Compliance of dental health care providers with the infection prevention and control protocol in Gaza Strip: a cross-sectional study

Abstract

BackgroundThe Palestinian Ministry of Health (MOH) developed the infection prevention and control (IPC) protocol in 2004 to control infection among dental health care providers in their interactions with clients, the community, and the environment. Adherence to the protocol has not previously been reported. We compared compliance of dental health-care providers with the IPC protocol and in MOH and United Nations Relief and Work Agency for Palestine Refugees (UNRWA) clinics and assessed factors affecting adherence. MethodsWe did a cross-sectional observational study in all Gaza Strip governorates. A self-administered questionnaire was sent to 137 dental health-care providers in the region to collect data about compliance with the IPC protocol. In parallel, we completed two observational checklists for each dental health-care provider during visits to clinics: one assessing compliance (completed three times with 3-day intervals) and one assessing the presence and availability of IPC systems and supplies (completed once). Data were analysed by χ2 and t test, with p<0·05 indicating significance. Ethics approval was obtained rom the Palestinian Helsinki Committee, and dental health-care providers gave written informed consent for inclusion in the study. Findings137 (100%) dental health-care providers completed questionnaires. 82 (60%) respondents were men and 55 (40%) were women. 90 (66%) worked in MOH clinics (67 dentists and 30 practical nurses) and 40 (34%) in UNRWA clinics (24 dentists, 14 practical nurses, one dental nurse, and one oral hygienist). 134 (98%) of 137 dental health-care providers had received a hepatitis B vaccination. 97 (80%) dental health-care providers in MOH clinics and 38 (95%) of those in UNRWA clinics showed compliance in applying the IPC protocol during practice (p<0·001). Only 40 (29%) of respondents in MOH clinics and only four (3%) in UNRWA clinics had a hard copy of the IPC protocol. 29 (21%) of 137 respondents had systems for monitoring infection rates in their clinics. 65 (47%) attributed the shortage of IPC materials in clinics, such as bleaching agents, suction tubes, face shield or masks, and aprons, to lack of availability in central medical stores. 104 (76%) of respondents showed good knowledge of the importance of IPC standards for society, 115 (84%) had suggestions for modification of the protocol, and 137 (100%) reported that there was no protocol for prevention of medical injuries (eg, needlestick injury) as only a post-exposure programme was included in the IPC protocol. Adherence of dental health care providers to the IPC protocol was significantly higher in UNRWA clinics than in MOH clinics (p<0·001). InterpretationThere is an urgent need to develop the IPC protocol for dentistry. Future interventions and training, securing essential IPC materials, and increased monitoring of IPC coverage in MOH and UNRWA clinics will be needed to achieve this goal. FundingNone.