Standard Precautions Among Health Care Workers

Medical and Health Science Project and Seminar Material

Abstract

History has it that anything that the hand of Midas touched turned to gold. There is power in the touch. As healing can come from a touch, so also infection, disease and eventually death can come from a touch, be it for the person touching or the person being touched. Hence the study examined the the standard precautions among Health care workers. From findings it was concluded that, In general, knowledge and practice of SP is an important issue in public health to reduce transmission of HAI. Several international and regional studies have found that the frequency of knowledge was much higher than that of practice of each single measure but in varying degrees .

Chapter One

Introduction

The normal skin is designed to reduce water loss, protect against abrasions and to act as a permeability barrier1. It is colonized by bacteria usually of two categories: Resident flora and transient flora. The Resident flora are less likely to cause health care related infections, while the transient flora are the ones mostly implicated in healthcare associated infections. The transient flora is gotten from hand contact with patients, their belongings, beddings, body fluids, etc. These hands are used to transfer infection from person to person. Because the hands play an important role in transmitting infection, hand hygiene is therefore of importance in reducing the transmission of infection. It is for this reason that the Centre for Disease Control (CDC) added Hand Hygiene to the Universal or standard precautions.

Health care workers who have occupational exposure to blood are at increased risk for acquiring blood-borne infections. The level of risk depends on the number of patients with that infection in the health care facility and the precautions the health care workers observe while dealing with these patients.

There are more than 20 blood borne diseases, but those of primary significance to health care workers are, hepatitis due to either the hepatitis B virus (HBV) or hepatitis C virus HCV) and acquired immuno-deficiency syndrome (AIDS) due to human immuno-deficiency virus (HIV).

Contaminated sharps such as needles, lancets, scalpels, broken glass, specimen tubes and other instruments, can transmit blood borne pathogens such as HIV, Hepatitis B (HBC) and Hepatitis C viruses (HCV).

Unsafe injections and the consequent transmission of blood borne pathogens are suspected to occur routinely in the developing world. Furthermore, 18 studies present convincing evidence on the association of unsafe injection practices and the transmission of blood borne viruses such as hepatitis B and C, Ebola, Lassa virus infections and malaria. Such practices account for a significant number of hepatitis B and C infections. Quantitative information on injection use and unsafe injections (defined as the reuse of syringe or needle between patients without sterilization) was obtained by reviewing the published literature and unpublished WHO reports. It was estimated that each person in developing countries receives an average of 1.5 injections per annum, but those confined to hospitals receive 10 – 100 times as many injections. Of these injection, 95% are therapeutic, majority of which are unnecessary. At least 50% of these injections are unsafe in developing countries.

Injection overuse and unsafe practices account for a substantial burden of death and disability worldwide5. The circumstances leading to needle-stick injury depends partly on the type and design of the device and certain work practices. Recapping of needles is a common cause of needle-stick injury. It is documented that 10-25% injuries occurred while recapping a used needle6. The recapping of needles has been prohibited under the occupation safety and Health Administration (OSHA) blood-borne pathogen standard.

An increasing number and variety of needle devices with safety features are now available. Needleless or protected needle I.V. systems have decreased the incidence of needle-stick injuries by 62% – 88%8.

The prevalence of HBS Ag in healthy blood donors in Kathmandu valley has been reported to be about 1.67%9. Sero prevalence study suggests that the overall anti-HCV positivity in blood donors is about 0.3% in Nepal10. The prevalence of HIV sero-positivity in healthy blood donors has been reported to be about 0.2% in Nepal10.
In Saudi Arabia, the prevalence of HBs Ag in healthy blood donors ranges from 2.7% to 9.8% 9-10. Sero-prevalence studies suggest that the overall anti-HCV positivity is about 3.5% to 5% 10=11.

Thalassemia and Sickle Cell disease are common in Saudi Arabia and prevalence of hepatitis C virus antibodies among this high risk group is about 40%12. The prevalence of HIV sero-positivity has been reported to be about 0.09% in the Kingdom.

These figures suggest that a sizeable number of individuals are a potential risk for transmission of blood-borne diseases to doctors, laboratory technicians, blood bank workers, nurses, personnel working in renal dialysis and transplant units, and other health care workers.

It has been found that the risk of transmission of HIV/AIDS to health care workers via needle stick incidents is 0.3% (1 case per 300 needle stick incidents). A data combined from more than 20 prospective studies worldwide of healthcare workers exposed to HIV infected blood through percutaneous injury revealed an average transmission rate of 0.3% per injury.

The above studies including the study carried out by Ofili et al on nurses in Central Hospital in Benin City clearly revealed that knowledge of healthcare workers about the risk associated with needle stick injuries and blood-borne infections in their day to day activities in the work place and use of preventive measures is inadequate15. It is believed that only one out of three needle stick injuries are reported in the U.S., while these injuries virtually go undocumented in many developing countries.

The incidence of infection with Hepatitis B virus has declined in healthcare workers in recent years largely due to the widespread immunization with hepatitis B vaccine.17 In many health facilities, even though the personnel are vaccinated, the sero-conversion status after vaccination is not assessed.

The potentially infectious nature of all blood and body substances necessitates the implementation of infection control practices and policies.

In 1985, in order to increase awareness among healthcare workers of the dangers of sharp injuries and other types of disease transmission, the Centres for Disease Control (CDC) and the Occupational Safety and Health Administration (OSHA) in the United States introduced the “universal precaution Guidelines, which became the worldwide standard in both hospital and community care settings until 1996.

In 1996, the definition and recommendations of universal precautions was revised by the centre for disease control and prevention (CDC) and given the new name of standard precaution.

Today, standard precaution is the primary strategy to be used to reduce the risk of transmission of blood borne pathogens from moist body substances and applies to all persons, patients, clients and staff regardless of their diagnosis or presumed infectious status. Their implementation is meant to reduce the risk of transmitting micro-organisms from both known and unknown sources of infection within the health care system.

Applying standard precautions has become the primary strategy to preventing nosocomial infections in hospitalized patients. The health, safety and welfare of employees have been a major concern of the Nigerian Government. “The Workmen’s Compensation Act” of June 11, 1987 is a clear demonstration of the Federal Government’s concern for health, safety and welfare of the Nigerian worker.

The requirements for standard precautions in everyday practice include: hand washing, personal protective equipment (PPE), safe waste disposal system, correct sterilization and disinfection processes, appropriate use of instruments and equipment, vaccination, education and post exposure protocol (PEP).

Statement of the Problem

Health Care Workers (HCWs) are exposed to blood borne infections by pathogens such as HW, Hepatitis B and C viruses, as they perform their clinical activities in the hospital. There is a rising prevalence of morbidity and mortality as a result of hospital acquired infections (noso comical infections and blood-borne infections like HIV, HBV and HBC). There is a continued unwarranted and unsafe use of injections, lack of adequate sharps containers and disposal facilities, shortage of supply of injection equipment which has led to the increased incidence of needle stick injuries and blood-=borne infections among health care workers. Lack of knowledge and noncompliance with standard precautions place health care workers at significant health risks.

Identified and similar problems exist in Central Hospital, Warri, other health establishments in Delta State as well as other states, but no study has been done to address the issue.

Justification for the Study

The rising prevalence of morbidity and mortality as a result of nono comical and blood borne infections is as a result of lack of awareness, wrong attitude towards and non-compliance with the definitions and recommendations of standard precautions. Compliance with standard precautions has been shown to reduce the risk of exposure to blood and body fluids.

This study will expose the level of awareness, attitude and practice of standard precautions among the HCWs and hence the study could be used as a baseline for intervention. It could identify gaps which would be recommended for correction through interventions. Also, in the design of an evaluation, it could be pre and/or post-test depending on the study design. This study could also be used to monitor trends of events concerning knowledge, attitude and practice of standard precautions among health care workers in Central Hospital, Warri by reviewing from time to time, the incidence of needle stick injuries and the morbidity and mortality pattern.

Aims and Objectives

The general objective is to assess the knowledge, perception and practice of standard precautions among health care workers in Central Hospital, Warri, Delta State.

Specific objectives:

To determine the level of knowledge of standard precautions among health care workers in Central Hospital, Warri.
To determine the attitude of health care workers in Central Hospital, Warri towards standard precaution.
To determine the level of practice of standard precaution among health care workers in Central Hospital, Warri.

Significance of the Study:

This research, the first of its kind to be done in governmental hospitals in West Bank, to assesses knowledge and practice of SP measures and those related to SI among health care workers. Globally, many studies have been conducted about knowledge and practice of SP measures and those . Safety of Nurses and patients is considered an important issue in controlling and limiting the transmission of infectious disease between health care providers and patients. Following such standard precautions, which are easy and simple, would reduce the transmission of many types of contagious disease, thus reducing the economic burden of treating these diseases.

This study also calculated SI and NSI among participants. It is important to know prevalence of SI and NSI because needle sticks and sharps injuries represent a significant hazard in professional health care providers and exposure to blood and body fluid has been considered as part of nurses’ job. It is expected that this study will play an important role in highlighting the importance of knowledge and compliance with SP among health care workers during daily work. It is also expected to highlight the size of the problem of SI and NSI.

Chapter Five

Conclusion and Recommendation

5.1 Conclusion:

In the light of the review of literature, the study found that in the Arab world and in Palestine in particular, there is a need for studies in this field of research because standard precautions are considered one of the most important public health concerns. This is also important in planning for the improvement of people’s health. The study also found that the frequency of knowledge was much higher than that of practice of each single measure but in varying degrees. At the same time, the greater knowledge leads to better practice.

It was also found that, when participants were classified according to their categories, there were no statistically significant differences in means’ scores of knowledge and practice of SP measures and those related to SI among the different educational level of nurses. That is, knowledge and practice aren’t related to undergraduate study. The study found that prevalence of sharp injuries was high. They represented (66.8%) while the needle stick injuries represented more than two thirds of these injuries. Therefore, it is important for the health sector and hospitals to take proper actions and procedures to reduce these injuries, thus reducing incidence and spread of infections.

5.2 Recommendations:

Conducting further observational studies to assess practice of standard precautions because they are more accurate than using questionnaires. The observation method also gives an idea about reasons behind this.
Conducting further studies to identify the reasons or factors behind the significant correlations between knowledge of SP measures related to SI and work place.
Providing the hospitals with personal protective equipment to reduce exposure of nurses to blood-borne pathogens and nosocomial infection.
Holding regular lectures, educational programs and training for nurses to improve their knowledge about standard precaution measures which could improve their compliance with standard precaution measures.
Making changes in behavior to reduce exposure to nosocomial infections, sharp injuries and needle stick injuries (for example not recapping or bending the needle after use).
Developing surveillance systems or protocol in hospitals for reporting injuries, and exposure to blood and body fluid.\ Introducing standard precautions into nursing curricula and pre-employment education. This is in addition to holding qualifying exams for nurses before working in hospitals.
Implementing complete sharp injuries and needles stick injuries prevention systems which include training of nurses, surveillance system, availability of sharp containers or an effective disposal system to dispose of sharp objects in a safe way.

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