| dc.description.abstract | Background: Worldwide it is estimated that more than 3 million Health care workers (HCWs) experience a percutaneous injury with a contaminated object annually. Half of these occur in sub-Saharan Africa (Pruss-Ustun et al., 2005). The Centre for Disease Control and Prevention (CDC) estimates that 380,000 needle-stick injuries occur in United states of America (USA) hospitals each year, and 61 % are caused by hollow-bore needles. It is estimated that 4.4 % of HIV infections and 32% of HBV infections among HCWs are due to occupational exposures (Rapiti et al., 2005).
Studies in West Africa reported between 27-57.8% Needle stick Injury (NSI), while studies in the East African region reported Nxlexposure rates of 40-60% among HeWs in Uganda and Tanzania. A study conducted in Kenyan rural health facilities in Thika district, reported an occupational exposure rate of 30 % among health workers (Taegtmeyer et al., 2008) and in Kenyatta National Hospital (KNH), Ngesa reported an exposure rate of 59.5% among registered nurses in a public tertiary hospital in Kenya (Ngesa, 2006, unpublished data).
Objective: The aim of the study was to determine the prevalence of occupational exposures to selected blood-borne pathogens (HIV and HBV) among health workers, in two Kenyan hospitals, one public referral and teaching hospital and the other, a private university teaching hospital.
Methodology: This was a descriptive cross-sectional study carried out in Moi Teaching and Referral hospital (MTRH), Eldoret, and at the Aga Khan University Hospital, Nairobi (AKUH, N). Three hundred and sixty five (365) study participants were randomly selected by applying multi-stage probability sampling procedure. Quantitative data were collected by use of structured, close-ended questionnaires in the months of February and March, 2012 through face to face interviews. Data were analysed using EPI INFO 2000 and Statistical Products and Services solutions (SPSS) version 17.0. Patterns of association were analysed using Chi-square tests, while statistical significance was assessed using logistic regression.
Results: The overall prevalence of occupational exposures in the two facilities was 36%. In the private hospital the prevalence was 23%. compared to 43% in the public hospital. Type of facility, department, availability and location of disposal container, and procedure being performed at the time of exposure were found to be significantly associated with occurrence of occupational exposures. The overall HB vaccination uptake was 53.4% fully vaccinated, 18.9% had partial, while 27.7% had never been vaccinated.
Eighty percent (80%) of participants in the private hospital had received at least one dose of HBV vaccine as compared to only 68% in the public hospital. Out of all the participants who sustained percutaneous injuries in both hospitals, only 31 % utilised HIV Post Exposure Prophylaxis (PEP), with perceived low risk of infection being the commonest reason why PEP was not used. There was no statistical significant difference in use of PEP between the two hospitals (p=0.1371). The overall exposure reporting rate was 54% in both hospitals, and the most common reason cited for not reporting was perceived low risk of transmission of HIV and HBV by the participants.
Conclusion: The prevalence of occupational exposures among health workers could be much higher than is documented due to under-reporting. There was a statistical significant difference between occurrence of occupational exposures and the type of facility, number of years in employment, staff category, department where one worked, type of procedure being performed and the availability of and location of the disposal container at time of exposure. There was a low PEP uptake of 31 % in both hospitals but there was no statistical significant difference in the use of HIV PEP and HBV vaccination status in the two hospitals, and socio-demographic characteristics. There is an urgent need for the health institution managers and health partners to address the health workers perception of low risk of HIV and HBV transmission after an occupational exposure to blood, or other potentially infectious body fluids in the workplace.
Recommendations: Policy makers and health institution managers to formulate policy guidelines that enforce the primary prevention strategies on how to curb accidental occupational exposures. Health worker in-service training on HBV and HIV disease transmission, prevention and control should be undertaken as mandatory in continuous medical education; and should be made a requirement for licensing and registration by the relevant professional bodies. Health institutions should all come up with standard operating procedures on how to report occupational exposures and access PEP.
A copy of the National Guidelines on HIV PEP should be distributed to each department in all hospitals and Hf.Ws trained periodically on its application. Hepatitis B vaccination of HCWs should be given at no cost to the staff. An intensive educational programme to increase HBV vaccination rate of HCWs and improve HIV PEP uptake should be rolled out to all the health institutions. Further research should be conducted to address gaps in Knowledge, attitude, skills and workplace practices of health workers. | en_US |
