Análise das diretrizes de biossegurança frente à COVID-19 e implementação no ensino e nos serviços odontológicos no Brasil

Abstract

This thesis aimed to analyze the global guidelines set for the COVID-19 prevention and control and their implementation in dental education and services, both at the public and private levels in Brazil. To achieve such aim, four studies were developed, as follows: (1) literature review, searching the data bases and gray literature published up to 12th May 2020; (2) cross-sectional research with quantitative-qualitative approaches in which the sample comprised all dentistry undergraduate courses in Brazil that were registered in the e-MEC webpage up to 2017. Data collection occurred from March/2021 to June/2021; 3) Observational cross-sectional study with dental surgeons participating in the multicentric study carried out in southern Brazil between August and October/2020; 4) Prospective study with repeated measures, including oral health professionals to compare the implementation of biosafety measures in two phases of the pandemic (1st phase: August and October /2020 and 2nd phase: March and May/2022). The review included 27 documents showing scientific quality limitations regarding scientific rigor, conflict of interests, and applicability. Those documents were summarized into 122 recommendations. Study 2 included 83 courses. Public courses showed lower frequency of return to the onsite activities (p=0.038), with higher proportion of suspension of clinical and laboratory activities (p≤0.001), and greater difficulty of structure adjustment and input availability. Private courses presented higher availability of resources to return to the onsite activities, such as structure, workers, and professors (p<0.001). In study 3, dental surgeons working in public services reported more frequently having suspended elective procedures, avoiding procedures that depended on sprays and X-rays, usually in a four-hand work model (p<0.001). Those in the private service tended to report more frequently their taking part in decision making, the use of sterilized hand pieces, high-power suction, and rubber dam isolation, also carrying out teleguidance/telemonitoring (p≤0.001). Study 4 included 253 professionals that took part in the phases of the research. Most of the measures were kept in the second phase. In the public sector, reduction was observed in the guidance to patients about the COVID-19 (p=0.001); while in the private sector, the use of the new PPE recommended decreased (p≤ 0.001). In both years, the public sector showed higher adhesion to the biosafety protocols and assisted work, while the private sector privileged the use of teledentistry, the use of rubber band and high-power suction along with cleaning and disinfection measures (p< 0.005). We concluded that a wide variety of biosafety guidelines was identified for the dental practice. However, the scientific quality of such documents was low. Each sector presented specificities in relation to the implementation of biosafety measures. Studies regarding the implementation of biosafety measures in teaching and in the professional activity showed that the public sector faced more challenges related to the adjustment of structures and inputs, while the greatest challenge to the private sector referred to the suspension of the service offer.