SARS前後牙科患者就醫行為及對『感染控制』認知之研究

前言：大多數的病患進入牙科診所時並不了解和在意牙科感染控制執行的情形，但是在92年3月全台灣陷入SARS威脅與恐慌的壓力下，而牙醫師在醫療時與病患的口腔及呼吸道極為接近，所以受感染機率高。因此本篇研究的主要目的是調查SARS前後民眾就醫行為的影響及對牙科診所感染控制的態度，以及對SARS認知狀況。研究方法與分析：研究對象以高雄縣市之牙科醫療院所隨機抽樣22家，發出890份問卷，問卷對象是20-80歲的牙科候診病患，回收後取得有效問卷620份，回收率69.7%，利用JMP電腦軟體分析。結果：經卡方檢定分析SARS前及後牙醫就診行為的變化，發現SARS前後行為的變化均有顯著的差異(p<0.05)。例如病患在SARS前不舒服才看牙醫佔61.1%，在SARS後(56.1%)；痛的受不了才看牙醫佔9.8%，在SARS後(13.9%)；選擇牙醫診所看診的理由在SARS前醫療品質占79.2%、乾淨且消毒完善(70.1%)、服務態度(64.1%)，在SARS後分別佔82.7%，78.2%，64.4% 。又八成以上的患者認為如果政府能對診所感染控制認證，會是他們選擇診所的必要條件。在患者就診過程中，82.9%希望牙醫師在治療牙齒過程中跟他們說明每一個步驟，而希望牙醫師說明已更換所有器械(78.2%)、說明整個消毒及感染控制流程(69.4%)和說明已清潔診療椅(58.4%)，但是醫師主動做到的依序占83.1%、65.3%、63.1%、50.8%。除此之外，「年齡」、「教育程度」、「職業」、「近一年內看牙次數」與「就醫行為和對院內感染的態度」具相關性；年齡愈大、教育程度愈高、年間看牙次數在兩次以上者愈注意診所感染控制執行的情形，職業中以醫療事業和家管者對診所執行感染控制的注意程度較高，學生則較低。「教育程度」、「職業」、「年收入狀況」會影響SARS的認知結果；教育程度愈高、從事醫療相關事業及年收入愈高者對SARS認知愈好。結論與建議：研究結果發現在SARS前病患很在乎牙科醫療院所的乾淨且消毒完善，在SARS後尤其明顯。牙醫師在給予病患治療過程中雖已滿足大部分病患的需要，但是非治療部份，特別是診所消毒與感染控制方面離病患期望尚有落差，這是需要再與病患溝通的地方。因此若有相關認證，應可消除病患疑慮。

關鍵字

牙科； SARS ；感染控制；交互感染

並列摘要

Preface: Most dental patients do not understand nor pay attention to the conditions of infection control during their visits to dental clinics. However, people have started to notice the importance of dental infection control after being influenced and pressured by the threat and fear of the SARS outbreak throughout all of Taiwan during March of 2003. SARS is transmitted by saliva and inhaled through the respiratory tract. Dentists are very close to their patient’s mouth and respiratory tract during treatment; therefore, it is easy to spread the SARS infection. Therefore, the purpose of the study is to investigate the impact on dental visiting behavior and the attitude toward sterilization and infection control in dental clinics and the recognition of SARS among general population before and after the SARS outbreak. Study Method and Analysis: The sample size of this study was 22 dental clinics in Kaohsiung City and Kaohsiung County through randomized sampling. Eight hundreds and ninty questionnaires were sent out to dental patients from ages 20 to 80 years old. Six hundreds and twenty questionnaires were useful among those returned, and the return rate was 69.7% using JMP computer software analysis. Results: Through chi-square analysis, the results illustrated that there was significant difference in the change of dental visiting behavior (p<0.05). Before the SARS outbreak, 61.1% of patients visited dentists when they felt pain or uncomfortable, whereas after the SARS outbreak, it was 56.1%. Before the SARS outbreak, 9.8% patients visited dentists only when they could not tolerate the pain, whereas after the SARS outbreak, it was 13.9%. The factors involved in choosing a dental clinic were the treatment quality (79.2%), clean and thorough sterilization (70.1%), and service attitude (64.1%); whereas the percentages were 82.7%, 78.2%, and 64.4% respectively after the SARS outbreak. More than 80% of the patients believed that government certification of the clinic’s infection control would be the essential factor in their selecting a dental clinic. During the process of dental treatment, 82.9% of patients wished that the dentists would explain each infection control procedure to them, mentioning all the equipment being changed (78.2%), the process of whole sterilization and infection control (69.4%), and the treatment chair being cleaned (58.4%). However, percentages of dentists that have explained the above items were 83.1%, 65.3%, 63.1%, and 50.8% respectively. In addition, age, education level, occupation, number of dental visits per year also affected the dental visiting behavior and the attitude toward sterilization and infection control in the dental clinics. Patients of older age, higher education level, or with more than two dental visits a year pay more attention to the condition of sterilization and infection control in the dental clinics. Among the occupations, patients who were in the medical field or were housewives took more notice to infection control, whereas students pay less attention to infection control. In addition, education level, occupation, and income also affected patients’ recognition toward SARS; patients who were highly educated, working in the medical field and earned higher income had higher recognition toward SARS. Conclusion and Suggestions: This study found that patients were concerned about the clean and complete sterilization in the dental clinics before the SARS outbreak, but it became more obvious after the outbreak. Although the dentists had satisfied most needs of patients during the treatment, they still had not met the patients’ expectations regarding sterilization and infection control. Dentists need increased communication with the patients regarding these issues. Therefore, if the government certifies the infection control of dental clinics, the patients’ worries and concerns will be satisfied.