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1.1 Background of the study
Infection is one of the most important problems in health services around the world. It is one of the most important causes of morbidity and mortality associated with clinical, diagnostic and therapeutic procedures. Health care workers are at high risk of needlestick injuries and blood-borne pathogens when performing clinical activities at the hospital3. They are exposed to blood-borne pathogens such as human immunodeficiency virus and hepatitis B virus (HBV) and hepatitis C virus (HCV), acute injuries and contact with blood and others 4. According to a WHO estimate, in 2002, acute injuries caused 16,000 hepatitis C viruses, 66,000 hepatitis B viruses, and no HIV and hepatitis C.7 It is important to prevent infection by preventing exposure. Recapsulation, disassembly and improper disposal increase the risk of needlestick injury.8, 9 The incidence rate of these causal factors is higher in developing countries for the higher injection rate with previously used syringes .10 Developing countries where the prevalence of HIV-infected patients is worm Needle-stick injuries have also been reported as the most common occupational hazards in a Nigerian university hospital.11 The World Health Organization (WHO) estimated that about 2.5% of HIV cases among health care workers and 40% of hepatitis B and C cases in HCWs are the result of these exposures.12 Irrational injection practices and dangerous are widespread in developing countries.13 The practice of needle recapping has been identified as contributing to the incidence of needle sticks. z health care workers .5, 14 It is estimated that only one in three needlestick injuries are reported in the United States, while these injuries are virtually undocumented in many developing countries15. Risk injections and subsequent transmission of blood-borne pathogens are suspected
It has been estimated that every person in developing countries receives on average 1.5 infections per year. 16, 19 Approximately 90-95% of the injections are therapeutic, while 5-10% are given for immunization.17 It has been shown that between 70% and 99% of these injections are useless, whereas at least 50% are hazardous in 14 of 19 countries in five developing regions with data. 17, 18, 19, 20. Hauri et al. The WHO Department of Essential Health Technologies estimates that 3.4 injections per person per year in developing countries.16, 18 In Nigeria, the annual average was 4.9 injections per year.21 One overuse and unsafe practices Eighteen studies have reported a convincing link between risky injections and transmission of hepatitis B and C, HIV, Ebola and Lassa infections, and malaria.19 Injury from sharps have been associated with the transmission of more than 40 pathogens, including HBV, HCV, HIV, haemorrhagic fevers, malaria and tetanus, increasing the risk and burden of infectious diseases.22,23,24, Contaminated sharps such as needles, lancets, scalpels, sample tubes, and other instruments can transmit blood-borne pathogens such as HIV, hepatitis B (HBV), and hepatitis viruses. tite C (HCV) .26 The circumstances leading to needlestick injury depend in part on the type and design of the device and certain work practices27. In addition, the level of risk depends on the number of patients infected in the health facility and the precautions they observe when dealing with these patients. .27 It is documented that 10 to 25% of injuries occurred during retreading of a used needle5. Needle recapping has been banned under the Occupational Safety and Health Administration (OSHA) standard 28 Combined data from more than 20 prospective studies worldwide on health workers exposed to HIV-infected blood by percutaneous injury revealed an average transmission rate of 0.3% per injury, 4, 15, 27, 29 and a mucosal exposure of approximately 0.09.30 The most common mode of transmission of HIV – from tainted blood to health care workers is needlestick injury.27 The larger the size and depth of blood inoculation the higher the risk4. Conjunctival transmission and open lesions. the skin can also come into contact with fluids containing HIV.4
An increasing number and variety of needle devices with safety features are now available. Needleless or extended needle I.V. systems have reduced the incidence of needlestick injuries by 62% – 88% .31 Some of these injection devices are; Self-locking, manually retractable, automatically retractable syringe, standard disposable and needle extractor.
The World Health Organization defines a safe injection as a given injection using appropriate equipment, which does not harm the recipient and does not expose the supplier to any hazardous waste for the community.32 A safe injection is given only when there is no other suitable alternative. Developing countries, particularly those in sub-Saharan Africa, which have the highest prevalence of HIV-infected patients worldwide, also report the highest incidences of occupational exposure.12, 25, 33 Infections with HCV and HBV are generally considered endemic. Sub-Saharan Africa.33
Occupational safety for health care workers is often neglected in low-income countries despite the increased risks associated with occupational exposure to blood, insufficient personal protective equipment and limited organizational support for safe practices33.
However, surveys in different parts of the country indicate that the HCV prevalence is 0.9-5.8% 34.35 and the estimates for HBV range from 4.7% to 14.4%. According to projections for 2010, the prevalence of HIV / AIDS in Ethiopia is estimated at 2.8% .40 In a study of standard precautions carried out from February to May 2010 in 10 hospitals and 20 health centers in two administrative regions of the country. Ethiopia (Harare and Dire Dawa), HIV / AIDS prevalence estimates for 2010 are 4.4% for Harare and 5.7% for Dire Dawa.40 The prevalence of HBS Ag in blood donors in the Kathmandu Valley would be about 1.67% .41 The sero-prevalence study suggests that the overall anti-HCV positivity in blood donors is about 0.3% in Nepal.42 The prevalence HCV seropositivity in health blood donors is approximately 0.2% in Nepal. in healthy blood in Saudi Arabia ranges from 2.7% to 9.8% .39-40 Sero-prevalence studies suggest that the overall anti-HCV positivity is about 3.5 – 5% .43-45
Thalassemia and sickle cell disease are common in Saudi Arabia, and the prevalence of hepatitis C antibodies in this high-risk group is about 40% .45 The prevalence of HIV-positive status has been estimated at about 0.09% in the kingdom. 46 These figures suggest that a significant number of people pose a potential risk of transmitting blood-borne diseases to doctors, laboratory technicians, blood bank workers, nurses, staff working in the kidney dialysis and transplantation units, and other health care workers. 47
Recognizing this threat, the United States Centers for Disease Control and Prevention (CDC) has proposed a series of procedures to prevent occupational exposures and to handle potentially infectious materials such as blood and body fluids. These procedures, known as Standard Precautions (SPS), advise health care workers (HCSCs) to practice regular personal hygiene; use protective barriers such as gloves and a gown whenever there is contact with patients’ mucous membranes, blood and body fluids; eliminate sharp objects, body fluids and other clinical waste properly.48, 49, 50
The potentially infectious nature of all blood and body substances requires the implementation of infection control practices and policies. There are more than 20 blood-borne diseases, but those of primary importance to health workers are hepatitis due to hepatitis B virus (HBV) or hepatitis C virus (HCV) and acquired immunodeficiency syndrome (AIDS). To minimize the risk of HIV / AIDS, HBV and HCV through unsafe injection practices, the Federal Ministry of Health has progressively eliminated the use of sterilizable injection equipment in Nigeria51. Standard precautions apply to blood; all body fluids, secretions and excretions (except sweat), whether or not they contain visible blood; non-intact skin, and mucous membranes, 22, 23, 52, 53, 54 any loose tissue or organ (other than intact skin) of humans (alive or done), human immunodeficiency virus (HIV) or virus hepatitis B (HBV) containing culture medium or other solutions.54
Universal precautions are a set of guidelines to protect health care workers against blood-borne infections55. In 1981, the CDC proposed the concept of “universal precautions”, originally designed to protect HCVs from exposure to blood-borne pathogens. .56, 57 The definition and recommendations for universal precautions have been revised by the Centers for Disease Control and Prevention (CDC) and have the new standard precautionary name 58, which combines the main features of universal precautions and isolation. According to standard precautions, the blood and body fluids of all patients are considered potentially infectious for HIV, HBV and other blood-borne pathogens54,58. In addition, standard precautions stipulate that TS take precautions to prevent needlestick injuries. scalpels, and other sharp instruments or devices during procedures and disposal.5 The term “standard precautions” replaces “universal precautions” Standard precautions are considered an effective means of protecting health care workers, patients and the public, thus reducing the risks of hospitalization (nosocomial infections). ) infections.51
The components of standard precautions include; hand hygiene, personal protective equipment (PPE), gloves, cap, gowns, mask, waste disposal system, appropriate sterilization and disinfection processes, appropriate use of instruments and equipment, vaccination, education, screening transfusion blood To reinforce the existing components above, three additional practice areas have been added: respiratory hygiene / cough tag, safe injection practices and use of masks for insertion or injection of equipment into vertebral or epidural spaces by lumbar puncture (eg, myelogram, spinal or epidural anesthesia). 62 Reports indicate that standard precautions are effective in preventing incidents of occupational exposure and associated infections.25, 63 Universal precautions have been shown to reduce the risk of exposure to blood and body fluids.64 However, studies have consistently reported consistent adherence to standard precautions by health care workers in both developed and developing countries.12, 55, 65, 66 The standard precautions are aimed at reducing the risk of transmission of infectious agents from recognized and unrecognized sources of infection in health facilities. The incidence of hepatitis B infection has declined among health care workers in recent years, mainly because of widespread hepatitis B vaccination.67 In many health facilities, although Personnel are vaccinated. Standard precautions are also intended to protect the patient by ensuring that caregivers do not transmit infectious agents to patients through their hands or equipment during patient care. Exposure of employees to bloodborne pathogens from blood and other potentially infectious materials (OPIM) occurs because employees do not use universal precautions.68 OPIM is defined as:
- The following human body fluids: sperm, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva during dental procedures, any liquid visibly contaminated with blood and all fluids in situations where it is difficult, if not impossible, to differentiate between body fluids.68
- any loose tissue or organ (other than intact skin) from a human (living or dead) 68;
- HIV – containing tissue cultures of cells, organ cultures, and HIV or HBV – containing culture medium or other solutions, and infected blood, organs or other tissues of experimental animals by HIV or HBV.68
The blood-borne pathogen standard allows hospitals to use acceptable alternatives to universal precautions69. Infection control methods / concepts are called “bodily isolation” and standard precautions69. These methods define all liquids and bodily substances as infectious. the methods incorporate not only the fluids and materials covered by the blood-borne pathogen standard, but extend coverage to include all body fluids and substances69.
These concepts are acceptable alternatives to universal precautions, provided that the facilities that use them meet all other requirements of the standard.69 To comply with OSHA standards, the use of universal precautions or standard precautions is acceptable. .69
Since it is not possible or cost-effective to test all patients before administering pathogens, and the identification of patients infected with blood-borne pathogens can not be reliably made by antecedents medical and physical examination, standard precautions are recommended. by the United States Centers for Disease Control (CDC), regardless of diagnosis and treatment setting.70, 71
Statement of the Problem
Health care workers are exposed to occupational risks when carrying out clinical activities in hospitals.72 The occupational health of approximately 35 million health personnel, or approximately 12% of the workforce, has neglected72. exposed to blood-borne infections with pathogens such as HIV, hepatitis B and hepatitis C, sharps injuries and contact with deep body fluids.4, 5, 58 time of the HIV epidemic in sub-Saharan Africa 73 real and meaningful. It has been found that the risk of transmission of HIV / AIDS through needle stick incidents is 0.3%, 4,15,27,29; That is, 1 case per 300 incidents of needlestick. Â Â
The Occupational Safety and Health Administration estimates that 5.6 million health workers around the world who handle sharps devices are at risk of exposure to blood-borne pathogens74. These injuries are usually under-reported for many reasons such as stigma. .15 The HIV sero-prevalence varies considerably from one country to another and from one region to another in the same country75. A survey conducted in Nigeria found an overall prevalence of HIV of 4.4% 75. This high prevalence in the country poses a professional risk for health care workers. HIV / AIDS is a major health problem in Nigeria76. Nigeria is one of the countries most affected by the HIV / AIDS epidemic, with an estimated 2.99 million people currently infected.76 More than one million people (1.70 million) have already died of AIDS76 since it was reported and confirmed in Nigeria in 1986.77
The health consequences of these infections are enormous; Symptoms of HCV infection occur only 20 to 30 years after viral transmission.78 In addition, approximately 60-85% of HCV infections cause cirrhosis of the liver and liver cancer61. There is no immunization against HCV and HIV. infection by preventing exposure.7
The increasing prevalence of morbidity and mortality from exposure to blood-borne infections is due to lack of knowledge, poor attitude to standard precautions and poor practices such as needle folding, needles, the reuse of needles and the lack of adequate containers for sharp objects and disposal, the shortage of injection equipment and the unjustified and dangerous use of injections expose patients and health workers to occupational exposure. cause needlestick injuries.81
WHO estimates that 16 billion injections are given each year in developing and transition countries with an annual average of 1.5 injections per person per year.17 70 to 99% of these injections are unnecessary, while 50% are dangerous in 14 of the 19 countries. In Nigeria, the annual average was 4.9 injections per person per year21. The socio-economic and psychological burden of unsafe injections occurs at the individual, family, community and national levels. It is estimated that each year, the global annual cost of indirect medical costs due to hepatitis B and C and HIV / AIDS is estimated at US $ 535 million.
Globally, in 2000, it was estimated that 21 million cases of hepatitis B virus (HBV) infection, 2 million cases of hepatitis C virus (HCV) infection and 260,000 cases of HIV infection accounted for 32%, 40% and 40%. 5% of infections due to dangerous injection practices, respectively.84
It is estimated that 9.18 million DALYs will be lost between 2010 and 2030, although interventions implemented in 2000 for safe and appropriate use of injections may reduce this risk. 22, 84 The WHO estimates that 501,000 deaths occurred as a result of unsafe injection practices.84 These deaths could have been prevented through injection safety practices, a standard precautionary element, an integral component of infection prevention and control, and key caregiver. security. Such deaths involving family members, especially bread winners, could cause grief and poverty for many families. The increasing prevalence of morbidity and mortality from these blood-borne infections can result in absenteeism. treatment, reducing the effects on workers and decreasing productivity, which will have a negative effect on the economy. Despite the risk to health care workers, studies have reported suboptimal and non-uniform adherence to standard precautions taken by health care workers in both developed and developing countries. 12, 55, 65, 66 For example, in a study in Benin City, only 34.2% of nurses had heard of universal precautions, 85 and in another study in southeastern Nigeria, only 15, 2% of the doctors had a good standard practice. précautions.7 However, it is known that these preventive strategies are generally not fully implemented and / or compromised in the health care systems of most developing countries.25 Compliance with these universal precautions reduces the risk of exposure to blood and blood. organic liquids. In high-income countries, standard precautions are taken to protect against occupational exposure to blood and the risk of blood-borne pathogens, but the situation is different in low-income countries, where standards precautions are partially practiced.65 Occupational safety of health care workers is often neglected in low-income countries despite an increased risk of infection due to a higher prevalence of the disease, low awareness of the risks associated with occupational exposure to blood, insufficient protective equipment organizational support for safe practices.33 Efforts to reduce infection levels in populations, such as hepatitis and HIV, are important goals.
Identified and similar problems exist in Central Hospital, Warri, other health facilities in Delta State as well as in other states. However, the knowledge, attitude and practice of standard precautions in workers at Warri Central Hospital have not been evaluated before.
Significance of the Study
Overall, available data show that needlesticks and blood-borne pathogens pose a serious threat to patients, health workers and the host community.The increasing prevalence of morbidity and mortality from nosocomial and communicable infections such as HIV / AIDS HBV and HCV, among others, result from a lack of awareness, poor attitude and non-compliance with the definitions and recommendations of standard precautions. Compliance with standard precautions has been shown to reduce the risk of exposure to blood and body fluids. For this reason, monitoring the compliance of HCWs with standard precautions is an important component of the control of occupational and nosocomial infections, as it allows for the assessment of risks associated with occupational exposure to infection.89
This study will outline the level of awareness, attitude and practice of standard precautions in HCWs and could therefore serve as a basis for intervention. It will also identify gaps that would be recommended for correction through interventions. This study could be used to monitor trends in events regarding knowledge, attitude and practice of standard precautions among health care workers at Central Hospital, Warri, from time to time examining the incidence of puncture wounds. needle and the profile of morbidity and mortality. in standard precautionary practices among these health workers and the results of the study will be used for planning the health education intervention program. It will also provide reference material for the academic society as well as further research.
1.2Â Â AIMS AND OBJECTIVES
The general objective is to assess the knowledge, perception and practice of standard precautions among health care workers in Central Hospital, Warri, Delta State.
- To assess the level of knowledge of standard precautions among health care workers in Central Hospital, Warri.
- To ascertain the attitude of health care workers in Central Hospital, Warri towards standard precautions.
- To determine the level of practice of standard precautions among health care workers in Central Hospital, Warri.
- To determine the level of immunization of the health care workers against infectious diseases such as HBV.
- To describe the action taken by the health care workers when they are exposed to occupational hazards and injuries.
- To ascertain the attitude of Â the health care workers towards patients with
To determine the practice of environmental cleanliness and waste disposal of the health care workers in Central Hospital Warri.
- To determine some of the factors that affect knowledge, attitude and practice of standard precautions among the health care workers.
KNOWLEDGE, PERCEPTION AND STANDARD PRECAUTION AMONG HEALTH WORKERS IN NIGERIA