125 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2025, 9 (2): 125-128

ReseaRch aRticle

Awareness and Commitment to Infection Control Principles 
among Students of the College of Dentistry at Tikrit University, 
Iraq
Salaheddin M. Shehade1, Shatha N. Tawfeeq2, Hassan M. Jindall, Mustafa D Younus3, 
Noralhuda A. Ibrahim4

1Department of Medical Microbiology, College of Science, Cihan University-Erbil, Kurdistan Region, Iraq, 2Department of Basic 
Science, College of Dentistry, Tikrit University, Iraq, 3Department of Nursing Techniques, Kirkuk Technical Medical Institute, 
Northern Technical University, Iraq, 4Department of Anesthesia Technologies, Cihan University-Erbil, Erbil, Kurdistan Region, Iraq

ABSTRACT

Many recent studies have shown that many dentists and dental students are at high risk of infection with several serious pathogens 
during working or training in dental clinics. These significant infections can be prevented by adhering to general safety precautions and 
applying infection control rules. This study aimed to assess awareness, attitudes, and practices of infection control techniques among 
senior dental students. At Tikrit University, the questionnaire was contained of 20 questions regarding awareness about infection control 
practices, barrier techniques. The study revealed that 83.8% of the respondent students were aware of standard precautions within the 
health care setting. About 79% had adequate knowledge about hand hygiene, but 67% of responded participants were exposed to a hand 
hygiene training course. Only 66% of students responded that they are committed to hygienic hand washing before and after contact 
with patients. 40.7% of responders responded that they wear their laboratory coat outside dental clinics, and 51% of female students wear 
jewelries and/or artificial fingernails during training in dental clinics. Results of this study highpoint the need of persistent education 
to develop awareness and commitment to infection control principles among students of the College of Dentistry at Tikrit University.

Keywords: Cross-infection, dental clinics, infection control practice, safety precautions

INTRODUCTION

Transmission of infectious pathogens between patients and 
medical staff is called cross-infection and it is common in 
dental clinics, and may result in serious infections.[1] Dental 

health personnel as well as senior dental students have high risk 
of infection with blood-borne pathogens, such as hepatitis B virus, 
hepatitis C virus, hepatitis D virus and human immunodeficiency 
virus, also they are at high risk of contact with some respiratory 
pathogenic microorganisms, such as Mycobacterium tuberculosis, 
streptococci, and viruses or bacteria that inhabit the oral cavity 
and/or the upper respiratory tract.[2] This risk is heightened 
by unintended injuries caused by dental instruments during 
different dental procedures and patient treatment in a dental 
office. These important infections can be prevented using general 
safety precautions and applying infection control guidelines in 
addition to specific prophylaxis by vaccination and appropriate 
post-exposure management. Most patients in the dental clinic 
appear to be in good health with no obvious manifestations of 
any infectious disease. However, some of them may be a source 
of infection with important pathogenic organisms, as they 
may be asymptomatic carriers of these pathogens or have an 
asymptomatic infection with them. Hereafter, hazard controlling 

policies or standard precautions should not be applied based 
solely on the patient’s apparent condition.[3]

Several studies in recent years have shown that many 
dentists and dental students have been infected with several 
important pathogens, some of which are blood-borne, such as 
hepatitis B and C, and some of which are respiratory, such as 
COVID-19. These infections were often transmitted to them from 
the patient due to their failure to strictly adhere to prevention 
instructions and infection control principles while 
working with patients.[4] The possibility of dental students 

Corresponding Author: 
Salaheddin M. Shehade, Department of Medical Microbiology, 
College of Science, Cihan University-Erbil, Kurdistan Region, Iraq. E-
mail: salaheddin.mohamad@cihanuniversity.edu.iq

Received: October 23, 2025 
Accepted: November 29, 2025 
Published: December 20, 2025

DOI: 10.24086/cuesj.v9n2y2025.pp125-128

Copyright © 2025 Salaheddin M. Shehade, Shatha N. Tawfeeq, Hassan M. 
Jindal, Mustafa D Younus, Noralhuda A. Ibrahim. This is an open-access article 
distributed under the Creative Commons Attribution License.

Cihan University-Erbil Scientific Journal (CUESJ)



Shehade, et al.: Awareness to Infection Control among Dentistry Students

126 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2025, 9 (2): 125-128

being exposed to various pathogenic agents, some of which are 
dangerous, while performing dental procedures during clinical 
training in the final years of study or after their graduation and 
work as dentists in their clinics, makes it the duty of dental 
colleges to spread awareness about infection control and to 
educate students deeply about the pathogenic agents that can 
be transmitted to them while working in the clinic and how to 
prevent them effectively.[5]

Dental colleges and faculties are accountable for providing 
appropriate infection control awareness and measures, also they 
should provide decent training for dental students to protect 
themselves and their patients, and in the aim of establishing 
of safer environment in the work. Dental colleges and relevant 
health authorities usually prepare guidelines specifically about 
the importance of exposure to infections in dental clinics, 
standard precautions, and infection control procedures. For 
these strategies and guidelines to be effective and fulfill their 
intended purpose, students must be followed up and encouraged 
to understand, comprehend, and adhere to them.[5,6]

These strategies typically include standard precautions 
that target to guarantee a safe working environment and 
avoid the potential spreading of occupational and nosocomial 
infections among dental students or dentists and patients. 
Consciousness and amenability with these references are vital 
for the prevention of occupational infections for healthcare 
staff, including dentists and dental students. Inappropriately, 
despite the significant highlighting positioned on consistent 
infection control procedures and measures, it looks that only a 
small number of dental students and dentists adhered actively 
to necessary procedures in dental practice.[7-9] Several recent 
researches have shown that several dental students have not 
constantly accurately followed these measures.[10]

Proper and effective education about cross-infection in 
dental clinics may have an important action in the effective 
preparation of dental stunts and dentists by aiding them to 
implement satisfactory knowledge and attitudes linked to 
infection control measures.[11-13] Since there are no sufficient 
studies in Iraq on the dental students’ knowledge and 
awareness about the standard precautions and infection 
control procedures or the extent of their commitment to 
these procedures and principles, this study aims to evaluate 
Knowledge, Attitudes, and Practices of Infection Control 
among Dental Students at Tikrit University, Iraq.

MATERIALS AND METHODS

This study is a questionnaire-based cross-sectional study, 
and was accompanied on 250 last dental students, Faculty 
of Dentistry, Tikrit University, Iraq, during the academic year 
2024–2025. Where dental students start their clinical training 
in their 4th year of education.

A special questionnaire was designed and distributed 
among 5th-year students  (last year of undergraduate education). 
The anonymous self-administered questionnaire was designed 
by researchers to cover key points of IPC practices guidelines 
and was comprised of 20 open- and close-ended questions 
related to awareness, infection control training and practice, 
the adequate use of personal protective tools, percutaneous, 
awareness about importance of contact with blood or bloody 

fluids during treatment of dental patients, and approaches of 
necessary measures to different types of infections.

The questionnaire was distributed to students via email 
in the form of a Google Form, and students’ knowledge and 
awareness about infection control and prevention practices were 
assessed depending on their answers to the used questionnaire.

Statistical analysis of the obtained data was accompanied 
using SPSS version 20.

RESULTS

The percentage of students, who responded to the 
questionnaire, completed it, and returned it to the researchers 
was 84% (211/250) regarding the gender of responded 
students, they were 84 females and 127 males.

The mean age of the responded participant students was 
23.16 ± 1.76, extending from 20 to 32 years; 127/211 (60%) 
were males, and 84/211 (40%) were females [Table 1].

Regarding general knowledge and awareness about 
infection control strategies among dental students, results of 
the study showed that a total of 177/211 (83.8%) respondent 
students were aware of standard precautions within the 
health care setting (dental clinics). About 79% (167/211) 
had adequate knowledge about hand hygiene, but 67% of 
responded participants were exposed to a hand hygiene 
training course (141/211). However, only 66% of students 
(139/211) responded that they are committed to hygienic 
hand washing before and after each contact with patients or 
with suspected materials.

Regarding the minimum time needed for hand washing, 
70% of respondents (148/211) responded that the minimum 
time needed for hand washing is 20 s [Table 2].

About using the protective techniques and tools during 
clinical training in dental clinics, the study reveals that (76.7%) 
of participant students (162/211) stated wearing gloves all the 
time during training in dental clinics, while 53.5% reported 
wearing masks at all times (113/211) [Table 3].

Regarding to Commitment to healthy behavior and attitude 
during training in dental clinics, 86/211 (40.8%) of responders 
responded that they usually wear their laboratory coat outside 
dental offices during training in dental clinics, and 43/84 
of female students (51%) responded that they usually wear 
jewelries and/or artificial fingernails during training in dental 
clinics. Furthermore, 18% of the responders (38/211) sometimes 
are eating or drinking during training in dental clinics [Table 4].

Concerning the knowledge and awareness about 
the transmission modes of some common and important 
infectious diseases, the study showed that 81.5% (172/211) 
of responders believe that invasive procedures rise the risk 

Table 1: Distribution of the participant students according to gender

Gender No. %

Male 127 60

Female 84 40

Total 211 100



Shehade, et al.: Awareness to Infection Control among Dentistry Students

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Table 4: Commitment to Healthy attitude during training 
in dental clinics

Type of practice No. %

Wearing a laboratory coat outside the dental clinic 86 40.7

wearing jewelries and/or artificial fingernails 
during training in dental clinics

43/84 51

eating or drinking during training in dental clinics 38 18

Table 2: General knowledge and awareness regarding infection 
control strategies among responded students

Type of knowledge or awareness No. %

Awareness of standard precautions within the 
health care setting (dental clinics)

177 83.8

Having adequate knowledge about hand hygiene 167 79

Exposed to a hand hygiene training course 141 67

Committed to hygienic hand washing before and 
after each contact with patients or with suspected 
materials.

139 66

Awareness about the minimum time needed for 
hand washing

148 70

Table 3: Using the protective techniques and tools during clinical 
training in dental clinics

Type of practice No. %

Always wearing gloves during training in dental clinics 162 76.7

Wearing masks at all times during training in 
dental clinics

113 53

Wearing gloves and masks 147 69

Table 5: Knowledge and awareness about the transmission modes 
of some infectious diseases

Knowledge and awareness about the 
transmission modes

No. %

Invasive procedures rise the risk of nosocomial 
infections

172 81.5

Transmission of blood-borne infection is possible 
after a single contaminated needle stick injury

161 76.3

Hepatitis B and C can be transmitted through 
bloody saliva.

47 22

of nosocomial infections, and 76.3% (161/211) responded 
that transmission of blood borne infection is possible after a 
single contaminated needle stick injury, while 22% (47/211) 
of responders think that hepatitis B and C can be transmitted 
through bloody saliva [Table 5].

DISCUSSION

Adequate awareness and a healthy attitude are the main 
necessities for the prevention of most infectious diseases, 
especially among healthcare workers and dental medical 
students.[14-16] In this study, a high rate of questioned students, 
84% (211 out of 250), responded to the questionnaire about 
knowledge and attitudes about infection control measures 
in dental clinics. The rate of responding male students was 
higher than the rate among females, but without a significant 
difference (85% and 78.2 % prospectively).

Regarding general knowledge and awareness about 
infection control among dental students, results of the study 
showed a high percentage of knowledge and awareness among 
responded students, as (83.8%) respondent students were 
aware of standard precautions within the dental clinics, and 
about 79% had adequate knowledge about hand hygiene, but 
67% of responded participants were exposed to hand hygiene 
training course. However, only 66% of students (139/211) 
responded that they are committed to hygienic hand washing 

before and after each contact with patients or with suspected 
materials.

Despite the high percentage of theoretical awareness, 
only 65% of students responded that they are committed to 
hygienic hand washing before and after each contact with 
patients or with suspected materials.

Also, the study reveals that (76.7%) of participant 
students (162/211) are always wearing gloves during training 
in the dental clinic, while only 53.5% reported wearing masks 
in the training at all times.

This moderate adherence to hand hygiene practice may 
indicate an important gap between knowledge and practice. 
This may be due to the lack of good role models for these 
students among their teachers and supervisors. This perhaps 
may also be due to the lack of effective monitoring of them 
while they are training in the dental clinics. Similar results 
were shown in other studies.[17-19]

This study showed important unhealthy students’ attitudes 
and practices during training in dental clinics, as 40.7% of 
responders responded that they usually wear their laboratory 
coats outside the dental clinics. About 51% of female students 
usually wear jewelries and/or artificial fingernails during 
laboratory sessions. Furthermore, 18% of the responders 
(38/211) sometimes are eating or drinking during training in 
dental clinics.

This may indicate a general lack of adherence to the 
instructions among many students. It may also indicate a lack 
of appreciation for the importance of these instructions in 
preventing infections.[19-22]

The study showed moderate percentage regarding the 
knowledge and awareness about the transmission modes of 
some important infectious diseases, as 81.5% of responders 
believe that invasive procedures rise the risk of nosocomial 
infections, and 76.3% responded that transmission of blood 
borne infection is possible after a single contaminated needle 
stick injury, while 22% of responders think that hepatitis B and 
C can be transmitted through bloody saliva.

Similar studies showed that a short course of infection 
control that is provided in most medical schools may not be 
enough to make all students awarded of infection control 
measures and safety techniques.[23-26]

CONCLUSION

This study revealed different levels of knowledge, awareness, 
and attitude regarding infection control precautions and 



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128 http://journals.cihanuniversity.edu.iq/index.php/cuesj CUESJ 2025, 9 (2): 125-128

measurements among students of the dental college at Tikrit 
University, Iraq. Furthermore, showed insufficient practical 
adherence to some important precautions among significant 
proportion of participated students. To improve the safety of 
dental students during clinical training in dental clinics, we 
believe that it is essential to begin teaching the necessary basic 
knowledge about transmission of common and important 
infections and the principles of infection control and 
prevention protections during the 1st year of study in the dental 
college. These educational and awareness programs should be 
supported by practical commitment to preventive measures 
by senior colleagues and clinical trainers. Understanding and 
accepting the assurance to preventive and infection control 
procedures should be a significant aim of education in medical 
colleges.

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