Septic Environment of Dental Clinics in Korea

Transcription

1 International Journal of Clinical Preventive Dentistry Volume 6, Number 1, March 2010 Septic Environment of Dental Clinics in Korea Sun-Ha Ahn 1, Mi-Ra Lee 2, Yu-Jeong Lee 3, Jong-Ae Chun 4 1 Department of Dental Hygiene, Andong Science College, 2 Department of Dental Hygiene, Jeonbuk Science College, 3 Department of Dental Hygiene, Yeoju Institute of Technology, 4 Department of Dental Hygiene, Taegu Science College, Korea Objective: The aim of this study is to collect bacteria from tools, equipments, and workers in dental clinics, and compare the amount of bacteria measured by the Ultrasnap TM ATP method with the amount of effort put into practice of infection prevention. The results will be provided as basic data to find the current problems of infection prevention in Korean dental clinics and search for ways that will lead to future improvements. Materials and method: Micro-organism was measured by Ultrasnap TM ATP swab for Dentist, Dental hygienist unit chair and Dental machine. The Questionnaire was delivered to all subjected dental clinics. Results: Personal trial for anti-septic was revealed as, aseptic in and gloves but not well managed in Mask and gown. However, measured by Ultrasnap TM there were few micro-organism in dentist's Mask but some micro-organism were found in dentist's Hands. There is a strong relationship between the trial of staff's antiseptic management for dental instruments and RLU measurement for dental instruments. It means that, if we achieve a higher level of anti-septic for dental instruments, we can reduce the RLU level in each dental instrument, effectively. One thing special is the most relationship in Light Gun Tip. Conclusion: Light gun tip might be a standard to check the hygiene level of septic environment for a dental clinic, because of the high co-relation between the trials for anti-septic and the decreasing the RLU level, at dental clinic. Keywords: dental infection, RLU Introduction As the interest about infection prevention is recently increasing, the Ministry of Health and Welfare has established dental clinic infection prevention standards (2006) about the disinfection, sterilization, and handling of dental tools and equipments used in dental clinics. This set of standards was made to be put into practice and prevent cross infection between patients, between patients and clinic workers. However, workers in dental clinics are always exposed to a wide variety of pathogenic microbes in their dental clinics. Recently, the appearance of the lethal HIV virus has increased the level of seriousness of infection in dental clinics (1,2). Corresponding author Sun-Ha Ahn ash-lji@hanmail.net Received January 24, 2010, Revised February 3, 2010, Accepted February 20, 2010 Many kinds of viral and bacterial diseases are specified as infective diseases. Among these, there are several diseases that require the highest level of vigilance: these diseases that are recently drawing the most attention are HIV (human immunodeficiency virus), HBV (hepatitis B and C virus) infections and herpes virus infections such as those by HSV (herpes simplex virus), human herpes virus-6, epstein-barr virus, and cytomegalovirus. Infection causes, routes of infection, diagnostic or treatment methods, and the complex interrelationship between these diseases are being studied and reported (3-6). As shown in many epidemiological studies about the causes, infection routes, and genetic characteristics or similarities of related viruses, the possibility of HIV infection is considered to be exceedingly low. When HIV infection routes are understood, and effective and realistic countermeasures are established and practiced, that probability of infection will be further reduced to a much lower level (7-9). 15

2 International Journal of Clinical Preventive Dentistry For prevention of nosocomial cross infection in dental clinics, infection preventive measures such as sterilization and disinfection are the most basic components of medical practice. In order to prevent infection in dental settings, the CDC (Center for Disease Control) consolidated previous recommendations and added new ones for infection control in dental settings in Recommendations are provided regarding 1) educating and protecting dental health-care personnel; 2) preventing transmission of bloodborne pathogens; 3) hand hygiene; 4) personal protective equipment; 5) contact dermatitis and latex hypersensitivity; 6) sterilization and disinfection of patient-care items; 7) environmental infection control; 8) dental unit waterlines, biofilm, and water quality; and 9) special considerations (e.g., dental handpieces and other devices, radiology, parenteral medications, oral surgical procedures, and dental laboratories). These recommendations were developed in collaboration with and after review by authorities on infection control from CDC and other public agencies, academia, and private and professional organizations (10). With the report of AIDS-related infective diseases as a turning point, the interests of health care professionals and the general public about infective diseases were higher in the past 20 years than in any other age. Epidemiological studies on causes and infection routes of these diseases are underway, and methods to diagnose, prevent, and treat these diseases are being developed. Infective diseases can be transmitted horizontally or vertically between the patients, practitioners, coworkers, and their families. Factors such as the pathogen's toxicity, number, amount, host susceptibility, and others affect whether a person is infected or not (11). As above, cross infection risks through numerous routes are present in dental clinics due to various forms of patient contact and characteristics of clinical practice. Table 1. Region of dental clinic Region N % Knowing and controlling such risks has become an essential part of measures to protect dental clinic workers from occupational hazards and to prevent the transmission of infective diseases via dental clinical care. Workers in dental clinics should prevent dental clinic infections between dental clinic workers and patients by having knowledge about what situations may cause infection, and based on such knowledge, keeping to the ways that can prevent exposure to contaminated liquids, aerosol, blood, and saliva (12). So this study measured the amount of bacteria from tools, equipment, and workers in dental clinics. The amount of effort put into infection prevention was also found out. A comparison was made between these two, and the results may be used as the basic data for search of current problems in practice of infection prevention in Korean dental clinics and establishment of ways for future improvements. Subject and Methods 1. Subject dental clinics which were agreed and joined voluntary were selected for this study (Table 1). 2. Methods Micro-organism was measured by Ultrasnap TM ATP swab for Dentist, Dental hygienist unit chair and Dental machine. The Questionnaire was delivered to all subjected dental clinics. 1) Ultrasnap TM ATP swab. The method for Hygiena's Ultrasanp TM is activate the ATP of micro-organism by dropping the Rushterin solution on to the used swab, within 15 seconds, the result appears in RLU (relative light unit) (Figure 1). Total Seoul Rural ) The Questionnaire The Questionnaire was delivered to examine the anti-septic trials by each dental clinic, at such point as dentist's hands and Figure 1. Ultrasnap TM ATP swab. 16 Vol. 6, No. 1, March 2010

3 Sun-Ha Ahn, et al:septic Environment of Dental Clinics in Korea Some materials or some instruments, the degree for steps of anti-septic trials ranging from score 1 to 5 (Table 2). 3) Data analysis For analysis of the difference between the amount of effort put into practice of infection prevention and the degree of clinical environment hygiene, independent samples t-test was used for items that follow standard distribution, and Mann-Whitney U test was used for items that do not follow standard distribution. Spearman correlation coefficient was used for analysis of the correlation between the amount of practice effort and hygiene degree. Frequency and percentages were calculated to study the amount of practice efforts. Results 1. Personal trial for anti-septic and the measurement of RLU Personal trial for anti-septic was revealed as, aseptic in and gloves but not well managed in Mask and gown. However, Table 2. The Questionnaire for self recognition and trials about the antiseptics at dental clinics Exam. target /score hands mask gown Dental hygienist hands Apron Unit chair headrest Unit chair bracket High speed hand piece 3-way syringe Ultra sonic scaler Suction tip Light gun tip measured by Ultrasnap TM there were few micro-organism in dentist's Mask but some micro-organism were found in dentist's Hands (Table 3). 2. Trial for anti-septic in basic dental unit and the measurement of RLU Dental staffs do not think so much of the trial for anti-septic management on dental unit chair or apron as the highest level of RLU was found the cuspidor in unit chair (Table 4). 3. Trial for anti-septic management in dental instruments and the measurement of RLU Even the dental staffs did not think of managing dental instrument such as the 3 way syringe, Scaler, and Suction Tip, But lots of micro-organisms were found in the 3-way syringe and light gun tip (Table 5). 4. Spearman's co-relation co-efficient between the dental personl's management and the measurement of RLU As seen in Table 6, glove ability was significantly correlated to Gown Changing and Dental hygienist Hands washing and others with the greatest significance found with Glove Changing (p<0.05). The staff's trial for anti-septic management and RLU dentist's glove was revealed a high relation. The more trial for anti-septic management, the less in RLU in dentist's glove (Table 6). Table 4. Trial for anti-septic in basic dental unit and the measurement of RLU Disposable apron Recycling apron Unit chair headrest Unit chair bracket N 43 7 Trial for anti-septic (5 point) 3.49± ± ± ± ±1.25 Micro-organism (RLU) 74.43± ± ± ± ± Table 3. Personal trial for anti-septic and the measurement of RLU hands glove mask gown Dental hygienist hands Dental hygienist glove N 47 Trial for anti-septic (5 point) 4.18± ± ± ± ± ±1.43 Micro-organism (RLU) ± ± ± ± ± The degree of practice was calculated in Likert scale of score 1-5. Table 5. Trial for anti-septic management in dental instruments and the measurement of RLU High speed hand-piece 3-way syringe tip Ultra sonic scaler Suction tip Light gun tip N Trial for anti-septic (5 point) (p) 2.92±1.56 a 1.68±0.84 b 1.58±0.54 b 1.58±0. b 3.38±1.32 c ANOVA: the same letter means no difference statistically. Micro-organism (RLU) (p) ± a ± b ± c ± d ± e IJCPD 17

4 International Journal of Clinical Preventive Dentistry As seen in Table 7, 3-way syringe tip ability was significantly correlated to Hands Washing and Dental hygienist Hands washing. ability was significantly correlated to ability was significantly correlated to (p<0.05). There was not so much correlation between the trial for staff's anti septic management and RLU measurement, in these items (Table 7). As seen in Table 8, Unit chair bracket cleansing ability was significantly correlated to Dental hygienist Hands. and Light gun tip cleansing ability was significantly correlated to Hands (p<0.05). There is little correlation between the trial of anti septic management for dental instrument and the RLU measurement of dental personal's body (Table 8). As seen in Table 9, High speed hand-piece cleansing & Changing ability was significantly correlated to Unit chair Table 6. Spearman's co-relation co-efficient between the dental personl's management and the measurement of RLU I Measure RLU Staffs management hands glove mask gown Dental hygienist hands Disposable apron hands washing glove changing mask changing gown changing Dental hygienist hands washing Disposable apron changing ** * 0.336* 0.415* * * *p<0.05, **p<0.01. Table 7. Spearman's co-relation co-efficient between the dental personl's management and the measurement of RLU II Measure RLU Staffs management Unit chair headrest Unit chair bracket High speed hand-piece 3-way syringe tip Ultra sonic scaler Suction tip Light gun tip hands washing glove changing mask changing gown changing Dental hygienist hands washing Disposable apron changing * * * *p<0.05. Table 8. Spearman's co-relation co-efficient between the dental personl's management and the measurement of RLU III Measure RLU Staffs management hands glove mask gown Dental hygienist hands Disposable apron Unit chair headrest cleansing Unit chair bracket cleansing High speed hand-piece cleansing & changing 3-way syringe tip cleansing & changing Ultra sonic scaler cleansing & changing Suction tip cleansing & changing Light gun tip cleansing cleansing * * * *p< Vol. 6, No. 1, March 2010

5 Sun-Ha Ahn, et al:septic Environment of Dental Clinics in Korea bracket and High speed hand-piece and 3-way syringe tip and others with the greatest significance found with Light gun tip. 3-way syringe tip cleansing & Changing ability was significantly correlated to Unit chair bracket. Ultra Sonic Scaler cleansing & Changing ability was significantly correlated to High speed hand-piece and 3-way syringe tip and others with the greatest significance found with Ultra Sonic Scaler. Light gun tip cleansing ability was significantly correlated to Unit chair headrest and Unit chair bracket and High speed hand-piece and 3-way syringe tip and Suction tip and (p<0.01). cleansing ability was significantly correlated Unit chair bracket. There is a strong relationship between the trial of staff's antiseptic management for dental instruments and RLU measurement for dental instruments. It means that, if we achieve a higher level of anti-septic for dental instruments, We can reduced the RLU level in each dental instruments, effectively. One thing special is the most relationship in Light Gun Tip (Table 9). 42% of dentists were found to clean their hands between every patient and to use disinfectants for hand cleaning. The rate of glove changes for every patient was found to be 60%, indicating a relatively good level. The most common number of dentists' mask change was found to be 2-3 per day, as 48% of dentists changed masks 2-3times a day. The most common frequency of gown change and laundry by dentists was found to be once every 2-3 days, at 52%. % of assistants were found to be washing their hands at each patient and using disinfectants. Disposable aprons were most commonly used, and 2-3 of those Table 9. Spearman's co-relation co-efficient between the dental personl's management and the measurement of RLU IV Measure RLU Staffs management Unit chair headrest Unit chair bracket High speed hand-piece 3-way syringe tip Ultra sonic scaler Suction tip Light gun tip Unit chair headrest cleansing Unit chair bracket cleansing 0.1 High speed hand-piece cleansing & changing way syringe tip cleansing & changing Ultra sonic scaler cleansing & changing Suction tip cleansing & changing Light gun tip cleansing 0.361** cleansing *p<0.05, **p< * 0.282* ** 0.356* * * ** * * ** ** * ** ** ** Table 10. Trials about the antiseptics at dental clinics Exam. target /score Total N (%) N (%) N (%) N (%) N (%) N (%) hands glove mask gown Dental hygienist hands Dental hygienist glove Recycling apron Disposable apron Unit chair headrest Unit chair bracket High speed hand piece 3-way syringe tip Ultra sonic scaler Suction tip Light gun tip 20 (40) 30 (60) 4 (8) 18 (36) 15 (30) 13 (30) 3 (6) 16 (32) 3 (6) 6 (12) 21 (42) 10 (20) 5 (10) 6 (12) 25 () 8 (16) 6 (14) 4 (8) 6 (12) 5 (10) 28 (56) 7 (14) 1 (2) 24 (48) 26 (52) 7 (14) 6 (86) 16 (37) 4 (8) 1 (2) 16 (32) 13 (26) 5 (10) 9 (18) 15 (30) 18 (36) 22 (44) 1 (14) 5 (12) 22 (44) 26 (52) 27 (54) 29 (58) 7 (14) 4 (8) 1 (2) 3 (6) 3 (7) 39 (78) 8 (16) 22 (44) 22 (44) 21 (42) 18 (36) 26 (52) 10 (20) (100) (100) (100) (100) (100) (100) 7 (100) 43 (100) (100) (100) (100) (100) (100) (100) (100) (100) IJCPD 19

6 International Journal of Clinical Preventive Dentistry aprons were being mostly used per day, at 37%. Unit Chair Headrests were cleaned once a day and their vinyl covers were exchanged once a day in 39% of cases, indicating a low exchange profile. Level of effort with Unit Chair Bracket was low, as their surfaces were disinfected with alcohol at each patient and 1~2 of them were used per day in 44%. Exchange and cleaning of High speed Hand Piece connecting parts was surface alcohol disinfection at each patient and 1-2 used per day in 52%, indicating a low level of effort. Exchange and cleaning of 3-Way Syringe Tip was surface alcohol disinfection for each patient and 1-2 used per day, indicating a low level of effort. Effort level was also low in Ultra Sonic Scaler Tip connecting parts, as they were surface-disinfected with alcohol at each patient in 58% of cases. Effort level was also low in Suction Tip connecting parts, as they were surface-disinfected with alcohol once a day in 36% of cases. Effort level was the lowest in Light Gun Tips, as they were surface-disinfected with alcohol once a day in 52% of cases. was water-cleaned, sprayed with disinfectants, and their filter changed in 56% of cases: showing a relatively good level of maintenance (Table 10). Discussion The demand for medical services is ever increasing with improvements in general living standards, increase average age, changes in disease features, and development of diagnostic methods. However, a dental clinic is a place crowded with people who are more susceptible to diseases than others, and is a special environment in which contact infection and cross infection as well as environmental contamination can easily occur because there are many sources of pathogens such as the widely various kinds of microbes in patient blood and saliva, diagnostic tools, and other equipments. The level of medical service quality in Korea was dramatically increased recently with introduction of the newest drugs and medical equipments. However, some fields still are falling behind in their basic conditions and basic measures are being neglected in these fields. Unfortunately, nosocomial infection is still one of these fields (13). Therefore, dental healthcare workers should be aware of which circumstances may induce infection, and based on this knowledge, they should always use methods that can prevent exposure to contaminated liquids, aerosol, blood, and saliva. This will prevent infection in dental clinics between dental healthcare workers and dental patients. Although previous studies examined the effort degree and level of recognition about infection management in dental clinics, this study collected bacteria from tools, equipments, and workers in dental clinics, and compared the amount of bacteria measured with the amount of effort put into practice of infection prevention. Study subjects were dental clinics randomly selected from Seoul region [20], Kyunggi region [6], Chungcheong-do [6], Gyeongsang-do [6], and Gangwon-do [6] (Table 3). The amount of bacteria on dentists' hands was found to be RLU, and the effort degree score was It was found that dentists washed their hands well between each patient (40%). Also, the glove wearing rate in dental clinics was 98%. This was higher than the result in the study by Cho (14) that stated 18.4% of dental clinics always wear gloves. This showed that glove wearing in dental clinics was being practiced well. The amount of bacteria in assistants' hands was found to be RLU, and the effort degree score was Hand washing between each patient was being practiced (36%). A difference of RLU was seen in the amount of bacteria between dentists' hands and assistants' hands. We think this is because dentists wash their hands less often because they wear gloves (Table 3, 10). The hand is the most important origin and mean of infective disease transmission. Although hand washing is often neglected because of its mundane character, it is an important method of personal hygiene and one of the foremost infection control methods in dental clinicians. The CDC is trying to reduce cross infection risks with Guideline for Hand Hygiene in Health-Care Settings, including directions such as "Perform hand hygiene with either a nonantimicrobial or antimicrobial soap and water when hands are visibly dirty or contaminated with blood or other potentially infectious material. If hands are not visibly soiled, an alcohol-based hand rub can also be used. Follow the manufacturer's instructions" (1). Korea also needs to effectively distribute a hand hygiene guideline for a thorough infection control, so that potential pathogens in out hands will be reduced and cross infection risks between patients and dental clinic workers will also be reduced. The amount of bacteria on dentists' gloves was found to be 7.32RLU, and the effort degree score was Glove change between each patient was being well practiced (60%). The effort degree score of assistant glove wearing was found to be 3.20 (Table 3), and they were found to wear gloves on only important surgeries (44%) (Table 10). Therefore, the importance of assistants' glove wearing for infection control must be recognized. The principle should be to change gloves between each patient, and the hands should be washed in order to reduce microbe infections. One should not wash gloves for reuse purposes. It is recommended that new gloves be used immediately when gloves are torn in the clinic, because of microbe exposure risks (15,16). For a more efficient control of infection, we concluded that gloves need to be changed between each patient, and that hand washing should be done before and after wearing gloves. The amount of bacteria was found to be RLU, and Vol. 6, No. 1, March 2010

7 Sun-Ha Ahn, et al:septic Environment of Dental Clinics in Korea masks were found to be used per day on average with an effort degree of score The use of a single mask per patient was found to be 8%, lower than 11.4% in the study by Yoon (17). So we could see that this was not being practiced well (Table 3, 10). Masks protect clinic workers from patients' intraoral microbes and from equipments contaminated by patient bodily fluids. They also protect the patients from the clinicians' microbes. Therefore, it is recommended that masks be changed between each patient for a thorough infection control. Measures should be devised for immediate mask exchange when masks get wet. The amount of bacteria on gowns was found to be RLU, and the effort degree score was Gowns were washed and changed once every 2-5 days (52%) on average (Table 3). Therefore the amount of bacteria was low compared to the degree of efforts. We thought that this is because gowns that are too contaminated get exchanged immediately. Gowns protect the clinic workers from blood, saliva, and other contaminants in the clinic. In order to protect dental clinic personnel, gowns that can cover the arms should be worn. Use of disposable gowns is also adequate. We thought that worn gowns should be collected separately in order to minimize transmission of infective microbes. Aprons were used in all cases. The amount of bacteria on disposable aprons was 74.43RLU, and the effort degree score was The amount of bacteria on cloth aprons was 68.57RLU, and the effort degree score was apron changes were done on average. There was a significant difference of 5.86RLU between the amount of bacteria on disposable aprons and cloth aprons (Table 4). Compared to the effort degree, the hygiene level was found to be managed relatively well. We think that the hygiene level was found to be high because there were cases in which the timing of bacteria measurement and apron change coincided. Also, apron change was done at each patient in 30% of cases. This was lower than 66.7% in the study by Yoon (17). In order to prevent infection in dental clinics, it is advisable to change aprons between each patient and to use disposable aprons with water-proof treatment on the back. The average amount of bacteria on Unit Chair Brackets was found to be 89.10RLU and the effort degree was quite high at score 2.38, indicating a high level of hygiene compared to the effort degree (Table 4). We thought that this is because most clinics put trays or waterproof cloth to cover the Unit Chair Bracket. The average amount of bacteria on unit chair headrests was found to be RLU, the hygiene level being better than the effort degree of score Although the hygiene level was high compared to the effort degree, we think that it is because the level of personal hygiene care has improved recently. For a thorough prevention of infection, disposable caps should be used. The average amount of bacteria on spittoons was found to be RLU and effort degree score was 2.60, showing low levels in hygiene and effort degree alike (Table 4). To prevent infection by saliva or blood in spittoons, disinfection should be done at each patient in order to prevent infection. The average amount of bacteria on high speed hand-piece connecting parts was found to be RLU and effort degree score was 2.92, indicating that effort degree and hygiene levels were both relatively well maintained (Table 5). Viruses are present mostly in the inside of hand-pieces rather than connection parts. Therefore it is recommended that the hand-piece be run idling at least 20 seconds before and 30 seconds after treatment, so that the viruses inside get evacuated (18). The average amount of bacteria on 3-way syringe tips was found to be RLU and effort degree score was 1.68, showing low levels in both effort degree and hygiene levels. Only 2 dental clinics changed 3-way syringe tips between each patient, and the remaining 48 clinics only performed surface disinfection. Since the hygiene level of 3-way syringe tips is very poor, it is recommended that sterilized and disinfected 3-way syringe tips be used for each patient. It is also recommended that liquid chemical sterilants or ethylene oxide be used for sterilization for a greater control and countermeasuring (18-21). The average amount of bacteria on Ultra Sonic Scaler connecting parts was found to be RLU and effort degree score was 1.58, showing low levels in both effort degree and hygiene levels. It was seen that a thorough maintenance is needed for the connecting part as well as for tips. As with hand-pieces, viruses are mostly in the inside of Ultra Sonic Scalers, so it was recommended that they be run idling at least 20 seconds before and 30 seconds after treatment, so that the viruses inside get evacuated (18). The average amount of bacteria on suction tip connecting parts was found to be RLU and effort degree score was 1.58, showing low levels of hygiene compared to effort degree (Table 5). We thought that the hygiene level was found to be low because suction tips are exchanged between each patient. Rather than the connecting part, risk of cross infection is higher when suction is done directly though the suction tip and saliva or blood is flown back into the patient's mouth due to low suction pressure or gravity. It is recommended that a regular maintenance and repair is done through monitoring of Unit Chair pressure control device (22,23). The average amount of bacteria on Light gun tips was found to be RLU and effort degree score was 3.38, showing low levels of hygiene compared to effort degree (Table 5). We think that surface disinfection is not adequate for bacteria reduction because it is done with alcohol. We think that it is advisable IJCPD 21

8 International Journal of Clinical Preventive Dentistry to use disposable caps or wraps be used between each patient in order to block infection. As infection prevention effort degree and dental clinic environment hygiene degree showed a negative correlation in most items, we could see that hygiene degree is improved with decreasing amount of bacteria when infection prevention efforts are well performed. For dentists' gloves that come in direct touch with the contents in a patient's mouth, the number of glove changes had a negative correlation with the amount of bacteria. So it could be seen that the more often a dentist changes his gloves, the lower the amount of bacteria., and a higher hygiene degree. The staff's trial for anti-septic management and RLU dentist's glove was revealed a high relation. The more trial for anti-septic management, the less in RLU in dentist's glove. There was not so much correlation between the trial for staff's anti septic management and RLU measurement, in these items. There is little correlation between the trial of anti septic management for dental instrument and the RLU measurement of dental personal's body. There is a strong relationship between the trial of staff's antiseptic management for dental instruments and RLU measurement for dental instruments. It means that, if we achieve a higher level of anti-septic for dental instruments, We can reduced the RLU level in each dental instruments, effectively. One thing special is the most relationship in Light Gun Tip. With the results above, we think that cooperated participation and effort by all personnel directly and indirectly involved in clinic activities is the only way to achieve an efficient prevention of nosocomial cross infection. In order to provide a safer environment for dental clinic workers and patients alike, more aggressive infection control programs and systems should be developed and introduced, and directions on education and training are needed. Conclusion This study compared the infection prevention effort degree to the amount of bacteria from clinic workers and clinic equipments/devices, independent samples t-test was used for items that follow standard distribution, and Mann-Whitney U test was used for items that do not follow standard distribution. Spearman correlation coefficient was used for analysis of the correlation between the amount of practice effort and hygiene degree. Frequency and percentages were also calculated to study the amount of practice efforts, and the following conclusions were drawn: 1. The anti-septic management for dental person's hands or glove were well done but dentist's little bit high in RLU measurement in dentist's hands. 2. The trial for anti-septic management by staffs was a little bit poor and the existence of RLU level was high. in Unit chair and the relative instruments. So, it needed to try the aseptic control more in detail. in Korean dental society. 3. The co-relation coefficient was estimated as high between the staff's trials for anti-septic management in detail instrument and the amounts level of RLU, measured by Ultrasnap, So it was effective to control the dental instruments for anti-septic. 4. Light gun tip might be a standard to check the hygiene level of septic environment for a dental clinic, because of the high co-relation between the trials for anti-septic and the decreasing the RLU level, at dental clinic. References 1. CDC. Gudelines for Infection Control in Dental Health-Care settings. MMWR; December 19, 2003:52(RR-17). 2. CDC. Epidermiologic Notes and Reports Update: Transmission of HIV Infection during an Invasive Dental Procedure. Florida MMWR; 1991;40(2):21-27, ADA Research Institute. Department of Toxioology: Infectious hazards for both dental personnel and patient in the operatory. J Am Dent Asso 1988: Barr C, E Miller L K. Loopez MR, et al. Recovery of infections HIV-1 from whole saliva. JADA; 1992: Friedrnan RB. Infections of the neck oral Maxillaidc Surg Clin North Am Miller CH. Sterilization and disinfection. Facts about adedly disease. J Am Dent Asso 1992: Scully C, Parter SR. The level of risk of transmission of human immunodeficiency virus betweem patients and dental staff. Br Dent J 1991;170: watt R G, Croucher R. perception of HIV/AIDS as an occupational hazard a qualitative invesigation. Int Dent J 1991;41: Greenspan D, white J Gerbert B, Greenspan J. UCS form, dental handpieces sterilization. Fact Sheet: Hiv transmission in dental settings; CDC. MMWR 2003;52 (No.RR-17) Hwang Byung nam. An Anti-Cross infection Protocol in Dentistry. The Journal of Korean Dental Association 1993; 31(12): Kim GK. Infection control in dental clinics. The Journal of Korean Dental Association 1993;31(2): Cho WS, Chun JH, Kim YJ. Perceived importance and activated performance of nurses for the prevention of nosocomical infection. Inje Medical Journal 1999;20(1): Cho YJ. A Study on infection control practices among dental 22 Vol. 6, No. 1, March 2010

9 Sun-Ha Ahn, et al:septic Environment of Dental Clinics in Korea hygienists. Seoul:Korea University Graduate School of Public Health; Larson EL. APIC guideline for hand washing and hand antisepsis in health-care settings. Am J Infect Control 1995;23: Murray CA, Burke FJ, McHugh S. An assessment of the incidence of punctures in latex and non-latex dental examination gloves in routine clinical practice. Br Dent J 2001;190: Yoon MS, Hong YP, Jung YG. The investigation on infection control in dental clinics. The Chung-Ang Journal of Nursing; 1997;1(2). 18. CDC. Recommended infection-control practices for dentistry, MMWR 1993;42(No. RR-8). 19. Food and Drug Administration. Dental handpiece sterilization [Letter]. Rockville, MD: US Department of Health and Human Services, Food and Drug Administration, Parker HH 4th, Johnson RB. Effectiveness of ethylene oxide for sterilization of dental handpieces. J Dent 1995;23: Pratt LH, Smith DG, Thornton RH, Simmons JB, Depta BB, Johnson RB. The effectiveness of two sterilization methods when different precleaning techniques are employed. J Dent 1999;27: Barbeau J, ten Bokum L, Gauthier C, Prevost AP. Cross-contamination potential of saliva ejectors used in dentistry. J Hosp Infect 1998;40: Mann GL, Campbell TL, Crawford JJ. Backflow in low-volume suction lines: the impact of pressure changes. J Am Dent Assoc 1996;127: IJCPD 23