PRACTICE OF UNIVERSAL PRECAUTIONS AND OCCUPATIONAL EXPOSURES AMONG HEALTH CARE WORKERS

1. PRACTICE OF UNIVERSAL PRECAUTIONS AND OCCUPATIONAL EXPOSURES AMONG HEALTH CARE WORKERS Tuteja A , Chintamani, Tuteja G, Department of Surgery ,VMMC & SJH, New Delhi. OPTIONALLOGO HERE OPTIONALLOGO HERE INTRODUCTION RESULTS AND OBSERVATIONS RESULTS AND OBSERVATIONS RESULTS AND OBSERVATIONS • WHO estimates 2.5%of HIV ,40% of Hep B and Hep C among HCWs –result of occupational exposures. • UP-reduce risk of transmission of blood borne pathogens • Level of knowledge and awareness of universal precautions –differs from one type of HCW to another. • Medical and nursing students –inadequate knowledge of appropriate protective equipment –involved in clinical procedures • Compliance of staff to universal precautions is generally deficient. • Suboptimal reporting of occupational exposure. • To study the knowledge and attitude of HCWs about universal precautions. • To estimate the level of adherence of universal precautions among HCWs . • To study the frequency and type of occupational accidents suffered by medical personnel. • Study Design Cross sectional • Time Period July 2011 • Study Location VMMC and SJH hospital • Participants N = 500, randomly selected • HCW (medical doctors, nurses , • porters, medical and nursing students). • METHODOLOGY • A 25 Item self administered, structured questionnaire was devised de novo and tested. • Written and informed consent was taken. • Demographic information, knowledge, awareness and compliance of UP, incidence of needle stick injuries ,steps to follow on occupational exposure was collected. • Analysis-SPSS version 16 • PARTICIPANT DEMOGRAPHICS • GENDER No. of Percentages • Subject (n = 414) • Female 178 43% • Male 236 57% • AGE (in yrs) 26 (17-59) • EDUCATIONAL STATUS • Medical students 104 25% • M B B S 38 9.2 % • M S / M D 118 28.5 % • Nursing Students 52 12.6 % • GNM + Class 12th 35 8.5% • BSc (nursing ) 12 2.9% • Class 8th 55 13.3 % • FACTORS AFFECTING UNIVERSAL PRECAUTIONS • Higher education level correlates positively with correct awareness and adherence of UPs. (P=0.000) • More than 5 yrs of practice is associated with greater knowledge and compliance of UP (P<0.05) • Self rated knowledge and confidence are not correlated with awareness and adherence of UP (P > 0.05). • Source of awareness helps to determine the level of knowledge, and although 77.8 % have received it through books , yet they did not have correct knowledge. • Most HCW on grading themselves felt their knowledge of UPs was sufficient, even though 55 % did not have correct information regarding recapping. • Occupational training is a comprehensive and reliable medium to receive ground knowledge, but only 24.9 % have received it. • Practice of UP has an attitudinal influence related to education and work experience. • General positive attitude to care for infected persons is seen. • Although not optimal –the level of awareness of PEP was 62.6 %. • Sampled population is small – difficult to generalize the findings. • Few respondents are students with limited clinical experience • Despite efforts to ensure privacy during interviews & no penalty for any response-under reporting of discriminatory behaviour and over reporting of correct practice and attitudes. • Obligatory training programs of universal precautions for all tiers of health staff. • Sufficient personal protective equipment to be provided. • Posters to be put up in all the wards promoting the use of UP s and establishing post exposure reporting systems. • Routine immunization of HCW s against Hep B. • Adherence and practice of UP are a concern and internationally suboptimal among many professionals (Askarian et al 2005). • Corroboration exists amongst the researchers as to the reasons for noncompliance such as lack of time, lack of means ,precautions not warranted ,interfere with patient care (Madan et al 2002). • Level of awareness of UP increased with longer years of service in health care sector and educational status (Vaz K, 2010). • Research confirms that compliance improves following structured intervention, such as educational training programme (Pruss-Ustua A. et al. 2005). PROFESSION No. of Percentages Subject (n = 414) Medical Students 104 25 Nursing Students 52 12.6 Doctors 154 37.7 Nurses 47 11.4 Porters 55 13.3 WORK EXPERIENCE < 5 YRS 252 61 >5 YRS 162 39 HBV VACCINATION YES 272 65.7 NO 142 35 RESPONDENTS UNDERSTANDING OF AIMS OF AIMS OF UP No. of Subjects (%) Protect HCWs 220 (53.1) Protect patients getting 112 (27.1) infected from HCWs Prevent mutual transfer of infection 252 (60.9) Protect HCWs -infectious waste 171 (41.3) Protect HCWs - sharp waste 194 (46.9) Identifying all correct aims  109 (26.2) SHOULD RECAPPING BE DONE ? Content goes here… DISCUSSION OBJECTIVE SOURCE OF KNOWLEDGE OF RESPONDENTS ABOUT UP MATERIALS AND METHOD LIMITATIONS TAKE HOME MESSAGE RESULTS AND OBSERVATIONS REVIEW OF LITERATURE OCCUPATIONAL EXPOSURES • 24.9% have received training of universal precautions • 11.1% subjects have had occupational exposures from blood and body fluid pathogens • 62.6 % -aware of steps of post exposure prophylaxis