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  International Journal of Hospital Research    2016, 5(1): 1-6http:// ijhr.iums.ac.ir Research Article Awareness Towards Occupation Exposure Among Health Care Workers of a Tertiary Care Hospital: A KAP Survey © 2016 Kashyap B and Gupta S; licensee Iran University of Medical Sciences. This is an open access article distributed un-der a Creative Commons Attribution-NonCommercial 3.0 Unported License (http://creativecommons.org/licenses/by/3.0), which allows unrestricted use, distribution, and reproduction in any medium, as long as the srcinal work is cited properly. Background and Objectives Health care workers (HCWs) as per the definition of World Health Organization (WHO) comprise part of the health system whose primary goal is to improve health of patients and hence are critical to the functioning of the health system. An accurate estimate of such a population is hard to achieve, however, the global health workforce is conservatively estimated by WHO to be just over 59 million making between 14% and 37% of all health ser-vice providers in countries with available census data. 1  HCWs are at an alarming risk of infections by blood borne pathogens through dangerous but preventable occupa-tional exposure to potentially infectious blood and body fluids. The types of occupational exposure in order of fre- *Corresponding Author: Bineeta Kashyap, Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India. Email: dr_bineetakashyap@yahoo.co.in Bineeta Kashyap 1 *, Shilpi Gupta 1   1  Department of Microbiology, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India. quency of occurrences include injury by sharps followed by needle-stick injuries (NSIs) and contact with infectious blood and body fluids of mucous membrane or non-intact skin. 2,3 Among the many potential blood borne pathogens that are known, hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency (HIV) are of utmost concern and are commonly encountered. Approximately 3 million NSIs are reported annually whereas the esti-mated risk of exposure to HBV, HCV and HIV are 6%-30%, 2 % and 0.3% respectively after documented ex-posure. 3,4 2.5% of HIV and 40% of hepatitis B or C cases consequent to occupational exposure have been report-ed among HCWs by WHO which amount to an estimat-ed 66 000 hepatitis B, 16 000 hepatitis C and 1000 HIV infections. 5  NSIs preventive interventions are also one of the major health concerns in India where almost 50% of HCW involved with injections administration reported one IJHR Open Access   doi 10.15171/ijhr.2016.01 Background and Objectives:  Health care workers (HCWs) are under constant exposure to the risk of occupational blood-borne infection, which most of the time can be avoided by observing standard precautions. The aim of this study was to assess the knowledge, attitudes, and practices of HCWs of a sample tertiary care hospital towards occupational exposure to blood-borne pathogens. Methods:  A cross-sectional study was carried out among HCWs of a 2500-bed tertiary care hospital. The study instrument was a structured and pretested questionnaire designed to measure the knowledge, attitude and practices of the participants towards occupational exposure. Findings:  Among the 380 respondents 22.63% gave history of sustaining needle-stick injury (NSI) in the preceding one year. The commonest clinical practice to cause NSI among doctors was blood sampling (37.5%) followed by re-capping of needles (31.3%). While 70.5% of the participants were aware of the immediate actions to be followed after NSI, only 47.36% gave partial correct answer to the questions regarding the number of diseases transmitted by NSI, and 44.2% had the correct knowledge about the post-exposure prophylaxis (PEP) facilities available in the hospital. Conclusions:  The prevention of transmission of blood-borne pathogens among HCWs requires an education-centric approach and a comprehensive infection control protocol along with strict compliance with the practices within the health care system. Keywords:  Health care workers, Needle-stick injuries, Blood-borne infection, Occupational risk. Abstract First Published online March 30, 2016  Kashyap B and Gupta S Occupational Exposure Among Health Care Workers 2 Int J Hosp Res   2016, 5(1):1-6 or more NSI in the previous one year. 6  The risk of these occupational exposure occurrences are on the rise in a developing country like India where health care delivery facilities more frequently encoun-ter overcrowding, low doctor to patient ratio, and lack of adequate facilities or uniform guidelines. Most of the pre-ventive interventions like adequate availability of post-ex-posure prophylaxis (PEP), safe injection practices, adher-ence to infection control guidelines, timely and appropriate post-exposure management or suitable legislations are rarely practiced all over in a low income country.Education of HCWs on the prevalence of such incidenc-es and the associated risk factors would go a long way in prevention of these exposures. A basic training pro-gramme among the HCWs regarding a comprehensive approach towards the preventive strategies is of para-mount importance in any hospital setting. The assessment of the level of knowledge of HCWs towards these aspects will not only reflect the baseline awareness of the gener-al population but also highlight the areas we need to fo-cus while implementing the preventive strategies against these exposures. The aim of the present study was to assess the knowledge, attitude, and practice of HCWs of a tertiary care hospital towards occupational exposure to blood borne pathogens. Methods A cross-sectional study was carried out among HCWs of a 2500 bedded tertiary care hospital, Maulana Azad Med-ical College & Lok Nayak Hospital, New Delhi, India. The target study population were the healthcare workers com-prising doctors (residents and interns), nurses (staff and student), and laboratory technicians. All potential study participants were invited to take part in the study. Three hundred eighty HCWs volunteered to participate in the study which was carried out for a period of 3 months un-dertaken as a part of infection control practices. A self-designed structured questionnaire based on the assessment of the knowledge, attitude and practices to-wards needle stick injuries was distributed among the vol-unteers and a pre-decided appropriate time of 10 minutes was given to fill the questionnaire. The validity and reli-ability of the questionnaire was pre-tested on a random sample of HCWs. The questionnaire consisted of items under three sections: (1) socio-demographic and profes-sional characteristics, (2) knowledge, attitude and practice towards NSI, and (3) occurrence of NSI in the past. A re-searcher or a member of the infection control team was present throughout the survey to clarify any doubt raised by the respondents during filling of the questionnaire. After filling the questionnaire, the correct answers were told and any query related to the topic was resolved by the infection control team.Ethical IssuesThe participants were briefed about the purpose of the study and their informed consents was obtained. The subjects were also ensured that their participations would entirely be anonymous and the information would be kept confidential at all stages of the study. Results A total of 380 HCWs participated in the study. Figure 1 shows the distribution of the various categories of par-ticipants which indicates that 78% of the study group comprised of the nursing staff or nursing students. The socio-demographic details including the professional or immunization information of the participants are laid down in Table 1. The majority (84.7%) of the HCWs were fe-males and the age varied between 20 years to more than 50 years with almost half belonging to the age group of 20 to 30 years. 33.7% of the HCWs had been serving in the hospital for past 3 to 5 years whereas 31.6% of them had less than one year of experience as a HCW in the hospital. Though 54.2% of HCWs gave a history of complete immu-nization against HBV, none of them had got their anti-HBs antibody titres done to assess their immunization status. Out of the total of 380 HCWs recruited in the KAP (knowledge, attitude and practice) study, 86 (22.63%) gave history of sustaining NSI in the preceding 1 year. Ta-ble 2 shows the details of those 86 cases who sustained NSI among the population included in the KAP study. The maximum occurrence of NSI was evident in intern (90%) followed by 14 out of 42 (33.3%) residents, more than half of which admitted of sustaining NSI in their one year ten-ure. Nursing staff and students, however, reported consid-erably lower occurrence of NSI (17%), though over 70% of the incidences have occurred in the last year. Two of the interns reported NSI to have occurred to them on more 42%36%6%5%11%Staff nursesStudent nursesLab techniciansInternsResidents Figure 1.  Distribution of the Participants.  Occupational Exposure Among Health Care Workers Int J Hosp Res   2016, 5(1):1-6 Kashyap B and Gupta S 3 than three occasions within a year. The commonest clinical practice to cause NSI among doctors was blood sampling (37.5%), followed by re-capping of needles (31.3%). Injury sustained during injections (intravenous, subcutane-ous, intramuscular) was the commonest clinical activity among nurses (61.53%). Fifty-two out of 86 (60.46%) HCWs admitted of not wearing gloves while they sus-tained NSI. Sixty-eight out of 86 (79.06%) cases did not know about the complete follow up protocol in case of any needle stick injury.Table 3 shows the knowledge, attitude and practice of the respondents towards NSI. One hundred eighty (47.36%) of the participants gave partial correct answer to the question regarding the number of diseases trans-mitted by NSI. Correct answer for immediate step to be followed after NSI was given by 268 (70.5%) of the par-ticipants. Only 44.2% of the study group had the correct knowledge about the PEP for HIV and HBV. While the rest of the surveyed sample were either aware of only HIV PEP or answered none, 62 (16.31%) were unaware that hospital has a protocol for reporting NSI. Most of participants (96.8%) expressed an attitude that train-ing for needle stick injury protocol and management is necessary. Discussion The importance of timely identification and prevention of infections among HCWs cannot be overemphasized in a hospital setting where the health of the employee is con- Table 1.  Socio-Demographic Prole of HCWs Under KAP Survey (n = 380) Demographic DetailsNumber (%) SexMale 58 (15.3)Female 322 (84.7)Age (years)20-30188 (49.5)31-40160 (42.1)41-5021 (5.5)>5011 (2.9) Duraon as HCWs in the hospital (years) <1120 (31.6)1-282 (21.6)3-5128 (33.7)>550 (13.1) HBV (Immunizaon status)Paral 104 (27.4) Complete 206 (54.2) No vaccinaon 70 (18.4) An-HBs anbody tres afer HBV immunizaonNone  Abbreviations: HCWs, health care workers; HBV, hepatitis B virus; KAP, knowledge, attitude and practice. Table 2.  Details of NSI Cases Among the KAP Survey Participants (n = 86) Doctor (n = 62)Technician (n = 22)Nurses (n = 296)Resident(n = 42)Intern(n = 20)Staff (n = 160)Student(n = 136) No. of HCW who sustained NSI14 (33.3%)18 (90%)2 (9.1%)28 (17.5%)24 (17.6%)No. of times NSI in last 1 year  1 time 9 (64.3%)10 (55.5%)2 (100%)20 (71.4%)18 (75%) 2 times 3 (21.4%)6 (33.3%) - 2 (7.1%)4 (16.7%)3 times2 (14.3%) -- 4 (14.3%)2 (8.3%)> 3 times - 2 (11.1%) - 2 (7.2%) - Stage of occurrence of NSI During injection 2 (14.3%) -- 18 (64.3%)14 (58.3%)Blood sampling2(14.3%)10 (55.5%)2 (100%)2 (7.1%)6 (25%)Re-capping/Re-bending of needle2 (14.3%) 8 (44.4%) - 6 (21.4%)4 (16.7%)Major/minor surgical procedures4 (28.6%) -- 2 (7.1%) -Others 4 (28.6%)  ---- No. of HCW wearing gloves at the time of NSI4 (28.6%)12 (66.7%)2 (100%)16 (57.1%)18 (75%)No. of HCW who took PEP2 (14.3%)2 (11.1%)06 (21.4%)10 (41.7%)HBV immunization statusComplete10 (71.4%)02 (100%)20 (71.4%)4 (16.7%)Partial2 (14.3%)10(55.6%)06 (21.4%)16 (66.6%)No 2 (14.3%)8 (44.4%)02 (7.2%)4 (16.7%) Abbreviations: HCW, health care worker; HBV, hepatitis B virus; KAP, knowledge, attitude and practice; PEP, post-exposure prophylaxis; NSI, needle-stick injury .  Kashyap B and Gupta S Occupational Exposure Among Health Care Workers 4 Int J Hosp Res   2016, 5(1):1-6 Table 3.  Knowledge, Attitude and Practice of HCWs Towards NSI (n = 380) Questions Based on KnowledgeOptionsNo. (%) How many diseases are transmitted by NSICorrect132 (34.7)Partial correct180 (47.4)Not answered68 (17.9)Maximum risk of transmission among viral infections for NSI.Correct124 (32.6)Incorrect256 (67.4)Does our facility have a procedure for reporting NSI? Yes 318 (83.7)No46 (12.1)Don’t know16 (4.2)Do you know about Standard precautions? Yes 360 (94.7)No20 (5.3)What is the immediate step taken after NSI?Correct302 (79.5)Incorrect78 (20.5)PEP after NSI is available for?Correct186 (48.9)Incorrect194 (51.1)In our hospital where ART for PEP HIV is available at?Correct170 (44.7)Partially correct194 (51.1)Don’t know16 (4.2)Is it necessary to take consent of source for testing for viral markers? Yes 274 (72.1)No106 (27.9)Who would be contacted rst soon after NSI?Correct116 (30.5)Incorrect264 (69.5)Is it necessary to take PEP in case of exposure by an unknown source? Yes 216 (56.9)No164 (43.1) Questions Based on Attitude Whether NSI should be reported? Yes 358 (94.2)No22 (5.8)Needle should be re-capped or bent after use? Yes 76 (20)No304 (80)Needle should be discarded immediately after use? Yes 185 (48.7)No195 (51.3)Do we need to know and practice standard precautions? Yes 374 (98.4)No6 (1.6)Do you think training for NSI is necessary? Yes 368 (96.8)No12 (3.2) Questions Based on Practice Do you practice SP while phlebotomy? Yes 360 (94.7)No20 (5.3)Do you bend/recap needle after use? Yes 114 (30) No266 (70)Do you use needle destroyer after use? Yes 374 (98.4)No6 (1.6)Do you practice follow up procedure for NSI? Yes 153 (40.3)No227 (59.7)Do you practice to report the case after NSI? Yes 162 (42.6)No218 (57.4) Abbreviations: HCW, health care worker; KAP, knowledge, attitude and practice; PEP, post-exposure prophylaxis; NSI, needle-stick injury; HIV, human immunodeciency virus; ART, antiretroviral treatment; SP, safety practice.
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