Factors affecting the infection control behaviours of Korean dental hygienists in response to the coronavirus disease 2019 pandemic

Abstract

Objectives

This study aimed to identify the factors affecting the prevention of cross‐infection with coronavirus disease‐19 (COVID‐19) among Korean dental hygienists.

Methods

The level of knowledge about COVID‐19 (KNW_CO), level of awareness of infection control (AWR_IC), degree of performance for infection control (PRF_IC), and organizational factors for infection control (OFW_IC) of clinical dental hygienists in Korea to prevent COVID‐19 transmission were investigated. A self‐written online questionnaire was administered to dental hygienists currently working in dental clinics or hospitals, and the survey results of 263 participants were analysed. Pearson's correlation coefficients were calculated for relationships between the KNW_CO, AWR_IC, PRF_IC, and OFW_IC. Multiple linear regression analysis was performed to identify the factors affecting the PRF_IC. Statistical significance was set at p < 0.05.

Results

Knowledge about COVID‐19, AWR_IC, PRF_IC, and OFW_IC were significantly correlated with each other. OFW_IC (β = 0.491, p < 0.001), followed by AWR_IC (β = 0.428, p < 0.001) and KNW_CO (β = 0.095, p = 0.013), had the greatest impact on PRF_IC with regard to the prevention of COVID‐19 transmission.

Conclusions

Organizational factors for infection control and AWR_IC should be strengthened to improve PRF_IC and prevent COVID‐19 transmission during dental care.

1. INTRODUCTION

The spread of coronavirus disease 2019 (COVID‐19) was first confirmed in Wuhan, Hubei Province, China, in December 2019. ¹ As of January 1, 2022, approximately 281.18 million people have been diagnosed worldwide, while approximately 5.41 million have died from the disease. ¹ The mortality rate of COVID‐19 is approximately 1.92%, and globally, the mortality rate is 0.3%–7.6%, depending on regional differences. ¹ Population group age structure, infection status, and other factors, especially among elderly individuals or those with low immune function and underlying diseases, commonly lead to severe illness and death. ¹ COVID‐19 is defined as a respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. ¹ SARS‐CoV‐2 is an RNA virus belonging to the Coronaviridae family. ¹ It is known to be transmitted through the spread of droplets (saliva) generated by coughing or sneezing as well as by contact with the eyes, nose, and mouth after the touching of an object contaminated with the coronavirus. ¹

The Korea Centers for Disease Control and Prevention (KCDC) published standard prevention guidelines for healthcare‐associated infections in 2017. ² This document details the most basic and important rules for providing treatment to and performing procedures in patients at medical institutions, including the principles of hand hygiene, use of disposable gowns and gloves, and wearing appropriate personal protective equipment such as goggles or face shields. ² The use of gloves, a personal protection tool, to minimize the risk of cross‐infection is also recommended, and care must be taken in a wide range of activities, including reprocessing equipment, using multipurpose dental dispensers, handling contaminated equipment, handling oral equipment, and managing dental objects. ² However, although most dental health workers recognize the need for the implementation of basic protection through improved infection control measures, a high fear of infectious diseases and disease transmission persists, while the actual compliance rate is low. ³ , ⁴

The Centers for Disease Control and Prevention released the 2020 Comprehensive Hospital Preparedness Checklist for COVID‐19, ⁵ a checklist of the training and equipment required in preparation for the possibility of a COVID‐19 patient visiting the dentist. ⁵ The document may help prevent the spread of respiratory diseases such as COVID‐19 in the facility and aid in the monitoring and management of all medical personnel who may be exposed to COVID‐19. ⁵ We expect the development of a dental infection management strategy that actively utilizes this checklist.

During such an epidemic, when an asymptomatic infected person visits a dentist and receives treatment, it is possible that droplets from the patient may splatter and infect dental staff or other patients. In particular, because many pieces of equipment that generate aerosols are used in dental clinics or dental hospitals, an environment in which viruses can easily propagate can be created. ⁶ , ⁷ , ⁸ , ⁹ According to a study by Estrich et al. ¹⁰ , several dental hygienists in Puerto Rico have been diagnosed with COVID‐19 or had previously tested positive. In order to prevent infection, the use of personal protective equipment, which was significantly related to work experience, COVID‐19 concern level, and personal protective equipment supply level, was more strongly enforced. This was similar to Bontà et al.'s findings of Italian dental hygienists. ¹¹ Therefore, it is necessary to investigate the factors affecting the infection control behaviour of dental hygienists, who are mostly responsible for infection control in dentistry. This would help us understand current conditions and what measures or efforts are needed to prevent cross‐infection with COVID‐19 in the future. The purpose of this study was to investigate the knowledge level of COVID‐19 (KNW_CO), level of infection control awareness (AWR_IC), degree of infection control performance (PRF_IC), and organizational factors of infection control (OFW_IC) among Korean dental hygienists. In addition, we attempted to identify the factors affecting the PRF_IC.

2. STUDY POPULATION AND METHODOLOGY

2.1. Study group

This study was approved by the institutional review board of Cheongju University (approval no. 1041107‐202,012‐HR‐070‐01). A self‐reported online survey was conducted for 1 day (January 21, 2021). Applicants were recruited from a domestic portal site, and an online survey was conducted. To avoid duplicate responses, mobile phone numbers were examined and discarded after data were collected. The inclusion criteria were current hygiene licensure and active practices. A total of 300 questionnaire responses were collected. However, 37 participants were excluded from the analysis because they were included in other occupational groups or answered insincerely. Thus, data from 263 participants were analysed. Participants' general characteristics, including age, education level, number of years worked, type of work institution, number of dental hygienists in the organization, number of unit chairs, residential area, monthly pay, and routine task types, were obtained.

2.2. Questionnaire on knowledge levels regarding COVID‐19

Knowledge about COVID‐19 was identified by asking about information known about COVID‐19. ¹² The KNW_CO question is composed of the following six items: definition of COVID‐19, transmission route, incubation period, recognition of preventive behaviour rules, blood transmission infections, and recognition of required behaviours when suspicious symptoms are noted. In the exploratory factor analysis, the value of Bartlett's sphericity test was 595.311, which was significant (p < 0.001), and the Kaiser–Meyer–Olkin test value was 0.791, confirming its appropriate design. ¹³ The Cronbach's alpha of the KNW_CO questionnaire was 0.835, confirming its reliability. ¹⁴ The answers to questions about the KNW_CO were answered on a five‐point Likert scale (1 = strongly disagree to 5 = strongly agree). The higher the score, the higher was the KNW_CO.

2.3. Questionnaire on awareness of infection control

The AWR_IC involves determining and discerning how infection should be prevented. ¹⁵ A total of 19 AWR questionnaires were used to assess cross‐infection prevention behaviour. The questionnaires were composed of correcting and supplementing the following data and existing research findings: standard precautions for medical‐related infections of the KCDC, guidelines for the prevention and management of infections in the dental clinic of the Korea Central Quarantine Countermeasure Headquarters, ¹⁶ cases of operation of medical institutions related to COVID‐19, ¹⁷ and studies by Nam, ¹⁸ Bhagavathula et al., ¹⁹ and Khader et al. ²⁰ on infection prevention in dental practice. The value of Bartlett's sphericity test was 2342.329, which was significant (p < 0.001), while the Kaiser–Meyer–Olkin test value was 0.882, confirming its appropriate design. ¹³ Cronbach's alpha for the infection prevention–related awareness questionnaire was 0.896, confirming its reliability. ¹⁴ The answers to the questions regarding the AWR_IC were answered on a five‐point Likert scale (1 = strongly disagree to 5 = strongly agree). The higher the score, the higher was the AWR_IC.

2.4. Questionnaire on performance for infection control

The PRF_IC assesses whether infection prevention activities were performed. The AWR_IC and PRF_IC questions were identical. The value of Bartlett's sphericity test was 3759.781, which was significant (p < 0.001), and the Kaiser–Meyer–Olkin test value was 0.906, confirming its appropriate nature. ¹³ Cronbach's alpha of the infection prevention–related performance questionnaire was 0.923, confirming its reliability. ¹⁴ The answers to the questions regarding the PRF_IC were answered on a five‐point Likert scale (1 = strongly disagree to 5 = strongly agree). The higher the score, the higher was the PRF_IC score.

2.5. Questionnaire on the organization factor for infection control

The OFW_IC is the degree of interest and effort in infection control in the workplace to prevent COVID‐19 transmission. The value of Bartlett's sphericity test was 2729.482, which was significant (p < 0.001), and the Kaiser–Meyer–Olkin test value was 0.941, confirming its appropriate design. ¹³ Cronbach's alpha for the infection prevention–related organizational factor questionnaire was 0.946, confirming its reliability. ¹⁴ The answers to questions for the OFW_IC were answered on a five‐point Likert scale (1 = strongly disagree to 5 = strongly agree). The higher the score, the higher was the OFW_IC.

2.6. Statistical analysis

All collected data were statistically analysed using IBM SPSS Statistics 25 (SPSS Inc.), and statistical significance was set at p < 0.05. Bartlett's sphericity test and the Kaiser–Meyer–Olkin test were performed to determine whether the test items had internal consistency and reliability. One‐way analysis of variance with Scheffé's post hoc test or the t‐test was performed to identify differences in the KNW_CO, AWR_IC, PRF_IC, and OFW_IC according to participants’ general characteristics. A paired t‐test was performed to analyse the differences between the AWR_IC and PRF_IC, whereas Pearson's correlation analysis was performed to detect differences between the KNW_CO, AWR_IC, PRF_IC, and OFW_IC. To analyse the factors affecting the PRF_IC, multiple linear regression analysis of the entering method was performed, and KNW_CO, AWR_IC, and OFW_IC were used as independent variables.

3. RESULTS

3.1. Participants' general characteristics

The average participant age was 31.44 ± 5.09 years, with 27–31 years being the most common age group (44.1%). Regarding educational level, 57.4% had an associate's degree. Furthermore, 33.5% of the participants had ≥7 years of experience and 17.1% had 5–6 years of experience. Regarding the type of institutional workplace, dental clinics accounted for 55.1%, while dental hospitals or a higher level accounted for 45.0%. Most organizations (51.3%) had four to eight dental hygienists on staff. Most of the work locations were metropolitan areas. The routine task types were as follows: dental care (68.1%), disinfection or sterilization (37.6%), administration (35.7%), consultations (20.9%), and all of the above (17.9%; Table 1).

TABLE 1.

General characteristics of the study participants (N = 263).

Characteristics	Categories	N (%)	Mean ± SD
Age (years)	<27	36 (13.7)	31.44 ± 5.09
	27–31	116 (44.1)
	32–36	64 (24.3)
	≥37	47 (17.9)
Education level	Associate degree	151 (57.4)
	Bachelor's degree or higher	112 (42.6)
Number of years worked	<3	68 (25.9)	5.96 ± 4.27
	3–4	62 (23.6)
	5–6	45 (17.1)
	≥7	88 (33.5)
Type of work institution	Dental clinic	145 (55.1)
	Dental hospital level or higher	118 (44.9)
Number of dental hygienists in organization	<4	93 (35.4)
	4–8	135 (51.3)
	≥9	35 (13.3)
Number of unit chairs	<6	116 (44.1)
	≥6	147 (55.9)
Residential area	Metropolitan area	190 (72.2)
	Non‐metropolitan area	73 (27.8)
Monthly pay ($)	<2000	69 (26.2)
	2000–2360	102 (38.8)
	2360–2730	59 (22.4)
	≥2730	33 (12.5)
Type of task (multiple responses)	Dental care work	179 (68.1)
	Administration	94 (35.7)
	Consulting	55 (20.9)
	Disinfect or sterilize	99 (37.6)
	Perform all the above tasks	47 (17.9)

3.2. Results of knowledge levels of COVID‐19

The overall average score of the KNW_CO was 4.23 ± 0.75 out of 5. Among the general characteristics of the study participants, the difference in KNW_CO was confirmed only by age (p = 0.037; Table 2). By item, “I know the rules of conduct to prevent COVID‐19 (4.47 ± 0.63)” had the highest score, whereas “I can explain the definition of COVID‐19 (4.00 ± 0.87)” had the lowest score (Table 3).

TABLE 2.

Differences in the KNW_CO, AWR_IC, PRF_IC, and OFW_IC according to general characteristics of the study participants.

Characteristics	Categories	KNWCO		AWRIC		PRFIC		OFWIC
		Mean ± SD	F or t (p‐value † )	Mean ± SD	F or t (p‐value † )	Mean ± SD	F or t (p‐value † )	Mean ± SD	F or t (p‐value † )
Age (years)	<27	4.27 ± 0.61	2.877 (0.037)	4.53 ± 0.52	3.076 (0.028)	4.17 ± 0.72ab	6.880 (<0.001)	3.94 ± 1.02	2.652 (0.049)
	27–31	4.12 ± 0.53		4.35 ± 0.45		4.12 ± 0.51a		3.89 ± 0.79
	32–36	4.33 ± 0.53		4.53 ± 0.45		4.40 ± 0.48b		4.21 ± 0.72
	≥37	4.35 ± 0.61		4.51 ± 0.47		4.46 ± 0.47b		4.16 ± 0.87
Education level	Associate degree	4.24 ± 0.55	0.114 (0.736)	4.43 ± 0.48	0.491 (0.484)	4.24 ± 0.58	0.456 (0.500)	4.00 ± 0.90	0.265 (0.607)
	Bachelor's degree or higher	4.22 ± 0.58		4.47 ± 0.45		4.28 ± 0.51		4.05 ± 0.73
Number of years worked	<3	4.16 ± 0.54	2.362 (0.072)	4.48 ± 0.50	1.704 (0.167)	4.30 ± 0.57	0.878 (0.453)	4.15 ± 0.74	1.388 (0.247)
	3–4	4.16 ± 0.58		4.34 ± 0.52		4.18 ± 0.61		4.06 ± 0.78
	5–6	4.08 ± 0.50		4.45 ± 0.40		4.20 ± 0.56		3.83 ± 0.86
	≥7	4.31 ± 0.58		4.50 ± 0.42		4.30 ± 0.48		3.99 ± 0.91
Type of work institution	Dental clinic	4.24 ± 0.54	0.039 (0.844)	4.50 ± 0.43	0.332 (0.565)	4.23 ± 0.57	0.822 (0.366)	3.91 ± 0.91	0.140 (0.709)
	Dental hospital level or higher	4.22 ± 0.59		4.38 ± 0.50		4.29 ± 0.53		4.16 ± 0.69
Number of dental hygienists in organization	<4	4.16 ± 0.57	1.270 (0.282)	4.42 ± 0.47	0.320 (0.726)	4.21 ± 0.62	0.769 (0.464)	3.81 ± 1.00a	5.265 (0.006)
	4–8	4.28 ± 0.54		4.46 ± 0.48		4.30 ± 0.51		4.11 ± 0.73b
	≥9	4.24 ± 0.64		4.48 ± 0.44		4.24 ± 0.48		4.24 ± 0.56b
Number of unit chairs	<6	4.26 ± 0.58	0.358 (0.550)	4.48 ± 0.48	1.161 (0.282)	4.28 ± 0.60	0.309 (0.578)	3.94 ± 0.97	1.929 (0.166)
	≥6	4.22 ± 0.55		4.42 ± 0.46		4.24 ± 0.50		4.09 ± 0.70
Residential area	Metropolitan area	4.23 ± 0.54	0.035 (0.852)	4.43 ± 0.46	0.663 (0.416)	4.27 ± 0.52	0.642 (0.424)	3.99 ± 0.83	1.065 (0.303)
	Non‐metropolitan area	4.25 ± 0.62		4.49 ± 0.48		4.21 ± 0.61		4.11 ± 0.83
Monthly pay ($)	<2000	4.35 ± 0.60	2.071 (0.104)	4.56 ± 0.47	2.214 (0.087)	4.34 ± 0.63	2.027 (0.111)	4.17 ± 0.88	1.467 (0.224)
	2000–2360	4.20 ± 0.55		4.41 ± 0.50		4.21 ± 0.52		3.97 ± 0.79
	2360–2730	4.12 ± 0.54		4.37 ± 0.44		4.16 ± 0.55		3.89 ± 0.85
	≥2730	4.31 ± 0.53		4.48 ± 0.36		4.39 ± 0.39		4.10 ± 0.80
Mean ± SD		4.23 ± 0.75		4.45 ± 0.77		4.27 ± 0.91		4.02 ± 1.05

Note: All values indicate mean ± standard deviation. Different superscripts indicate that there was a statistically significant difference between groups for each variable according to the Scheffe post hoc test (p < 0.05).

Abbreviations: AWR_IC, awareness of infection control; KNW_CO, knowledge levels of COVID‐19; OFW_IC, organization factor for infection control; PRF_IC, performance for infection control.

^† p‐values were obtained using one‐way ANOVA to compare the groups.

TABLE 3.

Questions about the KNW_CO

Question number	Question contents	Mean ± SD
Q1‐K	I can explain the definition of COVID‐19	4.00 ± 0.87
Q2‐K	I can explain the transmission route of COVID‐19	4.05 ± 0.82
Q3‐K	I know the incubation period of COVID‐19	4.18 ± 0.78
Q4‐K	I know the rules of conduct to prevent COVID‐19	4.47 ± 0.63
Q5‐K	I know that medical needles can cause blood transmission infections	4.34 ± 0.76
Q6‐K	I know the rules of conduct in case of suspected COVID‐19 symptoms	4.37 ± 0.67
Total mean ± SD		4.23 ± 0.75

3.3. Results of awareness of infection control versus performance for infection control

The overall average AWR_IC score was 4.45 ± 0.77 out of 5. Among the general characteristics of the study participants, the difference in AWR_IC was confirmed only by age (p = 0.028; Table 2). High scores were confirmed for the following questions: “I must wash my hands after treatment (4.69 ± 0.56),” “I must wear a mask during treatment (4.65 ± 0.64),” and “I must wash my hands before treatment (4.64 ± 0.57).” The lowest score was identified for “I must change my mask each time I see a new patient (3.86 ± 1.21)” (Table 4).

TABLE 4.

Questions about the AWR_IC and PRF_IC for preventing COVID‐19 transmission.

Question number	Question contents	AWRIC a Mean ± SD	PRFIC Mean ± SD	For t (p‐value † )
Q1	I use hand sanitizer	4.54 ± 0.66	4.45 ± 0.70	2.086 (0.038)
Q2	I cover the anaesthesia needle cap after anaesthesia	4.57 ± 0.67	4.52 ± 0.66	1.282 (0.201)
Q3	I inquire about systemic diseases (infectious disease) for each patient	4.54 ± 0.70	4.41 ± 0.76	2.449 (0.015)
Q4	I wash my medical uniform after treating patients with infectious diseases	4.28 ± 0.89	3.83 ± 1.20	6.415 (<0.001)
Q5	I change my medical uniform once a day	4.11 ± 1.04	3.83 ± 1.30	4.262 (<0.001)
Q6	I sterilize or disinfect the dental handpiece after treatment	4.61 ± 0.66	4.42 ± 0.79	3.995 (<0.001)
Q7	I ventilate after procedures that generate aerosols	4.40 ± 0.81	4.11 ± 1.05	4.542 (<0.001)
Q8	I disinfect surfaces touched by patients after each patient visit	4.48 ± 0.77	4.39 ± 0.82	1.674 (0.095)
Q9	I change the headrest cover every day	4.25 ± 0.97	3.80 ± 1.21	7.526 (<0.001)
Q10	I change the barrier film for each patient	4.38 ± 0.85	4.02 ± 1.10	5.882 (<0.001)
Q11	I wash my hands before treatment	4.64 ± 0.57	4.59 ± 0.69	1.389 (0.166)
Q12	I wash my hands after treatment	4.69 ± 0.56	4.62 ± 0.62	1.826 (0.069)
Q13	I use a paper towel to dry my hands after washing	4.48 ± 0.71	4.46 ± 0.85	0.492 (0.623)
Q14	I wear gloves during treatment	4.63 ± 0.63	4.57 ± 0.75	1.649 (0.100)
Q15	I change my gloves to new ones each time the patient changes	4.60 ± 0.72	3.45 ± 0.81	3.403 (0.001)
Q16	I wear a mask during treatment	4.65 ± 0.64	4.71 ± 0.55	−1.656 (0.099)
Q17	I change my mask to new ones each time the patient changes	3.86 ± 1.21	3.54 ± 1.42	4.791 (<0.001)
Q18	I wear a face shield during treatment	4.46 ± 0.74	4.26 ± 0.93	3.872 (<0.001)
Q19	I wear safety glasses during treatment	4.34 ± 0.86	4.13 ± 1.12	3.324 (0.001)
Total mean ± SD		4.45 ± 0.77	4.27 ± 0.91

^a Questions about the AWR_IC for preventing COVID‐19 transmission included the term “must” before the verb in the question.

^† p‐values were obtained by paired t‐test to compare the means of the AWR_IC and PRF_IC.

The overall average PRF_IC score was 4.27 ± 0.91 out of 5. Among the general characteristics of the study participants, differences in PRF_IC scores were confirmed only according to age (p < 0.001). A significantly lower PRF_IC was confirmed in 27‐ to 31‐year‐olds (4.12 points out of 5) than in 32‐ to 36‐year‐olds (4.40 points out of 5) and ≥37‐year‐olds (4.46 points out of 5; Table 2). High scores were confirmed for the following questions: “I wear a mask during treatment” (4.71 ± 0.55), “I wash my hands after treatment” (4.62 ± 0.62), and “I wash my hands before treatment” (4.59 ± 0.69). The lowest score was identified for the question “I change my mask with new ones each time the patient changes” (3.86 ± 1.21; Table 4).

The overall mean PRF_IC score was lower than the overall mean AWR_IC score. Significant differences were confirmed between the PRF_IC and AWR_IC in the following questions: “I wash my medical uniform after treating patients with infectious diseases” (p < 0.001), “I change my medical uniform once a day (p < 0.001)”, “I sterilize or disinfect the dental handpiece after treatment” (p < 0.001), “I ventilate after procedures that generate aerosols” (p < 0.001), “I change the headrest cover every day” (p < 0.001), “I change the barrier film for each patient” (p < 0.001), “I change my gloves with each new patient” (p = 0.001), “I change my mask with each new patient” (p < 0.001), “I wear a face shield during treatment” (p < 0.001), and “I wear safety glasses during treatment” (p = 0.001; Table 5).

TABLE 5.

OFW_IC questions about preventing COVID‐19 transmission.

Question number	Question contents	Mean ± SD
Q1‐O	My institution is very interested in infection control	4.25 ± 0.86
Q2‐O	My institution strives to create a safe medical environment to avoid exposure to infection	4.21 ± 0.90
Q3‐O	At my institution, when I am performing unsafe work, my colleagues pay attention and help if necessary	4.04 ± 0.99
Q4‐O	My institution has guidelines to refer to when exposed to dangerous situations related to infection	3.86 ± 1.11
Q5‐O	My institution has established internal rules for the prevention and management of COVID‐19 infection	4.06 ± 0.96
Q6‐O	At my institution, when an employee goes to work, they use a non‐contact thermometer to measure their body temperature before entering the workplace	4.12 ± 1.10
Q7‐O	At my institution, at the time of eating, our employees performed distancing or installed partitions	3.60 ± 1.35
Q8‐O	My institution provided education on COVID‐19 infection prevention rules and training on hand hygiene and protective equipment to employees	3.95 ± 1.13
Q9‐O	My institution has a sufficient stockpile of antiviral drugs to prepare for the COVID‐19 pandemic	3.76 ± 1.23
Q10‐O	My institution has enough personal protective equipment (masks, gloves, facial shields, etc.) to prepare for the COVID‐19 pandemic	4.30 ± 0.87
Q11‐O	My institution facilitates the appropriate use of infection control items such as hand sanitizers and personal protective equipment	4.27 ± 0.87
Q12‐O	My institution monitors employees for COVID‐19 infection and takes appropriate measures	4.00 ± 1.05
Q13‐O	At my institution, workers only wear medical uniforms inside the dental clinic or dental hospital, do not go outside wearing the uniform, and change into the clothes they wash every day	3.86 ± 1.26
Total mean ± SD		4.02 ± 1.05

3.4. Results of the organization factor for infection control

The overall average score was 4.02 ± 1.05. A significant difference was observed in terms of age (p = 0.049) and number of dental hygienists in an organization (p = 0.006; Table 2). High scores were confirmed for the following questions: “My institution has enough personal protective equipment (masks, gloves, facial shields, etc.) to prepare for the COVID‐19 pandemic” (4.30 ± 0.87), “My institution facilitates the appropriate use of infection control items such as hand sanitizer and personal protective equipment” (4.27 ± 0.87), and “My institution is very interested in infection control” (4.25 ± 0.86). The lowest score was obtained for the question “At my institution, at the time of eating, our employees performed distancing or installed partitions” (3.60 ± 1.35).

3.5. Correlation between knowledge levels of COVID‐19, awareness of infection control, performance for infection control, and organization factor for infection control

Significant positive correlations were confirmed between the KNW_CO, AWR_IC, PRF_IC, and OFW_IC (p < 0.001). The highest correlation was identified between the PRF_IC and OFW_IC (r = 0.786, p < 0.001), while the lowest correlation was observed between the KNW_CO and OFW_IC (r = 0.540, p < 0.001; Table 6).

TABLE 6.

Correlations between the KNW_IC, AWR_IC, PRF_IC, and OFW_IC for preventing COVID‐19 transmission.

Variables	r (p)
	KNWIC	AWRIC	PRFIC	OFWIC
KNWIC	1
AWRIC	0.550 (<0.001)	1
PRFIC	0.596 (<0.001)	0.760 (<0.001)	1
OFWIC	0.540 (<0.001)	0.569 (<0.001)	0.786 (<0.001)	1

3.6. Multiple regression analysis for the performance for infection control

As a result of checking multicollinearity to verify the assumptions regarding the independent variables of the multiple regression analysis, the tolerance of the regression analysis was 0.59–0.62, which was over 0.1, and the variance inflation factor was 1.61–1.69. None of the values exceeded the reference value of 10; thus, multicollinearity was not observed. In addition, the Durbin–Watson value used to verify the independence of the residuals was 1.995, which is close to 2, indicating a lack of autocorrelation and that the regression model was appropriately designed to explain the dependent variable. The regression model for the PRF_IC was significant (F = 284.983, p < 0.001), and the explanatory power of the model was 76.7%. The factor with the greatest influence on the PRF_IC was OFW_IC (β = 0.491, p < 0.001), followed by AWR_IC (β = 0.428, p < 0.001) and KNW_CO (β = 0.095, p = 0.013; Table 7).

TABLE 7.

Factors influencing the PRF_IC for preventing COVID‐19 transmission.

Variables	B	SE	β	t	p	Tolerance	VIF
KNWIC	0.419	0.167	0.095	2.507	0.013	0.621	1.609
AWRIC	0.716	0.065	0.428	11.004	<0.001	0.594	1.685
OFWIC	0.673	0.053	0.491	12.713	<0.001	0.602	1.661

Note: R ² = 0.767, Adj R ² = 0.765, F = 284.983, p < 0.001.

4. DISCUSSION

As of September 3, 2020, >7000 healthcare workers worldwide have died of COVID‐19. ²¹ According to the World Health Organization, the main transmission routes of microorganisms in dental clinics and hospitals include direct or indirect contact, droplets, and air. ¹ COVID‐19 is a respiratory disease; therefore, caution is needed in dental clinics or dental hospitals, where it is easily spread through contact and droplets. Therefore, it is important to identify factors that affect dental hygienists’ PRF_IC to prevent cross‐infection with COVID‐19. As a result of this study, KNW_CO, AWR_IC, and OFW_IC were identified as factors significantly affecting PRF_IC.

Among the general characteristics, the KNW_CO, AWR_IC, and PRF_IC showed significant differences only according to age (p < 0.05). The KNW_CO, AWR_IC, and PRF_IC tend to increase with age, consistent with previous studies. ¹⁸ , ²² , ²³ , ²⁴ The average KNW_CO score was 4.23 ± 0.75. Kwon and Lee reported that the average correct answer rate for knowledge about COVID‐19 among Korean nurses was 69%. ²⁵ With similar results, another Kwon reported that the level of COVID‐19 knowledge of Korean nurses was 17.58 ± 2.60 out of 25 points. ²⁶ And, it was reported that the level of COVID‐19 knowledge of 119 emergency medical technicians in Korea, who are healthcare workers facing COVID‐19 patients, was 16.46 ± 55 out of 20 points. ²⁷ Another medical technician, Korean radiologist, reported that the average correct answer rate for COVID‐19 knowledge was 66%. ²⁸ Direct comparison may be difficult due to differences in the investigation period and the scoring criteria between studies. Nevertheless, dental hygienists may be at the forefront of the spread of infection, such as via droplets and contact, owing to the characteristics of dental treatment compared to other occupations. The risk of infection and the importance of infection control education curriculum will be proportional. Therefore, the KNW_CO of dental hygienists may be higher than those of other occupations.

In this study, the AWR_IC and PRF_IC were investigated using the same questions. A significant correlation was confirmed between the AWR_IC and PRF_IC (r = 0.760, p < 0.001). This result is consistent with the results of a previous study that confirmed a significant correlation between the AWR_IC and PRF_IC (r = 0.624, p < 0.001), ⁴ with an average AWR_IC score of 4.45 ± 0.77, average PRF_IC score of 4.26 ± 0.92, and average PRF_IC score of approximately 0.2 points lower than that of the AWR_IC. Regarding the detailed question, “I change my gloves with each new patient,” the AWR_IC was 4.60 ± 0.72 and PRF_IC was 3.45 ± 0.81, confirming the biggest difference of 1.15. These results suggest that dental hygienists are aware of infection control measures, but do not always perform them. In previous studies, the average infection control awareness score was 3.33 ± 0.38, while the average infection control performance score was 3.04 ± 0.37, showing a difference of 0.30, which is consistent with this study (p < 0.001). ⁴ These results suggest that glove replacement is slightly less common than other infection‐control actions.

According to a previous study, the most common reason for dental hygienists not to wear protective equipment was an inconvenience (49.8%), followed by a lack of time (17.4%) and other reasons (18.1%). ²⁹ Therefore, it is important to develop convenient protective equipment and ensure adequate time to apply protective equipment.

In this study, the KNW_CO, AWR_IC, PRF_IC, and OFW_IC were significantly correlated (p < 0.001). The significant correlation between AWR_IC and PRF_IC is consistent with previous findings. ³⁰ The OFW_IC (β = 0.491, p < 0.001) had the greatest impact on the PRF_IC, followed by the AWR_IC (β = 0.428, p < 0.001) and KNW_CO (β = 0.095, p = 0.013). Moreover, in this study, the average OFW_IC score was high (4.02 ± 1.05 out of 5). However, in Yassi and Annalee's study, only 5% of the participants reported receiving quality internal training, and 30% of the participants reported not receiving the required training. ³¹ These results may have been confirmed because organizational efforts related to infection control were higher than before the COVID‐19 pandemic. Ryu et al. reported that only 28.6% of the participants' dental institutions had an adequately well‐equipped system for treating infected patients and only 23.8% of the institutions had an adequately well‐equipped system for infected staff. ³¹ According to previous studies, dentists were aware of COVID‐19 symptoms and transmission patterns, infection control measures, etc., whereas dental hygienists' understanding and additional preventive measures to protect patients from COVID‐19 were limited. ²⁰ For systematic and systematic infection control, both the will of dentists and dental hygienists for infection control and the interest of patients are important. ³²

A significant difference in the OFW_IC was observed based on the number of dental hygienists in an organization. Similarly, Jeong and Lee ³⁰ reported that the larger the working organization, the higher the AWR_IC and PRF_IC. According to Oh and Lee's study, as the size of the institution increased, the greater the average of formalization, which indicates the degree of institutionalization and regulation. ³³ As the number of dental hygienists increased, there was a tendency to have hierarchical organizational culture, market‐oriented culture, and adhocracy culture, and institutionalization of the organizational structure had a significant effect on knowledge sharing. ³³ This corresponds to the results of this study that the greater the number of dental hygienists in this study, the greater the interest in efforts to implement infection control measures at work. The significance of this study is that it identified the KNW_CO, AWR_IC, OFW_IC, and PRF_IC of Korean dental hygienists during the COVID‐19 pandemic and identified the factors affecting PRF_IC. In addition, since the current infection control method was investigated, it can be used as basic data for various studies such as research for prevention of cross‐infection of other diseases as well as COVID‐19 or research for infection control education of dental hygienists. Protocols for improving dental infection control are being developed worldwide. ³⁴ , ³⁵ , ³⁶ In this study, OFW_IC was found to have the greatest effect on PRF_IC. In this way, it would be effective to identify the factors to increase PRF_IC in the development of infection control protocols and develop protocols in the direction of strengthening them.

This study was conducted by 263 dental hygienists in Korea, using convenience sampling. In particular, since the subjects were recruited through the Internet, only those who could access the Internet were selected as study subjects. Therefore, there are limitations in representing Korean dental hygienists. In addition, this study was measured at the beginning of the COVID‐19 epidemic. In addition, it is necessary to continuously study the infection control of dental hygienists because the response system of each country is changing according to changes in the trend of coronavirus‐infected people. Questionnaires can induce prejudice by self‐administered questionnaires, and the fact that the questionnaire items are not standardized is also a limitation of the study. In conclusion, OFW_IC is more important than KNW_CO and AWR_IC in improving the PRF_IC of dental hygienists. Therefore, to improve the infection control behaviours of dental hygienists, the organizational efforts of dental institutions should be strengthened.

5. CLINICAL RELEVANCE

With the recent prolonged COVID‐19 outbreak, quarantine and infection prevention in treatment rooms have emerged as major concerns. In particular, medical personnel, including dental hygienists, are at the forefront of exposure to infections caused by bacteria and viruses in a patient's blood and saliva. Furthermore, the medium of infection varies; this includes being pierced by sharp needles or instruments and contact with droplets. Organizational efforts such as securing time and interest from the organization for infection control, preparing guidelines and rules for infection control within the organization, establishing a systematic infection control training system, developing convenient protective equipment, securing time to apply protective equipment, and providing sufficient protective equipment are required to prevent COVID‐19 transmission in dental offices.

5.1. Principal findings

Among the general participant characteristics, significant differences were confirmed according to age for all factors related to knowledge, awareness, performance, and organization. The number of dental hygienists also significantly impacted organizational factors. Multiple regression analysis revealed that organizational factors had the greatest influence on performance (β = 0.491, p < 0.001), followed by awareness (β = 0.428, p < 0.001) and knowledge (β = 0.095, p = 0.013).

5.2. Practical implications

This study found that organizational factors in hospitals had the greatest influence on the degree of performance related to the prevention of COVID‐19 transmission. Efforts are needed to increase hospital organization–related factors.

FUNDING INFORMATION

No external funding was obtained for this study.

Park H‐R, Min J‐H. Factors affecting the infection control behaviours of Korean dental hygienists in response to the coronavirus disease 2019 pandemic. Int J Dent Hygiene. 2022;00:1‐10. doi: 10.1111/idh.12654

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.