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A Study on the Disinfection of Implant Hand Drivers and Semi-Hazardous Instruments in Dental Workers
Int J Clin Prev Dent 2023;19(2):27-33
Published online June 30, 2023;  https://doi.org/10.15236/ijcpd.2023.19.2.27
© 2023 International Journal of Clinical Preventive Dentistry.

Hee-Ja Na, Ae-eun Moon

Department of Dental Hygiene, Honam University, Gwangju, Korea
Correspondence to: Ae-eun Moon
E-mail: 673happy@honam.ac.kr
https://orcid.org/0000-0003-2365-7518
Received April 19, 2023; Revised May 29, 2023; Accepted June 12, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
This study aims to increase the success rate of implants and provide academic basic data in the future by conducting implant infection management by conducting a study on the disinfection of implant hand drivers and quasi-risk instruments of dental workers. This study included 199 dental workers working at Y Dental Clinic, S Dental Clinic, and I Dental Clinic in the G area from March 1 to March 30, 2023, regarding the disinfection of implant hand drivers and quasi-hazardous equipment. I did a questionnaire survey. I surveyed the questionnaire. Participants in the study are G. power 3.1 program, 199 people were calculated with an effect size of 0.3, a significance level of 0.05, and a power of 0.95. The data collected in this study were analyzed using the SPSS 21.0 program. In order to understand the general characteristics of the subject, the average and standard deviation were obtained, and multivariate analysis technology for implant hand driver, 3WAY syringe disinfection, dental chair surface disinfection, and high-speed handpiece disinfection was conducted according to the sterilization method. Cross-analysis of work experience and implant hand driver disinfection, cross-analysis of work experience and 3WAY syringe disinfection, and two independent samples t-test were performed for dental workers’ health status and implant instrument disinfection. In addition, regression analysis of age and implant hand driver disinfection, 3WAY syringe disinfection, dental chair surface disinfection, suction line disinfection, and alcohol disinfection were analyzed at the significance level of .05. In age and implant hand driver disinfection, the F statistic is 13.944, significance probability .468, which is not significant at the significance level of .05 (t=6.159, p=.468). However, in age and 3WAY syringe disinfection, the F statistic is 13.944, and the significance probability is .002, showing a significant explanation at the significance level of .05. (t=−3.197, p=.002). In age and dental chair surface disinfection, the F statistics are 13.944, and the significance probability is .000, which is significantly explained at the significance level of .05 (t=−3.817, p=.000). In age and suction line disinfection, the F statistic is 13.944, and the significance probability is .000, indicating a significant explanation at the significance level of .05. (t=−3.842, p=.000). In age and alcohol disinfection, the F statistic is 13.944, and the significance probability is .000, showing a significant explanation at the significance level of .05 (t=−5.050, p=.000).
Keywords : dental worker, implant hand driver, quasi-hazardous instruments, disinfection, 3WAY syringe, alcohol
Introduction

Dental staff are exposed to various sources of infection present in the patient’s saliva and blood because they handle instruments in direct contact with the patient’s oral tissue [1]. Therefore, it is known that dental staff have a higher risk of developing infectious diseases than other occupational groups [2]. Infectious diseases that can spread in dental clinics range from simple colds to pneumonia, tuberculosis, herpes simplex, hepatitis, and acquired immunodeficiency [3]. Due to the nature of dental treatment, high-speed handpieces or vibration scalers are used, so aerosols occurring during the treatment process can cause infection between patients and dental staff, and between patients and patients. It is known that many patients receiving dental prosthetics are elderly patients who are not only vulnerable to highly contagious diseases but also have a high risk of transmitting such diseases [4]. Therefore, infection control to prevent cross-infection in the course of dental prosthetic treatment has become an important problem for both dental medical staff and patients. The 2017 Korea Centers for Disease Control and Prevention’s guidelines for disinfection and sterilization of medical institutions were divided into assessment, personal protection, instrument cleaning and sterilization based on infection control protocols [5]. In particular, step-by-step sterilization methods such as deposition before sterilization, pre-cleaning, drying and lubricating to prevent corrosion, packaging, high-level disinfection or sterilization are recommended [6]. With many technological advances since dental implants were introduced by Brånemark, treatment with dental implants has become an essential treatment method for repairing defective teeth [7]. However, the manufacturer’s instructions on infection control of quasi-risk instruments for implant prosthetics are not clearly presented, and research on this is also insufficient. Therefore, this study aims to investigate the infection control practices of dental workers in charge of infection control, patient management, sterilization, and disinfection in dental clinics to increase the success rate of implant surgery and provide basic data for dental workers’ infection control.

Materials and Methods

1. Objects of the study

This study included 199 dental workers working at Y Dental Clinic, S Dental Clinic, and I Dental Clinic in the G area from March 1 to March 30, 2023, regarding the disinfection of implant hand drivers and quasi-hazardous equipment. I did a questionnaire survey. Participants in the study are G.199 people were calculated with power 3.1 program, the effect size was 0.3, the significance level was 0.05, and the power was 0.95. After visiting the dentist in person, explaining the purpose of the study and how to fill out the questionnaire, it was collected after self-filling. The survey consists of 5 general characteristics, an implant hand driver, and 6 paragraphs of 3WAY syringe disinfection practice, and 5 points are given to “very important” and 1 point to “not important” on the Likert 5 point scale, meaning that the higher the score, the higher the recognition. The IRB (NO1041223201912HR18) of this study was approved by Honam University’s Bioethics Research Committee.

2. Experimental method

The dental institution’s implant hand driver and quasi-risk instrument infection control survey tool [8] was prepared as an infection prevention guideline (Ministry of Health and Welfare, 2022) [9] and measured on a Likert 5-point scale. Cronbach’s alpha was 0.94. As a general characteristic 5, age, working period, health status, and compliance with the sterilization method set after treatment of infected patients were examined. The six questions for the semi-risk instrument disinfection and sterilization practice test of dental workers under implant procedures are as follows. Disinfection and sterilize the implant hand driver and 3WAY syringe during treatment. What disinfectant is most commonly used when disinfecting implant hand drivers and 3WAY syringes? Disinfect sodium hypochlorite, alcohol, and unit tray of each patient. The high speed handpieces are pre-patient rotation. The suction line is managed using a separate disinfectant.

3. Data analysis

The data collected in this study were analyzed using the SPSS 21.0 program. In order to understand the general characteristics of the subject, the average and standard deviation were obtained, and multivariate analysis technology for implant hand driver, 3WAY syringe disinfection, dental chair surface disinfection, and high-speed handpiece disinfection was conducted according to the sterilization method. Cross-analysis of work experience and implant hand driver disinfection, cross-analysis of work experience and 3WAY syringe disinfection, and two independent samples t-test were performed for dental workers’ health status and implant instrument disinfection. In addition, regression analysis of age, implant hand driver disinfection, 3WAY syringe disinfection, dental chair surface disinfection, suction line disinfection, and alcohol disinfection were analyzed at the significance level of .05.

Results

The number of participants in general matters is 199. In terms of gender, the mean and standard deviation was 1.155 (.363), indicating that women were higher. The average and standard deviation of the age was 1.663 (1.115), the average and standard deviation of the work experience was 1.693 (1.107), the average and standard deviation of the health condition was 1.472 (1.500), and the average and standard deviation of the sterilization method was 3.527 (1.242) (Table 1).

Table 1 . General information analysis (N=199)

itemNMeanSD
Gender1991.155.363
Age1991.6631.115
Work experience1991.6931.07
Physical condition1991.472.500
Compliance with sterilization method1993.5271.242
Valid n (by list)199


In Table 2, in the cross-analysis of work experience and implant hand driver disinfection, 57 people were in the first and second years of work experience, 58.45% were in the case of implant hand driver disinfection, and 60.5% were in the case of “yes and very yes.” In the third to fourth years of working experience, 26 people were “not and ordinary,” 26.45% and 27 people were “yes and very yes,” showing 29.6%. As a result of x2 test to see if there is a significant difference in the cross-analysis between work experience and implant hand driver disinfection, the x2 statistical value was 41.811, and the significance probability was .000, indicating a significant difference between work experience and implant hand driver disinfection at .05.

Table 2 . Cross-analysis of work experience and implant hand driver disinfection

Cross-analysis

ItemImplant hand driver disinfectionThe entire

I don’t think soIn generalThat’s rightIt is quite so
Work experience1 or 2 yrsFrequency31261545117
Hand driver disinfection (%)56.4%60.5%65.2%57.0%58.8%
3 or 4 yrsFrequency151181953
Hand driver disinfection (%)27.3%25.6%34.2%24.4%26.6%
5 or 6 yrsFrequency500712
Hand driver disinfection (%)9.1%0.0%0.0%9.0%6.0%
7 or 8 yrsFrequency00077
Hand driver disinfection (%)0.0%0.0%0.0%9.0%3.5%
9 or 10 yrsFrequency460010
The entireHand driver disinfection (%)7.3%14.0%0.0%0.0%5.0%
The entireFrequency55432378199
Hand driver disinfection (%)100.0%100.0%100.0%100.0%100.0%

x2=41.811a (df=16, p=.000).



In Table 3, in the cross-analysis of work experience and 3WAY syringe disinfection, 39 people in the first and second years of work experience showed 50.85% and 78 people in “yes and very yes,” showing 68.5%. In the third to fourth years of working experience, 25 people were “not and ordinary,” 26.45% and 27 people were “yes and very yes,” showing 33.5%. As a result of conducting an x2 test to see if there is a significant difference in the cross-analysis between work experience and 3WAY syringe disinfection, the x2 statistical value was 49.076, and the significance probability was .000, indicating a significant difference between work experience and 3WAY syringe disinfection at the significance level.

Table 3 . Cross-analysis of work experience and 3WAY syringe disinfection

Cross-analysis
3WAY syringe disinfectionThe entire

I don’t think soIn generalThat’s rightIt is quite so
Work experience

1 or 2 yrsFrequency15243246117
3WAY syringe disinfection (%)41.7%60.0%82.1%54.8%58.8%
3 or 4 yrsFrequency16962253
3WAY syringe disinfection (%)44.4%22.5%15.4%26.2%26.6%
5 or 6 yrsFrequency070512
3WAY syringe disinfection (%)0.0%17.5%0.0%6.0%6.0%
7 or 8 yrsFrequency50027
3WAY syringe disinfection (%)13.9%0.0%0.0%2.4%3.5%
9 or 10 yrsFrequency001910
3WAY syringe disinfection (%)0.0%0.0%2.6%10.7%5.0%
The entireFrequency403984199
3WAY syringe disinfection (%)100.0%100.0%100.0%100.0%

x2=49.076a (df=12, p=.000).



Table 4 conducted two independent samples t-test according to dental worker health status and implant hand driver disinfection. The average and standard deviation of 105 dental workers was 3.466 (1.286), 94 infectious diseases were infected, 3.797 (1.205), and the difference in dental worker health was significant. However, the surface disinfection of dental chairs was 105 good, the average and standard deviation was 3.714 (1.276), and the t statistics on whether the health status of dental workers differed in surface disinfection of dental chairs were 2.285, and the significance probability was .023. In addition, 48 people were disinfected with sodium hypochlorite and dental workers’ health conditions, with an average and standard deviation of 2.645 (1.263), an average and standard deviation of 52 infectious disease infections (1.478), and a t-statistic value of −4.278, which is significant (Table 4).

Table 4 . Two independent samples t-test different from dental worker’s health condition and implant instrument disinfection

Collective statistics

ItemPhysical conditionNMeanSDtp
Disinfection of implant hand driverGood health1053.4661.286−1.868.063
Infectious disease, infection943.7971.205
Disinfection of 3WAY syringeGood health1053.7141.276−1.911.061
Infectious disease, infection944.021.983
Dental chair surface disinfectionGood health1053.9711.2892.285.023
Infectious disease, infection943.5421.357
Hypochlorous acid disinfectionGood health482.6451.263−4.278.000
Infectious disease, infection523.8261.478


In Table 5, the F statistics in age and implant hand driver disinfection were 13.944 and significance probability.468, which are not significant at the significance level of .05 (t=6.159, p=.468).

Table 5 . Regression analysis of age and implant hand driver disinfection, 3WAY syringe disinfection, dental chair surface disinfection, suction line disinfection, and alcohol disinfection

Coefficientsa

ModelNon-standardized coefficientsStandardized coefficientstp


βStandardized error β
1(constant)2.997.4876.159.000
Hand driver disinfection.041.057.047.727.468
Disinfecting 3WAY syringe−.194.061−.201−3.197.002
Dental chair surface disinfection−.206.054−.247−3.817.000
Sterilization of suction line.213.055.2443.842.000
Alcohol disinfection−.243.048−.325−5.050.000

aDependent variable: age.

R2 (adj. R2)=.265(.246), F=13.944.



However, in age and 3WAY syringe disinfection, the F statistic is 13.944, and the significance probability is .002, showing a significant explanation at the significance level of .05 (t=−3.197, p=.002).

In age and dental chair surface disinfection, the F statistics are 13.944, and the significance probability is .000, which is significantly explained at the significance level of .05 (t=−3.817, p=.000).

In age and suction line disinfection, the F statistic is 13.944, and the significance probability is .000, indicating a significant explanation at the significance level of .05 (t=−3.842, p=.000).

In age and alcohol disinfection, the F statistic is 13.944, and the significance probability is .000, showing a significant explanation at the significance level of .05 (t=−5.050, p=.000).

Discussion

Disinfection and sterilization processes such as dental equipment and equipment are essential to prevent the spread of infectious pathogens. Effective infection control methods in dental and dental laboratories should be used to prevent cross-infections that can occur in dentists, dental hygienists, dental technicians, and patients alike and prevent accidents that can occur due to failure of infection control [10]. In this study, the number of participants in general matters was 199.In terms of gender, the mean and standard deviation was 1.155 (.363), indicating that women were higher. The average age and standard deviation were 1.663 (1.115), higher in their 20 s, and the average and standard deviation of work experience was 1.693 (.107), higher in the first and second years. The average and standard deviation of health conditions were 1.472 (.500) better, and the average and standard deviation of compliance with the sterilization method was 3.527 (1.242), indicating that the sterilization method was somewhat not observed (Table 1). Before disinfecting and sterilizing dental appliances in dental clinics, a process of cleaning the appliances using water, mechanical friction, and detergents is required. After cleaning the instrument, disinfection and sterilization processes are performed [11]. In Table 2 of this study, in the cross-analysis of work experience and implant hand driver disinfection, 57 people were in the first to second years of work experience, 58.45% were in the case of implant hand driver disinfection, and 60.5% were in the case of “yes and very yes.” In the third to fourth years of working experience, 26 people were “not and ordinary,” 26.45% and 27 people were “yes and very yes,” showing 29.6%. As a result of x2 test to see if there is a significant difference in the cross-analysis between work experience and implant hand driver disinfection, the x2 statistical value was 41.811, and the significance probability was .000, indicating a significant difference between work experience and implant hand driver disinfection at .05. Devices used in dental treatment can be classified into high-risk, quasi-risk, and non-risk instruments depending on the risk of transmission of potential infectious diseases. In 1996, the American Dentist Association According to the published infection control recommendations, dental implant surgical instruments are high-risk instruments used for penetrating the patient’s mucous membrane or for vascular or aseptic tissue, so a sterilization process is required. On the other hand, the dental implant hand driver used in the dental implant prosthetic treatment process is a semi-risk device that is not inserted into aseptic tissue or vascular system, but comes into contact with mucous membranes or damaged skin. Medical instruments belonging to quasi-hazardous instruments should be disinfected at a moderate level or higher to the extent that they kill all microorganisms and some bacterial spores [12]. In Table 3 of this study, in the cross-analysis of work experience and 3WAY syringe disinfection, 39 people in the first to second years of work experience showed 50.85% and 78 people in the first and second years of work experience showed 68.5%. In the third to fourth years of working experience, 25 people were “not and ordinary,” 26.45% and 27 people were “yes and very yes,” showing 33.5%. As a result of conducting an x2 test to see if there is a significant difference between work experience and 3WAY syringe disinfection, the x2 statistical value was 49.076, and the significance probability was .000, indicating a significant difference between work experience and 3WAY syringe disinfection at the significance level of .05. However, it is easy to neglect the disinfection and sterilization of prosthetic devices due to the perception that the risk of cross-infection due to dental implant prosthetic devices is lower than that of dental implant surgical devices. As a disinfectant for disinfection above the intermediate level, it is alcohol and effective against micro-organisms. It denatures proteins and dissolves lipids, which are effective against viruses with general bacteria, tuberculosis bacteria, and envelope. However, it does not work on fungi or endospores. It is used for the skin of the hand or injection area and for medical devices such as thermometers and stethoscopes. Sodium hypochlorite is effective against microorganisms, but sterilizes or inactivates general bacteria, fungi, and viruses. It is ineffective in apo, and the sterilization effect on tuberculosis bacteria is uncertain. It is used for disinfection of linen and tableware, and attention should be paid to bleaching and metal corrosiveness. The concentration of use is 0.01 to 1% (100 to 10,000 ppm) and is used in a concentration of 0.5% (5,000 ppm) for direct treatment of blood, body fluid, and excrement, but in this case, a sufficient amount should be used for the amount of blood, body fluid, and excrement. In Table 4 of this study, two independent samples t-testing of dental workers’ health status and implant hand driver disinfection showed a significant difference in the average and standard deviation of 105 dental workers (1.286), 94 infectious disease infections, 3.797 (1.205), and the average and standard deviation of dental workers’ health conditions. However, the surface disinfection of dental chairs was 105 good, the average and standard deviation was 3.714 (1.276), and the t statistics on whether the health status of dental workers was significantly different in performing surface disinfection were 2.285, and the significance probability was 0.023. In addition, 48 people were disinfected with sodium hypochlorite and the dental worker’s health condition, with an average and standard deviation of 2.645 (1.263), an average and standard deviation of 52 infectious disease infections (1.478), and a significant difference in dental worker’s health status. In an actual clinical environment, there is a possibility that reliable disinfection will not occur because bacteria may not only attach directly to the surface of the dental implant hand driver, but also to organic substances such as hemorrhoids or proteins such as blood. In Table 5 of this study, the F statistics in age and implant hand driver disinfection were 13.944 and the significance probability was .468, which was not significant at the significance level of .05 (t=6.159, p=.468). However, in age and 3WAY syringe disinfection, the F statistic is 13.944, and the significance probability is .002, showing a significant explanation at the significance level of .05 (t=−3.197, p=.002). Subsequently, in age and dental chair surface disinfection, the F statistic is 13.944, and the significance probability is .000, which is significantly explained at the significance level of .05 (t=−3.817, p=.000). Subsequently, in age and suction line disinfection, the F statistic is 13.944, and the significance probability is .000, indicating a significant explanation at the significance level of .05 (t=−3.842, p=.000). Finally, in age and alcohol disinfection, the F statistic is 13.944 and the significance probability is .000, showing a significant explanation at the significance level of .05 (t=−5.050, p=.000). Infection control of metal dental appliances shall be performed by high-pressure steam sterilization after cleaning. However, even though this study clearly recognizes the infection control method of dental medical equipment, the practice of actually implementing it is reported low [13]. Efforts should be made to recognize and educate the need for infection control in dentistry, as well as practice through motivation [14]. The limitation of this study was that the dental implant hand driver was not contaminated with organic matter and blood, which was different from clinical conditions.

Conclusion

This study is From March 1 to 30, 2023, 199 dental workers working at Y Dental Clinic, S Dental Clinic, and I Dental Clinic in the G area also surveyed the disinfection practice of quasi-risk medical devices during implantation. Participants in the study are G.With the power 3.1 program, 199 people were calculated with an effect size of 0.3, a significance level of 0.05, and a power of 0.95.

1. In this study, the number of participants in general matters was 199. In terms of gender, the mean and standard deviation was 1.155 (.363), indicating that women were higher. The average age and standard deviation were 1.663 (1.115), higher in their 20 s, and the average and standard deviation of work experience was 1.693 (.107), higher in the first and second years. The average and standard deviation of health conditions were 1.472 (.500) better, and the average and standard deviation of compliance with the sterilization method was 3.527 (1.242), indicating that the sterilization method was somewhat not observed (Table 1).

2. As a result of conducting an x2 test to see if there is a significant difference between work experience and implant hand driver disinfection, the x2 statistical value was 41.811, and the significance probability was .000, indicating a significant difference between work experience and implant hand driver disinfection at .05.

3. As a result of x2 test to see if there is a significant difference between work experience and 3WAY syringe disinfection, the x2 statistical value was 49.076, and the significance probability was .000, indicating a significant difference between work experience and 3WAY syringe disinfection at the significance level of .05.

4. It was analyzed that there was no significant difference in the health status of dental workers in disinfecting hand drivers. It was analyzed that there was a significant difference in the health status of dental workers in disinfecting the surface of dental chairs.

5. In age and implant hand driver disinfection, the F statistic was 13.944 and the significance probability was .468, which was not significant at the significance level of .05 (t=6.159, p=.468).

However, in age and 3WAY syringe disinfection, the F statistic is 13.944, and the significance probability is .002, showing a significant explanation at the significance level of .05 (t=−3.197, p=.002).

Subsequently, in age and dental chair surface disinfection, the F statistic is 13.944, and the significance probability is .000, which is significantly explained at the significance level of .05 (t=−3.817, p=.000).

Subsequently, in age and suction line disinfection, the F statistic is 13.944, and the significance probability is .000, indicating a significant explanation at the significance level of .05 (t=−3.842, p=.000).

Finally, in age and alcohol disinfection, the F statistic is 13.944 and the significance probability is .000, showing a significant explanation at the significance level of .05 (t=−5.050, p=.000).

Acknowledgements

I would like to thank the representative dental hygienist of each dental clinic.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

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