Observance of Sterilization Protocol Guideline Procedures of Critical Instruments for Preventing Iatrogenic Transmission of Creutzfeldt-Jakob Disease in Dental Practice in France, 2017
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample
2.2. Development of the Questionnaire
2.3. Interviews
2.4. Variables
2.4.1. Criteria Studied
2.4.2. Variables Generated from Indicators
2.4.3. Global Descriptive Indicators
2.5. Analyses
3. Results
3.1. Characteristics of Dental Practices
3.2. Conformity of Sterilization-Related Procedures
3.3. Stratified Global Indicators According to the Size of Dental Practices and the Relative Percentages of DAs in the Team
3.4. Interrelations between Stratified Global Indicators
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
- Brandel, J.-P.; Peckeu, L.; Haik, S. The French surveillance network of Creutzfeldt–Jakob disease. Epidemiological data in France and worldwide. Transfus. Clin. Biol. 2013, 20, 395–397. [Google Scholar] [CrossRef] [PubMed]
- EUROCJD. European Creutzfeldt-Jakob Disease Surveillance Network: EUROCJD Surveillance Data. Available online: http://www.eurocjd.ed.ac.uk/surveillance%20data%201.html (accessed on 25 February 2018).
- Douet, J.Y.; Lacroux, C.; Aron, N.; Head, M.W.; Lugan, S.; Tillier, C.; Huor, A.; Cassard, H.; Arnold, M.; Beringue, V.; et al. Distribution and Quantitative Estimates of Variant Creutzfeldt-Jakob Disease Prions in Tissues of Clinical and Asymptomatic Patients. Emerg. Infect. Dis. 2017, 23, 946–956. [Google Scholar] [CrossRef] [PubMed]
- Soundarya, S.; Usha, V.; Balaji, B. Prion Diseases of Human: A Review. Int. J. Oral Maxillofac. Pathol. 2013, 4, 43–49. [Google Scholar]
- Llewelyn, C.A.; Hewitt, P.E.; Knight, R.S.; Amar, K.; Cousens, S.; Mackenzie, J. Possible transmission of variant Creutzfeldt-Jakob disease by blood transfusion. Lancet 2004, 363, 417–421. [Google Scholar] [PubMed]
- De Pedro-Cuesta, J.; Glatzel, M.; Almazán, J.; Stoeck, K.; Mellina, V.; Puopolo, M.; Pocchiari, M.; Zerr, I.; Kretszchmar, H.A.; Brandel, J.P.; et al. Human transmissible spongiform encephalopathies in eleven countries: Diagnostic pattern across time, 1993–2002. BMC Public Health 2006, 6, 278. [Google Scholar]
- Sushma, B.; Gugwad, S.; Pavaskar, R.; Malik, S.A. Prions in dentistry: A need to be concerned and known. J. Oral Maxillofac. Pathol. 2016, 20, 111–114. [Google Scholar] [CrossRef] [PubMed]
- Blanquet-Grossard, F.; Sazdovitch, V.; Jean, A.; Deslys, J.P.; Dormont, D.; Hauw, J.J.; Marion, D.; Brown, P.; Cesbron, J.Y. Prion protein is not detectable in dental pulp from patients with Creutzfeldt-Jakob disease. J. Dent. Res. 2000, 79, 700. [Google Scholar] [CrossRef] [PubMed]
- Bourvis, N.; Boelle, P.Y.; Cesbran, J.Y.; Valleron, A.J. Risk assessment of transmission of sporadic Creutzfeldt- Jakob disease in endodontic practice in absence of adequate prion inactivation. PLoS ONE 2007, 2, e1330. [Google Scholar] [CrossRef]
- World Health Organization. WHO Guidelines on Tissue Infectivity Distribution in TSEs. Available online: http://www.who.int/bloodproducts/tse/WHO%20TSE%20Guidelines%20FINAL-22%20JuneupdatedNL.pdf (accessed on 25 December 2016).
- Jayanthi, P.; Thomas, P.; Bindhu, P.; Krishnapillai, R. Prion diseases in humans: Oral and dental implications. N. Am. J. Med. Sci. 2013, 5, 399–403. [Google Scholar] [CrossRef] [PubMed]
- Spongiform Encephalopathy Advisory Committee (SEAC). SEAC Position Statement vCJD and Endodontic Dentistry. Available online: http://www.vegsource.com/talk/madcow/messages/1000682.html (accessed on 25 December 2016).
- Walker, J.T.; Dickinson, J.; Sutton, J.M.; Raven, N.D.; Marsh, P.D. Cleanability of dental instruments—Implications of residual protein and risks from CJD. Br. Dent. J. 2007, 203, 395–401. [Google Scholar] [CrossRef] [PubMed]
- Porter, S.R. Prion disease: Possible implications for oral health care. J. Am. Dent. Assoc. 2003, 134, 1486–1491. [Google Scholar] [PubMed]
- World Health Organization. WHO Infection Control Guidelines for Transmissible Spongiform Encephalopathies: Report of a WHO Consultation, Geneva, Switzerland, 23–26 March 1999; WHO Communicable Disease Surveillance and Control: Geneva, Switzerland, 2000. [Google Scholar]
- Guide to the European Union (Prevention of Sharps Injuries in the Healthcare Sector) Regulations, 2014, HAS. Available online: http://www.hsa.ie/eng/Publications_and_Forms/Publications/Healthcare_Sector/Sharps_Regulations_Guidelines_2014.pdf (accessed on 18 December 2016).
- Sutton, J.M.; Dickinson, J.; Walker, J.T.; Raven, N.D. Methods to minimize the risks of Creutzfeldt–Jakob disease transmission by surgical procedures: Where to set the standard? Clin. Infect. 2006, 43, 757–764. [Google Scholar] [CrossRef]
- Dental Council of Ireland. Code of Practice Relating to Infection Control in Dentistry: Infection, Prevention and Control Dublin, Ireland, April 2015. Available online: http://www.dentalcouncil.ie/files/IPC%20Code%20-%20Final%20-%2020150402.pdf (accessed on 25 February 2018).
- Rutala, W.A.; Weber, D.J.; Society for Healthcare Epidemiology of America. Guideline for disinfection and sterilization of prion-contaminated medical instruments. Infect. Control Hosp. Epidemiol. 2010, 31, 107–117. [Google Scholar] [CrossRef] [PubMed]
- Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care; U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Oral Health: Atlanta, GA, USA, 2016. Available online: https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care.pdf (accessed on 25 February 2018).
- Kohn, W.G.; Collins, A.S.; Cleveland, J.L.; Harte, J.A.; Eklund, K.J.; Malvitz, D.M.; Centers for Disease Control and Prevention (CDC). Guidelines for infection control in dental health-care settings—2003. MMWR Recomm. Rep. 2003, 52, 1–61. [Google Scholar] [PubMed]
- Jakubovics, N.; Greenwood, M.; Meechan, J.G. General medicine and surgery for dental practitioners: Part 4. Infections and infection control. Br. Dent. J. 2014, 217, 73–77. [Google Scholar] [CrossRef] [PubMed]
- Saccucci, M.; Ierardo, G.; Protano, C.; Vitali, M.; Polimeni, A. How to manage the biological risk in a dental clinic: Current and future perspectives. Minerva Stomatol. 2017, 66, 232–239. [Google Scholar] [CrossRef] [PubMed]
- Sebastiani, F.R.; Dym, H.; Kirpalani, T. Infection Control in the Dental Office. Dent. Clin. N. Am. 2017, 61, 435–457. [Google Scholar] [CrossRef] [PubMed]
- Cleveland, J.L.; Bonito, A.J.; Corley, T.J.; Foster, M.; Barker, L.; Gordon Brown, G.; Lenfestey, N.; Lux, L. Advancing infection control in dental care settings: Factors associated with dentists’ implementation of guidelines from the Centers for Disease Control and Prevention. J. Am. Dent. Assoc. 2012, 143, 1127–1138. [Google Scholar] [PubMed]
- Gordon, B.L.; Burke, F.J.; Bagg, J.; Marlborough, H.S.; McHugh, E.S. Systematic review of adherence to infection control guidelines in dentistry. J. Dent. 2001, 29, 509–516. [Google Scholar] [PubMed]
- Health Service Executive Standards and Recommended Practices for Dental Services in a Local Decontamination Unit (LDU), HSE, 2012. Available online: https://www.hse.ie/eng/about/who/qid/quality-and-patient-safety-documents/standardsdentalldu.html (accessed on 25 February 2018).
- Guide de Prévention des Infections Liées aux Soins en Chirurgie Dentaire et en Stomatologie; Ministère de la Santé et des Solidarités, France, Direction Générale de la Santé: Paris, France, 2006. Available online: http://solidarites-sante.gouv.fr/IMG/pdf/Guide_de_prevention_des_infections_liees_aux_soins_en_chirurgie_dentaire_et_en_stomatologie.pdf (accessed on 25 February 2018).
- Cohen, J. A coefficient of agreement for nominal scales. Educ. Psychol. Measur. 1960, 20, 37–47. [Google Scholar]
- Das, A.S.; Zou, W.-Q. Prions: Beyond a Single Protein. Clin. Microbiol. Rev. 2016, 29, 633–658. [Google Scholar] [CrossRef] [PubMed]
- Rutala, W.A.; Weber, D.J. Disinfection and sterilization in health care facilities: What clinicians need to know. Clin. Infect. Dis. 2004, 39, 702–709. [Google Scholar] [CrossRef] [PubMed]
- Peretz, D.; Supattapone, S.; Giles, K.; Vergara, J.; Freyman, Y.; Lessard, P.; Safar, J.G.; Glidden, D.V.; McCulloch, C.; Nguyen, H.O.; et al. Inactivation of Prions by Acidic Sodium Dodecyl Sulfate. J. Virol. 2006, 80, 322–331. [Google Scholar] [CrossRef] [PubMed]
- Sakudo, A.; Ano, Y.; Onodora, T.; Nitta, K.; Shintani, H.; Ikuta, K.; Tanaka, Y. Fundamentals of prions and their inactivation (review). Int. J. Mol. Med. 2011, 27, 483–489. [Google Scholar] [CrossRef] [PubMed]
- Bonetti, D.; Young, L.; Black, I.; Cassie, H.; Ramsay, C.R.; Clarkson, J. Can’t do it, won’t do it! Developing a theoretically framed intervention to encourage better decontamination practice in Scottish dental practices. Implement. Sci. 2009, 4, 31. [Google Scholar] [CrossRef] [PubMed]
- Mutters, N.T.; Hägele, U.; Hagenfeld, D.; Hellwig, E.; Frank, U. Compliance with infection control practices in an university hospital dental clinic. GMS Hyg. Infect. Control 2014. [Google Scholar] [CrossRef]
- Su, J.; Deng, X.-H.; Sun, Z. A 10-year survey of compliance with recommended procedures for infection control by dentists in Beijing. Int. Dent. J. 2012, 62, 148–153. [Google Scholar] [CrossRef] [PubMed]
- Bonetti, D.; Clarkson, J.; Ramsay, C.; Young, L.; Cassie, H.; Black, I. Tailored action planning improves decontamination practice when providers are hugely variant in implementing guidance recommendations. Eur. Health Psychol. 2016, 18, 811. [Google Scholar]
- Cheng, H.-C.; Su, C.-Y.; Huang, C.-F.; Chuang, C.-Y. Changes in compliance with recommended infection control practices and affecting factors among dentists in Taiwan. J. Dent. Educ. 2012, 76, 1684–1690. [Google Scholar] [PubMed]
- Newlands, R.; Duncan, E.M.; Prior, M.; Elouafkaoui, P.; Elders, A.; Young, L.; Clarkson, J.E.; Ramsay, C.R.; Translation Research in a Dental Setting (TRiaDS) Research Methodology Group. Barriers and facilitators of evidence-based management of patients with bacterial infections among general dental practitioners: A theory-informed interview study. Implement. Sci. 2016, 11, 11. [Google Scholar] [PubMed]
- Brêda-Albuquerque, F.; de Farias, A.B.; de Prado, M.G.; Orestes-Cardoso, S. Influence of clinicians’ socio-demographic, professional and educational variables on their compliance with preventive measures against hepatitis B and C. Oral Health Prev. Dent. 2008, 6, 349–354. [Google Scholar] [PubMed]
- Oosthuysen, J.; Potgieter, E.; Blignaut, E. Compliance with infection control recommendations in South African dental practices: A review of studies published between 1990 and 2007. Int. Dent. J. 2010, 60, 181–189. [Google Scholar] [PubMed]
- McCarthy, G.M.; Koval, J.J.; MacDonald, J.K. Compliance with recommended infection control procedures among Canadian dentists: Results of a national survey. Am. J. Infect. Control 1999, 27, 377–384. [Google Scholar] [PubMed]
- Bagg, J.; Smith, A.J.; Hurrell, D.; McHugh, S.; Irvine, G. Pre-sterilization cleaning of re-usable instruments in general dental practice. Br. Dent. J. 2007, 202, E22. [Google Scholar] [CrossRef] [PubMed]
- Smith, A.J.; Bagg, J.; Hurrell, D.; McHugh, S. Sterilization of re-usable instruments in general dental practice. Br. Dent. J. 2007, 203, E16. [Google Scholar] [CrossRef] [PubMed]
- Kelsch, N.; Davis, C.A.; Essex, G.; Laughter, L.; Rowe, D.J. Effects of mandatory continuing education related to infection control on the infection control practices of dental hygienists. Am. J. Infect. Control 2017, 45, 926–928. [Google Scholar] [CrossRef] [PubMed]
- Moon, S.J.; Lee, K.J.; Han, S.Y. Effects of Infection Control Training on Dental Hygienists’ Health Beliefs and Practices of Infection Control. J. Dent. Hyg. Sci. 2017, 17, 226–232. [Google Scholar]
- Kee, Y.L.; Dhanraj, M. Prion Disease and Its Implication for Dentistry. J. Pharm. Sci. Res. 2016, 8, 1233–1236. [Google Scholar] [CrossRef]
Practice Items | N | % | % Conform to the Guidelines |
---|---|---|---|
V1 All medical devices are packaged in welded bags | 75.42 | ||
Yes | 135 | 75.42 | |
No | 44 | 24.58 | |
V2 All autoclavable medical devices are autoclaved | 78.77 | ||
Always | 141 | 78.77 | |
Often | 16 | 8.94 | |
Sometimes | 10 | 5.59 | |
Seldom | 10 | 5.59 | |
Never | 2 | 1.12 | |
V3 All detachable instruments (turbines, etc.) are removed after each treatment, and processed separately | 35.20 | ||
Always | 63 | 35.20 | |
Often | 19 | 10.61 | |
Sometimes | 21 | 11.73 | |
Seldom | 61 | 34.08 | |
Never | 15 | 8.38 | |
V4 Instruments are dried manually and carefully, using a single-use non-woven cloth and/or filtered compressed air | 26.25 | ||
Always | 47 | 26.25 | |
Often | 7 | 3.91 | |
Sometimes | 9 | 5.03 | |
Seldom | 80 | 44.69 | |
Never | 11 | 6.15 | |
Not applicable | 25 | 13.97 | |
V5 All pre-sterilization stages recommended by the manufacturer are followed | 58.10 | ||
Always | 104 | 58.10 | |
Often | 15 | 8.38 | |
Sometimes | 1 | 0.56 | |
Seldom | 5 | 2.79 | |
Never | 54 | 30.17 | |
V6 Inoperable custom-made devices are disposed of as healthcare waste | 43.58 | ||
Yes | 78 | 43.58 | |
No | 8 | 4.47 | |
No idea | 93 | 51.96 | |
Sum of procedures in accordance with Guidelines (N = 154) | Over 80% compliant behaviors: 23.38 (100%: 9.74) | ||
0 | 10 | 6.49 | |
1 | 20 | 12.99 | |
2 | 22 | 14.29 | |
3 | 32 | 20.78 | |
4 | 34 | 22.08 | |
5 | 21 | 13.64 | |
6 | 15 | 9.74 |
Practice Items | N | % | % Conform to the Guidelines |
---|---|---|---|
V7 Update of device journal | 41.90 | ||
Yes | 75 | 41.90 | |
No | 104 | 58.10 | |
V8 Autoclaves are suitable for reprocessing critical medical devices | 43.58 | ||
Yes | 78 | 43.58 | |
No | 6 | 3.35 | |
No idea | 95 | 53.07 | |
V9 Repeat reprocessing protocol is used in the event of failure | 52.51 | ||
Always | 94 | 52.51 | |
Often | 9 | 5.03 | |
Sometimes | 5 | 2.79 | |
Seldom | 9 | 5.03 | |
Never | 37 | 20.67 | |
No idea | 25 | 13.97 | |
V10 Compliance of load release protocol | 49.41 | ||
Always | 84 | 49.41 | |
Often | 10 | 5.88 | |
Sometimes | 5 | 2.94 | |
Seldom | 5 | 2.94 | |
Never | 16 | 9.41 | |
No idea | 45 | 26.47 | |
Not applicable | 5 | 2.94 | |
V11 The stream sterilizer complies with standard EN 13060 | 62.94 | ||
Yes | 107 | 62.94 | |
No idea | 63 | 37.06 | |
V12 The personnel tasked with processing medical devices receives specific training, updated regularly | 36.87 | ||
Yes | 66 | 36.87 | |
No idea | 113 | 63.13 | |
V13 There is a document in which all the events affecting the autoclave are noted (servicing, maintenance, breakdowns, etc.) | 20.67 | ||
Yes | 37 | 20.67 | |
No | 142 | 79.33 | |
V14 Information provided by the manufacturers mention that rotary instrument holders (turbines, contra-angles and handpieces) are ready to be pre-disinfected, cleaned and sterilized | 53.50 | ||
Always | 84 | 53.50 | |
Often | 14 | 8.92 | |
Sometimes | 2 | 1.27 | |
Seldom | 3 | 1.91 | |
Never | 5 | 3.18 | |
No idea | 41 | 26.11 | |
V15 After-sales service for the sterilizer is performed | 53.25 | ||
Yes | 82 | 53.25 | |
No | 17 | 11.04 | |
No idea | 55 | 35.71 | |
Sum of procedures in accordance with the Guidelines (N = 135) | Over 80%: 6.67 (100%: 0.74) | ||
0 | 7 | 5.19 | |
1 | 7 | 5.19 | |
2 | 19 | 14.07 | |
3 | 13 | 9.63 | |
4 | 18 | 13.33 | |
5 | 25 | 18.52 | |
6 | 15 | 11.11 | |
7 | 22 | 16.30 | |
8 | 8 | 5.93 | |
9 | 1 | 0.74 |
Practice Items | N | % | % Conform to the Guidelines |
---|---|---|---|
V16 Compliant implementation of prion cycle | 68.21 | ||
Yes | 118 | 68.21 | |
No | 55 | 31.79 | |
V17 Handling, loading, monitoring | 76.30 | ||
Always | 132 | 76.30 | |
Often | 30 | 17.34 | |
Sometimes | 4 | 2.31 | |
Seldom | 2 | 1.16 | |
Never | 2 | 1.16 | |
No idea | 2 | 1.16 | |
Not applicable | 1 | 0.58 | |
V18 When loading the steam sterilizer, the manufacturer’s recommendations are followed, or failing this, the bagged devices positioned are standing on edge, with paper touching paper and plastic touching plastic, without touching the walls, and not too tightly together | 66.04 | ||
Always | 105 | 66.04 | |
Often | 23 | 14.47 | |
Sometimes | 6 | 3.77 | |
Seldom | 9 | 5.66 | |
Never | 2 | 1.26 | |
No idea | 7 | 4.40 | |
Not applicable | 7 | 4.40 | |
V19 Temperature and duration of sterilization tray | 70.32 | ||
Always | 109 | 70.32 | |
Often | 9 | 5.81 | |
Sometimes | 1 | 0.65 | |
Seldom | 5 | 3.23 | |
Never | 17 | 10.97 | |
No idea | 9 | 5.81 | |
Not applicable | 9 | 5.81 | |
V20 Compliant result obtained for physicochemical integrator packaged inside bags and placed within the load | 65.16 | ||
Always | 101 | 65.16 | |
Often | 6 | 3.87 | |
Sometimes | 4 | 2.58 | |
Seldom | 3 | 1.94 | |
Never | 19 | 12.26 | |
No idea | 9 | 5.81 | |
Not applicable | 13 | 8.39 | |
V21 Result obtained for all flow indicators appearing on bags | 68.39 | ||
Always | 106 | 68.39 | |
Often | 7 | 4.52 | |
Sometimes | 3 | 1.94 | |
Seldom | 2 | 1.29 | |
Never | 18 | 11.61 | |
No idea | 10 | 6.45 | |
Not applicable | 9 | 5.81 | |
V22 Absence of moisture in bags and packaging integrity | 79.35 | ||
Always | 123 | 79.35 | |
Often | 9 | 5.81 | |
Sometimes | 3 | 1.94 | |
Seldom | 1 | 0.65 | |
Never | 7 | 4.52 | |
No idea | 6 | 3.87 | |
Not applicable | 6 | 3.87 | |
V23 Result of the last steam penetration test (Helix device) | 57.69 | ||
Always | 90 | 57.69 | |
Often | 11 | 7.05 | |
Sometimes | 7 | 4.49 | |
Seldom | 9 | 5.77 | |
Never | 22 | 14.10 | |
No idea | 8 | 5.13 | |
Not applicable | 9 | 5.77 | |
Sum of procedures in accordance with the Guidelines (N = 131) | Over 80%: 46.57 (100%: 22.14) | ||
0 | 1 | 0.76 | |
1 | 4 | 3.05 | |
2 | 1 | 0.76 | |
3 | 10 | 7.63 | |
4 | 14 | 10.69 | |
5 | 20 | 15.27 | |
6 | 20 | 15.27 | |
7 | 32 | 24.43 | |
8 | 29 | 22.14 |
Practice Items | N | % | % Conform to the Guidelines |
---|---|---|---|
V24 Quality of verification ensuring successful completion of cycle | 51.96 | ||
Yes | 92 | 51.96 | |
No | 57 | 31.28 | |
No idea | 30 | 16.76 | |
V25 Information required for traceability is entered in the I.T. system | 58.23 | ||
Yes | 92 | 58.23 | |
No | 52 | 32.91 | |
No idea | 14 | 8.86 | |
V26 I.T. system connects the medical device to the patient | 45.86 | ||
Yes | 72 | 45.86 | |
No | 59 | 37.58 | |
No idea | 26 | 16.56 | |
V27 Monthly monitoring of sterilization using biological indicators | 43.05 | ||
Yes | 65 | 43.05 | |
No | 45 | 29.80 | |
No idea | 41 | 27.15 | |
V28 Monitoring of sterilization using flow indicators | 67.11 | ||
Yes | 102 | 67.11 | |
No | 21 | 13.82 | |
No idea | 29 | 19.08 | |
V29 Monitoring of sterilization using integrators | 63.58 | ||
Yes | 96 | 63.58 | |
No | 22 | 14.57 | |
No idea | 33 | 21.85 | |
Sum of procedures in accordance with the Guidelines (N = 140) | Over 80% compliant behaviors: 38.57 (100%: 22.86) | ||
0 | 15 | 10.71 | |
1 | 11 | 7.86 | |
2 | 19 | 13.57 | |
3 | 23 | 16.43 | |
4 | 18 | 12.86 | |
5 | 22 | 15.71 | |
6 | 32 | 22.86 |
Global Indicators | >80% of Compliant Procedures in Group 1, N = 154 | >80% of Compliant Procedures in Group 2, N = 135 | >80% of Compliant Procedures in Group 3, N = 129 | >80% of Compliant Procedures in Group 4, N = 140 | |||||
---|---|---|---|---|---|---|---|---|---|
% | p-Value (2) | % | p-Value (2) | % | p-Value (2) | % | p-Value (2) | ||
# of caregivers (dentists + dental assistants) | 2–3 | 27.3 | 0.44 | 2.3 | 0.34 * | 58.3 | 0.07 | 37.8 | 0.05 |
4–5 | 17.3 | 7.7 | 33.3 | 25.0 | |||||
6+ | 25.9 | 9.6 | 49.1 | 49.1 | |||||
Total | 23.4 | 6.6 | 46.6 | 38.6 | |||||
# of dental units | 1–2 | 21.9 | 0.65 | 1.4 | 0.01 * | 43.1 | 0.42 | 25.8 | 0.002 |
3+ | 25.0 | 12.3 | 50.0 | 51.4 | |||||
Total | 23.4 | 6.6 | 46.6 | 38.6 | |||||
Ratio # of dental assistants/ # of dentists | <1 | 16.2 | 0.23 | 6.9 | 0.87 * | 45.2 | 0.98 | 32.3 | 0.63 |
Parity | 22.6 | 5.7 | 50.0 | 39.1 | |||||
>1 | 33.3 | 8.3 | 47.1 | 43.2 | |||||
Total | 23.4 | 6.6 | 46.6 | 38.6 |
Global Indicators | >80% of Compliant Procedures Group 2 | >80% of Compliant Procedures Group 3 | >80% of Compliant Procedures Group 4 | |||||||
---|---|---|---|---|---|---|---|---|---|---|
% | p-Value (2) | Kappa (3) % Agreement | % | p-Value (2) | Kappa (3) % Agreement | % | p-Value (2) | Kappa (3) % Agreement | ||
>80% of compliant procedures Group 1 | >80% | 10.7 | 0.17 * (n = 111) | κ = 0.096 74.8 Poor | 62.5 | 0.22 (n = 112) | κ = 0.19 60.7 Poor | 60.0 | 0.003 (n = 117) | κ = 0.26 67.5 Fair |
≤80% | 3.6 | 40.0 | 29.9 | |||||||
Total | 5.4 | 46.4 | 37.6 | |||||||
>80% of compliant procedures Group 2 | >80% | 66.7 | 0.30 * (n = 117) | κ = 0.06 55.6 Poor | 77.8 | 0.03 * (n = 127) | κ = 0.13 63.8 Poor | |||
≤80% | 45.4 | 37.3 | ||||||||
Total | 47.0 | 40.2 | ||||||||
>80% of compliant procedures Group 3 | >80% | 62.1 | <0.0001 (n = 121) | κ = 0.37 68.6 Fair | ||||||
≤80% | 25.4 | |||||||||
Total | 43.0 |
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Bourgeois, D.; Dussart, C.; Saliasi, I.; Laforest, L.; Tramini, P.; Carrouel, F. Observance of Sterilization Protocol Guideline Procedures of Critical Instruments for Preventing Iatrogenic Transmission of Creutzfeldt-Jakob Disease in Dental Practice in France, 2017. Int. J. Environ. Res. Public Health 2018, 15, 853. https://doi.org/10.3390/ijerph15050853
Bourgeois D, Dussart C, Saliasi I, Laforest L, Tramini P, Carrouel F. Observance of Sterilization Protocol Guideline Procedures of Critical Instruments for Preventing Iatrogenic Transmission of Creutzfeldt-Jakob Disease in Dental Practice in France, 2017. International Journal of Environmental Research and Public Health. 2018; 15(5):853. https://doi.org/10.3390/ijerph15050853
Chicago/Turabian StyleBourgeois, Denis, Claude Dussart, Ina Saliasi, Laurent Laforest, Paul Tramini, and Florence Carrouel. 2018. "Observance of Sterilization Protocol Guideline Procedures of Critical Instruments for Preventing Iatrogenic Transmission of Creutzfeldt-Jakob Disease in Dental Practice in France, 2017" International Journal of Environmental Research and Public Health 15, no. 5: 853. https://doi.org/10.3390/ijerph15050853