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ORIGINAL ARTICLE
Year : 2013  |  Volume : 3  |  Issue : 2  |  Page : 67-71
Awareness and risk perception of hepatitis B infection among auxiliary healthcare workers


Department of Oral Pathology, M S Ramaiah Dental College and Hospital, Bangalore, Karnataka, India

Date of Web Publication29-Nov-2013

Correspondence Address:
Anveeta Agarwal
M S Ramaiah Dental College and Hospital, MSRIT Post, MSR Nagar, Bangalore 560 034, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0762.122434

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   Abstract 

Context: Auxiliary healthcare workers (AHCWs) have a higher risk of occupational exposure to hepatitis B virus infection than the general population. Daily handling and exposure to biomedical wastes, blood, and its products make the AHCWs vulnerable to blood borne diseases among which Hepatitis B is one of the world's most common and serious infectious diseases. Aims: To evaluate the HBV infection related awareness and occupational risk perception among AHCWs. Settings and Design: Survey. Materials and Methods : A cross-sectional survey was carried out in M. S. Ramaiah Medical and Dental Hospitals among 300 auxiliary health workers which comprised of laboratory technicians, hygienists, laundry workers, and the housekeeping staff. After acquiring ethical clearance and informed written consent, they were explained about the objective of the study and were requested to fill a standard questionnaire. The data was compiled and subjected to statistical analysis using the Statistical Package for Social Sciences (SPSS) software. Statistical Analysis Used : SPSS Software Version 19. Results: Our survey revealed that 90.03% of the respondents were aware of hepatitis B infection (HBI) and 67.2% answered questions correctly on risk perception. Only 37% of the respondents correctly answered questions on biomedical waste management. Conclusions: Overall, an adequate awareness and a moderate occupational risk perception about HBI were found among the study group. However, knowledge regarding hospital waste disposal was found to be insufficient. Our vision aims at a nation committed to combat silent epidemic of viral hepatitis infection.


Keywords: Auxiliary healthcare workers, biomedical waste management, blood borne diseases, hepatitis B infection, infection control, needle stick injury, occupational exposure


How to cite this article:
Patil S, Rao RS, Agarwal A. Awareness and risk perception of hepatitis B infection among auxiliary healthcare workers. J Int Soc Prevent Communit Dent 2013;3:67-71

How to cite this URL:
Patil S, Rao RS, Agarwal A. Awareness and risk perception of hepatitis B infection among auxiliary healthcare workers. J Int Soc Prevent Communit Dent [serial online] 2013 [cited 2019 Nov 13];3:67-71. Available from: http://www.jispcd.org/text.asp?2013/3/2/67/122434



   Introduction Top


Hepatitis B infection (HBI) is one of the major public health problems globally and is the 10 th leading cause of death. Worldwide, more than two billion of the population have evidence of past or recent HBV infection and there are more than 350 million chronic carriers of this infection. [1],[2] The number of HBsAg carriers in India has been estimated to be over 40 million. Estimates indicate that annually over 100,000 Indians die due to illness related with HBV infection. [3]

HBV is a 42 nm DNA virus assigned to the family Hepadnaviridae. The inner core of the virus contains hepatitis B core antigen ( HBcAg ) ; hepatitis B e antigen (HBeAg); a partially double-stranded 3,200-nucleotide DNA molecule, and DNA polymerase with reverse transcriptase activity surrounded by an outer lipoprotein envelope containing the surface antigen (HBsAg). [4] Humans are the only known natural host and the virus circulates in the blood in concentrations as high as 108 virions per ml. Transmission of HBV occurs through percutaneous or permucosal exposure to infective body fluids. In addition to sexual contact and drug injection, nosocomial transmission is also a possibility. [5]

Blood and blood products are the most common vehicle of transmission in healthcare settings. [6] With the increasing number of invasive diagnostic and therapeutic procedures, there is an increasing risk of HBV infection to the auxiliary healthcare workers (AHCWs). [7] The AHCWs constantly come in contact with blood and its products due to daily handling of biomedical wastes and while performing invasive procedures. Hence, it is necessary for them to be aware of HBI and its prevention. In the present study, we have aimed at investigating the HBV infection related awareness and occupational risk perception of the AHCWs.


   Meterials and Methods Top


A cross-sectional survey was carried out in M. S. Ramaiah Medical and Dental Hospitals among 300 AHCWs which comprised of laboratory technicians, hygienists, laundry workers and the housekeeping staff. After ethical clearance and written consent, they were counseled and explained about the objective of the study and were requested to answer a standard questionnaire with multiple choices. The devised questionnaire comprised of 20 questions and was prepared in two languages, one being English and the other in the local language, that is, Kannada. The data was compiled and subjected to statistical analysis. The data was analyzed through Statistical Package for Social Sciences (SPSS) package (IBM SBSS Statistics-Statistical Package for the Social Sciences).


   Results Top


The various groups of AHCWs have been depicted in [Figure 1] and the overall responses have been depicted in [Figure 2]. It was encouraging to find that 96.2% of the 300 AHCWs were vaccinated against HBV.
Figure 1: Various groups of auxiliary healthcare workers

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Figure 2: Overall results obtained

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Overall, an adequate HBV infection related awareness was found among the group. 96.9% of the respondents knew that the main mode of transmission of Hepatitis B was through blood and its products. More than three quarters (76.3%) of the AHCWs knew that HBI causes liver cancer. Majority of the respondents (93.9%) were aware that HBI could spread through contaminated needles and syringes.

A moderate occupational risk perception was found among the group. Astonishingly, only 40.5% of the AHCWs knew the correct course of action after a needle stick injury. Just about 38.9% of the respondents knew that blood soaked cotton and dressings are discarded in yellow colored bags and 52.7% answered correctly that sharps and needles are disposed in white colored bags. 80.2% of the AHCWs used sharps container to dispose used needles and lancets.

The questions on the awareness and occupational risk perception of HBV infection and the percentage of correct responses are enlisted in [Table 1] and [Table 2], respectively.
Table 1: Results obtained on the awareness of hepatitis B infection in auxiliary healthcare workers

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Table 2: Results obtained on the occupational risk perception of hepatitis B infection in auxiliary healthcare workers

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   Discussion Top


AHCWs are at a greater risk at contracting blood borne diseases due to their constant contact with blood, body fluids, or sharps contaminated with blood. In the present study we found that there was adequate awareness among the group, but risk perception was found to be moderate. Information regarding biomedical waste management was particularly found to be inadequate and this is a matter of great concern. Suggestions for remedial steps to be taken to prevent nosocomial HBV infection in AHCWs are elaborated in [Table 3]. Hepatitis B vaccination protocol and needle stick injury prophylaxis are collated in [Table 4] and [Table 5], respectively [8],[9] . [Table 6] enlists the hospital waste management protocol. [10] Waste not properly managed can lead to serious health implications; therefore, proper waste disposal is mandatory and is protective against blood borne diseases.
Table 3: Remedial steps to prevent nosocomial hepatitis B infection in auxiliary healthcare workers

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Table 4: Vaccination protocol for hepatitis B

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Table 5: Guideline following exposure to hepatitis B virus (US public health services)

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Table 6: Different categories of waste and their color‑coded disposal

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In a similar study conducted by Singhal et al., in 2011 they found that a significant number (41.7%) of HCWs were unvaccinated even at an apex healthcare center. Two HCWs were found to be HBsAg positive. The antibody levels were significantly lower in those who were vaccinated more than 5 years ago than those who were vaccinated in last 5 years. [7] In the present study however, we found that 96.2% of AHCWs were vaccinated.

Another survey conducted by Carvalho in 2012 in Brazil revealed a seropositivity of 0.5% in students and 8.8% in professionals. They concluded that seroprevalence for previous contact with HBV was 17.6 times higher in professionals than in students. [11]

Khakhkar Vipul et al., in 2012 screened serum samples for presence of HBsAg, HBeAg, and anti-HBc with the help of enzyme-linked immunosorbent assay (ELISA). They inferred that the highest proportion of HBsAg positivity was found among laboratory technicians (4.1%) followed by nurses (1.7%). The distribution of the HBsAg was not associated with age and gender. However, the positive rates of HBsAg were the highest for the HCWs with more than 30 years in job, with overall positivity of 2.4% (1/41) suggesting a greater exposure to blood and other putative risk factors. [12]

In another survey done by Muhammad S Memon et al., in 2007, a total of 596 (64.6%) participants were immunized for HBV infection and 392 (66.2%) were inoculated three or more than three doses of vaccine. The pre-vaccination HBsAg status was checked in 380 (41.2%) and it was positive in 18 (4.7%) participants. The frequency of immunization was highest in doctors (92.4%) and lowest in nursing assistants (18.9%). [13]

A cross-sectional questionnaire based study done by Habib et al., among HCWs in 2011 revealed that overall knowledge were inadequate and behavior and attitude towards clinical practices were found compromised. Sixty-five percent believed that all HCWs are at risk and 89% believed that vaccination provides protection. [14] In the present study overall awareness was found to be adequate with 90.03% of AHCWs well-informed about HBI. On the other hand, risk perception was found to be inadequate with only 67.2% of AHCWs being well-informed on biomedical waste management.

In a survey conducted by Dannetun et al., in Sweden in 2006, they found that 79% (293/369) of HCWs had received at least one dose of vaccine, but only 40% (147/369) reported that they were fully vaccinated and 21% (76/369) had not been vaccinated at all. The majority of unvaccinated HCWs (72/76, 95%) stated that they would accept vaccination if offered. They concluded that the main barrier to better compliance with the guidelines is not lack of acceptance among the employees, but the failure of the employer to ensure that policies are implemented. [15]

AHCWs' safety is often overlooked, but these AHCWs comprise an invaluable part of our medical fraternity. It is our duty to ensure their safety.


   Conclusion Top


Awareness, precaution, and protection should be advocated in order to prevent the nosocomial spread of HBI. Therefore, there is a need for well-planned and clear policies for HBV screening, vaccination, and serological response checkups for all HCWs.

Also hospital waste management is an important aspect in preventing the HBI which should not be overlooked. The AHCWs should be trained and periodically monitored for effective hospital waste disposal. Health education campaigns and training programs should be regularly organized for health workers on hospital infection control. Staff safety is a challenge that must be met with a comprehensive effort. A reduction in health disparities can be brought about by a joint effort which should aim at the following:

  • Early detection and surveillance of viral hepatitis transmission and disease
  • Prevention of liver disease and cancer by improvising treatment and care
  • Implementation of vaccines to prevent hepatitis
  • Protecting patients and HCWs from hospital acquired viral hepatitis.


Staff safety is a challenge that must be met with a comprehensive effort and they should be made to understand the risks they are exposed to. We need to work towards building a healthcare workforce prepared to prevent and diagnose viral hepatitis and provide care and treatment to infected persons.

 
   References Top

1.Samuel SO, Aderibigbe SA, Salami TA, Babatunde OA. Health workers' knowledge, attitude and behaviour towards hepatitis B infection in Southern Nigeria. Int J Med Sci 2009;1:418-24.  Back to cited text no. 1
    
2.World Health Organization. Hepatitis B. (Fact sheet no. 204). Geneva: Available from: http://www.who.int/mediacentre/factsheets/fs204/en/index.html [Last accessed on 2013 Sep 10].  Back to cited text no. 2
    
3.Rapid Assessment of Hepatitis B Vaccine Introduction in India 1 st -6 th August; 2004 Proposal for INS support: India-GAVI Alliance (www.gavialliance.org/country/india/documents/)[Last accessed on 2013 Sep 10].  Back to cited text no. 3
    
4.Ananthanarayan and Paniker. Type B Hepatitis. In: Textbook of Microbiology. 8 th ed. Hyderabad: Universities Press Pvt Ltd; 2009. p. 538-44.  Back to cited text no. 4
    
5.Rawat S,Sharma N,Kumar M,Ahmed NK,Sailwal S ,Sharma S et al. Quantification of HBV DNA and its Impact on viral load monitoring. J Pharm Biomed Sci 2013;2:75-80.  Back to cited text no. 5
    
6.Shepard CW, Simard EP, Finelli L, Fiore AE, Bell BP. Hepatitis B virus infection: Epidemiology and vaccination. Epidemiol Rev 2006;28:112-25.  Back to cited text no. 6
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7.Singhal V, Bora D, Singh S. Prevalence of Hepatitis B virus infection in healthcare workers of a tertiary care centre in India and their vaccination status. J Vaccines Vaccin 2011;2:118.  Back to cited text no. 7
    
8.Serum Institute of India Limited. Available from: http://www.seruminstitute.com/content/products/product_hepatitis.htm [Last accessed on 2013 Sep 10].  Back to cited text no. 8
    
9.Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. Available from: http://www.cdc.gov/mmwr/preview/mmwrh tml/rr5011a1.htm [Last accessed on 2013 Sep 10].  Back to cited text no. 9
    
10.Bio-Medical Waste (Management And Handling) Rules 1998, India. Available from: http://www.mppcb.nic.in/bio-medical_waste.htm [Last accessed on 2013 Sep 10].  Back to cited text no. 10
    
11.Carvalho P, Schinoni MI, Andrade J, Vasconcelos Rêgo MA, Marques P, Meyer R, et al. Hepatitis B virus prevalence and vaccination response in health care workers and students at the Federal University of Bahra, Brazil. Ann Hepatol 2012;11:330-7.  Back to cited text no. 11
    
12.Khakhkhar Vipul M, Thangjam Rubee C, Parchwani Deepak N, Patel Chirag P. Prevalence of Hepatitis B viral infection in health care workers of a tertiary care hospital. Nat J Med Res 2012;2:1768.  Back to cited text no. 12
    
13.Attaullah S, Khan S, Naseemullah, Ayaz S, Khan SN, Ali I, et al. Prevalence of HBV and HBV vaccination coverage in health care workers of tertiary hospitals of Peshawar, Pakistan. Virol J 2011;8:275.  Back to cited text no. 13
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14.Habib F, Khan DK, Shan-E-Abbas, Bhatti F, Zafar A. Knowledge and beliefs among health care workers regarding hepatitis B infection and needle stick injuries at a tertiary care hospital, Karachi. J Coll Physicians Surg Pak 2011;21:317-8.  Back to cited text no. 14
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15.Dannetun E, Tegnell A, Torner A, Giesecke J. Coverage of hepatitis B vaccination in Swedish healthcare workers. J Hosp Infect 2006;63:201-4.  Back to cited text no. 15
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]

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