ADDIS ABABA UNIVERSITY FACULITY OF MEDICINE SCHOOL OF PUBLIC HEALTH ASSESSMENT ON PREVLENCE OF WORK RELATED INJURIES AND PREVENTION PRACTICES OF HEALTH PROFESSIONALS TOWARDS OCCUPATIONAL TRANSMISSION OF HIV IN SELECTED HOSPITALS OF ADDIS ABABA By ZUFANHADIS(BSc) ADVISER:SOLOMONSHIFERAW(MD, MPH) , A THESIS SUBMITTED TO THE SCHOOL OF GR ADUATE STUDIES OF ADDISABABA UNIVERSITY IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF PUBLIC HEALTH ) JULY2008 ADDIS ABABA ETHIOPIA
ASSESSMENT ON PREVLENCE OF WORK RELATED INJURIES AND PREVENTION PRACTICES OF HEALTH PROFESSIONALS TOWARDS OCCUPATIONAL TRANSMISSION OF HIV IN SELECTED HOSPITALS OF ADDIS ABABA By ZUFANHADIS
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
ADDIS ABABA UNIVERSITY FACULITY OFMEDICINE SCHOOL OF PUBLIC HEALTH
ASSESSMENT ON PREVLENCE OF WORK RELATED INJURIES AND
PREVENTION PRACTICES OF HEALTH PROFESSIONALS TOWARDS
OCCUPATIONAL TRANSMISSION OF HIV IN SELECTED HOSPITALS OF
ADDIS ABABA
By ZUFANHADIS(BSc)
ADVISER:SOLOMONSHIFERAW(MD, MPH)
, A THESIS SUBMITTED TO THE SCHOOL OF GR ADUATE STUDIES OF
ADDISABABA UNIVERSITY IN PARTIAL FULFILLMENT OF THE
REQUIREMENT FOR THE DEGREE OF MASTER OF PUBLIC HEALTH)
JULY2008
ADDIS ABABA
ETHIOPIA
Acknowledgement
First of all, I would like to acknowledge my adviser Dr. Solomon Shiferew for his invaluable
inputs, suggestions and constructive comments at the various stages of this thesis from
proposal development through out the study.
My sincere acknowledgement is also extended to the study participants, facility heads of all
hospitals and owners of private hospitals of Addis Ababa.
I would also like to acknowledge School of Public Health in AAU for sponsoring this thesis. I
would like to extend my thank Dr.Amunieal Gesessaw and Dr.Kesetebirhan Adrnasu, for
supplying me with some materials to accomplish this work.
Lastly, I would like to extend my thanks to my husband and my family. I also thank all my
teachers and staff in the school of public health.
Southern, Nation ,Nationalities, and People Region
Time, Steam and Temperature
United Nations
Universal precaution
World Health 'Organization
Abstract
Introduction: The increasing prevalence of HIV increases the risk that health care workers
will be exposed to blood from patients infected with HIV, especially when blood and body
fluid precautions are not routinely followed.
Universal precautions mean taking precautions with everybody. Health providers should have
the right to be able to protect themselves against infection; whether it is HIV, Hepatitis or
other disease, clients have also the right to get safe service.
Objective: To assess prevalence of work related injuries, knowledge and practice of
prevention of occupational transmission of HIV among health professionals in selected
hospitals of Addis Ababa
Methods: Health institution based cross-sectional survey was conducted from January
through April/OS. Selected hospitals of Addis Ababa were included in the study. Three
hundred sixty two health professionals were interviewed; interview of appropriate persons
was conducted. Prevention practice of study department's was assessed by observation using
standard checklist.
Result: One hundred and five, 29 %of health professional reported that they had sustained
accidental needle stick injury and 61 (16.9%) sustained sharp injuries in the past one year.
Two hundred thirty (5S%) of health professional sustains exposure of blood and body fluids
to skin, eyes and mucous membrane.
Majority (69%) of health professional have knowledge about the presence of post exposure
prophylaxis (PEP) in their hospitals for a person sustaining needle stick injury or sharp injury.
Majority of respondents knew the most common diseases that can be transmitted by
accidental needle stick injunes or contaminated blood. HlV, HBV were mentioned by
majority of respondents.
Forty-seven (27.5%)ofpublic hospital healthcare workers and 23 (16.7%) of the interviewed
private healthcare workers had reported to have received training on IPIUP in the last two
years.
Conclusion and recommendation Considerable proportions of needle sticks, sharp injuries
and exposure of blood and body fluids occurred mainly due to recapping of needles, improper
collection and handling of sharps. In-service trainings of health professionals through mass
campaign concerning infection prevention is necessary by involving health professionals in
. the private sector, and national IP guideline should be made available to all health institutions
and health professionals should used it.
1. Introduction
1.1 Statement of the problem
HIV has significantly altered the face of health care and the lives of almost everyone in
our community. Health providers are at risk of developing infections in their work place.
The increasing prevalence of HIV increase the risk that health care workers will be
exposed to blood from patients infected with HIV, especially when blood and body fluid
precautions are not followed for all patients. The risk of transmission, particularly
through accidental needle stick injuries, contacts of blood and body fluids with broken
skin, and splash of the eye and other mucous membranes is known to transmit these
infections. HIV, HBV, and HCV are the commonest transmitted viruses and are
continuous to be a major concern for all of working in healthcare services. (l)
Occupational exposure to blood and body fluids puts healthcare providers at risk of.,
infection with blood-borne pathogens, such as hepatitis B virus (HBV), hepatitis C virus
(HCV) and HIV. Of the 35 million health workers worldwide, about three million are
exposed to such pathogens each year through percutaneous injuries (from syringes and
other sharp instruments) and more than 90% of these infections occur in developing
countries, where health workers often lack the knowledge, skills and resources necessary
to protect themselves and their clients from becoming infected.(2)
Studies have shown the risk of diseases after exposure to HBV from a single needle stick
injury ranges from 27-37%, while the risk following a single needle stick exposure to
HIV is much lower 0.2-0.4%, and 3-10% for HCV( 3)
People who provide or receive health care service whether in hospitals, clinic, or any
other health care setting are the risk of acquiring and transmitting potentially life
threatening infections through accidental exposure to blood and body fluids or
contaminated objects. Over the past two decades, considerable progress has been made
globally in understanding the basic principles of preventing such infections, but they
continue to be a significant cause of morbidity and mortality through out the world. (4)
The health care workers most often involved have been nurses, laboratory technicians,
surgical physicians, midwifery, gynecologists, health assistance, hospital laundries and
cleaners, emergency health workers, medical students and other workers have been
infected. From these surgical physicians and midwifes are at great risk. (4)
The World Health Organization (WHO) estimates that each year some 16 billion
ihjections are administered in developing and transitional countries. In some situations, as
many as nine out of ten patients presenting to a primary health care provider receive an
injection, of which over 70% are unnecessary or could be given in an oral formulation
(5). At the same time, there is lack of evidence about the number of needle stick injuries
and their consequences to health care providers, although unsafe injection practices have
been linked to the transmission of blood-borne pathogens between patients and health
care providers. To prevent the transmission of blood-borne pathogens that result from
unsafe injections, injection use must be reduced and injection safety achieved. A safe
injection does not harm the recipient, does not expose the health care worker to any risk
.and does not result in waste that is dangerous for the community.(S)
Specimens including blood, blood products, and body fluids, obtained from all patients
should be considered hazardous and potentially infected with transmissible agents (6).
Between 200 and 400 health care workers die each year as a result of hepatitis B infection
acquired on the job. The use of universal precautions helps minimize the transmission of
many transmissible diseases in addition to HIV. In the absence of any effective treatment,
prevention is the only way to combat the spread of HIV (6).
Despite relative ease of implementation, many health care providers have not used
universal precautions routinely. Recent studies have shown that >50% of health providers
engage in inadequate infection control practices, even in high-impact AIDS centers, and
up to 40% of the needle stick exposures were judged to be preventable (6).
Medical transmission of HIV-through unsafe injection, sharps injury and other unsafe
practices account for a significant proportion of new infections each year illness due to,HBV, HCV and HIV infection accounts for 1.3 million deaths and to a loss of 26 million
life years.(7)
Antiretroviral treatments after exposure to HIV can reduce the risk of infection. After a
needle stick injury with HIV-infected blood, zidovudine alone can reduces the risk of
HIV transmission form an average of 3 in 1,000 injuries less than 1 in 1,000.
Combination therapy with zidovudine and lamivudine is recommended for deeper
injuries and laceration (8).
Health professionals are considered necessary to study because they are essential in the
prevention and management of diseases. This study applies the concept to health workers
as a group likely to be at risk due to the nature of their occupation, since they may expose
to infection while on routine duty through either accident, negligence, inadequate
protection or other unforeseen circumstances. Infection prevention is critically important
to the effective provision and management of health care services.
So far, very few studies were .conducted in Ethiopia to assess frequency of exposure of
.HP to occupational injuries and status of knowledge and practice of health professionals
on preventive measures. Therefore, this study will help to identify practice of HP on
safety precautions and would have a significant in put for improving practice of
preventive measures in the clinical areas.
9. Reference
1. The prevalence of needle stick injuries in Medical, Dental, Nursing and Midwifery
Students at the university Teaching Hospitals of Shiraz, Iran Mehardad Askarian, Leila
melekmakan Medical Bulletin volume 60 June 2006 number 6.
2. Infection prevention and control (home page on the internet). C2007 (updated 2007 June 7;
, cited 2007 June 21) Available from: http://www.jhpiego.org
3. CDC. ALERT: Preventing needle stick injuries in Health care settings. (NIOSH): 2000
(108): 1-23.
4. Joseph R~Thum, HIV and Occupational risk Evolving ways to protect health care workers
vol 102/no 4 October 19971postgraduate medicine.
5. Hauri AM, Armstrong GL and Hutin Yl The global burdens of disease attributable to
contaminated injections give in health care settings. IntJ STD-AIDS.2004; 15(1}: 1-:-16.
6. Transmission of HIV 'to Health Care workers HIV and the Acquired Immunodeficiency
syndrorneIl prevention of HIV the Armenian medical net work Jan 25 2006 available on
line httpwww.health.am.
7. Simonsen L;Kane A.,. Lioyd J. Zaffran M., and Kane M. Unsafe injections in the
developing world and transmission of blood born pathogens: a review. B WHO 1999; 77')
(10): 789-799. (June 29, 2001).
8-Health Resources and Services Administration Ryan White CARE Act and the AIDS
Education and Training Centers and CDC available on the Internet at
(http://pepline. ucsf.edu/pepline)
9. Hutin, Y~ et al. Best injection practices for intradermal, subcutaneous and intramuscular
needle injection. Bulletin of World Health Organization (WHO), 2003;81: 491-500
10. Updated U.S. public health service Guidelines for the Management of occupational
Exposures to HBV, HCV, and HIV and Recommendation for post exposure prophylaxis
(June 26, 2001).
G 11. ILo cod of practice on HIV/ AIDS and the world of work available on
hfpp://www.ilo.org/public /.
_ Lemessa Oljira (BSc) impact of HIV/AIDS on the public sector Health care services in
Dire Dawa administrative counsel, L, EASTERN ETHIOPIA JULY 2000 .
. HIV and safe mother hood: what else can Health workers do? AIDS action (home page
on the internet) http://www.aidsaction.infolhsm/index.htm '.
~ . Case- control study of HIV Sero conversion in Health - care workers after percutaneous
exposure to HIV-infected blood --- France, United Kingdom, and United States, January
1988 - August 1994.
~5. Emilie H.S. Osborn,; Academia and clinic, Occupational Exposures to body fluids
among, medical students a seven-year longitudinal study mexine a papadakis, and Julie
Louise Gerberding, Simonsen L, Kane A., Lio.
6. Amuniel Gessessew Occupational Exposure of Health Workers to Blood and Body fluid:
Magnitude and Management in Tigray Hospitals 2007.
17. Who is at risk of infection? (Home page on the internet) h~m:/{\'y'~Y~y'"t,~!1.g~n9~X