The aim of this study was to assess the knowledge and awareness of risk factors and impacts of occupational injuries among Primary Healthcare workers in Oron Local Government Area of Akwa Ibom State. The population used for the study was sixty (60) healthcare workers who were randomly drawn from all the Primary Healthcare Centres in Oron. The survey descriptive research design was adopted and the instrument for data collection with (YES/NO) option questionnaire with two grade responses. Data was analysed using descriptive statistics involving the use of frequencies and percentages. It was shown from the data collected through questionnaire that there are awareness of risk factors involving occupational injuries among healthcare workers. The findings also show that government and other relevant health agencies have significant role to play on occupational injuries among healthcare workers in Oron. The result of the findings also revealed that though the healthcare workers are aware of some health hazards associated with occupational injuries, there is little they can do to prevent it occurrence. Based on the findings, the study calls for well throughout action to curb the basis of the recommendations made for the study. There should be the involvement of individuals, the healthcare workers themselves, the government and other relevant agencies and stakeholders in the planning, implementation and enforcement of appropriate health policies and programmes to check the menace.
1.1 Background of the Study
Health workers in health institutions (hospitals, clinics, health centres, etc) are faced with numerous health problems which impact seriously on their status. The hospital environment by its nature is full of hazardous problems. The problems could be classified into endogenous and exogenous (Asogwa, 2007).
- Exogenous problems are such that were brought into the hospital environment by the health worker suffering from such a condition such as tuberculosis, human immunodeficiency virus (HIV), chicken pox and other conditions that have long incubation period and cannot be diagnosed early for preventive measures to take place.
- Endogenous problems are those acquired within the hospital from patients, patients’ relations or even from workers. Example of such problems include Hepatitis B, HIV, other blood sera (that is hazardous due to exposure to infected blood and other body fluids). Other problems include protozoa infections such as malaria parasites. The hazard could occur through needle stick injuries, lacerations from razor or lancet or scalpel blades that were infected and other sharp instruments.
Asogwa (2007) stated that workers mostly at risk of health problems include doctors, nurses, laboratory staff, radiographers, mortuary attendants, cleaners, physiotherapists, community health practitioners and many others. The major sources of the health problem could be hospital wards, hospital clinics, theatres, laboratories, mortuaries and other areas where patients are being treated and blood and other body fluids and specimens are taken for investigations.
Occupationalinjuries remains a major occupational health hazard among healthcare workers in Nigeria, where the risk is hyperendemic. Primary healthcare workers are at an even greater risk due to poorer compliance with standard/safety precautions by them. The list and figures according to Reich and Okubo (1992), are not certain because of reporting irregularities. But they confirm the existence of serious and increasingly diversified problems.
A needlestick injury is a percutaneous piercing wound caused by a sharp instrument commonly encountered by people handling needles in the medical setting, such injuries are anoccupational hazards for healthcare professionals. Needlestickinjuries are particularly dangerous because they may transmit blood-borne diseases, including hepatitis B, hepatitis C and HIV/AIDS.
Despite their seriousness, it is estimated that half of all needlestick injuries go unreported. On the other hand, as needlesticks have been recognized as occupational hazards, their prevention has become the subject of regulations, (Wikipedia, the free encyclopedia).
Accidental injuries caused by sharp instruments and muscosal exposure to blood and body fluids of the patients present a high risk for healthcare workers. These incidents potentially predispose healthcare workers to infection with blood-borne pathogens. The most important of which are hepatitis C virus (HCV), hepatitis B virus (HBV) and human immune deficiency virus (HIV), (Shokuhi et al, 2012).
The American Centre for Disease Control (CDC) has estimated an annual rate of 385,000 needlestick and sharp injuries showing an increasing trend.
In November 2002, the World Health Organization (WHO, 2002) reported that 2.5% of HIV contaminations as well as 40% of HBV and HCV positive cases among Healthcare workers resulted due to occupational exposures.
Lack of documentation and reporting either the cutaneous injuries caused by sharp instruments or mucosal exposure to patients’ body fluids are considered as a major pitfall to protect the healthcare workers. Such an attitude mainly resulted for lack of knowledge regarding the importance of the issue, the wrong belief of the individual that he is knowledgeable enough to handle the case, the presupposition that no follow-up and support will be provided by the management and fear of losing situation. This eventually results in deprivation from receiving care and the necessary treatments; the efficacy of which have been proven beneficial. For instance, the post-exposure prophylaxis (PEP) for HIV was found to be effective in approximately 80% of cases (WHO, 2002).
Considering the increasing rate of blood-borne infections and economical and psychological burden of occupational exposure to the blood and body fluids of the patients highlight the immediate need for provisional training of the healthcare workers, such training includes awareness of the mechanisms leading to the infection, preventive measures, and the proper management of post exposure problem. Furthermore, safe equipment and protective instruments should be provided to all healthcare workers, and their utilization should even be made mandatory (Shokuhi et al, 2012).
According to World Health Organisation (WHO, 2008), more than 2 billion people alive today have been infected with hepatitis B virus (HBV) at some time in their lives. Of these about 350 million remain infected chronically and become carriers of the virus. Three quarters of the world’s population live in areas where there are high levels of infection. Hepatitis B (HB) infection is therefore one of the leading infectious diseases in the world and an important public health challenges.
National and regional prevalence rates of HB infection vary widely. It is reported to be 8-10% in South East Asia and sub Saharan Africa, 2-7% in eastern and southern Europe, Middle East and Japan, and 0.5 to 2% in the United States and Northern Europe. An estimated 600,000 persons die each year due to the acute or chronic consequences of hepatitis B. About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis caused by the chronic infection. The hepatitis B virus is 50 to 100 times more infectious than HIV (WHO, 2008).
Routes of infection include vertical transmission (such as through childbirth) and horizontal transmission (occupational exposure, sexual contact and intravenous drug use). The primary method of transmissions reflects the prevalence of chronic HBV infection in a given area. In low prevalence areas, injection drug use, drug abuse and unprotected sex are the primary methods, although other factors may also be important. In high prevalence areas, transmission during childbirth is the most common, although in other areas of high endemicity such as Africa, transmission during childhood is a significant factor. The prevalence of chronic HBV infection in areas of high endemicity is at least 8% (Fatusi et al, 2000).
Hepatitis B virus is an important occupational hazard for workers who are exposed to blood and blood products. Among healthcare workers, needle prick injuries are common, under-reported and yet pose a significant risk of exposure to potentially fatal blood-borne viruses. This group of workers therefore, represent one of the largest risk groups for HBV infection worldwide. PHC workers are at an even higher risk group because of poorer compliance with standard precautions. That is why the WHO has recommended that all healthcare workers should be vaccinated against HBV. Fortunately, Hepatitis B is preventable with a safe vaccine that is up to 95% effective especially when given during childhood.
In countries with a low prevalence (hepatitis B surface antigen (HBSAg) prevalence is lower than(2%) of HBV infection. HBV vaccination programmes for healthcare workers were initiated in the early 1980, with immunization being mandatory in some western European countries. In France this strategy, associated with a reinforcement of universal precautions, quickly resulted in a decrease in occupationally acquired HBV rates in hospitals and in health-related settings. However, in Nigeria vaccination coverage rates are still low even among healthcare workers.
Most studies on risks of HB infection and other occupationally acquired blood borne infections have concentrated on hospital employees to the detriment of primary healthcare workers. This recognition that healthcare workers in primary healthcare were and under-provided group with respect to education and training about occupational hazards made the UK’s National Institute of Clinical Effectiveness to recommend that everyone involved in providing care in the community should be educated about standard safety principles and trained in hand decontamination, the use of protective clothing, the safe disposal of sharps and the handling of blood and other body fluids (WHO, 2008).
According to World Health Organization (WHO, 2006) the high risk fast-paced healthcare industry present unique health and safety challenges to healthcare personnel including exposure to psychological and physical demands resulting in the incidence of musculoskeletal injuries of epidemic proportions, the dynamic healthcare environment demonstrates that workers are prone to injury through a host of factors unique to them being directly involved in patient care. Just as heredity and environment interact to result in disease, no single risk factor is responsible for injury but rather a complex interaction of worker, the patients and hospital characteristics. This critical review reports the risk factors and impact of musculoskeletal injuries with consideration for how those factors impact the worker, quality of care, and patient outcomes. The intent of this critical review is to summarize current literature, identify gaps in research and broaden the questions that are asked as the efforts to reduce occupational injury move forward not to provide definitive risk factors and impacts for occupational injury.
The risk factors of occupational injury are well documented; less understood is the impact of elevated incidence of occupational injury on patient safety. Nursing injury rates are linked to nursing shortages of nurses and less nursing time at the bedside, both of which have been scientifically linked to negative patient outcomes. Further investigation is needed in this area not only due to the pain and suffering experienced by those directly affected, but also because of the organizational impacts that indirectly affect patient care. The benefit of this research is to reveal the integral role the individual worker plays in patient outcomes, despite the quality of care they provide, a finding that could dramatically change strategic priorities to deliver exemplary patient care and ensure the health and safety of workers, patients and the public.
Following the researchers’ level of knowledge on the effect of occupational injuries on healthcare workers and his frequent visits to the primary healthcare centres in Oron Local Government Area. He observed the improper method of handling equipment by the healthcare workers, thus embarked on a research to assess the knowledge and awareness of risk factors and impacts of occupational injuries among Primary Healthcare workers in this study area and to proffer solutions to these problems. It is hoped that the recommendations of this study would be useful in this regard.