背景:作者着手确定与美国牙医实施疾病控制和预防中心2003年牙科保健机构感染控制指南中首次推荐的四种做法相关的因素。
方法:2008年,作者对6,825名美国牙医的分层随机样本进行了调查。回应率为49%。作者收集了有关牙医人口统计学和实践特征的数据,对感染控制的态度,关于指南的指导来源和关于外科手术需要使用无菌水的知识。然后,他们评估了这些因素对执行四项建议的影响:拥有感染控制协调员,保持牙科单位的水质,记录经皮损伤和使用更安全的医疗设备,例如更安全的注射器和手术刀。作者进行了双变量分析和比例赔率建模。
结果:34%的实践中的回应牙医没有实施或实施了四项建议之一,40%的人实施了其中两项建议,26%的人实施了其中三项或四项建议。承认感染控制重要性的牙医实施的可能性更高,从事牙科工作不到30年,在感染控制方面获得了更多的持续牙科教育学分,正确识别更多需要使用无菌水的外科手术,在更大的实践中工作,并且至少有三个关于指南的指导来源。在南大西洋有实践的牙医,美国中大西洋或中南部东部人口普查部门不太可能遵守。
结论:美国牙医对四项建议的执行情况各不相同。旨在提高对感染控制重要性的认识的策略,增加继续教育的要求和发展多种教学模式可能会增加当前和未来疾病控制和预防中心指南的实施。
BACKGROUND: The authors set out to identify factors associated with implementation by U.S. dentists of four practices first recommended in the Centers for Disease Control and Prevention\'s
Guidelines for Infection Control in Dental Health-Care Settings-2003.
METHODS: In 2008, the authors surveyed a stratified random sample of 6,825 U.S. dentists. The response rate was 49 percent. The authors gathered data regarding dentists\' demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the
guidelines and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of those factors on the implementation of four recommendations: having an infection control coordinator, maintaining dental unit water quality, documenting percutaneous injuries and using safer medical devices, such as safer syringes and scalpels. The authors conducted bivariate analyses and proportional odds modeling.
RESULTS: Responding dentists in 34 percent of practices had implemented none or one of the four recommendations, 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations. The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices and had at least three sources of instruction regarding the
guidelines. Dentists with practices in the South Atlantic, Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied.
CONCLUSIONS: Implementation of the four recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control, increasing continuing education requirements and developing multiple modes of instruction may increase implementation of current and future Centers for Disease Control and Prevention
guidelines.