|Year : 2016 | Volume
| Issue : 1 | Page : 18-23
Hepatitis C: Knowledge and attitude of graduating dentist from Faculty of Dentistry, Sebha, Libya
Syed Wali Peeran1, Syed Ali Peeran2, Fatma Mojtaba Alsaid1, Manohar Murugan3, Ahmed Taher ElHasan4, Mona Abdussalam Qasem Ahmed1
1 Department of Periodontics, Faculty of Dentistry, Sebha University, Sebha, Libya
2 Department of Prosthodontics, Faculty of Dentistry, Jizan University, Jazan, KSA
3 Department of Microbiology, Faculty of Medicine, Sebha University, Sebha, Libya
4 Department of Periodontics, Faculty of Dentistry, Benghazi University, Benghazi, Libya
|Date of Web Publication||15-Dec-2015|
Syed Wali Peeran
Department of Periodontics, Faculty of Dentistry, Sebha University, Sebha
Source of Support: None, Conflict of Interest: None
Objectives: The present study was undertaken to assess the knowledge and attitude of the graduating dentist with respect to various aspect of hepatitis C. Materials and Methods: A cross-sectional survey using a self-administered, structured, and pilot tested closed-ended 26-item questionnaire was completed by 99 dental students from Faculty of Dentistry, Sebha (Libya). Descriptive analysis was carried out, and Chi-square test was used for intergroup comparison. Results: Overall 54.5% students reported that their knowledge with respect to hepatitis C virus (HCV) infection was inadequate. 45.5% participants felt that books were the most common source for acquiring HCV information. Only, 44.4% participants were willing to treat high-risk HCV, patients. 70.7% interns feel that the dentists should not have the right to reject treating an HCV patient. 83% of the participants said that a dentist can contract hepatitis C from their patients if they do not use proper barrier techniques intergroup comparison showed statistically significant difference with issues related to contracting HCV from patient, HCV vaccine, treating patient in normal setting, perceptions toward HCV patients, and attitudes toward providing treatment. Conclusion: The study revealed that the knowledge of HCV among the dental students was not satisfactory, and their attitude toward HCV patients was discriminatory.
Keywords: Attitude, graduating dentist, hepatitis C, knowledge, Sebha
|How to cite this article:|
Peeran SW, Peeran SA, Alsaid FM, Murugan M, ElHasan AT, Ahmed MA. Hepatitis C: Knowledge and attitude of graduating dentist from Faculty of Dentistry, Sebha, Libya. Dent Med Res 2016;4:18-23
|How to cite this URL:|
Peeran SW, Peeran SA, Alsaid FM, Murugan M, ElHasan AT, Ahmed MA. Hepatitis C: Knowledge and attitude of graduating dentist from Faculty of Dentistry, Sebha, Libya. Dent Med Res [serial online] 2016 [cited 2019 Jul 18];4:18-23. Available from: http://www.dmrjournal.org/text.asp?2016/4/1/18/171920
| Introduction|| |
Health care professionals are at the risk of occupational hazards, and dental surgeons are not an exception. , These hazards include physical, chemical, biological, and psychological threats. Biological hazards can occur due to allergens of biological origin, infections, and cross contamination.  Dentistry, mostly a surgical field having repeated exposure to blood and body fluids, is a high-risk profession for the development of infectious diseases. Failing to utilize proper infection control measures leads to cross infection among dental patients.  These micro-organisms may include HIV, hepatitis B virus, hepatitis C virus (HCV), herpes simplex virus types 1 and 2, mycobacterium tuberculosis, and other viruses and bacteria, especially those affecting the upper respiratory tract. 
Viral hepatitis is an inflammation of the liver caused by one of the five hepatitis virus types A, B, C, D, and E. These viruses differ significantly in various epidemiological, diagnostic, and treatment aspects. Among these, hepatitis B and C have become a significant burden to public health all over the world.  Acute hepatitis C infection is responsible for 54,000 deaths and 955,000 disability-adjusted life years. The main burden from HCV infection comes from consequences of chronic infection. Each year 3-4 million persons are newly infected; 170 million people are chronically infected and are at a danger of developing liver disease including cirrhosis and liver cancer, and 350,000 deaths occur each year due to all HCV-related causes. 
Hepatitis C is caused by infection through the HCV, an enveloped, single-stranded, and positive-sense RNA virus. The virus infects liver cells and can cause severe inflammation of the liver with long-term complications. The onset of the disease is usually insidious, with anorexia, vague abdominal discomfort, nausea and vomiting, fever and fatigue, progressing to jaundice in about 25% of patients. HCV usually spreads by sharing infected needles with a carrier, by receiving infected blood, and from accidental exposure to infected blood. HCV does not spread by breastfeeding, sneezing, coughing, hugging, sharing eating utensils or drinking glasses, other normal social contact, food or water. 
Of those exposed to HCV, about 40% recover completely, but remaining, whether they are symptomatic or asymptomatic, become chronic carriers.  In chronic condition, cirrhosis develops in 10-20% cases, and hepatocellular carcinoma in 1-5% cases over a duration of 20-30 years. ,
Infection may be transmitted in dental practice by blood or saliva through direct contact such as accidental exposure because of cuts with sharp instruments, needlestick injuries during administration of local anesthesia and indirectly by droplets or aerosols. , Patients, dentists, dental students, and other dental health care workers (DHWs) have the potential of transmitting the infections to each other, because all infected patients cannot be identified by health history or tests.  The risk of infection after a needlestick injury with HCV-contaminated blood is 1.8% (ranges from 3% to 10%). , According to a report, frequency of seroconversion to anti-HCV following a needlestick injury was 9%.  As per the dental curriculum, the dental students start performing treatment on the patients by the 3 rd year of their graduation. At this stage, lack of experience and inadequate professional skills increases the risk of exposure to pathogens during invasive dental procedures. , During dental procedures, both performing dentists and patients are exposed to various infectious agents, it is important that all dental personnels have a good knowledge of infectious diseases, sterilization, and disinfection methods to reduce the risk of cross-infection during clinical practice.  Prevention is a very significant safeguard against the spread of viral hepatitis. By knowing facts, having proper knowledge, awareness and attitude, the threat of this disease can be prevented to a great extent.  Keeping the above facts in mind, the study was carried out to assess knowledge and attitude of the graduating dentist with respect to various aspect of hepatitis C.
| Materials And Methods|| |
The study design was a cross-sectional survey using a self-administered, structured, and pilot tested closed-ended 26-item questionnaire. The study was conducted among the graduating dentists (3 rd year, final year, and interns) at Faculty of Dentistry, Sebha University, Sebha (Libya). The questionnaire assessed the knowledge and attitudes toward hepatitis C.
As such, under knowledge section four domains were identified: General information (Q.1-3), transmission (Q.4-5), symptoms of hepatitis C (Q.6-9), and vaccination (Q.10).
Under the attitude section, two domains were identified: Perception toward hepatitis C patients and treatment modality (Q.11-26). The survey instrument was pilot tested on 20 dental students and revised according to their feedback. Fifty percent of the total strength of the students from 3 rd year to interns in the dental course were recruited for the study. 41 were 3 rd year students, 31 were from a final year, and 27 were interns. Among the total study sample of 99 students, 24 were males and 75 females. The study proposal was approved by the Ethics Committee of the Institution. Written informed consent was obtained from the study participants.
During the survey, the questionnaires were distributed to the students in their respective classrooms and 25 min of time was given to them to fill it out. The forms were collected, checked for completeness and all the doubts, if any, were cleared. The data were entered in MS Excel and analyzed using the Statistical Package for Social Sciences (SPSS) software 16.0 version, Chicago, US. Descriptive statistics including frequencies and percentages were calculated and the comparison between the participants as per their study year was done using Chi-square test. The level of significance was set at 5%.
| Results|| |
[Table 1] shows the percent distribution and comparison of the participants' knowledge about the various aspects related to HCV. Stratified based on the year of education, it appears that 39% 3 rd year, 45.2% final year, and 55.6% interns, respectively, rated their own knowledge regarding HCV infection as adequate (Q1). Books (45.5%) followed by visual media (29.3%) were the most common source for acquiring HCV information (Q.2). Overall, 51.5% participants identified blood and blood contact related as the major transmission route for HCV. Interns (66.7%) appeared more knowledgeable than a 4 th year (48.4%) and 3 rd year students (43.9%) (Q.3). The majority, 83% of the participants, said that a dentist can contract hepatitis C from their patients if they do not use proper barrier techniques (Q.4). In this regards, the 3 rd year students (68.3%) were comparatively less knowledgeable when compared to final year (96.8%) and interns (89%). The difference was found to be statistically significant (χ2 = 11.0, P = 0.004). Largely, 89.9% believe that a dentist can be responsible for transmitting HCV to his patient (Q.5).
|Table 1: Distribution and comparison of the participants knowledge about the various aspects related to HCV |
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Chronic hepatitis (Q.6), cirrhosis (Q.7), liver cancer (Q.8), and jaundice (Q.9) were identified as complications by 34.3%, 37.4%, 11.1%, and 27.3% participants, respectively. On asking about HCV vaccine availability (Q.10), overall 53.5% participants which included 68.3% 3 rd year students, 51.6% final year students, and 33.3% interns; answered that HCV vaccine was available. However, a statistically significant difference was obtained here (χ2 =8.06, P = 0.018).
41.4% participants were of the opinion that dentist can treat HCV infected patients in a normal dental setting, while overall 58.86% which included 78% 3 rd years, 41.9% 4 th year students, and 48.1% interns answered conversely (Q.11). The difference was found to be statistically significant (χ2 =11.1, P = 0.004).
[Table 2] shows the percent distribution and comparison between the responses given by the participants to the various questions related to the attitude toward hepatitis C. Largely, only 45.5% participants feel that, current curriculum will make them fit to manage patients with hepatitis C (Q.12). 66.7% participants feel confident that by taking the standard precautions there will be no transmission of hepatitis C infection. A statistically significant difference was noted (χ2 = 9.54, P = 0.009) wherein only 45.2% 4 th year students were confident in comparison to the higher percentage of 3 rd years and the interns (Q.13).
|Table 2: Distribution and comparison of the participant's attitude responses toward hepatitis C |
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Among all, 44.4% participants who were willing to treat high-risk hepatitis C patients, the majority belonged to the interns group (Q.14). The intergroup difference was statistically significant (χ2 =10.1, P = 0.006). Overall 68.7% participants replied that they would be stressed while treating a known case of hepatitis C (Q.15). Interns (85.2%) were more stressed than the 4 th years (77.4%) and 3 rd year students (51.2%), respectively. The intergroup difference was statistically significant (χ2 =10.33, P = 0.006). Largely, 54.5% participants said that they are morally or ethically responsible to treat hepatitis C patients (Q.16) and 74.7% participants agreed that patients should inform their hepatitis C positive status to dentists (Q.17); the difference here was statistically significant (χ2; =7.35, P = 0.025). Of all, 76.8% participants told that the dentist should inform his patients about his hepatitis infected status (Q.18). Treating a hepatitis C positive patient would increase the personal risk of acquiring the infection, and this was reported by 60.6% of the sample (Q.19). Almost 69% study participants answered that they would be stressed or worried while treating a known case of hepatitis C.
Majority, 91.9% believed that regular testing of dentists and DHWs for hepatitis C infection is necessary (Q.20), and 84.8% reported that patients should be tested for hepatitis C infection before any surgical procedure (Q.21). 79.8% respondents feel that the dental staff will fear if they come to know about the hepatitis C positive status of a patient (Q.22).
58.6% respondents feel that the dentists should not have the right to reject treating a hepatitis C positive patient (Q.23). Interns (70.4%) were in favor of this while the 3 rd year students were more discriminative on this issue. A statistically significant difference was noted among them (χ2 =6.2, P = 0.04). 72.7% are of the opinion that government should construct separate hospitals/clinics for treatment of hepatitis C patients (Q.24). In case of an emergency, only 38.4% said that they will perform mouth to mouth resuscitation for a hepatitis C positive patient (Q.25). In this regard, more number of 3 rd year students (51.2%) gave a positive response as compared to the others and the intergroup difference was statistically significant (χ2 =7.36, P = 0.025). 67.7% study participants told that they should maintain the confidentiality of a patient's hepatitis C positive status (Q.26).
| Discussion|| |
Though there is substantial literature regarding the knowledge and attitude of dental professionals toward infection control, ,, very few studies assessed the different categories of dental health care professionals and their knowledge and attitude toward hepatitis C infection. ,,
Majorly, 54.5% participants themselves reported that their knowledge with respect to HCV infection was inadequate which seems to be contradictory to the results reported by Tibdewal et al.  in which only 28.2% dental students themselves reported inadequate knowledge.
The graduating dental students (54.4%) are not satisfied with the current dental curriculum which does not provide them with sufficient knowledge needed to manage the HCV-infected patient. Lack of knowledge can lead to ignorance and misperception toward HCV infections and further while providing treatment to the affected patients. The present participants in the study considered books as the most common source of HCV information in comparison to the study results of Richmond et al.  where, journals were the most common source. Here, only 5% study participants acknowledged journals as the source of HCV information. This may be due to the fact that in dental schools for undergraduate students, more stress is given toward reading books and only at postgraduate level, journals are well thought as sources of information. This trend needs to be modified because journals are the best sources of current evidence-based knowledge.
Hepatitis C is a blood-borne disease. All the participants did not seem to have correct knowledge about its transmission. Although, interns (66.7%) were more knowledgeable as compared to the other groups, they had also opted for incorrect options like feco-oral route and sexual contact for transmission. A study among practicing dentists by Batool et al.  however had a different report wherein, 98.5% participants agreed that blood contact is the major route of hepatitis C transmission. This difference may be due to the fact that in the present study, the participants were still graduating and were in the learning phase.
Knowledge of dental students on cross infection from patients to dentist or dentist to patients was found to be adequate. However, on the individual level, the 3 rd year students had significantly lesser knowledge as compared to the other groups.
In the present study, the participants knew less about the complications of hepatitis C infection. This results are similar to the survey conducted by Joukar et al.  among health care workers. This may be due to the reason that hepatitis C patients are not regularly encountered with in dental clinical setting, and the dental curriculum also does not provide continuous updating of knowledge and training.
About 54% participants answered that HCV vaccine is available whereas in reality no viable vaccine against HCV exists at present. Inadequate knowledge and false belief of the existence of HCV is an issue that requires serious attention. Almost similar result has been reported by Setia et al.  Only, 41.4% study participants believe that hepatitis C positive patient be safely treated in a normal dental setting as against the higher percentage of dental students (62.2%) from India who feel so.
Standard precautions which include aseptic technique, hand washing, use of appropriate personal protective equipment, as well as appropriate reprocessing of instruments and environmental control, are recommended for the care and treatment of all patients regardless of their perceived or confirmed infectious status. , About 67% students were confident with the standard precautions used for prevention of hepatitis C transmission while in a study done by Temple-Smith et al.  in Australia around 100% dental professionals were aware of and claimed to practice standard precautions. There is an alarming need that dental students should strictly follow standard precautions in routine clinical practice with respect to the current study.
More than half of the study population (55.6%) answered that they will not treat high-risk patients including injecting drug users, while only 14% health professionals from Australia did not want to treat injecting drug users. 
Almost 69% respondents answered that they would be stressed or worried while treating a known case of hepatitis C, on the contrary, lower percentage of Indian students (48.3%) were worried of being infected from a known case of hepatitis C.  About 80% study participants told that dental staff will fear if they come to know about the hepatitis C positive status of a patient whereas 48% Australian health professionals  were fearful of contracting infection while treating a known case of hepatitis C patient.
More than half of the study participants (54.5%) reported that they are morally or ethically responsible to treat hepatitis C patients and 67.7% felt that they should maintain confidentiality of an HCV patient's positive status. 66.7% Indian dental students were morally responsible to treat HCV patient. 
Lack of correct knowledge can give rise to fear/stress of acquiring hepatitis C when treating patients. This can lead to a significant problem and ultimately reduce the dental student's willingness to treat people with hepatitis C. Adopting a discriminative behavior by rejecting to treat a hepatitis C positive patient and considering that government should construct separate hospitals for treatment of hepatitis C patients is not a favorable attitude that a graduating dentist should cultivate. However, an earlier study has reported such discriminative behavior toward HCV patients.
Not all people with hepatitis C know that they have the virus. Furthermore, those infected are not required to disclose their status nor undergo tests for infection control procedures by the dentist. It is important to remember that for treating patients known to have hepatitis C, it is never necessary to isolate the patient nor is it necessary to schedule the appointment at the end of the day. However, standard precautions are recommended for the care and treatment of all the patients regardless of their confirmed infectious status.
In case of an emergency, only 38.4% said that they will perform mouth to mouth resuscitation in a hepatitis C positive patient. Practically any disease transmissible by secretions or blood may be acquired during basic cardiopulmonary resuscitation (CPR). This fact and hesitation of mouth-to-mouth contact with other people discourages rescuer to perform the CPR in emergency situations. In spite of the number of potentially contagious diseases, only reports of isolated incidents have been published and no case of hepatitis or HIV transmission has been reported over the years.  Considering this fact that benefits are more than the risks, one should perform lifesaving mouth to mouth resuscitation during an emergency.
The results of the study indicate that overall, the dental student's knowledge was inadequate, and attitude seemed to be discriminatory. This significant knowledge deficit has the potential to negatively affect their clinical practice and put them at a risk of transmitting the hepatitis C infection. Furthermore, discriminatory attitude toward patients with hepatitis C can lead to a lesser number of patients consulting the dentists and following their advice.
This study is actually an eye-opener for the dental educational administrators who need to bring about a change in the dental curriculum such that stress should be given on making every graduating student knowledgeable in handling patients with not only hepatitis C but any other medical condition also.
This study indicates an urgent need to initially provide knowledge and training to handle patients with different medical conditions starting in the 3 rd year and further on compulsorily upgrade this knowledge every year with recent information by conducting continuing dental education programs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]