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E alua ion o In ec ion Con ol Awa eness and Compliance among
Unde g adua e Den al S uden s in he Teaching Hospi al o Ka achi
& Laho e, Pakis an
Seema Sha ique*
MPH, BDS, CHPE, Lec u e Communi y and P e en i e Den is y Depa men
Subjec Incha ge o Beha iou al Sciences, Uni e si y o Laho e
Email: [email p o ec ed]
D . Da osham Khan
Lec u e Communi y and P e en i e Den is y Depa men BDS, CHPE
Sindh Ins i u e o O al Heal h Sciences, Jinnah Sindh Medical Uni e si y
D Aqsa Younus
Lec u e , Depa men o O hodon ics, BDS, CHPE
Sindh Ins i u e o O al Heal h Sciences, Jinnah Sindh Medical Uni e si y
D Fiza I an
Lec u e , Depa men o O al Medicine, BDS, CHPE, Sindh Ins i u e o O al Heal h
Sciences, Jinnah Sindh Medical Uni e si y
D , Saima Ba ool Ja i
Lec u e , Depa men o O al Medicine, BDS, CHPE, Sindh Ins i u e o O al Heal h
Sciences, Jinnah Sindh Medical Uni e si y
D . Ba ool Jaam
Lec u e , Depa men o O al Medicine, BDS, CHPE, Sindh Ins i u e o O al Heal h
Sciences, Jinnah Sindh Medical Uni e si y
BACKGROUND: In ec ion con ol is a c i ical componen o den al educa ion and
clinical p ac ice. Den al s uden s a e a high isk o c oss-con amina ion due o equen
exposu e o blood and sali a du ing pa ien ca e. Adequa e knowledge and compliance
wi h in ec ion con ol p o ocols a e essen ial o p e en he ansmission o in ec ious
diseases in he den al se ing.
OBJECTIVE: To assess he knowledge, a i ude, and p ac ice (KAP) ega ding
in ec ion con ol among unde g adua e den al s uden s s aying a he eaching hospi al
o Ka achi, Pakis an
METHOD: A desc ip i e c oss-sec ional s udy was conduc ed among unde g adua e
den al s uden s om a selec ed eaching hospi al in Ka achi and Laho e . A sel -
adminis e ed, s uc u ed ques ionnai e was used o e alua e s uden s’ knowledge,
a i ude, and p ac ice ela ed o in ec ion con ol measu es including hand hygiene, use
o pe sonal p o ec i e equipmen , s e iliza ion, and was e managemen . Da a we e
analyzed using desc ip i e and in e en ial s a is ics o de e mine he associa ion
be ween demog aphic a iables
A
B
S
T
R
A
C
T
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RESULT:
Mos pa icipan s demons a ed sa is ac o y knowledge o basic in ec ion con ol
measu es; howe e , gaps we e iden i ied in compliance wi h s anda d p ecau ions,
pa icula ly in consis ence use o p o ec i e ba ie s and p ope s e iliza ion echniques.
A posi i e a i ude owa ds in ec ion con ol was obse ed, hough ac ual p ac ices we e
no always aligned wi h knowledge le els. S a is ically signi ican di e ences we e
no ed be ween clinical and p eclinical s uden s (p < 0.05)
CONCLUSIONS:
Al hough den al s uden s showed adequa e awa eness and posi i e a i udes owa ds
in ec ion con ol, inconsis encies in p ac ical applica ion highligh he need o
con inuous aining, s ic e supe ision, and ein o cemen o in ec ion con ol
p o ocols wi hin den al ins i u ions.
Keywo ds: In ec ion Con ol, Den al S uden s, Knowledge, A i ude, P ac ice, C oss-
Con amina ion, Ka achi, Pakis an.
In oduc ion:
Heal h-ca e Rela ed In ec ions (HAIs) also desc ibed as ‘Nosocomial In ec ions’ ha e
a signi ican h ea o he human li e.(1) HAIs a e associa ed wi h he medical o su gical
in e en ions. Heal h ca e p ac i ione when po en ially exposed o an asymp oma ic o
p e-symp oma ic in ec ed pa ien de eloped a signi ican isk o in ec ion.(2, 3) His o y
has p o ed ha he p esence o po en ial pa hogenic mic oo ganism in he inside
a mosphe e o heal h ca e ins i u ions c ea es a high isk o in ec ion. (4, 5)
Disease-causing po en ial pa hogens
Den is s a e a high isk o he pa hogenic mic oo ganisms due o hei close p oximi y
wi h he pa ien s’ o al ca i y and body luids.(6) Den al eaching hospi als pe o m a
la ge numbe o in asi e ea men s pe iodically inside a limi ed ope a ing oom whe e
a ema kable amoun o ae osols a e gene a ed. No ably, hese ae osols con ain a b oad
spec um o pa hogens and wi h he use o po en ially c i ical ins umen s, he e is a
signi ican isk o in ec ion om blood-bo ne diseases like Mycobac e ium
Tube culosis (TB), Human Immunode iciency Vi us (HIV), He pes Simplex Vi us,
Hepa i is B Vi us (HBV) and Hepa i is C Vi us (HCV), o d ople -bo ne in ec ions like
Me hicillin- esis an S aphylococcus au eus (MRSA), Co ona i us (COVID-19),
In luenza and Se e e Acu e Respi a o y Synd ome (SARS).(7-10) Fu he mo e, wi h he
inc ease o pa hogens in he heal hca e en i onmen ha a e esis an o an imic obial
d ugs, an ala ming si ua ion has been c ea ed.(11)
Mode o ansmission o in ec ion in den al p ac ices
These pa hogens can be ansmi ed in he den al clinics: (a) di ec ly h ough blood,
mucosal luids and pa ien s’ belongings, (b) indi ec ly h ough con amina ed equipmen
like c i ical ins umen s and su aces, (c) con ac o he mucosal-d ople s con aining
pa hogens (ae osols) om an in ec ed indi idual h ough sneezing, coughing o wi h
he use o con amina ed den al ins umen s (d) by ai bo ne pa hogens emained in he
clinic a mosphe e o a long pe iod.(8) The e o e, in ec ion con ol measu es ha e o be
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ensu ed by p ope hand hygiene, main aining s e ilized ins umen a ion and
en i onmen , and wi h u iliza ion o pe sonal p o ec i e equipmen (PPE).
Medical aspec o in ec ion con ol in den al p ac ices
All den al p ac i ione s ha e o ensu e adequa e in ec ion p e en ion and con ol
measu es o pa ien s’ sa e y and o hei own heal h. The ae osol dynamics o den al
eaching hospi als, whe e unde g adua e den al s uden s a e ained wi h a huge amoun
o pa ien low, con ain mo e po en ial pa hogenic o ganisms.(12) I is he e o e
necessa y ha ho ough and igo ous aining o in ec ion con ol mus be p o ided o
he den al pe sonnel especially o unde g adua e den al s uden s o a oid c oss
con amina ion be ween pa ien s and doc o s.(13) The medical aspec o in ec ion con ol
equi es a p ope p o ocol o hand hygiene, u iliza ion o PPE including glo es, masks,
eyewea and p o ec i e gowns, disin ec ion/s e iliza ion o c i ical ins umen s, su ace
cleaning, ubbe dam isola ion o p e en con ac o blood/mucosal luid wi h he den al
pe sonnel. Biohaza dous was e p oduced in he den al o ice mus be ea ed wi hin he
p o ocol p o ided in he CDC guidelines. Con amina ed needles a e disposed
immedia ely in punc u e-p oo con aine s o p e en acciden al needle inju ies. Den al
uni wa e lines a e pu ged a he beginning o day and an i-mic obial ea men s used
o p e en mic obial bio ilm g ow h and con amina ion.(14, 15)
Legal and inancial aspec s o in ec ion con ol in den al p ac ices
Den al p ac ices mus comply wi h in ec ion con ol egula ions se by agencies like
Occupa ional Sa e y and Heal h Adminis a ion (OSHA), Cen e s o Disease Con ol
and P e en ion (CDC), Asia Paci ic Socie y o In ec ion Con ol (APSIC) and s a e
den al boa ds o p o ec pa ien s and s a . These Regula ions co e a eas like
s e iliza ion, cleaning, was e disposal, accine equi emen s. Failu e o ollow
s anda ds o ca e can esul in malp ac ice liabili y i inadequa e p ac ices lead o pa ien
o s a illness/inju y.(16, 17) Es ablishing in ec ion con ol in den al p ac ices equi es
inancial s abili y. The e a e cos s associa ed wi h se ing up adequa e in ec ion con ol
sys ems - s e ilize s, au ocla es, washe -disin ec o s, PPE, sha ps con aine s e c.
Employees need egula aining and ce i ica ion in a eas like s e iliza ion, OSHA
s anda ds which ha e associa ed p og am/cou se ees.(18-20) The e o e, while necessa y
o compliance and pa ien sa e y, comp ehensi e in ec ion con ol does p esen an
ongoing inancial in es men o den al p ac ices.
The isk o in ec ion ansmission can be signi ican ly minimized by adhe ing o he
in ec ion p e en ion p o ocols alloca ed by CDC and Minis y o Na ional Heal h
Se ices Regula ions and Coo dina ion (NHSR&C), Go e nmen o Pakis an.
Ne e heless, in ec ious diseases a e p e alen in he den al ield globally, including in
Pakis an. Fu he mo e, he e was limi ed amoun o esea ch a ailable on he s a is ics
o den al eaching ins i u ions’ compliance o he modi ied in ec ion con ol p o ocols
o p e en he sp ead o in ec ion among unde g adua e s uden s. The e o e, his
esea ch aims o de e mine he knowledge, a i ude and p ac ical applica ion o di e en
echniques o in ec ion con ol being p ac ice in he go e nmen - unded den al eaching
hospi als o Ka achi, Pakis an. The awa eness among unde g adua e den al s uden s
owa ds he p o ocols o in ec ion con ol has been analyzed o iden i y whe he he
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exis ed knowledge is su icien o should go e nmen has o design speci ic aining
p og ams o he s uden s.
Me hodology:
Resea ch design
A c oss-sec ional esea ch analysis was conduc ed in he du a ion o 6 mon hs be ween
Sep embe 2024 o Feb ua y 2025 The esea ch se ings had been se up in he
depa men s o den is y o wo main eaching hospi als Jinnah Medical and Den al
College and Shalama Medical and Den al College Laho e
Sample size and echnique
Simple Random Sampling echnique was used o collec da a. Resea ch pa icipan s
we e selec ed andom. Sample size was calcula ed o es ima e he p e alence o
adequa e in ec ion –con ol compliance wi h 95% con idence and 5% ma gin o e o ,
esul ing in a a ge o n= 385 s uden s pe hospi al. A e applying a 15% allowance
o non– esponse, N in i ed = 282 pe hospi al we e in i ed.
Inclusion c i e ia
Pa icipa ions we e olun a y a e consen ; all esea ch pa icipan s had been p o ided
wi h he in o med consen o m including he pu pose o his esea ch. The a ge ed
esea ch pa icipan s we e he unde g adua e den al s uden s en olled in JMDC and
SMDC we e physically p esen du ing he pe iod o his esea ch. S uden s who we e
s udying in clinical yea s i.e. s uden s en olled in 3 d and 4 h p o essional yea s o hei
den al school we e included. S uden s o ei he gende male o emale we e included i
hey signed he in o med consen o m.
Exclusion c i e ia
Unde g adua e den al s uden s who we e no en olled in he den al schools o ei he o
hese ins i u ions we e excluded om his esea ch. Den al s uden s who we e no
p esen physically in he den al clinics du ing he cou se o his esea ch we e excluded.
Newly admi ed den al s uden s and s uden s o ini ial/p eclinical yea s i.e. 1s yea and
2nd yea den al s uden s we e excluded om his esea ch. Pa icipan s who had no
signed he in o med consen we e also excluded.
Su ey
A s uc u ed ques ionnai e was de eloped o his esea ch pu pose based on he
in ec ion con ol p o ocols. The ques ionnai e was dis ibu ed among he pa icipan s
in ha d copies h ough pe sonal in e iews. The ques ionnai e ook abou 5 o 10
minu es o comple e. This s uc u ed ques ionnai e is di ided in o pa s con aining he
demog aphic in o ma ion, immuniza ions o esea ch pa icipan s, knowledge o
in ec ion con ol, and he ex end o p ac ical applica ion in he den al clinics.
S a is ical Analysis
Desc ip i e s a is ical ools (pe cen ages and means) we e used o analyze he da a.
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Compa a i e analysis be ween di e en a iables was conduc ed wi h he use o Chi-
squa e es . P- alue < 0.05 was con empla ed o be s a is ically signi ican . S a is ical
analysis was execu ed by using SPSS e sion 26.
Resul s:
A o al o 282 unde g adua e den al s uden s pa icipa ed in his esea ch a e ul illing
he inclusion c i e ia and exclusion c i e ia. Table 1 demons a es socio-demog aphic
elemen s o esea ch pa icipan s. Ou o 282 pa icipan s, 191 (67.7%) we e emales
and 91 (32.3%) we e males. Two- hi ds pa icipan s (186) we e en olled in JMDC
while he one- hi d pa icipan s (96) we e en olled in SMDC espec i ely. Almos 50%
(142) pa icipan s we e s udying in 3 d p o essional yea while he emaining 50% (140)
pa icipan s we e s udying in hei 4 h p o essional yea .
Majo i y o esea ch pa icipan s (81.2%) ha e ag eed on he impo ance o
immuniza ion/ accina ion o unde g adua e den al s uden s ha i should be
compulso y o e e y den al s uden while ew pa icipan s (18.8%) ha e disag eed
because o he ac ha essen ial accina ion comes wi h po en ial side e ec s and ha e
a signi ican inancial bu den on s uden s.
Al hough 207 (73.4%) s uden s ag eed ha hey ha e accu a e knowledge o
employmen o Pe sonal P o ec i e Equipmen bu u he in es iga ion e ealed ha
only 57.8% s uden s we e awa e wi h he co ec donning sequence and 49.3% s uden s
ha e co ec knowledge o do ing ch onology. Compa a i e analysis demons a es no
signi ican ela ion be ween eaching ins i u ions and awa eness o donning and do ing
ch onology, χ2(1.399), p0.211 and χ2(1.47), p 0.211 espec i ely. Mos equen ly used
PPE we e Glo es (97.5%) and ace masks (93.6%) ollowed by p o ec i e eyewea
(68.4%) and gowns (35%). Majo i y o pa icipan s 218 (77.3%) disposed o
con amina ed Pe sonal P o ec i e Equipmen in a biohaza d bag and 246 (87.2%)
execu ed hand hygiene pos - ea men a e emo ing PPE. 81.2% (229) pa icipan s
su e ed sho age and insu icien supply o PPE by hei eaching hospi al/uni e si y
and 72.7% (205) pa icipan s had o pu chased PPE on hei own. To a oid sel -
con amina ion 46% (130) unde g adua e s uden s used scoop echnique du ing needle
handling while only 32.6% (92) s uden s used p e- ea men p ophylaxis mou hwash in
pa ien s. 4 h p o essional yea s uden s (62.9%) used su ace disin ec an a e e e y
pa ien we e mo e cau ious as compa e o 3 d yea s uden s (35.2%) who only used
su ace disin ec an a he end o he day, p 0.001.
Following an exposu e o blood o body luid wi h isible blood, 43.6% pa icipan s
we e ully awa e o he p e en i e s eps o ake, while only 39.7% (112) o pa icipan s
knew he ideal managemen o o n glo es du ing he den al p ocedu e. Abou 196
(69.5%) unde g adua e s uden s did no a end any so o aining cou se o session on
he in ec ion p e en ion and con ol p o ocols. Fu he in es iga ion e ealed ha abou
85 (43.4%) s uden s acknowledged ha hey did no ha e a ailabili y o hese cou ses
by hei eaching ins i u es, 63 (32%) pa icipan s esponded ha he cou ses o e ed by
p i a e ins i u es a e expensi e while 37 (18.9%) we e no awa e o he a ailabili y o
aining cou ses, and 11 (5.6%) conside ed i was unnecessa y o a end he cou se. A
chi-squa e es e ealed a signi ican associa ion be ween yea o s udy and aining
sessions a ended. The 4 h p o essional yea s uden s (42.9%) we e mo e likely o a end
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aining sessions in con as o 3 d p o essional yea s uden s (18.3%), p0.001. 162
(57.4%) s uden s we e unawa e abou ins i u ional policy and p ocedu e on In ec ion
Con ol.
Table 1 Socio-demog aphic cha ac e is ics o unde g adua e den al s uden s (n =
282)
Va iable
Ca ego y
F equency (n)
Pe cen age (%)
Gende
Female
191
67.7
Male
91
32.3
Ins i u ion
JMDC
186
66.0
SMDC
96
34.0
Yea o S udy
3 d P o essional
Yea
142
50.4
4 h P o essional
Yea
140
49.6
View on
Vaccina ion
Ag ee (should be
compulso y)
229
81.2
Disag ee (due o
side e ec s/cos )
53
18.8
Discussion:
In 1985, he Cen e s o Disease Con ol (CDC) p esen ed Uni e sal P ecau ions, and
la e in oduced S anda d P ecau ions in 1995. These p ecau iona y measu es se as
s anda d guidelines o he p e en ion o in ec ious diseases and ansmission o
po en ial pa hogens h ough blood, mucosal luid o by ae osols. (21)
C oss-in ec ion is de ined as he ansmission o pa hogens o mic oo ganisms om
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one pe son o sou ce o ano he (be ween pa ien s and den al p o essionals), po en ially
causing in ec ions. The CDC’s S anda d P ecau ions a e delibe a ed o es ablish a
s e ile wo king en i onmen and o inhibi he sp ead o Heal hca e Associa ed
In ec ions among pa ien s and den al pe sonnel. Knowledge and compliance o hese
p ecau iona y measu es a e c i ical o c oss-in ec ion p e en ion. Simila li e a u e is
a ailable wo ldwide abou den al s uden s’ compliance owa ds c oss-in ec ion
p e en ion, and he e is a widesp ead opinion ha den al s uden s ha e o be mo e
conscious o be p o ec ed om he isks o c oss-in ec ion. (22)
Cu en li e a u e e eals ha Den is s and Den al pe sonnel especially unde g adua e
den al s uden s a e a high isk o acqui ing in ec ion because o hei close p oximi y
wi h he pa ien s’ o al ca i y and con inuous exposu e o po en ial pa hogenic
mic oo ganisms h ough blood, mucosal luids and ae osols, and e en a ec ed by
needle inju ies.(6, 23) The isk o in ec ion ansmission can be educed h ough s ic
compliance o S anda d P ecau ions alloca ed by CDC. This p esen esea ch epo ed
he awa eness, a i ude and p ac ical app oach o in ec ion p e en ion among
unde g adua e den al s uden s o go e nmen - unded eaching hospi als o Ka achi,
Pakis an. These esul s co esponded wi h he esul s o o he ele an esea ches in he
ield. S i as a a KC e al. conduc ed a esea ch on 318 subjec s in Saudi A abia
epo ed an a e age le el o awa eness (51.6%) bu a good le el o a i ude (92.1%) o
subjec s owa ds in ec ion con ol.(24) Simila ly, ano he c oss-sec ional esea ch
conduc ed on 195 allied heal hca e p o essionals epo ed a mode a e le el o
awa eness (58.2%) and a good le el o a i ude (80%) (25)
To p e en c oss-in ec ion du ing den al ea men s, adequa e accina ion o den al
p o essionals is he bes p ocedu e. Pas li e a u e e ealed ha he equency o
hepa i is B accina ion among den al p o essionals is ound o be a ies om 38% o
100%.(23, 26, 27) Subs an ially, unde g adua e den al s uden s in he p esen esea ch had
posi i e a i udes ega ding accina ions as majo i y s uden s (86.9%) epo ed ha e
been accina ed agains COVID-19 and 75.5% s uden s accina ed agains Hepa i is B,
along wi h o he accines. Rahman e al. epo ed a simila inding (65%) (28).
Ne e heless, his equency is signi ican ly less han ha epo ed in o he ele an
s udies by Al-Mawe i e al. (26) and Ala ian e al. (27), which epo ed g ea e han 80%
equency o hepa i is B accina ion acqui ed by s uden s.
In heal hca e se ings, he bes p e en i e measu e agains c oss-in ec ion is he
app op ia e use o ba ie echniques. A ba ie can be c ea ed agains pa hogens by he
p ope u iliza ion o PPE which includes he use o glo es, masks, eyewea and
p o ec i e gowns.(18) Ou esea ch has epo ed he highes compliancy wi h he use o
glo es (97.5%) and ace masks (93.6%), hese ou comes a e co esponding o he
ou comes o pas esea ches conduc ed in o he coun ies like UAE (28), Saudi A abia
(26) and Ge many (23). Ne e heless, he equency o he use o p o ec i e eyewea and
gowns we e signi ican ly low, 68.4% s uden s used p o ec i e eyewea while only 35%
s uden s we e wea ing gowns a all imes. Howe e , noncompliance wi h he use o
eyewea and gowns is no dis inc i e o Pakis an, signi ican negligence has also been
ound among den al s uden s o o he coun ies like UAE (28) and Saudi A abia (26).
Al hough majo i y s uden s in ou esea ch ha e ag eed ha hey ha e he app op ia e
knowledge o PPE bu u he in es iga ion e ealed ha only hal o he subjec s we e
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awa e wi h he co ec donning and do ing ch onology. This lack o awa eness has also
been epo ed in he s udy conduc ed by Mahmood N., e al., among 204 on line
heal hca e wo ke s only 55.9% and 47.1% we e ha e he accu a e knowledge donning
and do ing ch onology espec i ely.(29).
Besides PPE, an e ec i e means o p e en he ansmission o heal hca e associa ed
in ec ions is o ollow p ope hand hygiene. I is manda o y o e e y heal hca e wo ke
o pe o m accu a e hand hygiene be o e and a e gi ing ea men s. The ecommended
CDC guidelines o p ope hand hygiene in ol es ei he he use o alcohol-based hand
sani ize (wi h 60% alcohol) o hands washing wi h soap and wa e ( o minimum 20
seconds).(18, 21). A good compliance has been epo ed in ou esea ch as majo i y o
s uden s execu e p ope hand hygiene ollowing he emo al o PPE. The e was also
posi i e compliance in handling he PPE was e as majo i y o s uden s disposed o PPE
in a biohaza d bag. Howe e , he e was a signi ican sho age in he a ailable o PPE
by he eaching ins i u es as 72.7% s uden s had o pu chased PPE om ou side which
has c ea ing a po en ial inancial bu den on he s uden s. This conce ning PPE sho age
has also been epo ed in a simila esea ch conduc ed by Mahmood N., e al. (29).
The use o p e- ea men p ophylaxis mou hwash wi h an isep ic solu ion is an e ec i e
means o p e en ing ai bo ne (ae osols) mic oo ganism ansmission inside he den al
clinics. In ou esea ch a signi ican noncompliance has been epo ed because only
one- hi d pa icipan s used he p e ea men an isep ic mou hwashes in pa ien s. This
negligence poin s ou he lack o awa eness among he unde g adua e den al s uden s
owa ds he ae osol dynamics gene a ed in he den al en i onmen . A simila
negligence has also been epo ed in a s udy conduc ed in Saudi A abia by Alha bi G.
e al. (30)
The clinical applica ion o ou esea ch in ends in he ac ha he e is a signi ican lack
o awa eness among unde g adua e den al s uden s ega ding in ec ion con ol
compliance because mo e han wo- hi d s uden s ha e no a ended any so o aining
cou se o session on he in ec ion p e en ion and con ol p o ocols.
Conclusion:
To conclude, unde g adua e den al s uden s in his esea ch epo ed a mode a e le el
o awa eness and a i udes owa ds in ec ion con ol. Fu he mo e, he e we e mode a e
compliance wi h he p o ocols o s anda d p ecau ions alloca ed by CDC. The e was a
signi ican sho age o PPE ha e been epo ed which should be immedia ely add ess
o he managemen o eaching ins i u es and s a e heal h au ho i ies o ensu e he
adequa e supply o PPE o all heal hca e wo ke s especially den is s and den al
pe sonnel o p e en con agious in ec ion ansmission. I should be manda o y o
eaching ins i u es o a ange wo kshops and semina s on p o ocols o s anda d
p ecau ions o unde g adua e den al s uden s o o e come he challenges o
noncompliance.
Limi a ions:
This esea ch had se e al limi a ions ha ha e o be conside : he limi ed sample size,
he i egula gende dis ibu ion, he andom selec ion o pa icipan s, and insu iciency
o bias e alua ion.
h p://am esea ch e iew.com/index.php/Jou nal/abou
Volume 3, Issue 10 (2025)
Online ISSN P in ISSN
. .
3007-3197
3007-3189
h p://am esea ch e iew.com/index.php/Jou nal/abou
Page 669
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