ASSESSMENT OF EXPOSURE TO BODY FLUIDS AMONG HEALTH CARE WORKERS

ABSTRACT

The purpose of this study was to assess exposure to body fluids among health care workers in Kaduna State hospitals. The study population comprises of all doctors, nurses, lab scientists and attendants working in Kaduna State hospitals. The sample size used for the study was 346 using the Yamane sample size selection formula. Stratified sampling method was used, the three existing senatorial zones served as strata. Each of the stratum was clustered according to the existing local government areas. Simple random sampling of deep and pick was used in selecting nine state hospitals, three from each senatorial zone. Purposive sampling was further used to select nine local governments that have hospitals. Proportionate sampling was used at the various selected state hospitals to distribute questionnaires to the health workers. The 346 questionnaires were administered out of which 297 (85.8%) were retrieved. The data collected was analysed using one-way analysis of variance and t-test at 0.05 level of confidence. A constant mean of 2.5 was used to ascertain the agreement of the respondents on the questionnaire items. Findings from the study showed that there were a significant difference in gender and job category in predisposing the healthcare workers in Kaduna State hospitals to body fluid hazards. It was, therefore, recommended that the state government should provide protective devices against body fluid hazards for healthcare workers in Kaduna State hospitals, there is a need to overhaul the approaches to handling hazardous materials in-line with WHO standard, this will help to prevent exposure of healthcare workers in Kaduna State hospitals to body fluid hazards.

CHAPTER ONE

INTRODUCTION

1.1         Background to the Study

Body fluids are liquids originating from inside the bodies of living humans. They include fluids that are excreted or secreted from the body. Human body fluids and other body tissues are widely recognized as vehicles for the transmission of human disease. Body fluid visibly contaminated with blood should be considered capable of transmitting hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Semen and vaginal secretions should also be considered potentially able to transmit these viruses. Similarly, cerebrospinal fluid, amniotic fluid, pleural fluid, synovial fluid, and peritoneal and pericardial fluids carry a significant risk of transmitting these viruses. In contrast, unless blood is visibly present, saliva, sputum, sweat, tears, feces, nasal secretions, urine, and vomitus carry a very low risk of transmission of HCV and HIV. It should be noted that saliva can also carry HBV. (Lohiya, Tan-Figueroa, Lohiya, Lohiya. 2013)

Exposure to body fluids among health care workers constitute a major occupational hazard globally, with an estimate of 2.6% of healthcare workers exposed to Hepatitis C virus (HCV), 59% to Hepatitis B virus (HBV) and 0.5% to Human Immunodeficiency virus (HIV), annually which equates to approximately 16,000 HCV infections, 66,000 HBV infections and 200-600 HIV infections, through occupational exposure, (Elliott, Ketton and Holt, 2005). The three body fluids pathogens that are the most commonly involved in occupational exposures in healthcare workers are hepatitis B, hepatitis C, and HIV (Weber, Rutala, Eron, 2012; Deuffic-Burbank, Delaroccque-Astagneau, Abitedoul, 2011).

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Healthcare workers exposures to these pathogen are widespread. Some studies have estimated that there are more than 400,000 parental exposures suffered by healthcare workers in the United States every year and that every year, 1 out of 10 healthcare workers in the United States suffer a splash exposure or a needle stick injury (Karmon, Mehta, Brehm, 2013; Henderson, 2012). The exact number of exposures is not known and part of the problem is under reporting: it has been estimated that approximately 50-67% of all needlesticks and exposures to bloodborne pathogens are not reported (Bernard, Dattilo, Laporte, 2013; CDC, 2008).

Healthcare workers and patients in low income countries, Nigeria inclusive are placed at increased risk of infections because of comparatively common unsafe practices. The risk of occupational infections in such countries is worsened by a range of factors including but not limited to hospital overcrowding, lower healthcare workers‘ patient ratio, inadequate or unavailability of basic safety equipment, partial awareness of body fluid exposure risk, and the recycling or reuse of contaminated needles and sharp instruments, (Bartlett, Weber, 2013; Kuhar, Henderson, Struble, 2013; Cosens, 2012)

The use of personal protective equipment (PPE), adherence to universal precautions, effective post-exposure management, engineered safer devices, injury surveillance, and relevant legislations are amongst strategies which are designed to maximize the safety of care providers and patients in healthcare setting. In many low-income countries, especially sub-Saharan Africa where more than 70% of the global HIV-infected population live, (Sagoes-Moses, Pearson, Perry, Jagger. 2001) these interventions which have been employed in developed countries are rarely available, (Awusabo-Asare , Marfo, 1997).

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Almost all healthcare workers are at risk for exposure to blood borne pathogens, but nurses are the group that is most affected (Camacho-Ortiz, Díaz-Rodríguez, Rodríguez-López, Martínez-Palomares, Palomares-De la Rosa, Garza-Gonzalez,2013; Yang, Wu, Wang. 2013). It has been estimated that more than 50% of nurses will experience at least one needlestick injury in their careers (Rhode, Dupler, Posta, 2013). Percutaneous exposures, (e.g. needle pricked injury and punctures or cuts with other sharps instrument) are most frequently sustained by those occupational groups that handle sharps instruments including surgeons but are also sustained by others including downstream workers such as those disposing waste (Attendants).

In this study, only exposure to body fluids that are capable of transmitting pathogens (HBV, HCV and HIV) to health care workers in Kaduna State hospitals are studied, because these three viruses are likely to be responsible for a much larger portion of the disease burden than other infections. This does not preclude the possibility that other infections may gain importance in the future.

1.2         Statement of the Problem

Globally, the cost of disease from occupationally acquired hepatitis B, hepatitis C, and HIV infection is high. Of 35 million Health Care Workers (WCHs) worldwide, the World Health Organization estimates that approximately 3 million experience percutaneous injuries each year. Of those injured HCWs, 70,000 are likely to be infected with hepatitis B virus as a result of exposure, 15,000 with HCV, and 1,000 with HIV, (WHO, 2007). Although, the majority of these occupational infections occur in developing countries, Nigeria inclusive, where the prevalence rates of bloodborne

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pathogens are high, most documented infections are reported from industrialized countries, where surveillance is most commonly conducted (Sagoe-Moses, et.al 2001). Studies carried out in several countries have reported varying rates of needle-stick injuries or exposure to body fluids among different healthcare worker categories. The number of occupational exposures to HIV in Estonia, Lithuania and Hungary is reported to be less than 10 annually in each of these countries, (Pillay, Colvin, Williams, Coovadia, 2001). The incidence of needle-stick injury among healthcare workers in Turkey over a one-year period was found to be 68%, (Cutter, and Jordan, 2004), while in Egypt and Uganda in 2002 was 36% and 55% respectively, (Ilhan, Durukan, Aras, 2006). According to a study carried out in an emergency Department in USA 2003, 60% of healthcare workers were exposed to blood and body fluids, (Merchant, Becker, Mayer, 2003), it was also reported as the most common occupational health hazard in a Nigerian Teaching Hospitals, (Orji, Fasubaa, Onwudiegwu, 2002).

Body fluid infections such as HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), are highly endemic in Nigeria (WHO,2013), one of the most populated developing nations in the world. Although a few studies from Nigeria have reported high prevalence of various forms of occupational exposures to blood and body fluids among health workers (Ansaet al., 2002; Erhaboret al., 2007; Isara et al., 2012; Medubietal 2006), there remains of dearth of studies from Nigeria describing the prevalence and determinants of these exposures in the different professional groups of health workers.

HIV is among the top 10 causes of death in developing countries Nigeria inclusive, and the leading cause of death in sub-Sahara Africa, (Sheriati, Shahidzadeh-mahani, Ovysi, Akhlaghi, 2007). It has been estimated that up to 60% of patients

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admitted in public sector hospitals in South Africa are HIV infected, (Patton, Coffey, Sawyer, 2009). In this prevalence environment, healthcare workers investigating and managing these patients are at risk of contracting HIV during the course of their duties. Only HBV vaccination is available, leaving healthcare workers at significant risk of morbidity and mortality when exposed to HCV and HIV, (Landovitz, Currier 2009).

Few studies from northern Nigeria, where Kaduna State is located, have reported high prevalence of various forms of occupational exposures to body fluids among health workers. Dimie, Kemebradikumo, Babatunde, George, Christian, Sanusi, (2014), showed that the prevalence of occupational exposures to body fluids, in northern Nigeria is (84.4%) in one or more type of exposures. Another research from the same region reveals a high prevalence of (73.1%) at least one or more episodes of occupational exposures. No study has been found on this title in the case study area to the best knowledge of the researcher.

Nevertheless, some HCWs who are colloquies of the researcher have reported to be complaining of exposure as a result of unavailability of protective equipment in their place of work, when the issue was discussed, the researcher observed more exposed victims from within and outside the area. Some of the complainers were at advanced age with high level of working experience, others were fresher‘s. It is based on these facts that the researcher assessed the exposure of health workers in Kaduna State hospitals to body fluid hazards, and to ascertain the factors that predispose them to exposure.

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1.3         Purpose of the Study

The main purpose of the study was to assess exposure to body fluids among healthcare workers in Kaduna state hospitals. The specific purposes of the study are to:

1. assess whether age is a factor that predispose health care workers to body fluids exposure in Kaduna State hospitals;

1. assess whether gender is a factor that predispose health care workers to body fluids exposure in Kaduna State hospitals;

1. assess whether years of working experience is a factor that predisposes health care workers exposure to body fluid in Kaduna State hospitals; and

1. assess whether job category is a factor that predispose healthcare workers to body fluids exposure in Kaduna State hospitals.

1.4         Research Questions

The study was conducted to answer the following specific questions:

1. Does age predispose health care workers to body fluids exposure in Kaduna State hospitals?

1. Does gender predispose health care workers to body fluids exposure in Kaduna State hospitals?

1. Do years of working experience predispose health care workers to body fluids exposure in Kaduna State hospitals?

1. Does job category predisposes health care workers to body fluids exposure in Kaduna State hospitals?

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1.5         Significance of the study

The study which is to assess the exposure to blood and body fluid among healthcare workers in Kaduna State hospitals is significant for the following reasons:

1. The results of this study will play a vital role in creating awareness and encourage practices of universal precautions among healthcare workers in Kaduna State hospitals.

1. The results of this study will give healthcare workers in Kaduna State hospitals an insight of the magnitude to which their profession exposes them to body fluid hazards and risk that the diseases pose to their health and survival.

1. The findings of this study will also provide the much more needed evidence base for policy, planning and implementation for healthcare workers safety and environment programming in Kaduna state hospitals.

1. The result of this study will draw the attention of the government, the hospital management, health facility administrators, those responsible for infection control policy and practice, for procurement of safety equipment and other healthcare supplies.

1. The findings of this study will help healthcare workers in Kaduna State hospitals to identify the benefits of using strategies to prevent exposure, safe injection practices, and the actions to take immediately after exposure.

1. The findings of this study will give healthcare workers in Kaduna State hospitals an insight on the likely factors that predisposes them to body fluid exposure.

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1.6         Basic Assumptions

On the basis of research evidence, the following assumptions are made for the purpose of this study:

1. that age can dispose health care workers to body fluids exposure in Kaduna State hospitals;

1. that gender can dispose health care workers to body fluids exposure in Kaduna State hospitals;

• that years of working experience can dispose health care workers to body fluid exposure in Kaduna State hospitals; and

1. that job category can dispose health care workers to body fluids exposure in Kaduna State hospitals.

1.7         Hypotheses

The following hypotheses were formulated for the purpose of this study:

Major Hypothesis

Health care workers are not significantly exposed to body fluid hazards in Kaduna State hospitals.

Sub-hypotheses

1. Age is not a significant predisposing factor of health care workers exposure to body fluid in Kaduna State hospitals.

1. Gender is not a significant predisposing factor of health care workers exposure to body fluid in Kaduna State hospitals.

1. Years of working experience is not a significant predisposing factor of health care workers exposure to body fluid in Kaduna State hospitals.

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1. Job category is not a significant predisposing factor of health care workers exposure to body fluid in Kaduna State hospitals.

1.8         Delimitation of the Study

The study was delimited to assessment of exposure to body fluids among health workers (Nurses, Doctors, Attendants, Lab scientist), directly and indirectly in contact with patients‘ body fluid in Kaduna State hospitals. The study was delimited to determine whether healthcare workers are exposed to body fluids hazards in Kaduna State hospitals. The study is also delimited to examine the factors that expose health workers to body fluids exposure in Kaduna State hospitals, and is also delimited to identify the occupational safety measures available for health workers against exposure to body fluid in Kaduna State health facilities. The study was geared towards the collection of responses from healthcare workers in Kaduna state hospitals which are dimmed to be matured to provide information on the variables considered for this study.

1.9          Limitation of the Study

Despite the fact that all the respondents were assured of confidentiality of their responses by the researcher, some refused to return back their filled questionnaire leading to having only (85.8%) retrieved questionnaire. This was due to fear or other reasons best known to them. However, services of the research assistants were tremendous as they explained each of the variables under investigated to the healthcare workers before filling the questionnaire.

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