Gore S M, Felix D H, Bird A G, Wray D
MRC Biostatistics Unit, Institute of Public Health, Cambridge, U.K.
J Infect. 1994 Mar;28(2):209-22. doi: 10.1016/s0163-4453(94)95740-1.
This retrospective study used a postal questionnaire to measure occupational risks and to assess infection control procedures among 310 dental practitioners. The study comprised general dental practices in the Lothian region of Scotland, Lothian Health Board Community Dental Service and Edinburgh Dental Hospital. Altogether, 217 dental practitioners responded by the due date giving recall of inoculation injuries within the previous 5 years and infection control measures employed. The study revealed that 191 practitioners (88%) had completed a course of hepatitis B vaccination but one-third of them had not been tested for post-vaccination antibody. In 1991, two thirds of dentists (66%: 137 of 207 respondents) wore the same pair of gloves, and 80% of dentists (142 of 177 respondents) wore the same mask, for dealing with more than one patient. The usual practice was to change gloves during sessions (44%: out of 71 dentists) and to change masks for each session or less often (75%: 73 out of 97 dentists). The proportion of dentists who never used gloves fell from 56% in 1981 to 1% in 1991. An autoclave was used for sterilisation by 85% of practitioners in 1991. Reported non-sterile inoculation injuries averaged 1.7 (S.D. = 3.2) injuries per dentist in the previous year with 56% of practitioners having had an injury. The average was 6.8 (S.D. = 15.9) injuries per dentist in the previous 5 years with 76% of practitioners having had an injury. Of recent non-sterile inoculation injuries described by dental practitioners, 30% constituted a moderate or high risk of transmission of infection to the practitioner (43 of 141 described injuries). Combined with HIV seroprevalance rates, probabilities of transmission and numbers of practising dentists, the mean reported number of non-sterile inoculation injuries in the previous 5 years may be used to provide estimates of expected numbers of dental practitioners occupationally infected with HIV in the previous 5 years. U.K. estimates were 0.004 dentists in Lothian region and 0.05 dentists in the Thames region occupationally infected with HIV in the previous five years. Non-sterile inoculation injuries appear to be a common hazard of dental practice. In any year, most dentists are exposed to the risk of blood-borne viral infection. Despite a high reported incidence of such injuries, dental practice within the U.K. appears to carry a low risk of acquiring HIV infection from occupational exposure.
这项回顾性研究采用邮寄问卷的方式，对310名牙科医生的职业风险进行了评估，并对其感染控制程序进行了评价。该研究涵盖了苏格兰洛锡安地区的普通牙科诊所、洛锡安健康委员会社区牙科服务机构以及爱丁堡牙科医院。共有217名牙科医生在规定日期前回复了问卷，提供了过去5年内接种损伤的回忆情况以及所采取的感染控制措施。研究表明，191名医生（88%）完成了乙肝疫苗接种疗程，但其中三分之一的人未进行接种后抗体检测。1991年，三分之二的牙医（207名受访者中的66%，即137人）在为多名患者治疗时佩戴同一副手套，80%的牙医（177名受访者中的142人）佩戴同一副口罩。通常的做法是在治疗过程中更换手套（71名牙医中有44%），以及每次治疗时或更少次数更换口罩（97名牙医中有75%，即73人）。从不使用手套的牙医比例从1981年的56%降至1991年的1%。1991年，85%的医生使用高压灭菌器进行消毒。据报告，上一年每位牙医非无菌接种损伤的平均次数为1.7次（标准差=3.2），56%的医生曾有过此类损伤。过去5年每位牙医的平均损伤次数为6.8次（标准差=15.9），76%的医生曾有过此类损伤。在牙科医生描述的近期非无菌接种损伤中，30%构成了感染传播给医生的中度或高度风险（141例描述损伤中的43例）。结合艾滋病毒血清流行率、传播概率以及执业牙医数量，过去5年报告的非无菌接种损伤平均次数可用于估计过去5年职业感染艾滋病毒的牙科医生预期人数。英国的估计数字为，洛锡安地区过去5年有0.004名牙医职业感染艾滋病毒，泰晤士地区有0.05名牙医。非无菌接种损伤似乎是牙科执业中的常见风险。在任何一年，大多数牙医都面临血源病毒感染的风险。尽管此类损伤的报告发生率较高，但英国的牙科执业因职业暴露感染艾滋病毒的风险似乎较低。
