Analyzing The Occupational Exposure Risks of Dental Healthcare Workers from The Perspective of Repeated Occupational Exposure

Analyzing The Occupational Exposure Risks of Dental Healthcare Workers from The Perspective of Repeated Occupational Exposure | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analyzing The Occupational Exposure Risks of Dental Healthcare Workers from The Perspective of Repeated Occupational Exposure Jia Xu, Peiyue Pan, Fuyu Song, Yun Gu, Qiao Xiong, Zhiqing Liu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5038786/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Nov, 2024 Read the published version in BMC Health Services Research → Version 1 posted 13 You are reading this latest preprint version Abstract Background Healthcare workers in dental hospitals frequently experience repeated occupational exposures (ROEs). In our study, we aim to analyze these repeated exposures among dental healthcare workers (DHWs), assess the risk levels of different risk factors, and explore the significance of ROE data for infection control in dental hospitals. Methods Based on hospital statistical data, we categorized the occupational exposure incidents at West China Hospital of Stomatology over the past seven years into initial and repeated exposures. We analyzed the association of various risk factors, including gender, personnel types, treatment locations, timing of occupational exposure, and pathways of occupational exposure, with the occurrence of repeated exposures. The Statistical Package for Social Sciences (SPSS) 21 was used to conduct chi-square analysis and binary logistic regression analysis, with the significance level set at p < 0.05. Results Compared to students, hospital dentists with teaching qualifications exhibited a higher risk of ROEs. The risk of repeated exposure for dental students was only 0.4 times that of hospital dentists (P=0.003). However, gender, treatment locations, timing of occupational exposure, and pathways of occupational exposure did not significantly impact the repeated exposures among DHWs. Conclusions Analyzing ROEs provides practical insights. In dental teaching hospitals, hospital dentists with teaching qualifications, who are often considered experienced, have the highest risk of ROEs. This suggests that the focus of educational efforts should be directed towards this kind of DHWs. occupational exposure dental healthcare workers infection prevention and control dental hospital Figures Figure 1 Figure 2 Introduction Due to the nature of their work and the working environment, healthcare workers often face a higher risk of direct exposure to the spread of infectious diseases and sharp injuries, which frequently results in occupational exposure. Within the healthcare workers, occupational exposure refers to instances where healthcare workers come into contact with hazardous substances or pathogens during the processes of diagnosis, treatment, and care[ 1 ]. This exposure typically involves hazardous substances or pathogens coming into contact with damaged skin through needles, sharp instruments, splashes, or entering the eyes, nose, mouth, and other mucous membranes[ 2 ] These situations can potentially lead to the spread of infectious diseases. According to data from the Centers for Disease Control and Prevention (CDC) in the United States and the European Agency for Safety and Health at Work, healthcare workers in hospitals in the US and Europe report over 385,000 and 1 million cases of needlestick injuries (NSIs) annually, respectively[ 3 ]. The World Health Organization (WHO) estimates that out of the global population of 35 million healthcare workers, around 3 million experience occupational exposure to blood each year[ 4 ]. In studies conducted in developing countries, the incidence of occupational exposure throughout healthcare workers' careers can even reach 100%[ 5 ]. Currently, at least 20 different pathogens are transmitted through occupational exposure, such as Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human Immunodeficiency Virus (HIV)[ 3 , 6 ]. Occupational exposure has become a significant cause of healthcare workers contracting HCV, HBV, and HIV[ 7 ]. It is estimated that annually, more than 150,000, 70,000, and 500 healthcare workers are infected with HCV, HBV, and HIV, respectively, due to occupational exposure[ 4 ]. While management measures for post-exposure to HIV and HBV are relatively well-established, there is currently no vaccine available for HCV, and the effectiveness of post-exposure prevention for HCV is also less than ideal[ 8 ]. These diseases pose catastrophic risks to healthcare workers experiencing occupational exposure. Furthermore, even if actual transmission of infectious diseases does not occur, occupational exposure can have significant negative impacts on the psychological well-being of healthcare workers, the motivation of medical students, and the financial and medical quality burdens on hospitals[ 5 , 9 – 12 ]. In fact, the risk of occupational exposure among dental healthcare workers (DHWs) is exceptionally high, making it one of the professions with the highest exposure risks[ 13 ] On one hand, DHWs frequently encounter infectious patients and pathogens. The oral cavity of a healthy individual serves as a ecological niche for numerous bacteria, fungi, and viruses, thereby providing ample potential pathogens for occupational exposure[ 14 ]. During the diagnosis and treatment of oral diseases, patients are required to remove their masks, exposing the oral and nasal cavities, which may contain pathogens from blood, saliva, and respiratory aerosols, making them more prevalent in dental clinics[ 15 , 16 ]. Moreover, certain systemic infectious diseases exhibit characteristic manifestations in the oral cavity, often leading patients to seek treatment at dental hospital, including bloodborne infections such as AIDS, syphilis, among others[ 17 , 18 ]. Even Hepatitis C infections and treatments can result in symptoms in the oral mucosa[ 19 ]. On the other hand, the treatment of oral and maxillofacial diseases necessitates the frequent use of small, sharp instruments such as files, dental burs, probes, as well as syringe needles, blades, and suturing needles, all of which are commonly utilized during procedures[ 19 , 20 ]. The use and cleaning of sharp instruments undeniably escalate the risk of occupational exposure[ 19 , 20 ]. Furthermore, the treatment procedures for oral diseases often entail working within confined spaces in the oral cavity with limited visibility, both of which contribute to occupational exposure resulting from healthcare workers' procedural errors[ 14 , 20 ]. Two studies from Asia have reported occupational exposure incidence rates of up to 80% among dentists and 61.9% among dental nurses, underscoring the severe challenge of occupational exposure faced by DHWs[ 21 , 22 ]. In reviewing previous studies, we have observed that occupational exposure among healthcare workers, including those in oral medicine, often occurs repeatedly, sometimes within a relatively short time frame[ 2 ]. Rawan et al . indicated that over the past five years, 48.9% of surveyed dentists experienced occupational exposure incidents two or more times[ 22 ]. Similarly, in two dental schools in China, 41% of surveyed dental students reported experiencing occupational exposure incidents two or more times[ 23 ]. While repeated occupational exposures (ROEs) among healthcare workers can have individual factors, it is crucial for infection control departments to pay attention when individuals who have experienced occupational exposure continue to encounter such incidents in their work. These issues may represent common challenges that warrant the attention of all colleagues. Analyzing the risk factors from each individual's perspective regarding ROEs provides a unique viewpoint in studying occupational exposure. Analyzing the reasons, scenarios, and individuals involved in ROEs may facilitate the development of proactive infection control strategies and public health policies. West China Hospital of Stomatology, a top-tier specialized hospital in China for dental medicine, boasts a substantial workforce capable of comprehensive diagnosis and treatment of oral diseases. Our study includes occupational exposure data from this hospital spanning from 2016 to 2022, with a specific focus on analyzing characteristics of ROEs incidents. We aim for this study to uncover the practical significance of ROEs data in hospital infection control. Furthermore, we seek to delve deeper into the occupational exposure risks faced by healthcare workers at West China Stomatology Hospital, especially those associated with sustained occupational exposure. Methods This study adheres to the ethical review guidelines of West China Hospital of Stomatology. Ethical approval was granted by the Medical Ethics Committee of West China Hospital of Stomatology, Sichuan University (Approval No. WCHSIRB-2024-299). This study analyzed the occupational exposure data from the Infection Control Department of West China Hospital of Stomatology, spanning from 2016 to 2022. The data collected from the Infection Control Department included the date of the event, masked personnel IDs (with names hidden), personnel types, clinical operation scenarios, instruments causing the injuries, and the department at the time of the incident. The inclusion criteria were any occupational exposures occurring in outpatient clinics, wards, and clinical auxiliary departments from 2016 to 2022. Excluded from the study were injuries occurring outside the hospital or unrelated to clinical work, as well as data with unclear or incomplete records. In this study, the ROEs were defined as occupational exposure events occurring on the same individual within 7 years, excluding the initial exposure. From the perspective of ROEs, we categorize these occupational exposure incidents into three types. Type A: Occupational exposure incidents involving individuals who experienced exposure only once (no repeated exposure). Type B: First-time exposure incidents for individuals with ROEs. Type C: Incidents occurring after the first exposure event for individuals with ROEs, indicating the ROEs. Personnel types were categorized as follows: hospital dentists, dental students, hospital dental nurses, and dental nurse students. Hospital dentists referred to doctors formally employed by West China Hospital of Stomatology, possessing intermediate or higher professional titles and qualifications to provide clinical guidance to dental students. Dental students refers to dental students conducting clinical internships under the supervision of oral physicians, including both graduate and fifth-year undergraduate students. Hospital dental nurses were nurses officially employed by West China Hospital of Stomatology, qualified to guide clinical internships for dental nurse students. Dental nurse students were nursing students conducting clinical internships in dental care. Treatment locations where occupational exposures occurred were classified as outpatient clinics, surgical operating rooms and wards, emergency departments, and clinical support units. The clinical support units encompass the laboratory department and sterilization supply rooms. We categorize the timing of occupational exposure into three categories: during treatment procedures, during instrument changes, and after treatment. During treatment procedures referred to exposures occurring while healthcare workers were focused on patient care inside the mouth or body. During instrument changes indicated exposures happening when healthcare workers were retrieving or replacing instruments and were injured by improperly handled sharp objects. After treatment referred to exposures occurring while healthcare workers were handling medical waste or sterling instruments. Statistical analysis involved using chi-square tests to assess differences in repeated exposure rates among different personnel types. Binary logistic regression analysis was used to analyze factors related to repeated exposure, including gender, personnel types, treatment locations, the timing of occupational exposure, and pathways of occupational exposure. Statistical significance level was accepted as p < 0.05 Results During the seven-year period from 2016 to 2022, there were a total of 695 occupational exposure incidents at West China Stomatology Hospital, Sichuan University. After excluding visiting physicians and visiting nurses who had been involved in clinical work at the hospital for less than one year, as well as non-clinical reasons for occupational exposure, there were 642 cases of occupational exposure incidents among hospital dentists, dental students, hospital dental nurses, and dental nurse students. From the perspective of ROEs, the number of Type A incidents was 487, Type B incidents numbered 74, and Type C incidents numbered 81. In the 81 cases of ROEs, there were 20 cases among our hospital dentists, 9 among hospital dental nurses, 46 among dental students, and 6 among dental nurse students. Males experienced ROEs 18 times, while females experienced it 63 times. Regarding the timing of repeated exposure, out of the 81 instances, 35 occurred during treatment procedures, 26 during instrument changes, 19 after treatment, and 1 during other timings (the doctor was injured while observing another doctor's procedure). In terms of treatment locations, the majority of incidents happened in outpatient clinics (68 cases), 10 occurred in surgical operating rooms and wards, 2 in emergency departments, and 1 in clinical support units. The main pathway leading to repeated exposure were dental burs, syringe needles, and suture needles, with 19, 16, and 15 occurrences respectively. Additionally, files, probes, splashed liquids, and knives caused 10, 6, 5, and 2 instances of repeated exposure, while other instrument types resulted in 8 instances of repeated exposure (Table 1 ). Table 1 The ROEs in West China Hospital of Stomatology, spanning from 2016 to 2022. Category Details N(%) Treatment locations Outpatient clinics 68(83.95%) Surgical operating rooms and wards 10(12.35%) Emergency departments 2(2.47%) Clinical support units 1(1.23%) Personnel type Hospital dentists 20(24.69%) Hospital dental nurses 9(11.11%) Dental students 46(56.79%) Dental nurse students 6(7.41%) Gender Female 63(77.78%) Male 18(22.22%) Timing During treatment procedures 35(43.21%) During instrument changes 26(32.1%) After treatment 19(23.46%) Others 1(1.23%) Pathway Syringe needles 16(19.75%) Bars 19(23.46%) Suture needles 15(18.52%) Files 10(12.35%) Probes 6(7.41%) Knives 2(2.47%) Splashed liquids 5(6.17%) Others 8(9.88%) We further analyzed the characteristics of repeated exposure events and first-time occupational exposure events. Table 2 illustrates the differences in work settings, roles, genders, timing of exposure incidents, and exposure sources between repeated exposure and initial exposure. According to the chi-square test for independence, there is a significant difference in the repeated occupational exposure among different personnel types (Table 2 , P = 0.015). In addition, the variables of gender, treatment locations, the timing of occupational exposure, and pathways of occupational exposure did not demonstrate a significant association with ROEs. Table 2 Comparison between the ROEs and the initial occupational exposure, spanning from 2016 to 2022. Repeated occupational exposure Category Details No Yes p-value N(%) N(%) Treatment locations Outpatient clinics 472(84.14%) 68(83.95%) 0.758 Surgical operating rooms and wards 52(9.27%) 10(12.35%) Emergency departments 24(4.28%) 2(2.47%) Clinical support units 13(2.32%) 1(1.23%) Personnel type Hospital dentists 66(11.76%) 20(24.69%) 0.015 Hospital dental nurses 59(10.52%) 9(11.11%) Dental students 382(68.09%) 46(56.79%) Dental nurse students 54(9.63%) 6(7.41%) Gender Female 418(74.51%) 63(77.78%) 0.585 Male 143(25.49%) 18(22.22%) Timing During treatment procedures 239(42.6%) 35(43.21%) 0.378 During instrument changes 138(24.6%) 26(32.1%) After treatment 171(30.48%) 19(23.46%) Others 13(2.32%) 1(1.23%) Pathway Syringe needles 126(22.46%) 16(19.75%) 0.423 Bars 113(20.14%) 19(23.46%) Suture needles 63(11.23%) 15(18.52%) Files 59(10.52%) 10(12.35%) Probes 48(8.56%) 6(7.41%) Knives 42(7.49%) 2(2.47%) Splashed liquids 42(7.49%) 5(6.17%) Others 68(12.12%) 8(9.88%) Next, we established a binary logistic regression model, and the result of the Hosmer-Lemeshow test showed p = 0.994, indicating a good fit of the binary logistic regression model. According to the binary logistic regression results, the risk of repeated exposure for dental students is 0.4 times that of hospital dentists (CI:0.22,0.73, p = 0.003), or in other words, hospital dentists have a higher risk of ROEs compared to dental students. The risk of repeated exposure for dental nurse students is approximately 0.39 times that of hospital dentists, with a slight significance (p = 0.09). From the perspective of pathways, compared to knives, suturing needles pose a higher risk of the ROEs (OR = 5.37, p = 0.04). (Table 3 ) Table 3 Odds ratios of the association between variables and the ROEs. Category Details OR(Cl 95%) p-value gender Female 1 male 0.71(0.39,1.32) 0.282 Personnel type Hospital dentists 1 Hospital dental nurses 0.57(0.21,1.55) 0.275 Dental students 0.40(0.22,0.73) 0.003 Dental nurse students 0.39(0.13,1.16) 0.090 Timing During treatment procedures 1 During instrument changes 1.48(0.73,3.00) 0.271 After treatment 0.99(0.47,2.10) 0.978 Others 0.66(0.08,5.75) 0.708 Treatment locations Outpatient clinics 1 Surgical operating rooms and wards 0.95(0.39,2.30) 0.947 Emergency departments 0.40(0.08,1.93) 0.402 Clinical support units 0.67(0.08,5.68) 0.673 Pathway Knives 1 Bars 2.64(0.56,12.38) 0.219 Suture needles 5.37(1.08,26.74) 0.040 Files 2.51(0.50,12.56) 0.263 Probes 2.41(0.45,12.81) 0.304 Syringe needles 2.24(0.48,10.49) 0.308 Splashed liquids 2.48(0.44,13.85) 0.300 Others 2.26(0.45,11.41) 0.325 We also summarized the reasons for the ROEs in the same individual (B and C type incidents). From the perspective of timing, 40 out of 81 repeated exposures (49.4%) occurred during the same operational circumstances as previous exposures(Fig. 1 ). Besides, among the 81 repeated exposures, 20 instances (24.7%) shared the same pathway as previous occupational exposures (Fig. 2 ). Discussion As mentioned earlier, healthcare workers in dental hospitals often face a high risk of occupational exposure. One of the manifestations of this high risk is the phenomenon of ROEs among healthcare workers. Reviewing previous studies, a substantial body of literature has reported the serious issue of ROEs among DHWs[ 22 , 23 ]. Analyzing the hospital infection exposure data from 2016 to 2022, we found a significant number of individuals experiencing ROEs within the hospital. This piqued our interest in analyzing these ROEs events from the records, as we believe it holds significant importance. Firstly, ROEs may reflect underlying issues that need addressing in hospital infection control. Factors leading to repeated exposure may signify loopholes in protocols or areas where operational procedures need improvement. Understanding which occupational exposures are harder for healthcare workers to avoid can guide hospitals in targeted occupational exposure prevention training. Secondly, studying ROEs helps in a more precise analysis of risk factors. Due to challenges in attaining the number of service instances, relying solely on questionnaire data often yields a composition ratio of occupational exposure influencing factors. While this ratio somewhat reflects factors contributing to occupational exposure, it's not the best indicator of risk factors. Analyzing repeated exposure data allows for calculating the repeated exposure rates among different personnel types, providing a more accurate reflection of exposure risks across various professions. Lastly, studying ROEs in records helps reduce errors caused by underreporting. Many past studies have shown that even with strict reporting requirements for occupational exposure in healthcare institutions, a significant number of cases still go unreported[ 24 ]. This limitation affects exposure rates and the calculation and analysis of risk factors based on hospital records. However, studying repeated exposure events in hospital records allows for analyzing the rates and risk factors of repeated exposure within a relatively willing-to-report group at least, potentially reducing errors caused by underreporting and providing a more accurate understanding of risk factor severity. In our study, we compared the relationship between the ROEs and initial occupational exposure in terms of personnel type, gender, operational scenarios, exposure sources, and department categories. Clinical staff in a university-affiliated dental teaching hospital can be categorized into four roles: hospital dentists, dental students, hospital dental nurses, and dental nurse students. Previous research has suggested that the type of personnel can influence the occurrence of occupational exposure due to differences in skill levels. Typically, students are considered to face a relatively high risk of occupational exposure, possibly even higher than their supervisors, due to their lack of experience[ 20 , 23 , 25 , 26 ]. Consequently, the focus of occupational exposure education has traditionally leaned towards students. However, in our study, we analyzed the proportion of ROEs among different personnel types from the perspective of repeated exposure. Surprisingly, hospital dentists had the highest proportion of ROEs over these seven years, and this finding was statistically significant. In contrast, the risk of the ROEs was lower for dental students and dental nurse students. It is undeniable that hospital dentists often engage in more complex and intricate tasks, which may increase the risk of occupational exposure. Previous research has also found that more experienced doctors may be less inclined to adhere to occupational exposure prevention strategies[ 22 , 27 ]. And our data also reflect that the awareness of occupational exposure prevention among hospital dentists in our hospital may be insufficient. Hospital dentists may be the focal group for occupational exposure education in the foreseeable future. Gender is one of the factors influencing occupational exposure. However, previous studies have shown varying impacts of gender on occupational exposure due to differences in study populations. A study conducted in Australia focusing on dentists and dental students indicated that females were more likely to experience occupational exposure in the form of needlestick injuries[ 20 ]. Some studies suggest that males are more prone to occupational exposure, with male healthcare workers even facing significantly higher risks compared to females[ 28 , 29 ]. In our study, we examined the risk of ROEs among male and female healthcare workers in dental hospitals and found no significant differences, not even slight ones. This finding aligns with many other studies that have not observed significant gender differences in occupational exposure[ 22 , 30 ]. While gender may influence an individual's fear of occupational exposure events and adherence to operational standards[ 31 ], we believe that these influences can be mitigated through training and other factors, which may explain the lack of significant gender impact on ROEs in our study. Due to the varying nature of work undertaken in different areas of a hospital, occupational exposure risks differ across these settings. Previous research has commonly indicated that operating rooms, where frequent contact with patient fluids and sharp instruments is required, are associated with higher risks of occupational exposure. Studies from King Khaled Eye Specialist Hospital have shown that, for ophthalmologists, the operating room accounts for 60.7% of needlestick-related occupational exposure events[ 6 ]. Research from Ethiopia also highlights the operating room as the most common site for bloodborne occupational exposure[ 4 ]. Additionally, the nature of emergency work may be related to the occurrence of occupational exposure; the high intensity of emergency work and inadequate rest can elevate exposure risks[ 32 , 33 ]. In our study, we categorized workplaces within a dental hospital as outpatient clinics, surgical operating rooms and wards, emergency departments, and clinical support units. The results indicated no significant differences in causing ROEs among outpatient clinics, surgical operating rooms and wards, emergency departments, and clinical support units in our hospital. Many dental procedures are performed in outpatient clinics, where healthcare workers frequently come into contact with high-speed rotating burs, various sharp instruments, patient fluids, and aerosols. From this perspective, outpatient departments in dental hospitals are also common sites for occupational exposure. Previous research has not extensively explored the occupational exposure risks between departments in dental hospitals. We believe that various workplaces in dental hospitals may carry higher risks of occupational exposure, particularly outpatient clinics whose risks should not be underestimated and may be similarly high as those in ward and operating rooms. However, we acknowledge that the sample size of exposure events in emergency rooms and non-clinical departments in this study is limited, and the analysis results may deviate from real-world scenarios. Many studies have paid great attention to the pathways of occupational exposure[ 4 , 14 , 20 , 33 ]. Various dental procedures performed by dentists often involve the use of high-speed dental handpieces and sharp instruments, which are essential tools for treating most oral diseases[ 34 ]. Occupational exposures frequently involve sharp instruments[ 34 ], and in this study, sharp instruments were identified as the primary cause of occupational exposure. Both initial and ROEs commonly involve injection needles, dental burs, suturing needles, files, probes, and knives. Dental prosthesis, orthodontic appliances, and sharp teeth of patients can also cause occupational exposures and repeated exposures, although data on these are relatively limited in this study. Additionally, aerosols and spatter generated during procedures such as high-speed dental handpiece use and irrigation are important pathways for occupational exposure. In our study, we compared the proportions of these pathways between initial and ROEs and found mostly no significant differences. However, in the analysis using binary logistic regression, the risk of ROEs due to suturing needles was over five times higher compared to scalpels and was statistically significant. Nevertheless, due to the small sample size, further research is needed to verify whether this result reflects clinical practice. Therefore, these factors can be considered equally important in causing ROEs among DHWs, and no pathway should be disregarded by healthcare workers themselves or hospital infection control departments. Furthermore, our statistical analysis of the reasons for multiple occupational exposures in the same individual showed that the proportion of repeated exposures through the same pathway was as high as 24.7%(Fig. 2 ). It is important to note that many exposure pathways can be prevented through simple preventive measures. For instance, wearing face shields and goggles can protect against exposure caused by splashing and spattering. Despite this, statistics still show that some healthcare workers experience ROEs due to splashes, indicating a lack of seriousness among a minority of healthcare workers regarding occupational exposure. This suggests that many healthcare workers may not have learned from previous exposures, which could also indicate insufficient training provided by hospitals. From another perspective, current control strategies are not yet sufficient to completely prevent occupational exposures caused by certain pathways (especially sharp injuries and needlesticks). Hospitals need to strengthen training for healthcare workers and develop updated control strategies. Occupational exposure is commonly associated with the patient treatment process. In previous research, the challenges faced during treatment procedures are considered the greatest due to the limited space, poor visibility, and patient movements[ 19 , 21 , 23 ]. However, during our statistical analysis, we found that occupational exposures occurring during treatment procedures are only a part of the overall occupational exposure. Unfortunately, many occupational exposures also occur during instrument changes and after treatment. Our results show that the risk of repeated exposures during these three timings does not significantly differ. This implies that all three timings require healthcare workers' attention and caution. Further analysis of 81 ROEs incidents revealed that 49.4% of these occurred during the same timing as previous exposures(Fig. 1 ). Although this striking figure may be related to broad grouping in the study, it does reflect the level of occupational exposure risk during these three timings. Occupational exposures during instrument changes and after treatment are particularly concerning, which may be related to healthcare workers' attitudes and hospital training. Ensuring standardized procedures and protocols is crucial in reducing occupational exposure risks. We believe that data on ROEs can guide the direction of infection control efforts in hospitals. Analyzing data on ROEs can help identify high-risk groups within the hospital for occupational exposures. Consequently, we can provide more targeted prevention education for individuals experiencing ROEs, which is advantageous for achieving better control of occupational exposures with limited resources. Targeted prevention and control training should involve intensifying training efforts for high-risk groups while providing more effective educational methods. Some studies suggest that solely providing occupational training or skill training may not effectively reduce the occurrence of occupational exposures[ 21 ]. Some conventional teaching methods often convey knowledge that is dry, difficult to understand, and not synchronized with clinical work[ 21 ]. Tailored prevention education for different groups is necessary; for instance, experienced doctors may not be engaged by generic educational materials. Research from Iran suggests that enhancing healthcare workers' perception of risks and understanding the severity of occupational exposure risks may be crucial for improving occupational exposure control[ 35 ]. ROEs may also indicate areas for improvement in equipment and operational processes. Previous research has indicated that using safer equipment and adopting safer operational procedures are undoubtedly beneficial for reducing occupational exposures[ 36 , 37 ]. The occurrence of ROEs may indicate deficiencies in certain instruments or operational procedures in terms of safety. For example, research suggests that avoiding unnecessary use of sharp suturing needles can reduce needlestick injuries[ 38 ]. High-quality evidence demonstrates that using blunt needles significantly reduces the risk of surgical personnel and their assistants contracting infectious diseases during a series of surgeries by reducing the number of needlestick injuries[ 9 ]. This approach may also be applicable in dentistry. Furthermore, reducing occupational exposures occurring during non-treatment operations is also a critical area for consideration. Currently, researchers are also working on developing new medical waste disposal devices, instruments transfer, and retrieval devices in an attempt to reduce occupational exposures[ 39 , 40 ]. Although ideal results have not yet been achieved, we believe that improving the usability and effectiveness of medical waste disposal devices may be a crucial pathway to reducing persistent occupational exposures. Conclusions Analyzing ROEs provides practical insights. In dental teaching hospitals, hospital dentists with teaching qualifications are more likely to experience repeated exposures compared to students. This suggests that the focus of educational efforts should be directed towards this kind of DHWs. Additionally, there are no significant differences in the impact of different treatment locations, timing and pathways of occupational exposure on the occurrence of ROEs. However, it is important to acknowledge that these factors may present equally high risks, and maintaining vigilance towards them is essential. Declarations Ethics approval and consent to participate Ethical approval was granted by the Medical Ethics Committee of West China Hospital of Stomatology, Sichuan University (Approval No. WCHSIRB-2024-299). Consent for publication Not applicable Availability of data and materials Data will be made available on reasonable request Competing interests The authors declare that they have no competing interests. Funding This work was financially supported by the Hospital Infection Prevention and Control Research Fund from Sichuan Preventive Medicine Association (SCGK202103). Authors' contributions All authors participated in the study. The study design was conducted by YZ, ZL and JX. Material preparation was performed by YZ and QX. Data analysis was performed by JX, PP and FS. The manuscript was written by JX, PP and YG. All authors have read and approved the final version of the manuscript. Acknowledgements We acknowledge and thank all individuals and departments that supported this research. References Hosseinipalangi Z, Golmohammadi Z, Ghashghaee A, Ahmadi N, Hosseinifard H, Mejareh ZN, Dehnad A, Aghalou S, Jafarjalal E, Aryankhesal A et al : Global, regional and national incidence and causes of needlestick injuries: a systematic review and meta-analysis . East Mediterr Health J 2022, 28 (3):233-241. 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Huynh R, Du D, Im JH, Zachar J, Zafar S: Identifying Trends of Percutaneous Injuries at an Australian Dental School . Int Dent J 2022, 72 (3):308-314. Yuan H, Shi R, Chen W, Ma Y, Liu Z, Liu F, Yang J: Evaluating occupational exposures of dental nurses: A retrospective study . Front Public Health 2022, 10 :1010531. Al-Sharif R, Husseini A: Assessment of adherence to infection prevention and control guidelines among dentists in the West Bank and Jerusalem . East Mediterr Health J 2023, 29 (3):205-211. Wu L, Yin YL, Song JL, Chen Y, Wu YF, Zhao L: Knowledge, attitudes and practices surrounding occupational blood-borne pathogen exposure amongst students in two Chinese dental schools . Eur J Dent Educ 2016, 20 (4):206-212. Xu X, Yin Y, Wang H, Wang F: Prevalence of needle-stick injury among nursing students: A systematic review and meta-analysis . Front Public Health 2022, 10 :937887. Younai FS, Murphy DC, Kotelchuck D: Occupational exposures to blood in a dental teaching environment: results of a ten-year surveillance study . J Dent Educ 2001, 65 (5):436-448. Liu Y, Li Y, Yuan S, Ma W, Chen S, Wang LY: Risk Factors for Occupational Blood Exposure, Compliance with Policies of Infection Prevention and Control, and Costs Associated with Post Exposure Management Among Nursing Staff . Infect Drug Resist 2024, 17 :1215-1228. Vijendren A, Sanchez J, Yung M: Incidence and reporting of sharps injuries amongst ENT surgeons . J Laryngol Otol 2016, 130 (6):581-586. Savić Pavičin I, Lovrić Ž, Zymber Çeshko A, Vodanović M: Occupational Injuries among Dentists in Croatia . Acta Stomatol Croat 2020, 54 (1):51-59. Dilie A, Amare D, Gualu T: Occupational Exposure to Needle Stick and Sharp Injuries and Associated Factors among Health Care Workers in Awi Zone, Amhara Regional State, Northwest Ethiopia, 2016 . J Environ Public Health 2017, 2017 :2438713. Al-Abhar N, Moghram GS, Al-Gunaid EA, Al Serouri A, Khader Y: Occupational Exposure to Needle Stick Injuries and Hepatitis B Vaccination Coverage Among Clinical Laboratory Staff in Sana'a, Yemen: Cross-Sectional Study . JMIR Public Health Surveill 2020, 6 (1):e15812. Kotelchuck D, Murphy D, Younai F: Impact of underreporting on the management of occupational bloodborne exposures in a dental teaching environment . J Dent Educ 2004, 68 (6):614-622. Mousavi SM, Yazdanirad S, Althubiti S, Majdabadi MA, Najarian F, Sepehr P: Determination and prioritization of factors affecting the occurrence of needle stick injuries among healthcare workers using techniques of Delphi and fuzzy analytical hierarchy process (FAHP) . BMC Public Health 2023, 23 (1):2009. Jahangiri M, Rostamabadi A, Hoboubi N, Tadayon N, Soleimani A: Needle Stick Injuries and their Related Safety Measures among Nurses in a University Hospital, Shiraz, Iran . Saf Health Work 2016, 7 (1):72-77. Liang Y, Yue L: Evolution and development: engine-driven endodontic rotary nickel-titanium instruments . Int J Oral Sci 2022, 14 (1):12. Alinejad N, Bijani M, Malekhosseini M, Nasrabadi M, Harsini PA, Jeihooni AK: Effect of educational intervention based on health belief model on nurses' compliance with standard precautions in preventing needle stick injuries . BMC Nurs 2023, 22 (1):180. Jovic-Vranes A, Jankovic S, Vranes B: Safety practice and professional exposure to blood and blood-containing materials in serbian health care workers . J Occup Health 2006, 48 (5):377-382. Tarigan LH, Cifuentes M, Quinn M, Kriebel D: Prevention of needle-stick injuries in healthcare facilities: a meta-analysis . Infect Control Hosp Epidemiol 2015, 36 (7):823-829. Sibanda T: Needle stick injuries are a preventable healthcare hazard . Bjog 2008, 115 (12):1579; author reply 1579-1580. Kim SM, Kim T, Lee JH, Cho SY, Cha WC: Effect of the Automatic Needle Destroyer on Healthcare Providers' Work in an Emergency Department: A Mixed-Methods Study . Healthc Inform Res 2022, 28 (2):123-131. Schuurmans J, Lutgens SP, Groen L, Schneeberger PM: Do safety engineered devices reduce needlestick injuries? J Hosp Infect 2018, 100 (1):99-104. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 11 Nov, 2024 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 27 Sep, 2024 Reviews received at journal 26 Sep, 2024 Reviewers agreed at journal 24 Sep, 2024 Reviews received at journal 24 Sep, 2024 Reviews received at journal 22 Sep, 2024 Reviewers agreed at journal 21 Sep, 2024 Reviewers agreed at journal 21 Sep, 2024 Reviewers agreed at journal 20 Sep, 2024 Reviewers invited by journal 20 Sep, 2024 Editor invited by journal 09 Sep, 2024 Editor assigned by journal 07 Sep, 2024 Submission checks completed at journal 07 Sep, 2024 First submitted to journal 05 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5038786","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":359870626,"identity":"2c152255-6b27-4e76-a4c4-e76899570e05","order_by":0,"name":"Jia Xu","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Jia","middleName":"","lastName":"Xu","suffix":""},{"id":359870627,"identity":"b0d51a3e-48d2-4686-a1ee-345b03855945","order_by":1,"name":"Peiyue Pan","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Peiyue","middleName":"","lastName":"Pan","suffix":""},{"id":359870628,"identity":"c06ff21d-b465-428d-b0b5-cbb937ed8420","order_by":2,"name":"Fuyu Song","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Fuyu","middleName":"","lastName":"Song","suffix":""},{"id":359870629,"identity":"5cf8ace8-116d-466b-82d0-228b76bbe411","order_by":3,"name":"Yun Gu","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Yun","middleName":"","lastName":"Gu","suffix":""},{"id":359870630,"identity":"c09df6af-915c-458c-af86-c9eb93a25573","order_by":4,"name":"Qiao Xiong","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Qiao","middleName":"","lastName":"Xiong","suffix":""},{"id":359870631,"identity":"e9d566ae-7658-4b38-8b92-315c07fe0419","order_by":5,"name":"Zhiqing Liu","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Zhiqing","middleName":"","lastName":"Liu","suffix":""},{"id":359870632,"identity":"22ce75e7-7f1d-4fb8-8947-d7da71d17b76","order_by":6,"name":"Yi Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIie3RMQrCMBSA4VcCdUmtk0QceoUUV9GrpBQ61b1jBqlXaPESjo4vZM0NXATBueIqaKvObUbB/FOG9/FIAuBy/WQEMXksV0DaQ1NYET/Bm8xSGJWJqowVoQtVS+1JahY62FqAqMqEDo6EAMsbDCRE4RT7iVelqAPjj4FtDjg7QlzvRT8hrN1CfUreJDYg+GmA+CznLWGeZPkZk9KC0JaouuTd9QGVDWH0KrAxontkrqRhw3eJdqluRPHsvvJyfxTLKJwPEJh8B9b42Tow3hWixZDL5XL9dy+f40tnJyDMfQAAAABJRU5ErkJggg==","orcid":"","institution":"Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Yi","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2024-09-05 14:08:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5038786/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5038786/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-024-11774-7","type":"published","date":"2024-11-11T15:57:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":66369957,"identity":"c8736172-d4aa-480f-985b-f1aa33a3e8f3","added_by":"auto","created_at":"2024-10-11 04:24:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":42022,"visible":true,"origin":"","legend":"\u003cp\u003eThe proportion of ROEs occurring due to the same timing as previous exposures.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5038786/v1/e34c44e82e02ece33b1c2dbf.png"},{"id":66369958,"identity":"37bcb403-4862-400d-8f47-b86e2405da53","added_by":"auto","created_at":"2024-10-11 04:24:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":57675,"visible":true,"origin":"","legend":"\u003cp\u003eThe proportion of ROEs occurring due to the same pathway as previous exposures.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5038786/v1/6d80d72bd9834059ff3a2c25.png"},{"id":69285224,"identity":"670b0413-2ced-415d-9c91-1ccda77f7efb","added_by":"auto","created_at":"2024-11-18 19:24:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1752324,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5038786/v1/b51fb40a-046e-499e-8108-aec8abce9e98.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analyzing The Occupational Exposure Risks of Dental Healthcare Workers from The Perspective of Repeated Occupational Exposure","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDue to the nature of their work and the working environment, healthcare workers often face a higher risk of direct exposure to the spread of infectious diseases and sharp injuries, which frequently results in occupational exposure. Within the healthcare workers, occupational exposure refers to instances where healthcare workers come into contact with hazardous substances or pathogens during the processes of diagnosis, treatment, and care[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This exposure typically involves hazardous substances or pathogens coming into contact with damaged skin through needles, sharp instruments, splashes, or entering the eyes, nose, mouth, and other mucous membranes[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] These situations can potentially lead to the spread of infectious diseases. According to data from the Centers for Disease Control and Prevention (CDC) in the United States and the European Agency for Safety and Health at Work, healthcare workers in hospitals in the US and Europe report over 385,000 and 1\u0026nbsp;million cases of needlestick injuries (NSIs) annually, respectively[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The World Health Organization (WHO) estimates that out of the global population of 35\u0026nbsp;million healthcare workers, around 3\u0026nbsp;million experience occupational exposure to blood each year[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In studies conducted in developing countries, the incidence of occupational exposure throughout healthcare workers' careers can even reach 100%[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, at least 20 different pathogens are transmitted through occupational exposure, such as Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human Immunodeficiency Virus (HIV)[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Occupational exposure has become a significant cause of healthcare workers contracting HCV, HBV, and HIV[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It is estimated that annually, more than 150,000, 70,000, and 500 healthcare workers are infected with HCV, HBV, and HIV, respectively, due to occupational exposure[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. While management measures for post-exposure to HIV and HBV are relatively well-established, there is currently no vaccine available for HCV, and the effectiveness of post-exposure prevention for HCV is also less than ideal[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These diseases pose catastrophic risks to healthcare workers experiencing occupational exposure. Furthermore, even if actual transmission of infectious diseases does not occur, occupational exposure can have significant negative impacts on the psychological well-being of healthcare workers, the motivation of medical students, and the financial and medical quality burdens on hospitals[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn fact, the risk of occupational exposure among dental healthcare workers (DHWs) is exceptionally high, making it one of the professions with the highest exposure risks[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] On one hand, DHWs frequently encounter infectious patients and pathogens. The oral cavity of a healthy individual serves as a ecological niche for numerous bacteria, fungi, and viruses, thereby providing ample potential pathogens for occupational exposure[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. During the diagnosis and treatment of oral diseases, patients are required to remove their masks, exposing the oral and nasal cavities, which may contain pathogens from blood, saliva, and respiratory aerosols, making them more prevalent in dental clinics[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Moreover, certain systemic infectious diseases exhibit characteristic manifestations in the oral cavity, often leading patients to seek treatment at dental hospital, including bloodborne infections such as AIDS, syphilis, among others[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Even Hepatitis C infections and treatments can result in symptoms in the oral mucosa[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. On the other hand, the treatment of oral and maxillofacial diseases necessitates the frequent use of small, sharp instruments such as files, dental burs, probes, as well as syringe needles, blades, and suturing needles, all of which are commonly utilized during procedures[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The use and cleaning of sharp instruments undeniably escalate the risk of occupational exposure[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Furthermore, the treatment procedures for oral diseases often entail working within confined spaces in the oral cavity with limited visibility, both of which contribute to occupational exposure resulting from healthcare workers' procedural errors[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Two studies from Asia have reported occupational exposure incidence rates of up to 80% among dentists and 61.9% among dental nurses, underscoring the severe challenge of occupational exposure faced by DHWs[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn reviewing previous studies, we have observed that occupational exposure among healthcare workers, including those in oral medicine, often occurs repeatedly, sometimes within a relatively short time frame[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Rawan \u003cem\u003eet al\u003c/em\u003e. indicated that over the past five years, 48.9% of surveyed dentists experienced occupational exposure incidents two or more times[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Similarly, in two dental schools in China, 41% of surveyed dental students reported experiencing occupational exposure incidents two or more times[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. While repeated occupational exposures (ROEs) among healthcare workers can have individual factors, it is crucial for infection control departments to pay attention when individuals who have experienced occupational exposure continue to encounter such incidents in their work. These issues may represent common challenges that warrant the attention of all colleagues. Analyzing the risk factors from each individual's perspective regarding ROEs provides a unique viewpoint in studying occupational exposure. Analyzing the reasons, scenarios, and individuals involved in ROEs may facilitate the development of proactive infection control strategies and public health policies.\u003c/p\u003e \u003cp\u003eWest China Hospital of Stomatology, a top-tier specialized hospital in China for dental medicine, boasts a substantial workforce capable of comprehensive diagnosis and treatment of oral diseases. Our study includes occupational exposure data from this hospital spanning from 2016 to 2022, with a specific focus on analyzing characteristics of ROEs incidents. We aim for this study to uncover the practical significance of ROEs data in hospital infection control. Furthermore, we seek to delve deeper into the occupational exposure risks faced by healthcare workers at West China Stomatology Hospital, especially those associated with sustained occupational exposure.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This study adheres to the ethical review guidelines of West China Hospital of Stomatology. Ethical approval was granted by the Medical Ethics Committee of West China Hospital of Stomatology, Sichuan University (Approval No. WCHSIRB-2024-299).\u003c/p\u003e \u003cp\u003eThis study analyzed the occupational exposure data from the Infection Control Department of West China Hospital of Stomatology, spanning from 2016 to 2022. The data collected from the Infection Control Department included the date of the event, masked personnel IDs (with names hidden), personnel types, clinical operation scenarios, instruments causing the injuries, and the department at the time of the incident. The inclusion criteria were any occupational exposures occurring in outpatient clinics, wards, and clinical auxiliary departments from 2016 to 2022. Excluded from the study were injuries occurring outside the hospital or unrelated to clinical work, as well as data with unclear or incomplete records.\u003c/p\u003e \u003cp\u003eIn this study, the ROEs were defined as occupational exposure events occurring on the same individual within 7 years, excluding the initial exposure. From the perspective of ROEs, we categorize these occupational exposure incidents into three types. Type A: Occupational exposure incidents involving individuals who experienced exposure only once (no repeated exposure). Type B: First-time exposure incidents for individuals with ROEs. Type C: Incidents occurring after the first exposure event for individuals with ROEs, indicating the ROEs.\u003c/p\u003e \u003cp\u003ePersonnel types were categorized as follows: hospital dentists, dental students, hospital dental nurses, and dental nurse students. Hospital dentists referred to doctors formally employed by West China Hospital of Stomatology, possessing intermediate or higher professional titles and qualifications to provide clinical guidance to dental students. Dental students refers to dental students conducting clinical internships under the supervision of oral physicians, including both graduate and fifth-year undergraduate students. Hospital dental nurses were nurses officially employed by West China Hospital of Stomatology, qualified to guide clinical internships for dental nurse students. Dental nurse students were nursing students conducting clinical internships in dental care.\u003c/p\u003e \u003cp\u003eTreatment locations where occupational exposures occurred were classified as outpatient clinics, surgical operating rooms and wards, emergency departments, and clinical support units. The clinical support units encompass the laboratory department and sterilization supply rooms.\u003c/p\u003e \u003cp\u003eWe categorize the timing of occupational exposure into three categories: during treatment procedures, during instrument changes, and after treatment. During treatment procedures referred to exposures occurring while healthcare workers were focused on patient care inside the mouth or body. During instrument changes indicated exposures happening when healthcare workers were retrieving or replacing instruments and were injured by improperly handled sharp objects. After treatment referred to exposures occurring while healthcare workers were handling medical waste or sterling instruments.\u003c/p\u003e \u003cp\u003eStatistical analysis involved using chi-square tests to assess differences in repeated exposure rates among different personnel types. Binary logistic regression analysis was used to analyze factors related to repeated exposure, including gender, personnel types, treatment locations, the timing of occupational exposure, and pathways of occupational exposure. Statistical significance level was accepted as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the seven-year period from 2016 to 2022, there were a total of 695 occupational exposure incidents at West China Stomatology Hospital, Sichuan University. After excluding visiting physicians and visiting nurses who had been involved in clinical work at the hospital for less than one year, as well as non-clinical reasons for occupational exposure, there were 642 cases of occupational exposure incidents among hospital dentists, dental students, hospital dental nurses, and dental nurse students.\u003c/p\u003e \u003cp\u003eFrom the perspective of ROEs, the number of Type A incidents was 487, Type B incidents numbered 74, and Type C incidents numbered 81.\u003c/p\u003e \u003cp\u003eIn the 81 cases of ROEs, there were 20 cases among our hospital dentists, 9 among hospital dental nurses, 46 among dental students, and 6 among dental nurse students. Males experienced ROEs 18 times, while females experienced it 63 times. Regarding the timing of repeated exposure, out of the 81 instances, 35 occurred during treatment procedures, 26 during instrument changes, 19 after treatment, and 1 during other timings (the doctor was injured while observing another doctor's procedure). In terms of treatment locations, the majority of incidents happened in outpatient clinics (68 cases), 10 occurred in surgical operating rooms and wards, 2 in emergency departments, and 1 in clinical support units. The main pathway leading to repeated exposure were dental burs, syringe needles, and suture needles, with 19, 16, and 15 occurrences respectively. Additionally, files, probes, splashed liquids, and knives caused 10, 6, 5, and 2 instances of repeated exposure, while other instrument types resulted in 8 instances of repeated exposure (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe ROEs in West China Hospital of Stomatology, spanning from 2016 to 2022.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDetails\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c4\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment locations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutpatient clinics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68(83.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical operating rooms and wards\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10(12.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency departments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(2.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical support units\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonnel type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(24.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital dental nurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(11.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDental students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46(56.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDental nurse students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(7.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63(77.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(22.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTiming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring treatment procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35(43.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring instrument changes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26(32.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19(23.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathway\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSyringe needles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(19.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBars\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19(23.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuture needles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(18.52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFiles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10(12.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProbes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(7.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(2.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSplashed liquids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(6.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(9.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe further analyzed the characteristics of repeated exposure events and first-time occupational exposure events. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the differences in work settings, roles, genders, timing of exposure incidents, and exposure sources between repeated exposure and initial exposure. According to the chi-square test for independence, there is a significant difference in the repeated occupational exposure among different personnel types (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, P\u0026thinsp;=\u0026thinsp;0.015). In addition, the variables of gender, treatment locations, the timing of occupational exposure, and pathways of occupational exposure did not demonstrate a significant association with ROEs.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison between the ROEs and the initial occupational exposure, spanning from 2016 to 2022.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eRepeated occupational exposure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDetails\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment locations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutpatient clinics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e472(84.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68(83.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.758\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical operating rooms and wards\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(9.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(12.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency departments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(4.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(2.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical support units\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(2.32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(1.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePersonnel type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHospital dentists\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e66(11.76%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e20(24.69%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHospital dental nurses\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e59(10.52%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e9(11.11%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDental students\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e382(68.09%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e46(56.79%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDental nurse students\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e54(9.63%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e6(7.41%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e418(74.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63(77.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143(25.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(22.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTiming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring treatment procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e239(42.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35(43.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.378\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring instrument changes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138(24.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26(32.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e171(30.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(23.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(2.32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(1.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathway\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSyringe needles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126(22.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(19.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.423\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBars\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113(20.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(23.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuture needles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63(11.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(18.52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFiles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59(10.52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(12.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProbes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48(8.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(7.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(7.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(2.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSplashed liquids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(7.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(6.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68(12.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(9.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNext, we established a binary logistic regression model, and the result of the Hosmer-Lemeshow test showed p\u0026thinsp;=\u0026thinsp;0.994, indicating a good fit of the binary logistic regression model. According to the binary logistic regression results, the risk of repeated exposure for dental students is 0.4 times that of hospital dentists (CI:0.22,0.73, p\u0026thinsp;=\u0026thinsp;0.003), or in other words, hospital dentists have a higher risk of ROEs compared to dental students. The risk of repeated exposure for dental nurse students is approximately 0.39 times that of hospital dentists, with a slight significance (p\u0026thinsp;=\u0026thinsp;0.09). From the perspective of pathways, compared to knives, suturing needles pose a higher risk of the ROEs (OR\u0026thinsp;=\u0026thinsp;5.37, p\u0026thinsp;=\u0026thinsp;0.04). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOdds ratios of the association between variables and the ROEs.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDetails\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOR(Cl 95%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.71(0.39,1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePersonnel type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital dentists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital dental nurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.57(0.21,1.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDental students\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.40(0.22,0.73)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDental nurse students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.39(0.13,1.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTiming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring treatment procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuring instrument changes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.48(0.73,3.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.271\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.99(0.47,2.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.978\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.66(0.08,5.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment locations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutpatient clinics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical operating rooms and wards\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.95(0.39,2.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency departments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.40(0.08,1.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical support units\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.67(0.08,5.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePathway\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKnives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBars\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.64(0.56,12.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSuture needles\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5.37(1.08,26.74)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFiles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.51(0.50,12.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.263\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProbes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.41(0.45,12.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSyringe needles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.24(0.48,10.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.308\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSplashed liquids\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.48(0.44,13.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.300\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.26(0.45,11.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe also summarized the reasons for the ROEs in the same individual (B and C type incidents). From the perspective of timing, 40 out of 81 repeated exposures (49.4%) occurred during the same operational circumstances as previous exposures(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Besides, among the 81 repeated exposures, 20 instances (24.7%) shared the same pathway as previous occupational exposures (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs mentioned earlier, healthcare workers in dental hospitals often face a high risk of occupational exposure. One of the manifestations of this high risk is the phenomenon of ROEs among healthcare workers. Reviewing previous studies, a substantial body of literature has reported the serious issue of ROEs among DHWs[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Analyzing the hospital infection exposure data from 2016 to 2022, we found a significant number of individuals experiencing ROEs within the hospital. This piqued our interest in analyzing these ROEs events from the records, as we believe it holds significant importance. Firstly, ROEs may reflect underlying issues that need addressing in hospital infection control. Factors leading to repeated exposure may signify loopholes in protocols or areas where operational procedures need improvement. Understanding which occupational exposures are harder for healthcare workers to avoid can guide hospitals in targeted occupational exposure prevention training. Secondly, studying ROEs helps in a more precise analysis of risk factors. Due to challenges in attaining the number of service instances, relying solely on questionnaire data often yields a composition ratio of occupational exposure influencing factors. While this ratio somewhat reflects factors contributing to occupational exposure, it's not the best indicator of risk factors. Analyzing repeated exposure data allows for calculating the repeated exposure rates among different personnel types, providing a more accurate reflection of exposure risks across various professions. Lastly, studying ROEs in records helps reduce errors caused by underreporting. Many past studies have shown that even with strict reporting requirements for occupational exposure in healthcare institutions, a significant number of cases still go unreported[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This limitation affects exposure rates and the calculation and analysis of risk factors based on hospital records. However, studying repeated exposure events in hospital records allows for analyzing the rates and risk factors of repeated exposure within a relatively willing-to-report group at least, potentially reducing errors caused by underreporting and providing a more accurate understanding of risk factor severity.\u003c/p\u003e \u003cp\u003eIn our study, we compared the relationship between the ROEs and initial occupational exposure in terms of personnel type, gender, operational scenarios, exposure sources, and department categories.\u003c/p\u003e \u003cp\u003eClinical staff in a university-affiliated dental teaching hospital can be categorized into four roles: hospital dentists, dental students, hospital dental nurses, and dental nurse students. Previous research has suggested that the type of personnel can influence the occurrence of occupational exposure due to differences in skill levels. Typically, students are considered to face a relatively high risk of occupational exposure, possibly even higher than their supervisors, due to their lack of experience[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Consequently, the focus of occupational exposure education has traditionally leaned towards students. However, in our study, we analyzed the proportion of ROEs among different personnel types from the perspective of repeated exposure. Surprisingly, hospital dentists had the highest proportion of ROEs over these seven years, and this finding was statistically significant. In contrast, the risk of the ROEs was lower for dental students and dental nurse students. It is undeniable that hospital dentists often engage in more complex and intricate tasks, which may increase the risk of occupational exposure. Previous research has also found that more experienced doctors may be less inclined to adhere to occupational exposure prevention strategies[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. And our data also reflect that the awareness of occupational exposure prevention among hospital dentists in our hospital may be insufficient. Hospital dentists may be the focal group for occupational exposure education in the foreseeable future.\u003c/p\u003e \u003cp\u003eGender is one of the factors influencing occupational exposure. However, previous studies have shown varying impacts of gender on occupational exposure due to differences in study populations. A study conducted in Australia focusing on dentists and dental students indicated that females were more likely to experience occupational exposure in the form of needlestick injuries[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Some studies suggest that males are more prone to occupational exposure, with male healthcare workers even facing significantly higher risks compared to females[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In our study, we examined the risk of ROEs among male and female healthcare workers in dental hospitals and found no significant differences, not even slight ones. This finding aligns with many other studies that have not observed significant gender differences in occupational exposure[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. While gender may influence an individual's fear of occupational exposure events and adherence to operational standards[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], we believe that these influences can be mitigated through training and other factors, which may explain the lack of significant gender impact on ROEs in our study.\u003c/p\u003e \u003cp\u003eDue to the varying nature of work undertaken in different areas of a hospital, occupational exposure risks differ across these settings. Previous research has commonly indicated that operating rooms, where frequent contact with patient fluids and sharp instruments is required, are associated with higher risks of occupational exposure. Studies from King Khaled Eye Specialist Hospital have shown that, for ophthalmologists, the operating room accounts for 60.7% of needlestick-related occupational exposure events[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Research from Ethiopia also highlights the operating room as the most common site for bloodborne occupational exposure[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Additionally, the nature of emergency work may be related to the occurrence of occupational exposure; the high intensity of emergency work and inadequate rest can elevate exposure risks[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In our study, we categorized workplaces within a dental hospital as outpatient clinics, surgical operating rooms and wards, emergency departments, and clinical support units. The results indicated no significant differences in causing ROEs among outpatient clinics, surgical operating rooms and wards, emergency departments, and clinical support units in our hospital. Many dental procedures are performed in outpatient clinics, where healthcare workers frequently come into contact with high-speed rotating burs, various sharp instruments, patient fluids, and aerosols. From this perspective, outpatient departments in dental hospitals are also common sites for occupational exposure. Previous research has not extensively explored the occupational exposure risks between departments in dental hospitals. We believe that various workplaces in dental hospitals may carry higher risks of occupational exposure, particularly outpatient clinics whose risks should not be underestimated and may be similarly high as those in ward and operating rooms. However, we acknowledge that the sample size of exposure events in emergency rooms and non-clinical departments in this study is limited, and the analysis results may deviate from real-world scenarios.\u003c/p\u003e \u003cp\u003eMany studies have paid great attention to the pathways of occupational exposure[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Various dental procedures performed by dentists often involve the use of high-speed dental handpieces and sharp instruments, which are essential tools for treating most oral diseases[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Occupational exposures frequently involve sharp instruments[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and in this study, sharp instruments were identified as the primary cause of occupational exposure. Both initial and ROEs commonly involve injection needles, dental burs, suturing needles, files, probes, and knives. Dental prosthesis, orthodontic appliances, and sharp teeth of patients can also cause occupational exposures and repeated exposures, although data on these are relatively limited in this study. Additionally, aerosols and spatter generated during procedures such as high-speed dental handpiece use and irrigation are important pathways for occupational exposure. In our study, we compared the proportions of these pathways between initial and ROEs and found mostly no significant differences. However, in the analysis using binary logistic regression, the risk of ROEs due to suturing needles was over five times higher compared to scalpels and was statistically significant. Nevertheless, due to the small sample size, further research is needed to verify whether this result reflects clinical practice. Therefore, these factors can be considered equally important in causing ROEs among DHWs, and no pathway should be disregarded by healthcare workers themselves or hospital infection control departments. Furthermore, our statistical analysis of the reasons for multiple occupational exposures in the same individual showed that the proportion of repeated exposures through the same pathway was as high as 24.7%(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). It is important to note that many exposure pathways can be prevented through simple preventive measures. For instance, wearing face shields and goggles can protect against exposure caused by splashing and spattering. Despite this, statistics still show that some healthcare workers experience ROEs due to splashes, indicating a lack of seriousness among a minority of healthcare workers regarding occupational exposure. This suggests that many healthcare workers may not have learned from previous exposures, which could also indicate insufficient training provided by hospitals. From another perspective, current control strategies are not yet sufficient to completely prevent occupational exposures caused by certain pathways (especially sharp injuries and needlesticks). Hospitals need to strengthen training for healthcare workers and develop updated control strategies.\u003c/p\u003e \u003cp\u003eOccupational exposure is commonly associated with the patient treatment process. In previous research, the challenges faced during treatment procedures are considered the greatest due to the limited space, poor visibility, and patient movements[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, during our statistical analysis, we found that occupational exposures occurring during treatment procedures are only a part of the overall occupational exposure. Unfortunately, many occupational exposures also occur during instrument changes and after treatment. Our results show that the risk of repeated exposures during these three timings does not significantly differ. This implies that all three timings require healthcare workers' attention and caution. Further analysis of 81 ROEs incidents revealed that 49.4% of these occurred during the same timing as previous exposures(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Although this striking figure may be related to broad grouping in the study, it does reflect the level of occupational exposure risk during these three timings. Occupational exposures during instrument changes and after treatment are particularly concerning, which may be related to healthcare workers' attitudes and hospital training. Ensuring standardized procedures and protocols is crucial in reducing occupational exposure risks.\u003c/p\u003e \u003cp\u003eWe believe that data on ROEs can guide the direction of infection control efforts in hospitals. Analyzing data on ROEs can help identify high-risk groups within the hospital for occupational exposures. Consequently, we can provide more targeted prevention education for individuals experiencing ROEs, which is advantageous for achieving better control of occupational exposures with limited resources. Targeted prevention and control training should involve intensifying training efforts for high-risk groups while providing more effective educational methods. Some studies suggest that solely providing occupational training or skill training may not effectively reduce the occurrence of occupational exposures[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Some conventional teaching methods often convey knowledge that is dry, difficult to understand, and not synchronized with clinical work[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Tailored prevention education for different groups is necessary; for instance, experienced doctors may not be engaged by generic educational materials. Research from Iran suggests that enhancing healthcare workers' perception of risks and understanding the severity of occupational exposure risks may be crucial for improving occupational exposure control[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eROEs may also indicate areas for improvement in equipment and operational processes. Previous research has indicated that using safer equipment and adopting safer operational procedures are undoubtedly beneficial for reducing occupational exposures[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The occurrence of ROEs may indicate deficiencies in certain instruments or operational procedures in terms of safety. For example, research suggests that avoiding unnecessary use of sharp suturing needles can reduce needlestick injuries[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. High-quality evidence demonstrates that using blunt needles significantly reduces the risk of surgical personnel and their assistants contracting infectious diseases during a series of surgeries by reducing the number of needlestick injuries[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This approach may also be applicable in dentistry. Furthermore, reducing occupational exposures occurring during non-treatment operations is also a critical area for consideration. Currently, researchers are also working on developing new medical waste disposal devices, instruments transfer, and retrieval devices in an attempt to reduce occupational exposures[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Although ideal results have not yet been achieved, we believe that improving the usability and effectiveness of medical waste disposal devices may be a crucial pathway to reducing persistent occupational exposures.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAnalyzing ROEs provides practical insights. In dental teaching hospitals, hospital dentists with teaching qualifications are more likely to experience repeated exposures compared to students. This suggests that the focus of educational efforts should be directed towards this kind of DHWs. Additionally, there are no significant differences in the impact of different treatment locations, timing and pathways of occupational exposure on the occurrence of ROEs. However, it is important to acknowledge that these factors may present equally high risks, and maintaining vigilance towards them is essential.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was granted by the Medical Ethics Committee of West China Hospital of Stomatology, Sichuan University (Approval No. WCHSIRB-2024-299).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be made available on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was financially supported by the Hospital Infection Prevention and Control Research Fund from Sichuan Preventive Medicine Association (SCGK202103).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors participated in the study. The study design was conducted by YZ, ZL and JX. Material preparation was performed by YZ and QX. Data analysis was performed by JX, PP and FS. The manuscript was written by JX, PP and YG. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge and thank all individuals and departments that supported this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHosseinipalangi Z, Golmohammadi Z, Ghashghaee A, Ahmadi N, Hosseinifard H, Mejareh ZN, Dehnad A, Aghalou S, Jafarjalal E, Aryankhesal A\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eGlobal, regional and national incidence and causes of needlestick injuries: a systematic review and meta-analysis\u003c/strong\u003e. \u003cem\u003eEast Mediterr Health J \u003c/em\u003e2022, \u003cstrong\u003e28\u003c/strong\u003e(3):233-241.\u003c/li\u003e\n\u003cli\u003eHameed T, Bashir EA, Khan AQ, Ahmad M: \u003cstrong\u003eSafety culture implications on safe work practices and work place exposure incidents in Operation Theater\u003c/strong\u003e. 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\u003cstrong\u003e100\u003c/strong\u003e(1):99-104.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"occupational exposure, dental healthcare workers, infection prevention and control, dental hospital","lastPublishedDoi":"10.21203/rs.3.rs-5038786/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5038786/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealthcare workers in dental hospitals frequently experience repeated occupational exposures (ROEs). In our study, we aim to analyze these repeated exposures among dental healthcare workers (DHWs), assess the risk levels of different risk factors, and explore the significance of ROE data for infection control in dental hospitals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on hospital statistical data, we categorized the occupational exposure incidents at West China Hospital of Stomatology over the past seven years into initial and repeated exposures. We analyzed the association of various risk factors, including gender, personnel types, treatment locations, timing of occupational exposure, and pathways of occupational exposure, with the occurrence of repeated exposures. The Statistical Package for Social Sciences (SPSS) 21 was used to conduct chi-square analysis and binary logistic regression analysis, with the significance level set at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared to students, hospital dentists with teaching qualifications exhibited a higher risk of ROEs. The risk of repeated exposure for dental students was only 0.4 times that of hospital dentists (P=0.003). However, gender, treatment locations, timing of occupational exposure, and pathways of occupational exposure did not significantly impact the repeated exposures among DHWs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnalyzing ROEs provides practical insights. In dental teaching hospitals, hospital dentists with teaching qualifications, who are often considered experienced, have the highest risk of ROEs. This suggests that the focus of educational efforts should be directed towards this kind of DHWs.\u003c/p\u003e","manuscriptTitle":"Analyzing The Occupational Exposure Risks of Dental Healthcare Workers from The Perspective of Repeated Occupational Exposure","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-11 04:24:47","doi":"10.21203/rs.3.rs-5038786/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-27T16:05:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-26T16:26:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"60642607662288275463851311208039287815","date":"2024-09-25T03:30:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-24T06:10:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-23T00:26:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"259913784531639016243562016536297277424","date":"2024-09-21T08:43:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"59897715881516968594677577213028993525","date":"2024-09-21T06:04:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"241807852232003490211275067364540594166","date":"2024-09-20T14:13:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-20T06:28:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-09-09T14:00:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-07T09:35:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-07T09:33:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-09-05T14:07:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9fa4065b-52b3-41bc-abfe-d6d3571b9a6b","owner":[],"postedDate":"October 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-18T19:17:15+00:00","versionOfRecord":{"articleIdentity":"rs-5038786","link":"https://doi.org/10.1186/s12913-024-11774-7","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2024-11-11 15:57:59","publishedOnDateReadable":"November 11th, 2024"},"versionCreatedAt":"2024-10-11 04:24:47","video":"","vorDoi":"10.1186/s12913-024-11774-7","vorDoiUrl":"https://doi.org/10.1186/s12913-024-11774-7","workflowStages":[]},"version":"v1","identity":"rs-5038786","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5038786","identity":"rs-5038786","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}