluations of patterns of adherence to IC standards should be undertaken to determine the success of efforts to ensure that the MNS is adopted by the profession at large. References 1.
Gershon RRM, Curbow B. K&n G, Celantano D. Correlates of attitudes concerning human
D, Lears K, Vlahov immunodeficiency
2.
virus and acquired immunodeficiency syndrome among hospital workers. AJIC Am J Infect Control 1994;22:293-9. McCarthy GM, MacDonald JK. Improved compliance with rec-
3.
ommended infection control practices in the dental office between 1994 and 1995. AJIC Am J Infect Control 1998;26:24-8. Gibson GB. Mathias RG, Epstein JB. Compliance to recommend-
4.
ed infection control procedures: changes over six years among British Columbia dentists. Can Dent Assoc J 1995;61:526-32. Irigoyen M. Zepeda M, L6pez-Cdmara V. Factors associated with Mexico City dentists’ willingness to treat AIDS/HIV-positive patients. Oral Surg Oral Med Oral Pathol Oral Radio1 Endod 1998;86: 169-74.
5.
6.
McCarthy GM, MacDonald JK. Gender differences in characteristics, infection control practices, knowledge and attitudes related to HIV among Ontario dentists. Community Dent Oral Epidemiol 1996;24:412-5. Grace EG, Cohen LA. Attitudes of Maryland dentists and hepatitis patients. Am J Dent 1993:6:32-34.
toward
AIDS
7.
Gershon RRM, Karkashian C. Vlahov D, Grimes M, Spannhake E. Correlates of infection control practices in dentistry. AJIC Am J Infect Control 1998;26:29-34.
8.
Treasure P, Treasure ET. Suwey of infection control procedures New Zealand dental practices. Int Dent J 1994:44:342-g. Trieger N. Schlesinger N. Kaufman E. Mann J. Israeli dentists:
9.
10.
survey of infection control promised patients. Special Centers for Disease Control
practices and care of medically Care Dent 1993; 13: I 17-2 I. and Prevention. Recommended
tion control practices for dentistry, Wkly Rep 1993;41(RR-8):1-12.
1993. MMWR
Morb
in
cominfecMortal
a