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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
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Zufan Hadis

Oct 24, 2014

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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
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Page 1: Zufan Hadis

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

Page 2: Zufan Hadis

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.

Page 3: Zufan Hadis

2. TABLES OF CONTENTS PAGE

1. ACKNOWLEGEMENT I

""\ TABLES OF CONTENTS II

.J.. LIST OF TABLES AND FIGURES , .. III

-t. LIST OF ABBEREVATION V

5. ABSTRACT...... VI

6. INTRODUCTION......................................................................... 1

7. LITRATURE REVIEW 5

8. OBJECTIVE OF THE STUDy............................. 16

9. METHODOLOGy 17

10. RESULT 27

11. DUSCUSSION 48

12. STRENGTH AND LIMITATION OF THE STUDy 55

13. CONCLUSION.................................... 56

14. RECIMMENDATION '" 58

15. REFERENCES.................................... 59

16. ANNEX........................... 62

Page 4: Zufan Hadis

List of Acronyms

AIDSAAHBAAUCl

DCH

EC

Fl\10HFRPCHBV

HevHCWs

HI

HIV

HLD

HP

IPMOHNGOsNSI.,OPDORPEP

PPE

RHBSNNPRTST

UNUP'VHO

Acquired immunodeficiency syndrome

Addis Ababa health bureau

Addis Ababa university

Confidence interval

Department of community health

Ethiopian calendar

Federal ministry of health

Faculty of research and publication

Hepatitis B virus

Hepatitis C virus

Health care workers

Health institution

Human Immunodeficiency virus

High Level Disinfection

Health professionals

Infection prevention

Ministry of Health

Non-Governmental Organization

Needle sticks injury

Out Patient Department

Odds Ratio

Post exposure prophylaxis

Personal Protective Equipment

Regional health bureau

Southern, Nation ,Nationalities, and People Region

Time, Steam and Temperature

United Nations

Universal precaution

World Health 'Organization

Page 5: Zufan Hadis

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.

Page 6: Zufan Hadis

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.

Page 7: Zufan Hadis

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)

Page 8: Zufan Hadis

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

Page 9: Zufan Hadis

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).

Page 10: Zufan Hadis

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.

Page 11: Zufan Hadis

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 /.

Page 12: Zufan Hadis

_ 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

health.org/ip/about/copyright.htm/ ©2004.

18. HIV and safe mother hood: what else can Health workers do? AIDS action (home page

on the internet) lutn.r/www.a idsaction. info/hsm/index.htm.''~"'M •••••• t.-:: _. .. _.~ . _ __ _ .

19. Christine L. Case, Ed.D. Microbiology Professor at Skyline College.

Biography, In: Access Excellence collection, Hand washing. Available

pnline at: http://www.accessexcellence.org/LC/SS/ferm_biography.html

20. Yosef W. Assessment of the safety of injections and related medical practices in health

institutions at Sidama Zone, SNPPRS IMPH thesis/. Addis Ababa University; 2004.

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Geneva: WHO; 1999.

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In: Access Excellence collection, Hand washing. Available online at:

http://www .accessexcellence .0rg/LC/S S/ferm_biograph y.html

Page 13: Zufan Hadis

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Tanzania. B WHO; 75 (2): 134-140.

_ . Family health department of FMOH Assessment of infection prevention Management of

_IPS sites in 4 regions: summary of findings. Addis Ababa: FHD; 2006

. Kiragu, Karusa, Thabale Ngulube, Mutinta Nyumbu, Panganani Njobvu, Peter Eerens,

d Chilufya Mwaba. 2007. "Sexual risk-taking and HIV testing among health workers in

Zambia," AIDS and Behavior 11(1): 131-136)

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