Hurlock (2002), bahwa tingkat pendidikan seseorang akan menentukan pola pikir dan wawasan,

selain itu tingkat pendidikan juga merupakan bagian dari pengalaman kerja. Semakin tinggi
pendidikan seseorang maka diharapkan stok modal manusianya (pengetahuan dan keterampilan)
akan semakin meningkat. Pendidikan memiliki peranan penting dalam menentukan kualitas
manusia. Lewat pendidikan, manusia dianggap akan memperoleh pengetahuan dan semakin tinggi
pendidikan akan semakin berkualitas.
ingkat pendidikan juga merupakan salah satu faktor yang mempengaruhi persepsi seseorang untuk
lebih menerima ide-ide dan teknologi yang baru

Hurlock B.E, 2007. Psikologi Perkembangan Suatu Pendekatan Sepanjang Rentang

Kehidupan. Penerbit Erlangga. Jakarta.
n the present study, the mean knowledge score was 51.45 3.16, (out of 63) and 65% of dentists participating in this study had a good
knowledge. Vitale et al. (12) showed that, most of the dentists in Italy had a proper knowledge about the transmission patterns of HIV,
HBV, and HCV. However, in Askarian et al. study (3), the level of knowledge about the modes of transmission of HIV was low. Also in AlSandook et al. study (10), the knowledge regarding the HIV and hepatitis B and C was low. Batool et al. (13) showed that, most of the
dentists were well-aware of the etiology and modes of transmission of HBV and HCV, but there was some lack of knowledge in this
matter. Based on their study, 7% of the dentists were unaware of HBV vaccine and 25% of them noted that vaccine for hepatitis C is
available. In the present study, 8% of the dentists noted about the existence of hepatitis C vaccine; although this ratio is lower than
Batool et al. report (13); nevertheless, it brings up a concern because almost all the dentists should be aware of existence of the HBV
and HCV vaccine. In the present study, there were no statistically significant differences between the level of the dentists knowledge and
their demographic information, which is consistent with the Crossley study (14). In Askarian et al. study (3), level of the knowledge
about the modes of HIV transmission was significantly associated with the education level. Also in Al-Sandook et al. study (10), the level
of the dentists knowledge on the infection of HIV, HBV, and HCV had a significant correlation with education and gender.

10. Al-Sandook T, Al-Naimi R, Younis M. An Investigation of Dentists Knowledge, Attitude and Practices towards
HIV+ and Patients with other Blood Borne Viruses in Mosul City. Al-Rafidain Den J. 2013;10(2)

In the present study, the average of the dentists practice scores was 64.41 4.49, indicating that the optimal performance of 95% the
dentists. One of the reasons which caused the dentists performed their duty by considering the principles of infection control, was their
training in recent years. For example, using the gloves, gown and face masks by the dentists was 99%, 98% and 93%, respectively. With
regard to some studies which have been carried out in Iran and Mexico (3, 16), the majority of dentists used gloves and face masks in
treating with the patients which agrees with our present results. In contrast with this study, Al-Sandook et al. ( 10) reported that only
2.38% of the dentists used three main protection tools (gloves, glasses, face masks), which is very lower than the reports from other
developing countries. Although hand washing is considered as one of the basic principles of the infection control, compliance by some
dentists is lower than ideal (3).
In the present study, 63% of the dentists reported that they washed their hands before treatment and 85% of them after treatment. In a
study in Italy and United States (18, 19), this ratio was reported 79% and 59%, respectively. Since the face mask is considered a source
of contamination, it must be changed during the work every 20 minutes of usage because it becomes saturated with many
microorganisms. Therefore, the dentists who use a face mask all day are at the greater risk of cross-infection than the dentists who do
not use (10). In this study, almost half of the dentists reported that they always change their face masks between patients. As
mentioned above, wearing gloves and face masks are more important than other infection control measures because these are more
visible and acceptable by the patients. In this study, there was no significant correlation between dentists practice and demographic
information. However, in the study of Savabi et al. (17), dentists practice was better in private and government clinics than dental
offices. Askarian et al. (3), showed that dentists with more experience had better performance. Because of the poor attitude of the
dentists towards the patients with HIV, HBV and HCV infections, educational programs are recommended to eliminate the fear and
concern towards hepatitis and HIV infections.

1. Ryalat ST, Sawair FA, Shayyab MH, Amin WM. The knowledge and attitude about HIV/AIDS among Jordanian
dental students: (Clinical versus pre clinical students) at the University of Jordan. BMC Res Notes. 2011;4:191. [DOI]
[PubMed]

2. Askarian M, Mirzaei K, McLaws ML. Attitudes, beliefs, and infection control practices of Iranian dentists
associated with HIV-positive patients. Am J Infect Control. 2006;34(8):530-3.

3. Askarian M, Mirzaei K, Cookson B. Knowledge, attitudes, and practice of iranian dentists with regard to HIVrelated disease. Infect Control Hosp Epidemiol. 2007;28(1):83-7. [DOI] [PubMed]

4. Samuel S, Aderibigbe S, Salami T, Babatunde O. Health workers knowledge, attitude and behaviour towards
hepatitis B infection in Southern Nigeria. Int J Med Me Sci. 2009;1(10):418-24.

5. Kabir A, Tabatabaei SV, Khaleghi S, Agah S, Faghihi Kashani AH, Moghimi M, et al. Knowledge, attitudes and
practice of Iranian medical specialists regarding hepatitis B and C. Hepat Mon. 2010;10(3):176-82. [PubMed]

6. Brailo V, Pelivan I, Skaricic J, Vuletic M, Dulcic N, Cerjan-Letica G. Treating patients with HIV and Hepatitis B
and C infections: Croatian dental students' knowledge, attitudes, and risk perceptions. J Dent Educ. 2011;75(8):111526. [PubMed]

7. Crossley ML. A qualitative exploration of dental practitioners' knowledge, attitudes and practices towards
HIV+ and patients with other 'high risk' groups. Br Dent J. 2004;197(1):21-6. [DOI] [PubMed]

8. McCarthy GM, Koval JJ, MacDonald JK. Factors associated with refusal to treat HIV-infected patients: the
results of a national survey of dentists in Canada. Am J Public Health. 1999;89(4):541-5. [PubMed]

9. Angelillo IF, Villari P, D'Errico MM, Grasso GM, Ricciardi G, Pavia M. Dentists and AIDS: a survey of knowledge,
attitudes, and behavior in Italy. J Public Health Dent. 1994;54(3):145-52. [PubMed]

10. Al-Sandook T, Al-Naimi R, Younis M. An Investigation of Dentists Knowledge, Attitude and Practices towards
HIV+ and Patients with other Blood Borne Viruses in Mosul City. Al-Rafidain Den J. 2013;10(2)

11. Razi A, Rehman uR, Naz S, Ghafoor F, Ullah Khan MA. Knowledge attitude and practices of university
students regarding hepatitis B and C. J Agricu Biol Sci. 2006;5(4):38-43.

12. Vitale F, Di Benedetto MA, Casuccio A, Firenze A, Calandra G, Ballaro F, et al. [The influence of professional
degree on the knowledge of HIV, HBV and HCV infections in dentistry practice]. Ann Ig. 2005;17(3):185-96. [PubMed]

13. Batool A, Misbah Ul Islam Khan K, Bano KA, Aasim M. Knowledge, Attitude and Practices of Dentists about
Hepatitis B and C Infection in Lahore. Pak J Med Res. 2012;51(3):93.

14. Crossley ML. An investigation of dentists' knowledge, attitudes and practices towards HIV+ and patients with
other blood-borne viruses in South Cheshire, UK. Br Dent J. 2004;196(12):749-54. quiz 780 [DOI] [PubMed]

15. Gachigo JN, Naidoo S. HIV/AIDS: the knowledge, attitudes and behaviour of dentists in Nairobi,
Kenya. SADJ.2001;56(12):587-91. [PubMed]

16. Maupome G, Acosta-Gio E, Borges-Yanez SA, Diez-de-Bonilla FJ. Survey on attitudes toward HIV-infected
individuals and infection control practices among dentists in Mexico City. Am J Infect Control. 2000;28(1):21-4.
[PubMed]

17. Savabi O, Hasankhani A, Mohamadikhah Z. The Attitude and Practice of Dentists in Relation with HIV and
HBV Infected Patients in Isfahan Province. Iran J Med Educ. 2011;10(5):868-76.

18. Gershon RR, Karkashian C, Vlahov D, Grimes M, Spannhake E. Correlates of infection control practices in
dentistry. Am J Infect Control. 1998;26(1):29-34. [PubMed]

19. McCarthy GM, Koval JJ, MacDonald JK. Compliance with recommended infection control procedures among
Canadian dentists: results of a national survey. Am J Infect Control. 1999;27(5):377-84. [PubMed]

1. Knowledge, Attitude and Practice regarding Hepatitis B infection and precaution

among dental health care providers in Baghdad city. Al nahrain university. Rafid
Shanan Abed. 2013
-

Mayoritas (96.2%) memiliki pengetahuan ssedang hingga tinggi (>50 skor pengetahuan) tentang
infeksi HBV dan pencegahan dalam praktik kedokteran gigi, masih ada miskonsepsi pada jawaban
responden. Perawat memiliki pengetahuan yang lebih rendah dan tindakan pencegahan yang lebih
buruk daripada dokter gigi. 91.2 memiliki perilaku yang baik tentang hepatitis B. Masih ada yang
belum mendapat vaksin dan tidak melakukan screening setelah terkena luka tusukan jarum bekas
pasien secara tidak sengaja. Hanya 46% yang telah menerima vaksin penuh. (Abed,2013)

Pakistan Oral & Dental Journal Vol 35, No. 1 (March 2015)

2. KNOWLEDGE, ATTITUDE AND PRACTICE OF HEPATITIS B

AMONG DENTAL AND MEDICAL STUDENTS OF PRIVATE
MEDICAL UNIVERSITY, KARACHI
1

ASGHAR ALI SHIGRI 2MOHAMMAD ALI LEGHARI 3SAMREEN MAZHAR 4MAHWISH

Dental graduates memiliki skor lebih tinggi dalam KAP dibandingkan mahasiswa
dengan hasil signifikan dg p value 0.0092

National survey on prevalence of hepatitis b revealed the occurrence of 2.5% HB Ag among

47043 people living in Pakistan.13 In our survey 85% students believed that hepatitis B is
prevalent disease in Pakistan. Hepatitis b frequency are mostly found higher in developing
countries14 in contrast the level are lowest in numbers in developed countries.15

The results of the current study about the comparison of hepatitis B and HIV virulence
showed deficiency in knowledge, 58% had answer positively and the results were
dissimilar from the survey done in male dental students at dental college in Kingdom of
Saudi Arabia17 where the frequency was 83%.
For over the two decades ago vaccination program was initiated to overcome the
prevalence and burden of hepatitis patients in population and since then it is available all
over the country.18,19 The level of knowledge of hepatitis b vaccine program was 71.35%
and the results were similar to research done among the medical students of Karachi. 20
Ghanaei et al found that frequency of students who answered in positive for the questions
of spread of Hepatitis B via blood contact, sexual transmission and through blood
transmission was 86.3%, 65.45% and 82.1% respectively. 16 In contrast, knowledge of
transmission of hepatitis b by means of sexual contact, blood transfusion and secretion
were 93% in this study.

3. Braz J Oral Sci.

October | December 2011 - Volume 10, Number 4
Knowledge, attitude and practice on hepatitis B
prevention among dental professionals in India
R. Sudhakara Reddy1, L. A. Swapna2, T. Ramesh3, K. Pradeep4
-

Mean score for knowledge of MDS staff was 56.42 8.11; for protective measures was
88.04 22.03; for attitude to prevent transmission was 54.93 4.58 (Figure
1).Hygienists showed minimum knowledge with mean score of 5.71 7.87, the
protective and preventive measures followed were with a mean score of 66.7 0.00 &
41.27 5.42 respectively. None of them scored positive answer to the question -Have
you attended any workshop regardinghepatitis transmission (or) prevention.
Frequency of correct answer was higher for the question Do you believe that hepatitis
can transmit through saliva from patients?, showing 81.3% positive response. Almost
of 77.2% participants got the vaccination against hepatitis B. Only 14.4% thoroughly
evaluated the patient to rule out any signs related to hepatitis. Nearly 65.9% of
respondents were willing to perform any treatment procedures on patients known

positive with hepatitis. As much as 53% of the dental health care professionals
advised routinely for their patients to undergo blood investigations to rule out
hepatitis before
doing any invasive procedures.
Under the category of questions relating to protective
and preventive measures to avert transmission of hepatitis
the results showed that about 89.8% of the participants
responded that they change gloves for every patient. Only
15% of the individuals used protective eye wear for all
procedures on patients or while assisting. 22.2% of the
participants advise pre-procedural oral rinses (betadine/
chlorhexidine etc) to the patients. Only 1.1% participants
used disposable kits for patients suspected or proved positive
for hepatitis. And merely 2.2% of the participants used rubber
dam where required to prevent atmospheric viral contamination.
Though the knowledge of private dental practitioners
Fig. 1. knowledge, Protective and Preventive measures followed by DHPs

was fair, their protective and preventive measures to avoid

hepatitis transmission were not up to the mark, probably
because of a small set up of clinics and other financial
constraints. There was an increase in knowledge of dental
health care professionals as their years of experience in dental
clinic was increased from 1-5 years to 6-11 years (Figure 2).
There was not much change in the knowledge, protective
and preventive measures between dental health care
professionals who had 6-11 and 11-15 years of experience.

Discussion
Though there is substantial literature regarding the
knowledge and attitude of dentists towards other infectious
diseases, no study assessed the different categories of dental
health care professionals and their attitude towards hepatitis
B infection and very few studies have been conducted in
India in this regard. This study showed that B.D.S staff had a
mean knowledge of 52.35, which was close to the knowledge
showed by M.D.S staff (mean value of 56.42). However, the
protective and preventive measures adopted by B.D.S staff
(mean values of 48.02 and 47.71, respectively) was lower
than the protective and preventive measures adopted by M.D.S
staff (mean values of 88.04 and 54.93, respectively). Though
the private practitioners showed a score of 49.77 as the mean
value in knowledge, their measures followed to protect and
prevent the transmission of Hepatitis was only 35.24 and
28.29 respectively. When the results were compared between
the female and the male dental health care professionals, it
was found that the female subjects were appropriately
following the protective and preventive measures to avert
the transmission of hepatitis. Several other similar studies
have also been conducted to investigate the infection control
knowledge, attitude and practice of dental health care
professionals. Previous study among Nigerian investigators
found that nearly 97.5% dentists routinely used gloves and
70.6% used face masks and 61.3% dentists reported to use
protective gowns and eye wear during the procedures10. In
our study, nearly up to 89.8% of the respondents changed
their gloves for every patient and 81.1% of participants used
protective clothing, but only 16.5% of participants used
protective eye wear during procedures. Previously, the
wearing of gloves before examining patients was hardly
practiced regularly as an essential part of cross infection
control. However, 25% of dental health care professionals in
this study routinely wore gloves before patient examination.

Whether routine wearing of gloves would prevent cross

infection of blood borne viruses has not been resolutely
established nevertheless, it would protect minor cuts, and
abrasions from contamination and so reduce the transmission
of HBV from carrier to practitioners10-13. Only 20.2%
practitioners in this study frequently scrubbed their hands
with disinfectant before and after gloving, there is evidence
of a reduction in skin flora when hands are scrubbed with
soap and this should be encouraged in practice14-16.
Viral hepatitis caused by HBV is a disease that has no
oral manifestation but is of great concern to the dental
profession due to ease of transmission of the virus from
patients with the condition. It may be difficult to identify
those capable of transmitting HBV for several reasons. Many
patients infected with hepatitis B virus may be unaware of
their carrier status or they may be asymptomatic. Others may
not want to disclose their infectious status10-12.
In a previous study, only 32% of the dentists took
vaccination against hepatitis, where as 77.2% of the dental
health care professionals in our study were vaccinated against
hepatitis10. Similar study conducted to assess the hepatitis B
awareness and attitudes among dental health care workers in
Riyadh Saudi Arabia, results showed that nearly 43% did
not have their antibody titre measured after completion of
the full course to assess the efficacy of the vaccine. On the
contrary, 87.9% of the dental health care professionals in
our study did not check their antibody titre measured after
completion of course of vaccination4. These findings are
somewhat similar to those of several other Western-based
studies in which post-vaccination testing had not been carried
out in between 38-54% of dental health care professionals17-21.
Saheeb et al in a similar study found that nearly 19.5% of
the dental health care professionals reused syringes, which
was less when compared to our study where nearly 56.5%
dental professionals reused syringes10.
Blood is very often found in the aerosols produced by
dental equipment like an ultrasonic scaler or other highspeed
equipment Ultrasonic scaling was obviously associated
with increased air contamination levels confirming the results
reported by several other studies showing that this procedure
is the main executor of airborne contaminants in dentistry.
Previous research demonstrated that rinsing with an antiseptic
mouthwash produced a 94.1% reduction in airborne
contaminants compared to the non-rinsed controls. Hence,
high volume suction evacuators and preprocedural oral rinses
would prevent the air contamination22-25.
A survey was conducted to assess the extent of awareness
regarding transmission of Hepatitis among the DHPs in
Bhimavaram, Andhra Pradesh, India. This study also threw
light on the knowledge, attitude and behavior of dental health
care professionals regarding the protective and preventive
measures to avert the transmission of hepatitis B, and also
made them seriously think about the risks that their patients
and they themselves face during the treatment procedures.
As we approached the participants to collect the filled
questionnaire, the respondents were curious to know the
correct protocol to follow during the dental treatment
procedures to prevent the transmission of hepatitis infection
and the information about the vaccination against hepatitis
and its importance. One of the limitations of this study was
that we could not supervise the respondents practice, so we
had to rely on their subjective self-assessment. Therefore,

the responses might not have accurately reflected the true

levels of knowledge, attitude and behavior, and thus, the
reported level of practice might be lower than the real level.
It is important for any hospital or a dental clinic to set up
CDC protocol to prevent the spread of infectious and
transmissible diseases. For this purpose, it is important that
the dental health care professionals be aware of the risks and
the seriousness of infections. Educational programs on
infection control isolation precautions for all the health care
workers, especially the dental health care professionals, and
the facilities to allow compliance with the infection policies
are necessary to lessen the infection hazards among dental
health care professionals and their patients.

healthline

ISSN 2229-337X

Volume 2 Issue 2 July-

December 2011
Page

Original Article

Prevention of Hepatitis B; knowledge and practices

among Medical students
Anjali Singh1, Shikha Jain1

Results :
A total of 150 students belonging to II year, III/I
and III/II were approached for the study. 50
students each were taken from each semester.
The mean age of respondents was 21.02 1.59
years.
Knowledge regarding Epidemiology of
Hepatitis B Virus
86.7 % of the medical students had correct
knowledge about Hepatitis B virus though only
66 % of II year students knew about the virus as
compared to III year (96%) students. The
difference between the knowledge of II and III
year medical students was found to be
statistically significant at 95% confidence
interval (Z=4.28). 64 % of medical students had
the knowledge regarding antigens of hepatitis B
virus however very few students of II year had
the knowledge as compared to III year students.
Regarding Antigens appearing first in blood and
antigens determining infectivity, the overall
knowledge was fair but it was very low among
II year students. The knowledge about mode of
transmission was less in II year students as
compared to III year students.(Figure 1)

Figure 1: Knowledge regarding

Epidemiology of Hepatitis B Virus:
Knowledge regarding transmission of Hepatitis B
Majority of the medical students had correct
knowledge regarding mode of transmission
however the knowledge was found to be less
among II year students as compared to III years
students .The knowledge about transmission of
Hepatitis B through sexual route (74%) by used
needles and syringes (83%) by blood transfusion
(87%)and through vertical transmission (78% )
was fairly high among overall medical students
however only (20-40% ) of the II year medical
students had correct knowledge regarding the
same.(Figure 2)
Figure 2: Knowledge regarding transmission
of Hepatitis B

Knowledge regarding prevention of Hepatitis B

The study reveals that majority of the III year
students knew about the vaccine type ,
vaccination schedule ,type of syringes ,route of
administration ,safe disposal of syringe and
needles and other preventive strategies .Very
few second year students had correct knowledge
regarding the same.(Figure 3)
Knowledge regarding Post Exposure
Prophylaxis for Hepatitis B
The students were asked about risk and post
exposure prophylaxis of Hepatitis B. Majority of
the students of III year gave correct answers of
the questions while only 20% of the II year
students had the correct knowledge regarding
PEP for hepatitis B.
Vaccination Status among medical students
84 % of the II year medical students were
completely vaccinated for hepatitis B as
compared to final year students where complete
vaccination was observed among only 50-60 %
of the students. The vaccination was found to be
less among girls as compared to boys. Though it
was statistically insignificant among III year
students but significant difference was observed
among
II year students at 95% confidence
interval. ( X2=4.50, p<0.05)(Table 1)
Reasons for not taking vaccine of Hepatitis B
29.3% of the medical students were not
vaccinated for Hepatitis B. Reasons were,
vaccination is not necessary (36%), lack of
information (28.50%) and afraid of needles

(14.3%).
Table 1: Vaccination Status among medical
students
Discussion
HBV infection is caused by DNA virus with
incubation period of 21-135 days. 5 Hepatitis B
virus (HBV) infection is an occupational risk for
physicians and surgeons especially in
developing countries where a carrier rate is
about 4%. HBV infection kills about 1.1 million
people globally every year6. However, incidence
of HBV infection could be brought down by
giving proper education regarding its
transmission and immunization of all medical
students with Hepatitis B vaccine.
The level of knowledge regarding epidemiology
was fairly good among III year medical students
as compared to II year students. There is no
formal school based health education in our
country which may be the important reason of
lower knowledge of Hepatitis B among II year
students. Similar level of knowledge was found
in the medical students of Delhi 7. However the
medical final year students are more
knowledgeable as compared to students of
Bangladesh and that of Vietnam .8
Scientific knowledge regarding HBV
transmission is essential for medical students.
They can take proper protection during their
clinical posting as HBV is 50 times easier to
transmit than HIV9. The study revealed majority
of the final year medical students and very few
students of II year had correct knowledge
regarding transmission of the disease in contrast
to first year students in Karachi who had better
knowledge regarding the transmission.10
It is common information and many students
have concluded that compared to other health
care workers, medical students were more at the
risk of exposure to risk factors of hepatitis B and
especially per-cutaneous injuries 11,12,13,14,15,16,17.
Final year students had better knowledge
regarding prevention of HBV as compared to
first year students. There is need for more
focused efforts and preventive measures to be
put in to protect the medical students from the
deadly infection. Regarding PEP only 20% of
the second year students were aware which calls
for well structured health education programs
stressing on the misconceptions prevalent
among the students.
In the present study, 63% of the students were
vaccinated against Hepatitis B. Although the

percentage of vaccinated students was high

among second year students but it is not
statistically significant (X2=4.35, df=2,p>0.05).
This was higher than the vaccination status of
42% reported among medical students of Lahore
and the vaccination status in a similar study
conducted in Bombay.18 However in the present
study, vaccination status of medical students
was lower than the vaccination rate 80%
medical student, high lighted by a similar study
conducted in Orissa, India. 19
The present study concludes that there is lack of
awareness among the medical students entering
into the profession about the hazards of
Hepatitis B, its transmission and mode of
transmission. More over, all the students were
not vaccinated against Hepatitis B, which made
them more vulnerable to the disease. Since
medical students are at increased risk of
acquiring needle stick injury, and increased
prevalence rate of Hepatitis B in India, medical
students should be routinely vaccinated upon
entry into the medical college. It is
recommended that a policy be implemented for
complete vaccination and health education of all
medical students in first year in all medical
colleges in our region. However, antibody titers
should be routinely checked among all
vaccinated because of non-response to the first
series of vaccination.

Knowledge, attitudes and practice of

dentists
concerning the occupational risks of
hepatitis B
virus in Al Jouf Province, Saudi Arabia
AH Al-Hazmi

Nigerian Journal of Clinical Practice Mar-Apr 2015 Vol 18 Issue 2

Out of the 48 questionnaires distributed; 41

(response rate: 85.4%) were collected and analyzed. The
general characteristics of dentists are shown in Table 1. The
majority of the participants were males (n = 27; 65.9%),
and the number of female dentists was only 14 (34.1%).
The male to female ratio was found to be 1.93:1; with
mean SD age were 38 11.2 years, range 27-60 years.
Dentists with 10 years of practice constituted more than
half of the sample (n = 23; 56.1%). Almost half of the
dentists surveyed had masters degree 20 (48.8%), and only

three were Saudi nationals (7.3%).

Majority of the dentists surveyed 34 (82.9%) perceived
that they are at high risk of contracting and spreading
HBV. Perception among male dentists was more than that
found among females (88.9% vs. 71.4%; P < 0.05). More
attention should be offered to the infectious, occupational
risk of HBV suggested by almost all dentists 40 (97.7%). The
vast majority of the dentists 36 (87.8%) believed that HBV
vaccine is safe and effective for all ages. Thirty-four (82.9%)
were vaccinated and reported having received three doses
of vaccine. Of the dentists, only 31 (75.6%) were aware
of their anti-HBs titers; immune due to HBV vaccination
ranked first among 24 (58.5%), followed by immune due
to natural infection among 4 (9.8%), whereas, 3 (7.3%)
dentists were susceptible.
Table 2 shows dentists correct answer rates on knowledge
about HBV distributed by their qualifications. Overall, only
60.5% of the answers were correct. As such, in each area
the mean proportion of the correct answers varied. HBV
is resistant to alcohol and some detergents was recognized
by minority of the dentists 17 (41.5%), HBV could be
infectious outside the body (e.g. in the environment)
recognized by 21 (51.2%), HBV can survive for prolonged
amount of times on unsterilized surfaces recognized by
27 (65.9%), HBV transmissible more than HIV recognized
by 29 (70.7%). On the basis of their qualifications, there
were a statistical significant correlations noted between
dentists qualifications and their correct answers regarding
HBV can survive for a prolonged amount of times on
unsterilized surfaces P < 0.05.
When inquired about what would they do if they suffer
from needlestick from patient with active HBV infection;
28 (68.3%) dentists responded that they will take HBV
vaccine with HBV immunoglobulin immediately, 3 (7.3%)
will take vaccine only, and 2 (4.9%) will take vaccine plus
lamivudine. Whereas, 8 (19.5%) dentists were not sure
about their action.
Regarding the possible modes for HBV transmission
[Table 3], all the participants 41 (100%) reported through
vertical transmission, 40 (97.6%) through needlestick
injuries or blood, 40 (97.5%) sexual intercourse, 29 (70.0%)
through saliva followed by breast milk 16 (39.0%). Whereas,
transmission by drinking from the same cup used by
an infected person was recognized by only 14 (34.1%).
Regarding hugging of, or sharing a toilet with infected
persons believed by (90.2% and 61.0%, respectively) as a
safe practices.
When asked about practical measures that might help
to prevent HBV, there was a very strong agreement
that ensuring safe injection practices (100%), followed
by active immunization (97.6%), sterilization of the
surgical instruments (95.1%), routine blood screening for
HBsAg (92.7%), wearing of disposal medical gloves (90.2%),
condom use (87.8%). Of the dentists, those with more than
10 years in practice use to sterilize their instruments more
frequent than those with <10 years in practice (95.7% vs.

83.3%; P < 0.05), (data not shown).

Table 4 shows dentists attitudes toward HBV. Almost
all the dentists 40 (97.7%) believed that more attention
should be offered to the infectious, occupational risks
of HBV. Nearly all 39 (95.1%) suggested vaccination
against HBV must be compulsory for all HCWs in Saudi
Arabia. Twenty-eight (68.3%) had a concern about
being infected with HBV. The proportion of concern
among female dentists was found more than that
among males (87.7% vs. 59.6%; P < 0.05). Having an
infected-colleague in the same workplace was accepted by
25 (61%) of the participants and 31 (75.6%) did not agree
with stigmata that has been attached with HBV-infected
patients. This study has shown that 29 (70.7%) dentists
feel confident in dealing with HBsAg-positive patients.
Confidence among males is found more than that among
female dentists (81.5% vs. 50.0%: P < 0.05; confidence
interval = 0.031, 0.040).
In the area of dentists practice toward protective barriers
during their surgical procedures. We found, 14 (34.1%)
always reported use double gloves, 25 (61%) sometimes,
and 2 (2.9%) never use double gloves. 19 (46.3%)
reported always use goggles, 15 (36.6%) sometimes, and
7 (17.1%) never use goggles. Whereas, 35 (85.4%) always
use masks, and 6 (14.6%) sometimes use masks. There
were no statistical significant differences noted between
males and female dentists regarding use of protective
barriers (P > 0.05) (data not shown).

Discussion
At the beginning of the third millennium, HBV remains
a major public health concern worldwide.[1] Fortunately,
infection with this virus is not only treatable but also
preventable.[1,3,4] Dentists play an important role with safety
from risk of blood born infectious agents like HBV.[1,4-6] They
can augment the knowledge and improve skills to reduce
the infectious, occupational risks of HBV.[1,4-6] Among all
the HCWs, dentists have the highest incidence of HBV
infection and this incidence increase with the length of
clinical practices.[1,4-6] Clearly, this study proves that dentists
practicing in our community were aware of magnitude of the
infectious, occupational risk of HBV. It was found 40 (97.6%)
suggested more attention should be offered to the infectious,
occupational risk of HBV. Majority 34 (82.9%) perceived
that they are at high risk of contracting and spreading HBV
and more than 2/3th had concern to get HBV. Our findings
are not dissimilar to a survey recently conducted in Iran,
which evaluated the knowledge, attitudes, and behavior of
physicians concerning HBV and HCV. The referred study
revealed that the concern about being infected with HBV
was 69.4 2.1 among the surveyed participants.[8]
It was encouraging to find that the vast majority of the
participants considered prevention and control remain
the main methods to address HBV. As such the most feasible
and effective means to prevent HBV, and its consequences

are by vaccination and avoidance of exposure to blood and

secretions.,[8-10] Interestingly, the vast majority of the dentists
surveyed believed that HBV vaccine is safe and effective for
people of all ages.[10,11] Worldwide, HBV vaccination coverage
among dentists is highly variable.[1] Fortunately, our study
has shown that the rate of vaccination coverage among our
dentists was 82.9% thatis equal to or more than that found
in other countries.[4-6,8-10] The finding of (85.7% females, vs.
77.8% males; P > 0.05) who have been vaccinated against
HBV is in agreement with results of a previous study carried
in Brazil to examine factors associated to the self-reporting of
HBV vaccination and immunization status among dentists.[4]
The referred study revealed that women had a 1.06-fold
greater frequency of vaccination against HBV than men. [4]
Findings in an Italian study, majority of the dentists did not
take the vaccine since 42.8% believed it as useless and 33.3%
as unsafe.[4] Fortunately, our findings do not support this data.
It was strongly recommended that, dentists should be aware
of their anti-HBs titer.[1,4-6,8] We found 3/4th of the dentists
knew their immunity status with anti-HBs. Immune due to
HBV vaccination ranked first among 25 (61%), followed
by immune due to natural infection among 4 (9.8%) of our
sample. Two dentists reported that they were susceptible to
infection with HBV. Despite 34 (82.9%) were vaccinated,
we found only 61% of the total were immune due to HBV
vaccination. Our findings could be because, first not
everybody actually responds to HBV vaccine; secondly
could be due to not all completed the three doses of HBV
vaccine.[3-6,9] Third, the level of anti-HBs titers declined
with the passage of time after vaccination.[11] For those who
are susceptible they should be protected and should receive
three doses of HBV vaccine.[3-6,11]
Knowledge of seromarkers of the highly infectious or
contagious patients is of a great value for dentists.[5,6] This
is because wounds caused by needles that are contaminated
with HBsAg and HBeAg positive blood are associated
with a 22-31% risk of developing hepatitis B and 37-62%
probability of establishing HBV infection.[5] Unfortunately,
it was found more than 1/3rd of the participants did not
recognize the seromarkers of the highly infectious or
contagious patients and only 5 (12.2%) were able to
interpret HBV seromarkers.[5,6] Attributable reasons could
be inadequate training programs about HBV.
It is well established that dental clinic is an environment
where the disease transmission occurs easily.[1,4-6,9,11] Clearly,
the important knowledge about the cross-infection control
methods. It was found only minority 16 (39%) recognized that
HBV is resistant to alcohol and some detergents, less than
half 20 (48.8%) recognized that HBV could be infectious in
the wet surfaces. Furthermore, <2/3rd recognized that HBV
can survive for 7-10 days on unsterilized surfaces. [6,12] Our
study is in agreement with those internationally that have
identified limitations in knowledge among all HCWs about
HBV and inadequate practice toward the occupational risk
of the disease.[8-11,13] This may indicate the importance of
training program (continuing medical education [CME]) in

improving the health behaviors in our dentists.

Our findings revealed that most of the responses show
adequate knowledge about modes of HBV transmission.
For specific modes of transmission (for example; saliva,
maternofetal, breast milk) there were a confusions and
misconceptions among the survey dentists.[2,3,6] This might
be due to the controversy of these issues and the lack of the
solid evidence. Of the participants, only 14 (34.1%) knew
that drinking from the same cup used by an infected person
could transmit HBV.[12] As such, it has been suggested that
blood borne infections may be transmitted through sharing
a water container since may be bleeding in or around the
mouth of an infected person.[12]
Regarding attitudes towards HBV, it was found more than
half of the dentists surveyed 23 (56.1%) were willing
to achieve a continuity of care for HBsAg-positive
patients. Also, 29 (70.7%) feel confident on dealing with
HBV-infected patients. Our findings are not dissimilar to
those reported in a recently conducted study in Jordan to
evaluate the willingness of clinicians in Jordan to provide
care to HBV-infected patient. The referred study revealed
that only 45% of the dental practices were willing to provide
care to a person infected with HBV.[14] Fortunately, this
study shows more suitable believes regarding HBV vaccine,
and almost all dentists surveyed showed more enthusiasm
towards vaccination against HBV must be mandatory
for all HCWs in Saudi Arabia. Also, nearly all suggested
that more attention should be offered to HBV, and were
willing to subscribe in regular training programs about
occupational risk of HBV. Our findings are in agreement
with those reported in a study conducted in Morocco to
evaluate knowledge and perception of hepatitis B among
Moroccan HCWs. The referred study revealed that almost
all the participants believed that HBV could be a serious
health problem, and regarded vaccination against HBV as
essential for all HCWs.[15]
Regarding use of the barrier techniques such as gloves,
facemasks or protective eyeglasses provides additional
barriers against HBV transmission.[1,8,13] Among the dentists
surveyed, use of personal protective measures during their
surgical procedures was inadequate. Including use of double
gloves (only 34.1% reported of always using double gloves),
protective eyeglasses (only 46.3% reported of always
wearing eyeglasses) and face masks (85.4% reported of
always uses masks). Our findings are in concordance with
international reports about the strict adherence to standard
precautions among the dentists; those reports demonstrate
that a few dentists have adhered to these procedures in their
clinical practice.[4,13] This could be because the key factors
associated with successful safety from the occupational
hazards are the dentists knowledge, interest level, and
ability to provide a logistical state of skills during daily
practices.[1,4-6,8,9]
Strengths of the current study included is the first
comprehensive PHC setting-based study carried out in Saudi
Arabia (Al Jouf Province) to obtain data on knowledge,

attitudes, and practice of dentists toward infectious,

occupational risk of HBV. Also, it refers to a common
health problem and targets a high-risk group, which can
have a significant influence on a serious health concern.
Also, it is the first local estimates of coverage the level of
HBV vaccination among dentists practicing in this part of
Saudi Arabia. In spite of the study findings, we acknowledge
its limitations; actually, it was relatively small scale study.
Moreover, all the information that we got are reported which
not necessary reflect the actual clinical decision.

Kuwait University
Health sciences center
Faculty of Dentistry
Elective Project Study Course No. 703

Knowledge, Attitude, and Practice of HBV vaccination among dentists in

primary
health care, dental centers and Kuwait university dental clinics (KUDCs)

Conducted by:
Mariam Abdal
Khayrat Al-Mousa
Supervisor
Dr. Bobby Joseph
Dec, 2013
RESULTS
In the present cross-sectional survey, 200 dentists from primary health care, dental centers
and KUDCs were approached. Out of these, 184 responded and returned a completed
selfadministered
questionnaire (response rate = 92%). This sample represents around 16% of all dentists
working at primary health care, dental centers and KUDCs in Kuwait (MOH, 2010). The
reason for
non-response was mainly lack of time because of the busy schedules of dentists.
Analysis was done on the 184 cases, with 119 (66.1%) male and 65 (33.9%) female. Majority
of the
participants were 40 yrs old (mean std. deviation equal to 2.64 1.212). Kuwaitis and
nonKuwaitis were more or less similarly presented, accounting for 50.8% and 49.2%
respectively.
Majority of them (55.1%) had master degree. More than three-quarters of the respondents
76.1%
were married. Additionally, More than 50% of dentists in our sample got their highest degree
from
USA and India and around 40% of participants work in the capital. Furthermore, More than
threequarters
had practiced dentistry for four years and more and around 90% were aware that viral
hepatitis B can be transmitted from patients to dentists and vice versa.

Knowledge
Tables (2) and (3) represent the results of the knowledge section of the questionnaire. The
questions were in a true, false and not sure format. The median knowledge score was 14
out of 18
with mean std. equal to 13.6 3.4. Thirty-one and half of the respondents answered less
than 14
out of 18 questions, which means that more than two-third of the participants have high
knowledge
about hepatitis B virus, vaccine and routs of transmission of the virus. Most of the
participants
answered 16 out of 18 questions correctly. All of the respondents were aware that HBV can
be
acquired from patient to dentists and 86.9% knew that the virus can be transmitted from
dentists to
patients. Moreover, 92.9% of the respondents considered it as serious disease. The majority
of the
respondents were aware of HBV vaccine, 85% were aware about the number of doses of
vaccination
required for complete protection. In addition, more than 55% of dentists have the knowledge
about
the potential routs of HBV transmission; broken skin in contact with saliva contaminated
with blood
of HBV positive patient, broken skin in contact with blood of HBV positive patient and
needle stick
injury had the highest percentage of knowledge. Lastly, eighty-five percent knew that
antibodies for
HBV need to be checked after receiving three titers and around 26.5% of respondents knew
that the
HBV vaccine is not for all people; this is true because there is contraindication for the
vaccine, such
as severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
(CDC,
2013). No significant association between knowledge score about HBV vaccination and
sociodemographic
characteristics and work-related variables of respondents except with nationality, which
shows that Kuwaitis have higher knowledge score than non-Kuwaitis (p-value 0.049) and
with years
of practice (p-value 0.001) in which those who have been practicing dentistry for 3 years and
more
have higher knowledge score.
Attitudes
Tables 4 and 5 demonstrate that most of the respondents have positive attitude toward HBV
vaccination mostly because they believe that their jobs puts them at risk of contracting HBV
infection and because it is serious disease. Around 14% had a negative attitude toward HBV
vaccination because they are worried of its adverse effects.
Practice
There was no significant association between knowledge score and practice and the only
exception was that those respondents (62%) who reported to be up-to-date with the new
guidelines

regarding HBV vaccination had significantly higher median knowledge score (MannWhitney U test,
p<0.021). As shown in table 6, about three quarters of the respondents (96.9%) have actually
ever
received Hepatitis B vaccine. 97.2% apply preventive measures at work (e.g. wearing mask,
glasses,
gloves, etc.).
DISCUSSION
The present cross-sectional study included 184 dentists from all governorates of Kuwait. The
aim of the study was to assess the level of knowledge, attitude and practice of dentists
regarding
HBV vaccination; and identify the factors associated with such practice. In this study, the
overall
prevalence of HBV vaccination among dentists was 96.6%. Although the majority of
participants
have high rate of knowledge the correlation between the vaccination rate and knowledge was
not
significant. Moreover, knowledge score about vaccination was not significantly associated
with the
socio-demographic variables (age and gender) and with work-related variables (academic
degree,
working status, country from which highest degree obtained and government). Significant
association was only found between nationality and knowledge score with p value equal to
0.045, as
well as with years of practice (p-0.001). Knowledge score was significantly higher for
respondents
with positive attitudes towards vaccination. However, no significant association was found
between
knowledge score and practicing vaccination. The results of the study can be used to develop
awareness programs and plan interventions to sustain the level of knowledge about HBV
vaccination
among dentists.
Knowledge of dentists about HBV, vaccine, conditions recommended by CDC for
vaccination
and routs of transmission.
Soad A. Habiba. et.al, 2012 reported in their similar study that participants knowledge
concerning the various aspects of HBV (knowledge of HBV infection, the routes of
transmission of
the infection, the ways of preventing the infection and the fact that the infection can be
transmitted as
a nosocomial infection) was generally high and consistent with current scientific evidence,
since the
majority were aware about HBV transmission from patients to HCWs (76.2%) and the
standard
precaution via vaccination (81.5%). In contrast, 57.7% knew that Hepatitis B can be
transmitted from
HCWs to patients. This indicated that there are wide areas where the knowledge was lower,
particularly regarding infections from health worker to a patient. Another study done among

Vietnamese American college students, found that those students had limited knowledge of
their
increased risk of HBV, which demonstrated the need for general HBV education. In our
study,
majority of the respondents demonstrated a high level of knowledge of HBV infection, the
routes of
transmission of the infection, the ways of preventing the infection and the fact that the
infection can
be transmitted as a nosocomial infection with a median of knowledge score reaching 14 out
of 18.
Also, we found that all respondents were aware that HBV can be acquired from patient to
dentist,
and 86.9% knew that the virus can be transmitted from dentist to patient. Association of
knowledge about vaccination with socio-demographic and work-related
variables
In this study, it was shown that the knowledge score was significantly associated with
nationality with (p=0.049 and mean std = 0.90 0.45) , in which Kuwaitis have higher
knowledge
score, but it was not significantly associated with gender, age, marital status, academic
degree,
working status, country of graduation, governorate and duration of graduation. In contrast to
our
study, higher knowledge scores was found among women than men; however, similarly age
was not
significantly associated with HBV knowledge (Jessica P. Hwang et.al, 2008). As age of
dentists, the
median knowledge score expected to significantly increase, but this was not the case in our
study
since the majority of the participants were 40 years old or more. However, as duration of
practicing
advances, the median knowledge score significantly increases (p-value 0.001) and this is
estimated
because as the dentist gains more experience, he will tend to be more knowledgeable and
more aware
of the burden of hepatitis B.
Association of knowledge with attitude towards vaccination
Results of the present study showed that the median knowledge score was significantly
higher, with p value equal to 0.000, for respondents with positive attitudes toward vaccination
who
believed that they are at risk due to the nature of their work, those who believed that HBV
vaccine is
effective in preventing the disease, and those who believed that the risk of death among the
vaccinated is reduced compared to the non-vaccinated. This can be understood if one takes
into
consideration the fact that ones beliefs and attitudes are directly affected by ones
knowledge. In
other words, a dentist who knows about hepatitis B and its vaccine would certainly believe
that he is
at risk for the illness and that the vaccine is effective and lowers the risk of death. On the
other hand,

knowledge score was lower for respondents with negative attitudes toward vaccination
however, this
result was not significant and the only negative attitude toward vaccination that was
significantly associated with knowledge score is the following belief that they have limited
contact with high-risk
patient. These attitudes reflect without a doubt the knowledge of the respondent as was
explained
earlier.
Association of knowledge with practice of HBV vaccination
Our data showed no significant association between knowledge score and practice of
vaccination. However, rate of vaccination among dentists (96.6%) was significantly related to
knowing that HBV carrier may look healthy without showing any symptoms of the disease
and
HBV can be lethal, with a (p value of o.ooo and o.o13) respectively. On the other hand, (Soad
A.
Habiba. et.al, 2012) found in their study that though many of the respondents had a relatively
high
knowledge of the HBV infection and vaccine, only 74.7% of them had ever received hepatitis
B
vaccine. Moreover, a significant association found between the knowledge score and being
up-todate
with the new guidelines of HBV vaccination. This is logical because those who appropriately
recommend vaccination must have a higher level of awareness of the importance and
preventative
value of the vaccine compared to those who do not, and hence must be more knowledgeable.
Though
majority of participants apply preventive measures at work, this was not significantly
associated with
their high knowledge score. A possible reason for that is these preventive measures are not
used
exclusively for preventing HBV infection but they are applied routinely for some other
reasons.
Attitudes towards HBV vaccination
In this study, participants were asked to respond to 9 items regarding positive attitude and 7
items regarding negative attitudes towards HBV vaccination. The majority of participants
reported
that they had a positive attitude towards the vaccination because they believed that they are at
risk
because of the nature of their work and believed in the effectiveness of the vaccine in
preventing the
disease. This suggests that dentists in primary health care centers and specialized centers as
well as
those working in the KUDCs predominantly use vaccination to reduce absenteeism due to
hepatitis B. Furthermore, they believed that hepatitis B is a serious illness. This finding is
similar to those of
another study (Soad A. Habiba. et.al, 2012), which showed that factors associated with a
positive
attitude towards vaccination were the belief in the efficacy of the vaccine and that their job
puts them

at risk of HBV infection (80.5%). In their study, they indicated that 87.1% reported their need
to be
protected from HBV infection, and 86.3% considered it necessary to receive the vaccine. In
our
study, we found that positive attitude toward HBV vaccination was also because of dentists
awareness that vaccination can reduce transmission to patients, the vaccine is mandatory by
higher
health authority as well as the risk of acquiring hepatitis B is reduced compared to nonvaccinated.
On the contrary, 14.7% had negative attitude toward vaccination due to their beliefs that they
are
worried about the vaccines adverse effects and 9.3% because vaccine is not available.
Practices of dentists regarding HBV vaccination
The present study showed no significant differences towards increase in vaccination rate
among socio-demographic variables and work-related factors. This is plausible as HBV
vaccine is
mandatory for health care workers before starting their practice. An Italian survey (Di
Giuseppe et.al,
2007) show that majority of dentists were not immunized against HBV, because 42.8%
considered it
useless and 33.3% unsafe. Fortunately, our study does not support this data. In another study
(Alavian SM et.al, 2005) vaccination against HBV was done in 94.9% of dentists. This figure
in our
study has increased to 96.6%. Positive progress, although it is certainly not enough. Reports
from
several countries indicate that some dentists do not engage in safe practices, especially in
wearing
gloves, facemasks, or protective eye glasses (Alavian SM et.al, 2005). In contrast, Ali Kabir
et.al,
2010, discovered that Iranian dentists are used to wearing double gloves, which is similar to
our
results.
Kurangnya pengetahuan akan resiko dan gejala menyebabkan kurangnya tindakan
pencegahan yang dilakukan dokter gigi dalam praktiknya. Pengetahuan dokter gigi dan
tenaga kesehatan lain dapat menjadi cerminan pengetahuan masyarakat tentang infeksi HBV.
Pengetahuan dan pencegahan yang kurang akan terus membawa tingkat infeksi HBV yang
tinggi di masyarakat (Tripati dkk., 2011).
Kadeh dkk. (2014) : 65% dokter gigi memiliki pengetahuan yang baik. Kebanyakan
memiliki pengetahuan yang baik mengenai transmisi. 93% memiliki pengetahuan yang baik
mengenai vaksinasi.

Penelitian Reddy dkk.(2011) menunjukkan tidak ada perbedaan yang signifikan

antara pengetahuan residen dan mahasiswa kepaniteraan.Perbedaan yang signifikan terlihat
pada perilaku pencegahan yang dilakukan.Residen memiliki perilaku pencegahan yang lebih
baik daripada mahasiswa kepaniteraan.Hal ini berbeda dengan hasil penelitian yang
dilakukan oleh Singh dkk. (2011) yang menyatakan bahwa mahasiswa kepaniteraan memiliki
pengetahuan lebih tinggi tentang hepatitis B. Hal ini dapat terjadi karena semakin tinggi
tingkat pendidikan dan karena kesibukan berpraktik, dokter gigi lupa akan materi yang
pernah diajarkan selama masa pendidikan strata satu.
Penelitian Abdal dan Al-Mousa (2013) tentang tingkat pengetahuan, sikap dan
perilaku dokter gigi di Kuwait menunjukkan bahwa tingkat pengetahuan tentang hepatitis B
tidak terkait dengan tingkat pendidikan.Belum tentu mereka yang lebih senior dan memiliki
tingkat pendidikan yang lebih tinggi memiliki pengetahuan yang tinggi pula tentang hepatitis
B.Tingkat pengetahuan tentang hepatitis B pada dokter gigi memiliki kaitan dengan lama
berpraktik.
Reddy, 2011
This study showed that B.D.S staff had a
mean knowledge of 52.35, which was close to the knowledge
showed by M.D.S staff (mean value of 56.42). However, the
protective and preventive measures adopted by B.D.S staff
(mean values of 48.02 and 47.71, respectively) was lower
than the protective and preventive measures adopted by M.D.S
staff (mean values of 88.04 and 54.93, respectively).

86.7 % of the medical students had correct

knowledge about Hepatitis B virus though only
66 % of II year students knew about the virus as
compared to III year (96%) students. The
difference between the knowledge of II and III
year medical students was found to be
statistically significant at 95% confidence
interval (Z=4.28). singh 2011
HBV transmissible more than HIV recognized
by 29 (70.7%). On the basis of their qualifications, there
were a statistical significant correlations noted between
dentists Our findings revealed that most of the responses show
adequate knowledge about modes of HBV transmission.
For specific modes of transmission (for example; saliva,

maternofetal, breast milk) there were a confusions and

misconceptions among the survey dentists.[2,3,6] This might
be due to the controversy of these issues and the lack of the
solid evidence. Of the participants, only 14 (34.1%) knew
that drinking from the same cup used by an infected person
could transmit HBV.[12] As such, it has been suggested that
blood borne infections may be transmitted through sharing
a water container since may be bleeding in or around the
mouth of an infected person.[12] Al-Hazmi 2015

Menurut Mubarak dkk. (2007) ada tujuh hal yang mempengaruhi pengetahuan, yaitu
pendidikan, pekerjaan, umur, minat, pengalaman, kebudayaan dan informasi. Tujuh hal
tersebut merupakan faktor yang berkaitan satu dengan yang lainnya dan tidak dapat berdiri
sendiri. Variasi dari gabungan berbagai faktor tersebut yang menghasilkan tingkat
pengetahuan yang berbeda pada tiap individu.
Survey yang dilakukan Chao dkk. (2010) menunjukkan bahwa sebagian besar tenaga
kesehatan di rumah sakit (dokter dan perawat) memiliki pengetahuan yang baik mengenai
agen penyebab infeksi HBV dan cara penyebarannya, namun masih banyak yang tidak
mengetahui potensi laten HBV kronis dan penampakannya yang asimtomatis pada pasien.
Pengetahuan tentang keberlanjutan infeksi yang dapat berakhir pada penyakit mematikan
seperti sirosis hati masih rendah. Hal tersebut yang membuat rendahnya tindakan pencegahan
yang dilakukan oleh tenaga kesehatan terhadap penyebaran infeksi HBV.
Akbulut dkk. (2011) menunjukkan 5th year student 65,6% 4th year 59% knowledge.
HBV>HIV 85%. 99% menggunakan facemask n gloves.
Menurut Reddy dkk.(2011) terdapat perbedaan dalam perilaku pencegahan dan
proteksi diri yang dilakukan sehari-hari dalam praktik antara residen dan mahasiswa
kepaniteraan.Residen dengan pengalaman dan lama praktik yang lebih tinggi menunjukkan
perilaku proteksi dan pencegahan yang lebih baik daripada mahasiswa kepaniteraan yang
baru saja memulai praktik di klinik.Perilaku pencegahan yang lebih baik juga didukung
dengan pengetahuan yang semakin bertambah seiring bertambahnya pengalaman praktik.

Model studi Knowledge Attitude Practice (KAP) merupakan model yang biasa
digunakan dalam berbagai penelitian untuk melihat adopsi perilaku dan perubahan perilaku
yang terjadi akibat interfensi pada komponen pengetahuan. KAP juga digunakan untuk
mengukur keberhasilan program promosi kesehatan dengan melihat output berupa perilaku
pada subjek yang diteliti. Knowledge (pengetahuan) mengukur pemahaman tentang suatu
topik.Attitude (sikap) melihat apa yang dirasakan serta ide awal yang mereka miliki tentang
topik tersebut. Practice (perilaku) sebagai cerminan atau pengamalan dari pengetahuan dan
sikap yang mereka miliki lewat suatu aksi nyata (Kaliyaperumal, 2004; Valente,2002).