Next Article in Journal
Latent Tuberculosis in Healthcare Professionals: A Cross-Sectional Study
Previous Article in Journal
Global Health Alert: Racing to Control Antimicrobial-Resistant Candida auris and Healthcare Waste Disinfection Using UVC LED Technology
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Hygiene
Volume 4
Issue 4
10.3390/hygiene4040031
hygiene-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

The Incidence of Clinical Injuries among Undergraduate Dental Students: A Prevention Protocol

by
Maria Antoniadou
*,
Maria Chanioti
,
Asteropi Pantelaki
,
Antonios Parasyris
,
Evangelia Piperi
and
Christos Rahiotis
*
Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, 11527 Athens, Greece
*
Authors to whom correspondence should be addressed.
Hygiene 2024, 4(4), 423-434; https://doi.org/10.3390/hygiene4040031
Submission received: 13 August 2024 / Revised: 28 September 2024 / Accepted: 30 September 2024 / Published: 2 October 2024
Browse Figures
Versions Notes

Abstract

:
Dental students are frequently exposed to percutaneous injuries (PCIs) due to the nature of their clinical work, which involves sharp instruments and close patient contact. The COVID-19 pandemic further emphasized the need for stringent biosafety measures and the use of personal protective equipment (PPE). Despite these precautions, injuries remain prevalent, highlighting the need for comprehensive education and training in biosafety and infection control. This study investigates the incidence and causes of injuries among undergraduate dental students during clinical sessions. This study was conducted at the Department of Dentistry, National and Kapodistrian University of Athens, focusing on injuries reported from 2021 to 2024. Data were collected through self-reported clinical records. The primary variables assessed included the type of injury, the instrument involved, the clinical procedure performed, and the immediate actions taken post-injury. Serological testing was conducted on students and patients to assess the risk of the transmission of bloodborne pathogens. The findings reveal a high prevalence of injuries, with needles being the most common cause (51.4%), followed by other tools such as dental probes (25.7%) and burs (8.6%). The most frequent injury type is piercing (74.2%), primarily affecting the fingers (88.6%). Periodontal treatments, restorative procedures, and endodontic treatments are the main activities leading to injuries, with 17.1% of injuries being caused by each. No statistically significant results are recorded. Despite regular medical records for most patients treated by injured students, serological testing shows significant positivity rates for HCV and HBV. Notably, most injured students demonstrate their commitment to safety by adhering to recommended post-exposure protocols, including wound cleaning, disinfecting, and serological testing. Furthermore, the impact of COVID-19 heightened the importance of personal protective equipment (PPE) and reinforced occupational health standards. Our study highlights the critical need for enhanced biosafety awareness and training among undergraduate dental students to reduce injury risks.

1. Introduction

Dentistry practice, among all other medical professions, exposes dentists and their personnel to patients’ oral fluids [1]. This, combined with the use of sharp instruments during dental procedures, increases the risk of injury to the dentist, potentially resulting in the transmission of infectious diseases by patients [2]. Specifically, there are certain infectious microorganisms known as bloodborne pathogens (BPS), including hepatitis B, hepatitis C, and human immunodeficiency virus (HIV), which cause severe human diseases [3]. The primary sources of BPS in the workplace are percutaneous injuries from needles and other sharp tools [4]. Therefore, the daily activities in a dental office—where continuous handling, use, and transport of sharp tools occur between colleagues, along with replacing, cleaning, and sterilizing these tools—create a high-risk environment for percutaneous injuries [5]. According to the World Health Organization (WHO), three million healthcare workers sustain injuries from needles and other sharp instruments annually [6].
During the COVID-19 pandemic, drastic measures were taken regarding the safety of dentists, their staff members, and the patients. It was discovered that contamination can occur through aerosols/droplets and small, tiny airborne particles containing the virus [7]. These measures included stricter surface decontamination, FFP2 masks, high-power suction, rubber dams, protective face shields, etc. [8]. Studies have shown that after the pandemic outbreak, the percentage of dentists using scrub caps has risen from 21% to 37%, and of those wearing protective face shields, from 36% to 59% [9]. However, even after the COVID-19 pandemic, it has been observed that the awareness of dentists and even more so that of students about the appropriate utilization of personal protective equipment (PPE) is insufficient [10]. Thus, practitioners without the proper cognition to shield themselves are more prone to life-threatening diseases [11].
The most common tools to cause injuries during dental practice are needles, followed by burs, scalpels, scalers, surgical elevators, explorers, and orthodontic wires, which are also found to be responsible for a significant portion of these injuries [12]. A study by Pereira et al. showed that burs are the most frequent tools that can lead to percutaneous injuries among dentists [2]. This is due to the lack of education regarding these types of injuries. In contrast, awareness and education regarding personal protective equipment and proper needle use during dental procedures have been improved [2]. Other causes attributed to this situation are anxiety and excessive levels of confidence [13,14]. Additionally, research indicates that distraction and hurrying through clinical procedures are the primary factors contributing to accidental injuries, underscoring the importance of maintaining focus [15]. Occupational fatigue, long working hours, and lack of sleep are also associated with a high chance of injuries [16]. Other high-risk factors are lack of protective glasses, masks, and PPE, and, lastly, lack of experience [17,18]; dental students are exposed to the highest rate of percutaneous injuries as they do not have the necessary skills to properly handle the various sharp tools used in dental practice [13,14,15].
Comprehensive data collection on traumatic injuries in dental clinical settings, such as percutaneous exposure injuries (PEIs), is paramount for advancing safety and education in the field [16,17,18,19,20,21,22,23,24]. Existing systems at institutions like the National Healthcare Group Polyclinics in Singapore and Griffith University Dental Clinic in Australia already play a crucial role in gathering information on these incidents, detailing their types and severity [25,26]. However, a critical need remains for more extensive data for several reasons. Firstly, detailed data can provide valuable insights into the causes and circumstances surrounding traumatic injuries during clinical procedures. This information would help facilitate the development of targeted educational programs aimed at prevention and empower institutions to improve preventive measures and safety protocols [17,18,19,20,21,22,23,24,25]. Such insights enable dental schools to refine training protocols, enhancing staff and patients’ safety [26].
Comprehensive data also serve as a foundation for evidence-based policy development within dental institutions. It guides the formulation of protocols for reporting and handling percutaneous exposures, and overall occupational safety measures [26,27]. Finally, these data fuel research initiatives to improve dental practices and technologies. Carrying out that allows researchers to analyze trends and outcomes associated with traumatic injuries to drive innovations in equipment design, procedural protocols, and safety measures. For all these reasons, this study aims to present data collected at the Department of Dentistry, School of Health Sciences, of the National and Kapodistrian University of Athens, Greece, regarding dental undergraduate students’ injuries that occurred in everyday dental practice in the undergraduate clinics of the department.

2. Materials and Methods

The Department of Dentistry at the National and Kapodistrian University of Athens maintains a strict protocol for handling personnel injuries, which proved robust even during the pandemic due to its adherence to international guidelines. In the event of an injury, immediate medical attention is sought as necessary, followed by prompt reporting to supervisors using a designated registration form (Supplementary Material Table S1). This form includes detailed information such as personal details, injury specifics including location and cause, and actions taken post-incident. The submitted forms are reviewed by a committee (Committee of Hygiene and Sterilization, CHS), including three academic educators who are clinical supervisors in the school’s clinics. The forms provide necessary instructions and ensure follow-up support for the injured personnel. Educational seminars and pre-clinic meetings inform students about reporting procedures, reinforcing a proactive approach to safety. Continuous review and updates to the protocol ensure alignment with the latest safety standards, emphasizing prevention and effective response to incidents within the department.
For this study, we used records of accidents that have taken place in the Department of Dentistry of the National and Kapodistrian University of Athens, shared by CHS. The study then focused on analyzing only undergraduate students (7–10th semester of studies). Thus, the inclusion criteria were undergraduate dental students actively participating in clinical sessions at the Department of Dentistry, National and Kapodistrian University of Athens, from 2021 to 2024. Exclusion criteria were all other school members apart from undergraduate dental students, including faculty, staff, postgraduate students, and individuals not directly involved in clinical sessions.
All necessary actions were taken to protect the personal data of the injured persons mentioned in the list. This study received a protocol citation from the department’s Board of Ethics (611/17 October 2023) as part of a more extensive research protocol addressing students’ knowledge of safety and sterilization issues.
Data collection was conducted using a dual approach involving self-reported injury sheets and an interview-based selection of information from clinical records. Participants were instructed to complete structured injury reporting forms detailing incidents comprehensively. Additionally, researchers interviewed participants to gather Supplementary Information from clinical records, ensuring thorough documentation of each reported injury. This combined method facilitated a comprehensive dataset encompassing both subjective accounts and objective clinical data, enhancing this study’s reliability and depth of analysis. Using structured forms and interviews allowed for an expanded exploration of injury characteristics, contributing to a more detailed understanding of the factors influencing accidents within the study context. Figure 1 is a flowchart with all the steps taken to carry out the present study.
In this study, information is displayed in correlation with the following factors: the status of the person who suffered the injury, the location of the accident, the activity being performed at the time of the accident, the type of injury, the tool that caused it, the care of the trauma area, the patient’s medical record, and the actions taken to address the injury.

3. Results

The documented injury incidents occurred during the COVID-19 and post-COVID-19 period from 2021 to 2024, as shown in Table 1. Descriptive statistics was used to present the data available.
After gathering all records for 2021 to 2024, as shown in Table 1, thirty-seven (37) sharp tools injured people during the period studied (2021 and 2024). The total number of injured accounts for 2.64% (1400 students total, 350 per year). Per status, it was reported as follows: (a) faculty—0, (b) associate—1, (c) postgraduate student—1, and (d) undergraduate student—35. Only 2 out of 37 were identified as non-undergraduate students and were excluded from the analysis of the results. Regarding the place of the accident, the Total Patient Care Clinic is the most common with 29 (82.8%) incidents, followed by 2 in the Oral Surgery Clinic (5.7%) and lastly 1 (2.8%) in the afternoon clinic on the third floor. Regarding the undergraduate status, 70% belonged to the fourth year of study and 30% to the fifth year. It is an equal distribution of the injuries between both sexes; 70% were female and 30% male. The mean age was 23.5. All injured individuals were in good health at the time of injury. All participants except one mentioned that it was their first time injured.
As derived from Figure 2, 25 injuries occurred during the COVID-19 period, especially from April 2021 to May 2023, and 12 injuries from June 2023 to April 2024 post-COVID-19. More specifically, we reported 25 accidents during two COVID-19 years vs. 12 in one post-COVID-19 year, which corresponds to approximately 12 accidents every year. A careful examination of the data shows 11 injuries in 2021, 11 in 2022, 8 in 2023, and 7 in 4 months of 2024.
As derived from Figure 3, the three most usual actions performed causing six injuries each are periodontic treatment (17.1%), restorative procedures (17.1%), and others including mostly prosthodontics (17,1%), followed by endodontic treatment (14.28%) with five accidents and lab injuries (11.4%) with four accidents. Lastly, during extractions, three accidents (8.57%) occurred.
In addition, concerning the type of injury as shown in Figure 4, piercing comes first with the significant number of 26 cases (74.2%) out of 35, with the second one being abrasion with 6 cases (17.1%). As indicated by Figure 5, the needle was the most frequently used tool responsible for injuries, reported by 18 undergraduate students (51.4%), and other tools, such as dental probes, had 9 reports (25.7%). Burs, also, caused 5 (14.28%) out of 35 accidents and lastly, microtools and scalpels caused 1 accident each (2.85%). As presented in Figure 4, 31 students (88.57%) were injured on their fingers, noting this area as the most vulnerable one during dental procedures. Two students (5.7%) were also injured on their palms and one on their arms (2.8%).
From the injury registration forms filled out by students, as shown in TS1, we collected information related to the patients’ medical records. Most patients treated had clean medical records, with 21 out of 35 (60%) fitting this category. Two patients (5.7%) had suspicious medical records, although one was found to be negative for HBV, HCV, and HIV after serological testing (2.8%). Furthermore, two patients had tested positive for HBV (5.7%) and one patient for HCV (2.8%). Two patients claimed to have clean medical histories but were found to be positive for both HCV and HIV (5.7%), and in one case for HBV too (2.8%), after testing. Following the injury, 22 students (62.8%) thoroughly washed, disinfected, and dressed their wounds when the patient had a clean medical record. However, in five cases (14.2%), the injured individuals had blood samples taken for serological testing after following the wound care procedure despite having clean medical records. After the injury, when the patient tested positive for one of the aforementioned infectious diseases, the student primarily followed the wound care procedure, and in three cases (8.6%), a blood sample was taken for serological testing. In one instance (2.8%), an antibody vaccine was administered to a student despite the patient having a clean medical record. Lastly, in one incident (2.8%), an antiviral treatment was given to one of the students after the injury, although, as reported, the patient’s medical record after serological testing was found to be clean. Specifically, the regimen used was Argiodin and Isentress for post-exposure prophylaxis.
It is essential to point out that, in the end, the students showed no problems after the injury, and the appropriate measures were taken. The most frequent actions taken after the injury are the procedure of cleaning the wound, followed by taking a blood sample for serological testing. Additionally, one student received antiviral treatment, which included Argiodin and PEP: Isentress. There were no statistical differences among the factors of this study.
The summarized results of Table 1 are as follows: (1) Most accidents occurred with undergraduate students (Category 4), particularly in the Oral Surgery Clinic (OSCL) and Prosthodontic Clinic (PRCL). (2) The most common action performed during the accident was periodontal treatment (PERIO). (3) Piercing injuries caused by needles were the most frequent type of injury. (4) The fingers were the most affected area. (5) Injured students most frequently treated patients with clean medical histories. (6) Thorough wound washing, disinfection, and dressing were the most common post-injury actions.

4. Discussion

Our study presents data on students’ injuries during clinical work in the undergraduate clinics of the Department of Dentistry at the National and Kapodistrian University of Athens from 2021 to 2024, post-COVID-19. There is a significant prevalence of injuries, with needles being the most common cause. Needles, burs, and dental probes are the primary tools causing injuries, consistent with studies from Australia and Trinidad [27,28]. The dental school environment is challenging and stressful [29]. Stress among dental students increases with each year of study, peaking during the clinical years [30,31]. This is due to the pressure to meet patient and instructor demands quickly and without sufficient experience [32,33,34]. Consequently, stress and anxiety can lead to inadequate patient care and a higher risk of injury [34]. Regarding the trauma area, fingers have the highest prevalence, accounting for over half of all injuries. This region is frequently affected, like findings at an Australian dental school (53%) and a Dental Department in Georgia (45%) [26,35]. In our study, periodontal treatments were the most common cause of trauma, followed by restorative procedures and endodontic treatments. Similarly, a six-year study at a university dental clinic in Australia found that percutaneous injuries occurred most frequently during restorative procedures, with local anesthesia and oral surgery following closely [27].
Furthermore, we found that most patients treated by the injured students had average medical records. However, four cases out of thirty-seven, after undergoing serological testing, were found to be positive, primarily for HCV and HBV. It is essential to mention that through percutaneous injuries occurring in dentistry, serious bloodborne diseases like human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and Treponema pallidum can be spread [36]. The chances of contracting infections following needlestick/sharp injuries (NSIs) from sources carrying pathogens are roughly 0.3% for HIV, between 6.0% and 30.0% for HBV, and 3% for HCV [37]. In Greece, the vaccination against hepatitis B is mandatory for dental students due to national regulations. At the School of Dentistry in Trinidad, the policy requires all students to be vaccinated against hepatitis B and undergo cross-infection control training before starting patient care. Furthermore, the school’s sharp injury protocol necessitates that following a contaminated percutaneous injury, the affected individuals undergo immediate and three-month follow-up testing for HIV and hepatitis B. They receive, also, anti-hepatitis B immunoglobulin and HIV PEP drugs and lastly, are offered pre- and post-test counseling [38,39].
Elsewhere, such as at the University of the West Indies School of Dentistry, when a percutaneous injury (PCI) occurs, students are advised to clean the wound with soap and water, rinse mucous membranes with water, report the incident to supervising faculty and clinic staff, and seek medical evaluation. They are directed to the emergency department or occupational health clinic for risk assessment, potential prophylactic treatment, and follow-up [28]. In our study, most injured students followed the wound-cleaning procedure with some providing blood samples for serological testing, regardless of the patient’s medical history or hepatitis/HIV status. Others received an antibody vaccine and antibiotic therapy, although less frequently. According to WHO guidelines, after occupational exposure to bloodborne pathogens, it is crucial to clean wounds with soap and water, allow the wound to bleed freely, and avoid using alcohol or potent disinfectants. If the eyes, nose, mouth, or mucous membranes are exposed, individuals should rinse with water for at least 10 min [39]. After a needlestick incident, patient risk factors should be evaluated. In addition, before testing for HIV and HCV, consent is obtained and blood samples are collected for bloodborne pathogen testing. Decisions on administering post-exposure prophylaxis (PEP) should follow [40]. Afterwards, exposed individuals should be referred to qualified providers for counseling, risk assessment, and the consideration of antiretroviral drugs or the hepatitis B vaccine [39,40,41,42].
While we reported an incidence rate of 2.64%, we believe that, as mentioned elsewhere, needlestick injuries are underreported in our case too [43,44,45]. In contrast to that, a recent study by Zachar and Reher (2022) that collected data over 6 years (2014–2019) reported almost 8.3 times more PEIs (308 PEIs, from which 67 were needlestick injuries) with an incidence rate of 0.109%.
As suggested so far, to limit dentist injuries, especially those of students due to sharp instruments, and to reinforce NSIS reporting, it is crucial to focus on appropriate education [19,24]. This can be achieved through two educational conventions: didactic and interactive seminars. Interactive seminars can include role-playing activities and discussions on the efficient protection and prevention of percutaneous injuries [20]. This approach is particularly effective for educating health practitioners [21]. Competent committees like the Department of Occupational Safety and Health can conduct these educational activities through this approach, and injuries can be reduced by teaching the safe management of needles and sharp tools [22,23]. Given the number of exposed students in our department, there is a significant need for enhanced biosafety awareness. Our study confirms that educational institutions play a crucial role in shaping students’ attitudes toward proper cross-infection control [46]. Especially, this education helps students perceive risk, enhance their knowledge of protection, and understand the importance of care during dental procedures, ultimately ensuring safe clinical practices, as mentioned elsewhere [47]. Consistent educational approaches are essential for preventing percutaneous injuries in dental practice. Practically, wearing two pairs of gloves during surgery reduces perforations and blood stains, indicating decreased percutaneous exposure [48]. Accidents with needles and sharp instruments can be prevented by careful handling, safeguarding, and proper disposal. Not bending, breaking, or handling needles without protection is essential [49]. After use, disposable syringes, needles, scalpel blades, and other sharp objects should be placed in puncture-resistant containers as performed in the clinics of the Dental Department of NKUA. Personal protective equipment, such as eyewear, masks, and gowns, is crucial during procedures due to the risk of splashing body fluids [50]. Additionally, safer instruments, like self-sheathing anesthetic needles and needleless jet anesthesia, can be implemented in routine practice [51,52].
Our study provides valuable insights into dental students’ injuries but has several limitations. Firstly, the number of reported injuries was relatively low compared to the total number of students in the clinical years, raising concerns about potential underreporting. Students may not have reported all percutaneous injuries, especially minor ones or those involving clean instruments and low-risk patients. Additionally, many students did not follow the recommended post-injury protocol, opting for self-treatment instead of providing blood for a serological analysis or receiving post-exposure prophylaxis (PEP). This lack of adherence to protocol further limits the completeness of our data. To address these issues, it is advised that dental schools offer additional education on post-exposure injury (PEI) management, emphasizing the importance of reporting and addressing even minor accidents due to the risk of transmitting bloodborne pathogens. We acknowledge that our study was conducted within a single department at the National and Kapodistrian University of Athens, which may limit the generalizability of our findings. However, this focused approach allowed us to perform an in-depth analysis of the incidence and causes of clinical injuries among undergraduate dental students within a controlled environment, providing detailed insights and a robust dataset. Despite this limitation, our findings align with other studies in different settings, suggesting common trends and risk factors in dental education environments. Future research should aim to include multiple institutions to enhance the generalizability of the results and provide a more comprehensive understanding of injury prevention in dental education. Our study sets the stage for such collaborative efforts and highlights the critical need for enhanced biosafety awareness and training across diverse educational settings.

5. Conclusions

This study highlights the crucial importance of preventive measures in reducing percutaneous injuries in dental practice. Needle injuries were the most common, indicating the need for proper handling and disposal of needles and sharp instruments, along with the use of personal protective equipment. Enhancing educational initiatives on safety protocols and post-exposure prophylaxis is essential. A comprehensive approach will help dental students understand the risks, adopt safer practices, and manage injuries effectively, ultimately ensuring a safer clinical environment.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/hygiene4040031/s1, Table S1: The registration form prototype that is completed by students in the event of an injury.

Author Contributions

Conceptualization, C.R. and M.A.; methodology, C.R., M.A., E.P. and M.C.; software, M.C., M.A., E.P. and C.R.; formal analysis, M.C., M.A., A.P. (Asteropi Pantelaki), A.P. (Antonios Parasyris) and C.R.; investigation, M.C., A.P. (Asteropi Pantelaki), A.P. (Antonios Parasyris) and M.A.; resources, M.A. and C.R.; data curation, M.C., M.A., E.P. and C.R.; writing—original draft preparation, M.C., M.A., A.P. (Asteropi Pantelaki), A.P. (Antonios Parasyris) and C.R.; writing—review and editing, M.C., M.A., E.P. and C.R.; visualization, M.A. and C.R.; supervision, M.A. and C.R.; project administration, M.A. and C.R.; funding acquisition, M.A. and C.R. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of the Department of Dentistry, National and Kapodistrian University of Athens (611/17 October 2023).

Informed Consent Statement

Patient consent was waived due to the use of only written data found in the relevant repository of the department.

Data Availability Statement

The data presented in this study are available on request from the corresponding author due to sensitive medical data.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Săndulescu, M.; Nicolescu, M.I.; Funieru, C.; Şahin, G.Ö.; Săndulescu, O.; ESCMID Study Group for Viral Hepatitis (ESGVH). Exposure to Biological Fluids in Dental Practice-Narrative Review on Appropriate Risk Assessment to Guide Post-Exposure Management. Pathogens 2023, 12, 968. [Google Scholar] [CrossRef] [PubMed]
  2. Mateus Cardoso Pereira, F.; Weber Mello, F.; Machado Ribeiro, D.; Porporatti, A.L.; da Costa, S.; Flores-Mir, C.; Gianoni Capenakas, S.; Leonardi Dutra, K. Prevalence of Reported Percutaneous Injuries on Dentists: A Meta-Analysis. J. Dent. 2018, 76, 9–18. [Google Scholar] [CrossRef] [PubMed]
  3. Denault, D.; Gardner, H. OSHA Bloodborne Pathogen Standards. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2024. Available online: https://www.ncbi.nlm.nih.gov/books/NBK570561/ (accessed on 20 July 2023).
  4. Ravi, A.; Shetty, P.K.; Singh, P.; Wakode, D.; Modica, S.F.; Kodaganallur Pitchumani, P.; Thomas, D.C. Needlestick Injuries in Dentistry: Time to Revisit. J. Am. Dent. Assoc. 2023, 154, 783–794. [Google Scholar] [CrossRef] [PubMed]
  5. Imran, A.; Imran, H.; Ashley, M.P. Straight to the Point: Considering Sharp Safety in Dentistry. Br. Dent. J. 2018, 225, 391–394. [Google Scholar] [CrossRef] [PubMed]
  6. Jaber, M.A. A Survey of Needle Sticks and Other Sharp Injuries among Dental Undergraduate Students. Int. J. Infect. Control 2011, 7, 3. [Google Scholar] [CrossRef]
  7. Clementini, M.; Raspini, M.; Barbato, L.; Bernardelli, F.; Braga, G.; Di Gioia, C.; Littarru, C.; Oreglia, F.; Brambilla, E.; Iavicoli, I.; et al. Aerosol Transmission for SARS-CoV-2 in the Dental Practice. A Review by SIdP COVID-19 Task-Force. Oral Dis. 2022, 28 (Suppl. S1), 852–857. [Google Scholar] [CrossRef]
  8. Limeres Posse, J.; van Harten, M.T.; Mac Giolla Phadraig, C.; Diniz Freitas, M.; Faulks, D.; Dougall, A.; Daly, B.; Diz Dios, P. The Impact of the First Wave of the COVID-19 Pandemic on Providing Special Care Dentistry: A Survey for Dentists. Int. J. Environ. Res. Public Health 2021, 18, 2970. [Google Scholar] [CrossRef]
  9. Cheng, H.C.; Chang, Y.J.; Liao, S.R.; Siewchaisakul, P.; Chen, S.L.S. The Impact of COVID-19 on Knowledge, Attitude, and Infection Control Behaviors among Dentists. BMC Oral Health 2021, 21, 584. [Google Scholar] [CrossRef]
  10. Rashid, S.; ElSalhy, M. Impact of COVID-19-Related Personal Protective Equipment Changes on Dental Education: A Qualitative Study to Explore Faculty and Student Perspective. Int. J. Dent. 2024, 2024, 5551126. [Google Scholar] [CrossRef]
  11. Bains, V.K.; Bains, R.; Gupta, V.; Salaria, S.K. Knowledge of COVID-19 and Its Implications in Dental Treatment, and Practices of Personal Protective Equipment among Dentists: A Survey-Based Assessment. J. Educ. Health Promot. 2021, 10, 79. [Google Scholar] [CrossRef]
  12. Rapiti, E.; Prüss-Üstün, A.; Hutin, Y. Sharps Injuries: Assessing the Burden of Disease from Sharps Injuries to Health-Care Workers at National and Local Levels. In WHO Environmental Burden of Disease Series; No. 11; World Health Organization: Geneva, Switzerland, 2005. [Google Scholar]
  13. Siddiqi, A.; Niazi, M.I.; De Silva, H.; Firth, N.; Konthasingha, P.; Zafar, S. Percutaneous Exposure Incidents: A Review of Practice and Awareness of Current Protocols at a Dental Faculty. Oral Surg. 2017, 10, e80–e87. [Google Scholar] [CrossRef]
  14. Ramos-Gomez, F.; Ellison, J.; Greenspan, D.; Bird, W.; Lowe, S.; Gerberding, J. Accidental Exposures to Blood and Body Fluids among Health Care Workers in Dental Teaching Clinics: A Prospective Study. J. Am. Dent. Assoc. 1997, 28, 1253–1261. [Google Scholar] [CrossRef] [PubMed]
  15. Siddiqi, A.; Morkel, J.A.; Stephen, L.X.G.; Moola, M.H. Occupational Blood Exposures at a Dental Faculty: A Three-Year Review. Int. Dent. SA 2007, 9, 28–36. [Google Scholar]
  16. Fisman, D.N.; Harris, A.D.; Rubin, M.; Sorock, G.S.; Mittleman, M.A. Fatigue Increases the Risk of Injury from Sharp Devices in Medical Trainees: Results from a Case-Crossover Study. Infect. Control Hosp. Epidemiol. 2007, 28, 10–17. [Google Scholar] [CrossRef] [PubMed]
  17. Hajmohammadi, M.; Saki Malehi, A.; Maraghi, E. Effectiveness of Using Face Masks and Personal Protective Equipment to Reducing the Spread of COVID-19: A Systematic Review and Meta-Analysis of Case-Control Studies. Adv. Biomed. Res. 2023, 12, 36. [Google Scholar] [CrossRef]
  18. HSE. Human Factors: Managing Human Failures. Available online: https://www.hse.gov.uk/humanfactors/topics/humanfail.htm (accessed on 29 May 2024).
  19. Moodley, R.; Naidoo, S.; Van Wyk, J. The Prevalence of Occupational Health-Related Problems in Dentistry: A Review of the Literature. J. Occup. Health 2018, 60, 111–125. [Google Scholar] [CrossRef]
  20. Meschi, M.; Shirahmadi, S.; Amiri, M.; Ebrahimi-Siaghi, N. Debating: Effective and Satisfactory Learning Method in Dentistry. BMC Med. Educ. 2024, 24, 307. [Google Scholar] [CrossRef]
  21. National Health and Medical Research Council. Australian Guidelines for the Prevention and Control of Infection in Healthcare; Australian Government, Australian Commission on Safety & Quality in Healthcare: Sydney, Australia, 2010. Available online: https://www.nhmrc.gov.au (accessed on 2 March 2021).
  22. Cheetham, S.; Ngo, H.T.; Liira, J.; Liira, H. Education and Training for Preventing Sharps Injuries and Splash Exposures in Healthcare Workers. Cochrane Database Syst. Rev. 2021, 4, CD012060. [Google Scholar] [CrossRef]
  23. Sofola, O.O.; Folayan, M.O.; Denloye, O.O.; Okeigbemen, S.A. Occupational Exposure to Bloodborne Pathogens and Management of Exposure Incidents in Nigerian Dental Schools. J. Dent. Educ. 2007, 71, 832–837. [Google Scholar] [CrossRef]
  24. Papadopoli, R.; Bianco, A.; Pepe, D.; Pileggi, C.; Pavia, M. Sharps and Needle-Stick Injuries among Medical Residents and Healthcare Professional Students: Pattern and Reporting in Italy—A Cross-Sectional Analytical Study. Occup. Environ. Med. 2019, 76, 739–745. [Google Scholar] [CrossRef]
  25. Wong, V.Y.Y.; Chao, P.J.S.; Lee, S.P.S.; Tan, Y.H.; Lim, J.S.L. A Descriptive Study of Percutaneous Injuries in National Healthcare Group Polyclinics Dental Clinics in Singapore from 2014 to 2020. BDJ Open 2023, 9, 45. [Google Scholar] [CrossRef] [PubMed]
  26. Huynh, R.; Du, D.; Im, J.H.; Zachar, J.; Zafar, S. Identifying Trends of Percutaneous Injuries at an Australian Dental School. Int. Dent. J. 2022, 72, 308–314. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  27. Zachar, J.; Reher, P. Percutaneous Exposure Injuries amongst Dental Staff and Students at a University Dental Clinic in Australia: A 6-Year Retrospective Study. Eur. J. Dent. Educ. 2021, 26, 288–295. [Google Scholar] [CrossRef] [PubMed]
  28. Smith, W.A.J.; Al-Bayaty, H.F.; Matthews, R.W. Percutaneous Injuries of Dental Personnel at the University of the West Indies, School of Dentistry. Int. Dent. J. 2006, 56, 209–214. [Google Scholar] [CrossRef] [PubMed]
  29. Mocny-Pachońska, K.; Doniec, R.; Trzcionka, A.; Pachoński, M.; Piaseczna, N.; Sieciński, S.; Osadcha, O.; Łanowy, P.; Tanasiewicz, M. Evaluating the Stress-Response of Dental Students to the Dental School Environment. PeerJ 2020, 8, e8981. [Google Scholar] [CrossRef]
  30. Alzahem, A.M.; Van der Molen, H.T.; De Boer, B.J. Effect of Year of Study on Stress Levels in Male Undergraduate Dental Students. Adv. Med. Educ. Pract. 2013, 4, 217–222. [Google Scholar] [CrossRef]
  31. Abu-Ghazaleh, S.; Sonbol, H.; Rajab, L. A Longitudinal Study of Psychological Stress among Undergraduate Dental Students at the University of Jordan. BMC Med. Educ. 2016, 16, 90. [Google Scholar] [CrossRef]
  32. Uraz, A.; Tocak, Y.S.; Yozgatligil, C.; Cetiner, S.; Bal, B. Psychological Well-Being, Health, and Stress Sources in Turkish Dental Students. J. Dent. Educ. 2013, 77, 1345–1355. [Google Scholar] [CrossRef]
  33. Sanders, A.E.; Lushington, K. Sources of Stress for Australian Dental Students. J. Dent. Educ. 1999, 63, 688–697. [Google Scholar] [CrossRef]
  34. Quick, K.K. A Humanistic Environment for Dental Schools: What Are Dental Students Experiencing? J. Dent. Educ. 2014, 78, 1629–1635. [Google Scholar] [CrossRef]
  35. Callan, R.S.; Caughman, F.; Budd, M.L. Injury Reports in a Dental School: A Two-Year Overview. J. Dent. Educ. 2006, 70, 1089–1097. [Google Scholar] [CrossRef] [PubMed]
  36. Shah, S.M.; Merchant, A.T.; Dosman, J.A. Percutaneous Injuries among Dental Professionals in Washington State. BMC Public Health 2006, 6, 269. [Google Scholar] [CrossRef] [PubMed]
  37. World Health Organization (WHO). Aide-Memoire: For a Strategy to Protect Health Workers from Infection with Bloodborne Viruses. In WHO/BCT/03.11; World Health Organization: Geneva, Switzerland, 2003; Available online: https://iris.who.int/bitstream/handle/10665/68354/WHO_BCT_03.11.pdf?sequence=1 (accessed on 29 May 2024).
  38. Smith, W.A.J.; Mohammed, S.K.; Al-Bayaty, H. Self-Reported Percutaneous Injuries of Students and Interns at the School of Dentistry in Trinidad: A Follow-Up Study of an Updated Sharps Protocol. Caribb. Med. J. 2020, 82, 1–8. [Google Scholar] [CrossRef]
  39. World Health Organization (WHO). WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy; Annex D; World Health Organization: Geneva, Switzerland, 2010. [Google Scholar]
  40. Lokesh, U.; Srinidhi, D.; Sudhakara Reddy, K. Post Exposure Prophylaxis to Occupational Injuries for General Dentist. J. Indian Prosthodont. Soc. 2014, 14 (Suppl. S1), 1–3. [Google Scholar] [CrossRef] [PubMed]
  41. HSE Public Health: National Health Protection Office. Emergency Management of Injuries (EMI) and Post-Exposure Prophylaxis (PEP) Guidelines 2024. Version 1.0. 5 March 2024. Available online: https://www.hpsc.ie/a-z/emi/EMIGuidelinesPeP.pdf (accessed on 26 May 2024).
  42. Abalkhail, A.; Kabir, R.; Elmosaad, Y.M.; Alwashmi, A.S.S.; Alhumaydhi, F.A.; Alslamah, T.; Almoammar, K.A.; Alsalamah, Y.A.; Mahmud, I. Needle-Stick and Sharp Injuries among Hospital Healthcare Workers in Saudi Arabia: A Cross-Sectional Survey. Int. J. Environ. Res. Public Health 2022, 19, 6342. [Google Scholar] [CrossRef]
  43. Lee, J.J.; Kok, S.H.; Cheng, S.J.; Lin, L.D.; Lin, C.P. Needlestick and Sharps Injuries among Dental Healthcare Workers at a University Hospital. J. Formos. Med. Assoc. 2014, 113, 227–233. [Google Scholar] [CrossRef]
  44. AlDakhil, L.; Yenugadhati, N.; Al-Seraihi, O.; Al-Zoughool, M. Prevalence and Associated Factors for Needlestick and Sharp Injuries (NSIs) among Dental Assistants in Jeddah, Saudi Arabia. Environ. Health Prev. Med. 2019, 24, 60. [Google Scholar] [CrossRef]
  45. Abebe, A.M.; Kassaw, M.W.; Shewangashaw, N.E. Prevalence of Needle-Stick and Sharp Object Injuries and Its Associated Factors among Staff Nurses in Dessie Referral Hospital, Amhara Region, Ethiopia, 2018. BMC Res. Notes 2018, 11, 840. [Google Scholar] [CrossRef]
  46. Gatto, M.R.; Bandini, L.; Montevecchi, M.; Checchi, L. Occupational Exposure to Blood and Body Fluids in a Department of Oral Sciences: Results of a Thirteen-Year Surveillance Study. Sci. World J. 2013, 2013, 459281. [Google Scholar] [CrossRef]
  47. Kumar, S.; Basak, D.; Kumar, A.; Dasar, P.; Mishra, P.; Kumar, A.; Kumar Singh, S.; Debnath, N.; Gupta, A. Occupational Hepatitis B Exposure: A Peek into Indian Dental Students’ Knowledge, Opinion, and Preventive Practices. Interdiscip. Perspect. Infect. Dis. 2015, 2015, 190174. [Google Scholar] [CrossRef]
  48. Mischke, C.; Verbeek, J.H.; Saarto, A.; Lavoie, M.C.; Pahwa, M.; Ijaz, S. Gloves, Extra Gloves or Special Types of Gloves for Preventing Percutaneous Exposure Injuries in Healthcare Personnel. Cochrane Database Syst. Rev. 2014, 3, CD009573. [Google Scholar] [CrossRef] [PubMed]
  49. Martins, A.M.; Pereira, R.D.; Ferreira, R.C. Compliance with Occupational Post-Exposure Protocol for Injuries among Dental Surgeons. Rev. Saude Publica 2010, 44, 528–540. [Google Scholar] [CrossRef] [PubMed]
  50. National AIDS Control Organisation. National Guidelines for HIV Care and Treatment 2021. Available online: https://naco.gov.in/sites/default/files/National_Guidelines_for_HIV_Care_and_Treatment_2021.pdf (accessed on 26 May 2024).
  51. Gupta, N.; Tak, J. Needlestick Injuries in Dentistry. Kathmandu Univ. Med. J. 2011, 35, 208–212. [Google Scholar] [CrossRef]
  52. Theocharidou, A.; Arhakis, A.; Kotsanos, N.; Arapostathis, K. Jet or Conventional Local Anaesthesia? A Randomized Controlled Split Mouth Study. Clin. Oral Investig. 2021, 25, 6813–6819. [Google Scholar] [CrossRef]
Hygiene 04 00031 g001
Figure 1. The flowchart of the methodology steps of the present study.
Figure 1. The flowchart of the methodology steps of the present study.
Hygiene 04 00031 g001
Hygiene 04 00031 g002
Figure 2. A diagram illustrating all reported % injuries in the Dental Department at the National Kapodistrian University of Athens during and post the COVID-19 period.
Figure 2. A diagram illustrating all reported % injuries in the Dental Department at the National Kapodistrian University of Athens during and post the COVID-19 period.
Hygiene 04 00031 g002
Hygiene 04 00031 g003
Figure 3. A diagram showing the most frequently reported dental procedures that lead to injury (%, percentage). Note—Other: Other Procedures, most of them Prosthodontic Treatments; Endo: Endodontic Treatment; Perio: Periodontal Treatment; Restorative: Restorative Procedures; Extraction: Extraction Procedures; Lab: Lab Procedures.
Figure 3. A diagram showing the most frequently reported dental procedures that lead to injury (%, percentage). Note—Other: Other Procedures, most of them Prosthodontic Treatments; Endo: Endodontic Treatment; Perio: Periodontal Treatment; Restorative: Restorative Procedures; Extraction: Extraction Procedures; Lab: Lab Procedures.
Hygiene 04 00031 g003
Hygiene 04 00031 g004
Figure 4. A diagram presenting the most frequently reported types of injuries and the most common trauma areas (%, percentage).
Figure 4. A diagram presenting the most frequently reported types of injuries and the most common trauma areas (%, percentage).
Hygiene 04 00031 g004
Hygiene 04 00031 g005
Figure 5. A diagram illustrating the most common tools causing injuries to undergraduate students (%, percentage).
Figure 5. A diagram illustrating the most common tools causing injuries to undergraduate students (%, percentage).
Hygiene 04 00031 g005
Table 1. Information about the injury’s date, the injured person’s status, and the accident’s location.
Table 1. Information about the injury’s date, the injured person’s status, and the accident’s location.
Full NameDateStatus
(1. Faculty; 2. Associate; 3. Postgraduate Student; 4. Undergraduate Student)		Place of the Accident (1. Bs lab; 2. Osc; 3. Omfs cl.; 4. Tpc cl.; 5. 2aft cl.; 6. 3aft cl.; 7. Orth cl.; 8. Ped cl.; 9. Post grad. cl.; 10. Other)
ID112.04.2144
ID220.04.2144
ID324.05.2144
ID401.10.2144
ID506.10.2144
ID606.10.2144
ID726.10.2144
ID902.11.2144
ID1029.11.2144
ID1113.12.2144
ID1203.02.2244
ID1307.02.2244
ID1407.02.2244
ID1515.03.2244
ID1623.06.2244
ID1727.06.224
ID1817.10.2244
ID1917.10.224
ID2014.11.2244
ID2122.11.2246
ID2208.12.2244
ID2403.02.2344
ID2528.02.2344
ID2623.10.2344
ID2715.11.2344
ID2806.12.2342
ID2912.12.2344
ID3020.12.2344
ID3122.02.2444
ID3206.03.2444
ID3321.03.2444
ID3410.04.2442
ID3510.04.2444
ID3612.04.2444
ID3718.04.2444
Note—BS LAB: Basement Laboratory; OSC: Oral Surgery Clinic; OMFS CL: Clinic of Oral and Maxillofacial Surgery; Tpc cl: Total Patient Care Clinic; 2aft cl.: 2nd Floor Clinic, Afternoon; 3aft cl: 3rd Floor Clinic, Afternoon; Orth cl: Orthodontic Clinic; Ped cl.: Pediatric Dental Clinic; Post grad. Cl.: Postgraduate Clinic. ID8 and ID23 were excluded from the analysis.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Antoniadou, M.; Chanioti, M.; Pantelaki, A.; Parasyris, A.; Piperi, E.; Rahiotis, C. The Incidence of Clinical Injuries among Undergraduate Dental Students: A Prevention Protocol. Hygiene 2024, 4, 423-434. https://doi.org/10.3390/hygiene4040031

AMA Style

Antoniadou M, Chanioti M, Pantelaki A, Parasyris A, Piperi E, Rahiotis C. The Incidence of Clinical Injuries among Undergraduate Dental Students: A Prevention Protocol. Hygiene. 2024; 4(4):423-434. https://doi.org/10.3390/hygiene4040031

Chicago/Turabian Style

Antoniadou, Maria, Maria Chanioti, Asteropi Pantelaki, Antonios Parasyris, Evangelia Piperi, and Christos Rahiotis. 2024. "The Incidence of Clinical Injuries among Undergraduate Dental Students: A Prevention Protocol" Hygiene 4, no. 4: 423-434. https://doi.org/10.3390/hygiene4040031

APA Style

Antoniadou, M., Chanioti, M., Pantelaki, A., Parasyris, A., Piperi, E., & Rahiotis, C. (2024). The Incidence of Clinical Injuries among Undergraduate Dental Students: A Prevention Protocol. Hygiene, 4(4), 423-434. https://doi.org/10.3390/hygiene4040031

Article Metrics

Back to TopTop