RESUMO
Introduction Hand hygiene is crucial for preventing healthcare-associated infections in dental settings. Despite its importance, the hand hygiene compliance rates remain unclear, particularly in dental university hospitals where teaching, research, and clinical practice intersect. This study aimed to establish a baseline of hand hygiene compliance rates in a dental university hospital, evaluate the effectiveness of direct observation in improving compliance, and compare practices among different categories of healthcare workers. Materials and methods This retrospective cohort study was conducted at Kanagawa Dental University Hospital from April 2022 to March 2023. The design included four blinded direct observations to establish baseline compliance rates, followed by educational training and four unannounced explicit observations. Compliance was assessed based on the World Health Organization's "Your 5 Moments for Hand Hygiene: Dental Care," adapted for dental outpatient services. The study focused on hand hygiene using alcohol-based hand sanitizers, and compliance rates were calculated for dentists, dental hygienists, dental assistants, and trainee dentists. Monthly consumption of hand sanitizer per patient was tracked from January 2019 as a secondary measure. Statistical analysis included Fisher's exact test, unpaired t-tests, and analysis of variance (ANOVA). Results The baseline hand hygiene compliance rate was low at 15.6%, with the highest compliance (25.0%) for "After touching patient surroundings." Post-intervention, the overall compliance rate increased significantly to 36.0% (p < 0.001). Significant improvements were observed in moments "After body fluid exposure risk" (11.1% to 31.3%, p = 0.004), "After touching a patient" (12.0% to 52.9%, p = 0.006), and "After touching patient surroundings" (25.0% to 73.3%, p = 0.001). Dental hygienists, assistants, and trainee dentists showed significant increases in hand hygiene compliance, while dentists did not. Hand sanitizer consumption increased significantly from 2019 (2.38 ± 0.29 mL per patient) to 2020 (3.47 ± 0.49 mL, p < 0.001) and remained elevated through 2023. Conclusions This study revealed low baseline hand hygiene compliance in a dental university hospital setting. While direct observation and education led to significant short-term improvements, especially among allied health professionals, the disconnect between observed compliance rates and hand sanitizer consumption suggests these changes may not represent sustainable behavioral shifts. The varying improvement rates among different healthcare workers and the challenges in maintaining long-term adherence highlight the need for tailored, continuous interventions in dental education and practice settings to enhance hand hygiene compliance.
RESUMO
PURPOSE: This study aimed to identify risk factors for distant metastasis (DM) in patients with squamous cell carcinoma of the oral cavity. MATERIALS AND METHODS: A retrospective analysis of 516 patients with squamous cell carcinoma of the oral cavity from 1986 through 2009 was performed. DM was classified as 2 types based on whether patients had locoregional failure (LRF). The frequency and clinicopathologic risk factors for the 2 types of DM were evaluated separately using univariate χ(2) tests and multivariate logistic regression models. Overall survival was evaluated with the Kaplan-Meier method and compared by the log-rank test. RESULTS: Fifty-four patients (10%) developed DM, 16 with isolated DM and 38 with DM with LRF. The 5-year survival rate from a DM diagnosis in patients with isolated DM was 13%, significantly higher than the rate of those with DM with LRF (0%; log-rank test, P < .05). Multivariate analysis indicated unique risk factors and common risk factors for the 2 types of DM. The common factors were nonsurgical treatment and the presence of pathologic positive nodes. The unique factors for isolated DM were histologic grade G3 and the later treatment period (after 1998). Conversely, the unique factor for DM with LRF was extracapsular spread. CONCLUSION: The risk of isolated DM development after 1998 was 2.6 times higher than that before 1997. Histologic grade G3 and the presence of pathologic positive nodes may play a causative role in isolated DM.