McCarthy G M, MacDonald J K
Faculty of Medicine and Dentistry, School of Dentistry, University of Western Ontario, London, Canada.
Am J Infect Control. 1998 Feb;26(1):24-8. doi: 10.1016/s0196-6553(98)70057-4.
To investigate changes in Ontario dentists' infection control practices between 1994 and 1995.
Data from responses of 4003 dentists to a 1994 survey and responses of 987 dentists to a 1995 survey were compared by using descriptive statistics from all respondents and McNemar's test for paired data from those participating in both surveys.
Response rates were 70% (1994) and 62% (1995). There were improvements in reports of routine use of gloves (92% to 94%); masks (73% to 79%); and protective eyewear (83% to 84%); vaccination for hepatitis B virus (HBV) or naturally acquired immunity of dentists (93% to 94%); HBV vaccination of clinical staff (64% to 77%); heat sterilization of handpieces (83% to 95%); and no extra precautions for patients with HIV (13% to 48%). Pairwise comparison of data for 788 dentists participating in both surveys showed statistically significant increases in reports of all practices except use of protective eyewear. The 1995 follow-up data also indicated low compliance with handwashing (74% before treating each patient; 62% after removing gloves); flushing water lines after treating each patient (54%); and using postexposure protocol for needlesticks and cuts (36%).
Dentists' reports of compliance with recommended infection control practices and universal precautions against HBV and HIV infection increased between 1994 and 1995, but most dentists apparently have not adopted universal precautions. More education is needed to promote universal precautions, HBV vaccination for clinical staff, handwashing, and postexposure protocol.
调查1994年至1995年间安大略省牙医感染控制措施的变化。
采用所有受访者的描述性统计数据以及对参与两次调查的人员的配对数据进行McNemar检验,比较了4003名牙医对1994年调查的回复数据和987名牙医对1995年调查的回复数据。
回复率分别为70%(1994年)和62%(1995年)。常规使用手套(从92%升至94%)、口罩(从73%升至79%)、防护眼镜(从83%升至84%)、乙肝病毒(HBV)疫苗接种或牙医自然获得性免疫(从93%升至94%)、临床工作人员的HBV疫苗接种(从64%升至77%)、手机的热力灭菌(从83%升至95%)以及对HIV患者不采取额外预防措施(从13%升至48%)方面均有改善。对参与两次调查的788名牙医的数据进行成对比较显示,除防护眼镜的使用外,所有措施的报告率均有统计学上的显著提高。1995年的随访数据还表明,洗手依从性较低(治疗每名患者前为74%;摘除手套后为62%);治疗每名患者后冲洗水管(54%);以及针对针刺伤和切割伤采用暴露后处理方案(36%)。
1994年至1995年间,牙医报告的遵守推荐的感染控制措施以及针对HBV和HIV感染的普遍预防措施有所增加,但大多数牙医显然尚未采用普遍预防措施。需要开展更多教育以推广普遍预防措施、临床工作人员的HBV疫苗接种、洗手以及暴露后处理方案。