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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 18  |  Issue : 2  |  Page : 91-94

Disposal of blood-soaked gauze by patients following tooth extraction: Are post-operative instructions adequate?


1 Department of Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
2 Department of Dental and Maxillofacial, Jos University Teaching Hospital, Jos, Nigeria
3 Department of Dental, University of Calabar Teaching Hospital, Calabar, Nigeria
4 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bayero University, Kano, Nigeria

Date of Submission01-Feb-2021
Date of Decision22-Jun-2021
Date of Acceptance09-Jul-2021
Date of Web Publication10-Dec-2021

Correspondence Address:
Dr. Benjamin Fomete
Department of Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njbcs.njbcs_3_21

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  Abstract 


Context: With regard to disposal of medical and dental hazardous wastes, proper guidelines have been set in place by the occupational safety and health administration. However, the same cannot be said of patients concerning appropriate disposal of gauze routinely placed to control bleeding from extraction socket and other oral surgery procedures. Aim: The aim of this study was to determine whether the post-extraction instructions given to patients on the disposal of blood-soaked gauze were adequate across Nigeria. Materials and Methods: We conducted a survey through an electronically transmitted self-administered closed anonymous questionnaire adapted from Franklin and Laskin, 2014. This survey was conducted amongst dentists who are involved in exodontia in the dental schools or in the adjoining university teaching hospitals in Nigeria. Results: There were 95 participants who completed the questionnaire out of 120 dental surgeons to whom the questionnaires were sent giving a response rate of about 79.1%. Of the 95 participants, 75 (78.9%) were male and 20 (21.1%) were female giving a male-to-female ratio (M:F) of 3.75:1. About 46 (48.4%) agreed to providing patients with post-operative instruction sheet after extraction or any other oral surgical procedure whereas 47.4% do not provide. Amongst those who gave instruction, the majority (23.2%) asked the patients to dispose of it in the bin followed by 4.2% who just asked the patients to dispose of it. Conclusion: This study has shown that majority of the dentists in Nigeria do not provide adequate information regarding disposal of gauze placed in the mouth postoperatively, and this may potentially pose a risk to transmission of deadly blood-borne infection with the attendant negative health effect.

Keywords: Blood, disposal, gauze, instructions


How to cite this article:
Fomete B, Agbara R, Osunde DO, Omeje KU, Nzomiwu LC, Okeke AU. Disposal of blood-soaked gauze by patients following tooth extraction: Are post-operative instructions adequate?. Niger J Basic Clin Sci 2021;18:91-4

How to cite this URL:
Fomete B, Agbara R, Osunde DO, Omeje KU, Nzomiwu LC, Okeke AU. Disposal of blood-soaked gauze by patients following tooth extraction: Are post-operative instructions adequate?. Niger J Basic Clin Sci [serial online] 2021 [cited 2022 Dec 9];18:91-4. Available from: https://www.njbcs.net/text.asp?2021/18/2/91/332188




  Introduction Top


With regard to disposal of medical and dental hazardous wastes, proper guidelines have been set in place by the occupational safety and health administration.[1] Nevertheless, the same cannot be said of patients concerning appropriate disposal of gauze routinely placed to control bleeding from extraction socket and other oral surgery procedures.[1],[2],[3],[4] Saliva and blood are mediators in the transmission of some viral diseases such as hepatitis B and C, HIV/AIDS and of recent the deadly coronavirus or COVID-19.[2] Moreover, some of the patients who come for these procedures may be carriers or out rightly infected/or symptomatic patients.[2] There may be high risk of cross infection as COVID-19 has a human-to-human transmission through respiratory droplets, contact, faecal, fart, oral transmission or direct contact with contaminated secretion like post-extraction gauze.

In order to achieve haemostasis, it is the norm in our practice to instruct patients who had tooth extraction or other intraoral minor surgical procedures to bite on a piece of gauze placed by the dental surgeon for 20–30 min before disposing it appropriately. These patients are advised to sustain bite force on this gauze for 30 min on another piece of gauze provided from the clinic[1]or on a clean handkerchief, in case further post-extraction bleeding occurs outside the clinic environment.

A previous study reported that 51% of respondents admitted manipulating the post-operative gauze in their mouth while waiting to be discharged from the dental clinic.[3] The author also noted that 9.5% of these patients who had intraoral gauze for haemostasis actually disposed of it either in the office toilet or trash basket.[3] There is a need for patients to be clearly instructed about the proper disposal of post-operative gauze so as to avoid transmission of infection, contamination of not just the office practice but also of the environment.

In view of the paucity of studies regarding the disposal of post-extraction gauze across Nigeria, we sought to investigate whether the post-extraction instructions regarding patient's disposal of gauze were adequate.


  Materials and Methods Top


We conducted a survey through an electronically transmitted self-administered closed anonymous questionnaire adapted from Franklin and Laskin.[1] This survey was conducted amongst dentists who are involved in exodontia in the dental schools or in the adjoining university teaching hospitals in Nigeria.

The questionnaire inquired about the provision of both written and verbal post-operative instructions and whether (or not) an extra gauze was given to the patient for control of possible bleeding onset after discharge from the department. Also extracted was dissemination of information to post-extraction patients on methods of disposal of these used blood-stained gauze packs, especially in those with known viral transmissible infections such as hepatitis or human immunodeficiency virus infection. The collected data were analysed using the Statistical Package for the Social SciencesStatistical Package for the Social Sciences (SPSS Program for Windows, version 20.0 SPSS Inc., Chicago, IL, USA), and the results were presented as frequencies, percentages and tables where appropriate. The research protocol was approved by the ABU Teaching Hospital Research Ethical Committee with reference code: ABUTH/HREC/Z01/2020.


  Results Top


There were 95 participants who completed the questionnaire out of 120 dental surgeons to whom the questionnaires were sent giving a response rate of about 79.1%. Of the 95 participants, 75 (78.9%) were male and 20 (21.1%) were female giving a male-to-female ratio (M:F) of 3.75:1. Majority (49, 51.5%) were in the age bracket of 31–40 years followed by 21–30 years (28, 27.45%); 37.9% of the respondents had spent between 1 and 5 years in practice followed by 16–20 years with 30 (31.65%) [Table 1]. About 48 (50.5%) agreed to providing patients with post-operative instruction sheet after extraction or any other oral surgical procedure whereas 47 (49.5%) do not provide. As to whether they provided verbal instructions to their patients after extraction or any oral surgery, 91 (95.8%) agreed to it whereas 2 (4.2%) do not provide verbal instruction. While 57 (60%) agreed to providing extra gauze for their patients, 36 (40%) do not provide any extra gauze [Table 2]. With regard to instructions on how to dispose the gauze postoperatively, about 54 (56.8%) do not give instruction to their patients compared to 41 (43.2%). Amongst those who gave instruction, the majority (n = 23, 71.9%) asked the patients to dispose of it in the bin followed by 21.9% who just asked the patients to dispose of it. As per patients with known infections such as HIV and hepatitis, 81 (85.3%) did not give specific instruction on how to dispose of the gauze compared to 14 (14.7%) who did [Table 3]. There was a significant difference between age, gender as well as years of practice and providing post-operative instruction sheet for patients after extraction [Table 4]. There were more male respondents within the age group of 31–40 years, and those who had practiced for between 1 and 5 years old provided post-operative instruction sheet for their patients [Table 4].
Table 1: Sociodemographic characteristics of the respondents

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Table 2: Responses to the post-operative instructions given to patients by dentists

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Table 3: Responses to ways of disposing blood-soaked gauze by dentists

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Table 4: Whether patients are provided with post-operative instruction sheet and number of years of practice

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  Discussion Top


The response rate of 79.1% which was obtained from the present study was by far higher than the response rate of 17% recorded by Franklin and Laskin.[1] This study shows a high male dominance in the Nigerian dental profession as previously reported by Onyebuchi[5] where he noted 56% of registered dentists of the male gender. This observation also corroborated the findings of Adebayo et al.[6] who documented 65.2% male predominance of registered dentists in Nigeria.

The age distribution pattern of the present study is consistent with the finding of Adebayo et al. who documented a preponderance of dentists within the age bracket of 30–34 years in residency training programme. The resident doctors are often the carder of dentists in charge of exodontia in our training institutions.

This study observed that majority (96.8%) of the respondents gave verbal instruction to their patients whereas about 50.5% provided their patients with written instruction. This is far lower than the findings by Franklin and Laskin,[1] where all their respondents provided both written and verbal post-operative instructions to their patients. However, Dai et al.[7] reported that all their respondents provided the verbal instruction, but about 69.0% of their respondents provided their patients with a post-operative instruction sheet.

This observation may be a reflection of the ratio of literate to illiterate people in our setting. Illiterate patients are less likely to accept written post-operative instruction when it is given to them.

More male respondents within the age group of 31–40 years and those who had practice years of between 1 and 5 years old provided post-operative instruction sheet for their patients more than their different counterparts. This could be a result of the male dominance in the profession. The age group could be due to the fact that most of the dental surgeons in charge of exodontia clinics are resident doctors who usually fall within that age group and are within the practice years of 1–5 years.

This study's findings also observed that 61% of the respondents provided extra gauze for their patients. This finding is similar to that of Dai et al.[7] (60.6%) but lower than the finding of Franklin and Laskin[1] where all respondents provided extra gauze to their patients. In this study, however, most of the respondents (70.7%) that provided extra gauze, instructed the patients on the way to dispose of them compared to 2.8% as reported by Dai et al.[7] In contrast, in the study by Franklin and Laskin,[1] only one out of their 65 respondents instructed the patients on the way to dispose of the gauze. The reason for this could be attributed to the fact that majority of our respondents are still young in the profession and will want to carry out all that they have been taught.

Amongst those who instructed the patients on how to dispose of the gauze in this research, 71.9% asked them to dispose of it in the litter bin. Even though it was not specified, it is believed that the bin will be disposed of by the appropriate authority, thereby avoiding contact with others. In contrast, Franklin and Laskin had no respondents with regard to disposal of gauze even though they provided a space for it. Chatzoudi[3] noted that 9.3% of the patients disposed of the contaminated gauze in the practice bathroom litter bin.

Regarding patients with known viral infections such as hepatitis B and C, HIV/AID or even COVID-19, this study found that only 12.0% gave them specific instructions. We also observed that amongst those who gave the patients specific instruction on how to dispose of it, majority (4.3%) asked them to dispose it in a nylon bag followed by toilet (3.1%). A search in the literature did not reveal any study with which to compare our findings.

The above findings demonstrated that dental surgeons do not provide adequate information regarding disposal of gauze placed in the mouth postoperatively. Such inactions could pose a risk of transmission of infection to the general public at the dental surgery, home or even on the street from inappropriately patient's disposed gauze. Beyond that, there is also a great risk to transmission of infection through contact from surfaces such as door handles, surgery chairs and other objects that were in contact with patients. This is so because, according to Chatzoudi,[3] patients manipulated gauze in their mouth while waiting to achieve haemostasis. In her report, nearly half of the study patients touched the gauze with their bare hands before its final disposal and only about half of the patients recalled having washed their hands whereas some neither recalled having manipulated the gauze in their mouth nor where they disposed it.[3] According to Boyce and Pittet,[4] hand hygiene has remained the most effective way of reducing transmission of infection in healthcare facilities. This action portends a possibility of a high risk of cross infection amongst and/or between staff and patients; in addition, the events of patients manipulating gauze in their mouth, make the risk of transmission of COVID-19 high. Therefore, patients might need to be educated on the fact that their blood is a possible source of infection and should be considered as such. They should also be advised to wash their hands before leaving the hospital and when they get home to reduce the risk of infection.

In accordance with the advice sheet developed by the British Dental Association in conjunction with the Department of Health in England, clinical waste is that which is soiled with blood, saliva or other body fluids and may prove hazardous to any person coming into contact with it.[8] Blood-soaked gauze is also classified as infectious/hazardous waste and should not be thrown into the regular garbage as the major concern is to prevent potential accidental transmission of infection.[9] In this era of COVID-19 pandemic, while trying to curtail and contain the virus, infection control should be duly observed.

Good standard global clinical best practices could be said to compel dental practitioners to properly educate patients on the need to dispose of this blood-soaked post-extraction gauze and other infectious waste properly in order to prevent cross infection, especially at this period of COVID-19 pandemic ravaging the global space.


  Conclusion Top


This study has shown that majority of the dentists in Nigeria do not provide adequate information regarding disposal of gauze placed in the mouth postoperatively, and this may potentially pose a risk to transmission of infection with the attendant negative health effect. There is a need for proper education of patients on proper disposal of blood-soaked gauze and the importance of handwashing after such disposal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Franklin A, Laskin DM. Are oral-maxillofacial surgery patients given proper postoperative instructions for disposal of blood-soaked gauze packs? J Oral Maxillofac Surg 2014;72:2107-8.  Back to cited text no. 1
    
2.
Huang N, Pérez P, Kato T, Mikami Y, Okuda K, Gilmore RC, et al. SARS-CoV-2 infection of the oral cavity and saliva. Nat Med 2021;27:892-903.  Back to cited text no. 2
    
3.
Chatzoudi M. Handling post-dental extraction patients: How to avoid trans-infection of blood-borne diseases. J Oral Maxillofac Surg 2009;67:2583-6.  Back to cited text no. 3
    
4.
Boyce MJ, Pittet D. Guideline for hand hygiene in health-care settings recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. MMWR Recomm Rep 2002;51:1-45.  Back to cited text no. 4
    
5.
Onyebuchi E. Population of Doctors in Nigeria Hits 74,543. Available from: https://www.thisdaylive.com. [Last accessed on 2020 Jul 04].  Back to cited text no. 5
    
6.
Adebayo ET, Ogini FO, Aborisade AO, Fomete B. Professional experience training attitudes and expectations of residents in dentistry: A nationwide survey. JWACS 2017;7:85-119.  Back to cited text no. 6
    
7.
Dai J, Zhang YP, Wang WM, Luo XM, Zhuo WJ, Yang WJ, et al. A survey on the disposal of blood-contaminated tampon after dental extraction. Springerplus 2016;5:1-5.  Back to cited text no. 7
    
8.
British Dental Association. Wate Disposal in Advice Sheet A12: Infection Control in Dentistry. London WIG 8YS: British Dental Association; 2003. p. 10.  Back to cited text no. 8
    
9.
Agarwal B, Kumar M, Agarwal S, Singh A, Shekhar A. Bio Medical Waste And Dentistry. J Oral Health Comm Dent 2011;5(3):153-155.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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