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.

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.

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)

item	N	Mean	SD
Gender	199	1.155	.363
Age	199	1.663	1.115
Work experience	199	1.693	1.07
Physical condition	199	1.472	.500
Compliance with sterilization method	199	3.527	1.242
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
Item			Implant hand driver disinfection				The entire
			I don’t think so	In general	That’s right	It is quite so
Work experience	1 or 2 yrs	Frequency	31	26	15	45	117
		Hand driver disinfection (%)	56.4%	60.5%	65.2%	57.0%	58.8%
	3 or 4 yrs	Frequency	15	11	8	19	53
		Hand driver disinfection (%)	27.3%	25.6%	34.2%	24.4%	26.6%
	5 or 6 yrs	Frequency	5	0	0	7	12
		Hand driver disinfection (%)	9.1%	0.0%	0.0%	9.0%	6.0%
	7 or 8 yrs	Frequency	0	0	0	7	7
		Hand driver disinfection (%)	0.0%	0.0%	0.0%	9.0%	3.5%
	9 or 10 yrs	Frequency	4	6	0	0	10
The entire		Hand driver disinfection (%)	7.3%	14.0%	0.0%	0.0%	5.0%
	The entire	Frequency	55	43	23	78	199
		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 disinfection				The entire
			I don’t think so	In general	That’s right	It is quite so
Work experience	1 or 2 yrs	Frequency	15	24	32	46	117
		3WAY syringe disinfection (%)	41.7%	60.0%	82.1%	54.8%	58.8%
	3 or 4 yrs	Frequency	16	9	6	22	53
		3WAY syringe disinfection (%)	44.4%	22.5%	15.4%	26.2%	26.6%
	5 or 6 yrs	Frequency	0	7	0	5	12
		3WAY syringe disinfection (%)	0.0%	17.5%	0.0%	6.0%	6.0%
	7 or 8 yrs	Frequency	5	0	0	2	7
		3WAY syringe disinfection (%)	13.9%	0.0%	0.0%	2.4%	3.5%
	9 or 10 yrs	Frequency	0	0	1	9	10
		3WAY syringe disinfection (%)	0.0%	0.0%	2.6%	10.7%	5.0%
The entire		Frequency		40	39	84	199
		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
Item	Physical condition	N	Mean	SD	t	p
Disinfection of implant hand driver	Good health	105	3.466	1.286	−1.868	.063
	Infectious disease, infection	94	3.797	1.205
Disinfection of 3WAY syringe	Good health	105	3.714	1.276	−1.911	.061
	Infectious disease, infection	94	4.021	.983
Dental chair surface disinfection	Good health	105	3.971	1.289	2.285	.023
	Infectious disease, infection	94	3.542	1.357
Hypochlorous acid disinfection	Good health	48	2.645	1.263	−4.278	.000
	Infectious disease, infection	52	3.826	1.478

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
Model		Non-standardized coefficients			Standardized coefficients	t	p
		β	Standardized error		β
1	(constant)	2.997	.487			6.159	.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		.244	3.842	.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).

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.

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).

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

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