doi: 10.62486/agodonto202326
ORIGINAL
Knowledge of the protocol
to be followed in the event of an accident with a sharp object during the
clinical practice of undergraduate students in the subject Integrated Adult
Clinical and Surgery III, School of Dentistry, Universidad Abierta Interamericana,
Buenos Aires, Argentina, 2024
Conocimiento del
protocolo a seguir en caso de ocurrir accidente con elemento cortopunzante
durante la práctica clínica de los estudiantes de pregrado en la asignatura
Clínica y Cirugía integradas del adulto III, de la escuela de Odontología de la
Universidad Abierta Interamericana, Buenos Aires, Argentina, 2024
Celeste Moreno Dommar1, Maria
Isabel Brusca1
1Universidad
Abierta Interamericana, Facultad de Medicina Y Ciencias de la Salud, Carrera de
Odontología. Buenos Aires, Argentina.
Cite as:
Moreno Dommar C, Brusca MI. Knowledge of the protocol to be
followed in the event of an accident with a sharp object during the clinical
practice of undergraduate students in the subject Integrated Adult Clinical and
Surgery III, School of Dentistry, Universidad Abierta Interamericana, Buenos
Aires, Argentina, 2024. Odontología (Montevideo). 2023; 1:26. https://doi.org/10.62486/agodonto202326
Submitted: 21-07-2023
Revised: 11-10-2023 Accepted: 25-12-2023
Published: 26-12-2023
Editor: Nairobi
Hernández Bridón 
ABSTRACT
Sharp accidents frequently occur during
the practice of dentistry, due to the use of sharp and pointed elements. This
usually happens to dentists and especially to students, due to conditions
attributable to the practice itself, such as: stress, movement of the patient,
reduced space, among others. Through an accident with sharps it is possible to
generate inoculation of pathogenic agents when exposed to contaminated
biological substances, the main pathogenic agents identified in various studies
are: HIV, Hepatitis B virus, Hepatitis C virus, among others. Biosafety
protocols have been established to make dental practice safe for the operator
and the patient, with the aim of minimising the possibility of
cross-contamination. However, in the event of an incident involving sharp
material, it is vitally important that the professional or student is well
informed about the prophylaxis protocol to be followed in order to reduce the
possibility of infection. This descriptive, cross-sectional research aims to
investigate the knowledge of the students of the adult III clinics of the
School of Dentistry of the Universidad Abierta Interamericana, Buenos Aires,
Argentina 2024, regarding this important aspect of biosafety. For this purpose,
a survey will be applied to verify the knowledge of preventive biosafety
measures, knowledge of pathogenic agents and knowledge of the protocol for
post-accident prophylaxis with sharp sharps.
Keywords: Biosafety;
Sharps; Percutaneous Injuries; Post-Exposure Prophylaxis for Sharps Exposure.
RESUMEN
Es frecuente que
ocurran accidentes cortopunzantes durante la práctica odontológica, motivado al
uso de elementos afilados y puntiagudos, suele ocurrir a los odontólogos y
especialmente a los estudiantes, por condiciones atribuibles a la misma
práctica, como: estrés, movimiento del paciente, espacio reducido, entre otros.
Mediante un accidente con elementos cortopunzantes es posible generar
inoculación de agentes patógenos al exponerse a sustancias biológicas
contaminadas, los principales agentes patógenos identificados en diversos
estudios son: VIH, Virus de Hepatitis B, Virus de Hepatitis C, entre otros. Se
han establecido protocolos de bioseguridad para hacer la práctica odontológica
segura para el operador y el paciente, con la finalidad de reducir al mínimo la
posibilidad de contaminación cruzada, sin embargo en caso de que se produzca el
incidente con material punzo cortante, es de vital importancia que el
profesional o estudiante esté bien informado sobre el protocolo de profilaxis
que debe seguir para disminuir la posibilidad de infección. La presente
investigación de tipo descriptiva, de diseño transversal pretende indagar sobre
el conocimiento de los estudiantes de las clínicas del adulto III, de la
escuela de Odontología de la Universidad Abierta Interamericana, Buenos Aires,
Argentina 2024, respecto a este importante aspecto de la bioseguridad, para
ello se aplicará una encuesta donde se verificará el conocimiento sobre medidas
de bioseguridad preventivas, conocimiento de agentes patógenos y conocimiento
de protocolo de profilaxis post accidente con punzo cortante.
Palabras clave:
Bioseguridad; Cortopunzante; Lesiones Percutáneas; Profilaxis Post Exposición a
Elemento Cortopunzante.
INTRODUCTION
Various studies have
demonstrated the occupational risk for healthcare workers of transmission of
pathogens through blood and other bodily fluids. This risk extends to students
in related disciplines.(1,2) There is a high incidence of sharps
accidents in dental practice among students, regardless of the year of study,
which reflects the need to implement measures for the surveillance and
prevention of such events due to the enormous potential consequences they often
have.(8,11,13)
It is estimated
worldwide that up to 44,5 % of healthcare workers report at least one needle
stick or accidental sharp injury per year.(12,14,15)
The main microorganisms
transmitted through accidental exposure to blood caused by needle injuries or
injuries after incidents involving cuts, punctures, or splashes with a risk of
infection may include the following:
Viruses
·
Hepatitis
B virus (HBV).
·
Hepatitis
C virus (HCV).
·
Human
immunodeficiency virus (HIV).
·
Cytomegalovirus
(CMV).
·
Epstein-Barr
virus (EBV).
·
Parvovirus.
Bacteria
·
Treponema
pallidum (syphilis).
·
Yersinia.
Parasites
·
Plasmodium.(11,16)
Hepatitis B (HBV),
hepatitis C (HCV), and human immunodeficiency virus (HIV) infection are
diseases that can potentially be transmitted through a sharps accident.
However, the risk is different for each disease, as is the protocol applied for
prophylaxis in case of a sharp object accident where the subject is exposed to
any of these pathogens.(10,12)
Dentistry can be
considered a safe profession, provided that effective safety protocols are
followed and there is increased awareness and adoption of universal
precautions.(17)
It is important to note
that Latin America has the highest prevalence of HBV transmission among
healthcare workers. The percentage of infections attributable to occupational
causes is 52 % for this virus, 65 % for HCV, and 7 % for HIV/AIDS.(18)
According to the WHO,
the annual estimate of healthcare workers exposed to blood-borne pathogens is
high. Worldwide, it was as follows:
·
2,6
% for HCV.
·
5,9
% for HBV.
·
0,5
% for HIV.
More than 90 % of these
infections occur in developing countries like Argentina, but most of these
accidents remain unreported. Sharps injuries cause psychological impacts such
as stress, fear, and distraction from work. Most of these accidents can be
prevented through the use of safety measures.(3)
General Objective
This study aims to
determine whether students enrolled in the Comprehensive Clinic and Adult
Surgery III course in the 2024 academic year know the protocol to follow in the
event of a sharps injury during their clinical activities.
METHOD
The study population
consisted of 26 students who make up the integrated adult clinic and Surgery
III at the School of Dentistry at the Inter-American Open University, Salta
982.
A survey was
administered (adapted from the research: Sneh L. et al. Knowledge, Awareness
and Practices regarding Sharp Injuries amongst Dental Students in Lucknow,
India).
The data were recorded
in a structured system distributed through Google Forms surveys and collected
simultaneously. The questionnaire, whose link is as follows: https://forms.gle/5XphrdKJr631uMxSA,
consisted of 20 questions and was used to obtain:
·
Demographic data.
·
Perception
of risk of acquiring injuries from sharp instruments Knowledge of the
transmission rate of hepatitis B and HIV.
·
Knowledge
of the steps to follow in case of an accident with a sharp object.
·
Knowledge
of the authorities and institutions to contact.
·
Prevalence of sharp injuries.
·
Frequency of sharp injuries.
·
Practice
during which the injury occurred.
·
Mechanism of injury.
·
Element
that caused the injury.
·
Reporting of injuries.
·
Protective practices.
·
Prevalence
of hepatitis B immunization.
·
Prevalence of tetanus immunization.
·
Immunization status.
The data will be recorded
in numbers (N) and percentages (%) tabulated as follows:
·
Knowledge,
awareness, and practice regarding needle stick injuries among dental students
in general.
·
Incidence
of needle stick injuries among students during various clinical procedures.
·
Causes
of needle stick injuries among students.
·
Knowledge
of the prophylaxis protocol to follow in the event of an accident involving a
sharp object.
RESULTS
The results obtained
after distributing the survey, in which 100 % of the students who make up the
Adult and Surgery III clinic participated.
Figure 1. Question
1
Figure 2.
Question 2
Figure 3.
Question
3
Figure 4. Question
4
Figure 5. Question
5
Figure 6. Question
6
Figure 7. Question
7
Figure 8. Question
8
Figure 9. Question
9
Figure 10. Question
10
Figure 11. Question
11
Figure 12. Question
12
Figure 13. Question
13
Figure 14. Question
14
Figure 15. Question
15
Figure 16. Question
16
Figure 17. Question
17
Figure 18. Question
18
Figure 19. Question
19
Figure 20. Question
20
100 % of the students
surveyed stated they knew of the risk of puncture and/or injury with sharp
objects during clinical procedures and of universal biosafety measures.
All students learned
about biosafety during their university studies in the following courses:
Microbiology, Comprehensive Adult Care I and II, and Practice I.
Only 84,6 % of
respondents said they knew the post-exposure prophylaxis procedure for sharps
injuries in clinical settings.
7,7 % of students
believe hand washing cannot reduce the risk of disease transmission.
100 % of those surveyed
said they knew they should go to a health center after a sharps injury,
although 11,5 % said they were unaware that this should be done within the
first hour of the injury.
When asked which
healthcare center they should go to in this type of emergency, the responses
were as follows:
·
Nearby
hospital/health center.
·
Infectious
disease center.
·
A
hospital designated by the university.
·
Don't
know/Don't remember.
·
Muñiz
Hospital, only 2 of those surveyed.
4 % of those surveyed
believe that not all sharp injuries that occur in the clinic should be
reported.
85 % agree that a blood
test should be performed after this type of injury, while 11,5 % do not know.
However, when asked what the test should be, there is a wide variety of
responses, which are described below:
·
Blood
test (unspecified).
·
Liver
function test and/or serology.
·
HIV,
hepatitis B/C
·
Sexually
transmitted diseases.
·
Blood
extraction at the central hospital.
·
Does
not know.
·
No
response.
3,8 % of the study
population said they had had a sharps accident during clinical practice six
months before the survey, while 96,2 % of respondents said they had not.
80,8 % of respondents
reported receiving education and training in biomedical waste management, while
19,2 % said they had not.
100 % of the study
population reported having been vaccinated against hepatitis B.
DISCUSSION
Dental students,
whether due to inexperience, lack of care, or lack of biosafety requirements,
are predisposed to a much higher incidence within their training field.(25)
The results obtained in research from various countries report a variety of
results, among which we can mention Ecuador's 82,9 % accident rate with sharp
objects in students at the comprehensive clinic of the Faculty.(22 )Mexico,
dentistry students in Mexico reported an accident rate of 46,6 %(26);
students at the public university in the city of Cartagena, Colombia, reported
46 %(27); university students in Brazil reported an accident rate of
23,3 %,(2) Paraguay 63 %,(28) 97,3 % was reported in a
study in India,(11) in the US there are reports of 66,7 %,(29)
27 % in Australia,(10) 63 % in Croatia,(5) and in Japan
70,3 %.(30)
In Argentina, a study
by the University of Córdoba sought to evaluate dental students' knowledge
regarding the protocol to follow in an accident involving a sharp object. The
study found that 95 % of students said they were aware of the protocol;
however, when asked to describe it, there were steps that they did not include
in their responses. As for notifying the group leader or teacher in charge,
only 5 % considered it necessary to comply with this step. Regarding promoting
bleeding, washing, and applying disinfectants, 55 % could describe the
measures, including the steps and disinfectants used. About going to health
centers, 57 % of students considered this aspect of the protocol, referring to
it using terms such as hospital, medical center, health center, and infectious
disease center.
Regarding serological
testing of the injured person and the patient, 44 % of students recognized the
need to perform serological testing on the injured person. Still, only 21 %
mentioned the need to test the patient. However, none mentioned that the patient
and the injured person should continue to be monitored long-term. Nineteen
percent considered it necessary to take medication, specifying, among other
things, vaccines, medication cocktails, and antibiotics. Nine percent indicated
antiviral regimens. Only 1 % responded that they would reassess the situation
in the short and long term.
A study conducted at
the University of La Plata, Argentina, aimed to identify the prevalence of
sharps accidents and biological material in dental students. UNLP reported a
significant predominance in females (78 %). The most frequent causes of
accidents reported were anesthesia needles (52 %), sharp instruments (27 %),
suture needles (12 %), biological material (6 %), and irrigation needles (4 %).(32)
About the prevalence of
sharps accidents reported in the literature compared to other professions, the
profession with the highest incidence of accidents is nursing. The prevalence
of biological accidents among students was as follows: in European countries,
the figures ranged from 10,2 % to 32 % in nursing, 16 % to 58,8 % in medicine,
and 21 % in dentistry. In Asian countries, the percentage in nursing varies
from 49 % to 96 %, in medicine from 35 % to 68 %, and in dentistry from 68 % to
75,4 %. In North America, the figures fluctuate around 11-72,7 % in medicine
and around 19,1 % in dentistry. Finally, in South America, the prevalence was
31,2-46,7 % in medicine and 40 % in nursing.(33)
CONCLUSIONS
Students enrolled in
Comprehensive Clinic and Adult Surgery III in the 2024 academic year have
deficiencies in their knowledge of the protocol to follow in the event of a
sharps injury during their clinical activities.
They are unaware of the
level of risk of accidents in the clinic. Although they say they are aware of
such risk, they could not correctly answer what steps to take if they had an
incident during practice.
Most of them have the
necessary immunizations as a preventive measure in case of sharp object
injuries.
Most students know the
biosafety measures required to work in the clinic.
Even though the
necessary biosafety measures for working in a clinic, the protocol for
accidents involving sharp objects, and the authorities to contact in the event of
such an accident are taught in the first years of the dentistry program in the
microbiology course, which is taught in the second year, it has been found that
when students arrive at the adult clinic and surgery III, which is taken in the
fifth year of the program, they are largely unaware of these measures,
especially regarding where to go when an emergency arises and how to properly
report the incident to the appropriate authorities. which is taken during the
fifth year of the degree program, they are very unfamiliar with the protocol
for accidents involving sharp objects and the authorities to contact in the
event of an accident.
Clinical dental
practice involves a great deal of responsibility toward patients and ourselves
as healthcare professionals. Part of this responsibility is having the basic
skills to respond when our physical integrity is accidentally compromised
during work. We must master and know how to put into practice the concepts of
biosafety, prevention, and the protocol to follow in the event of an accident
with sharps in the clinic, as well as the authorities, addresses, and
departments to contact, since time is also crucial in these events.
Considering the results
of this research, it is suggested that at the beginning of each year, a written
manual of steps to follow in the event of a sharp object accident be
distributed to students in each clinic. The manual should indicate the
authorities to contact, the addresses, and the department where the incident
should be reported in order to receive appropriate care and avoid failure to
report the incident, as described in the statistics.(3,34)
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FINANCING
None.
CONFLICT OF INTEREST
Authors declare that
there is no conflict of interest.
AUTHORSHIP CONTRIBUTION
Conceptualization: Celeste
Moreno Dommar, Maria Isabel Brusca.
Data curation: Celeste
Moreno Dommar, Maria Isabel Brusca.
Formal analysis:
Celeste Moreno Dommar, Maria Isabel Brusca.
Drafting - original
draft: Celeste Moreno Dommar, Maria Isabel Brusca.
Writing - proofreading
and editing: Celeste Moreno Dommar,
Maria Isabel Brusca.