Knowledge, Attitude And Practice Of Standard Precautions Among Health Care Workers Acknowledgements

Thalassemia and Sickle cell disease are common in Saudi Arabia and prevalence of hepatitis C virus anti-bodies among this high-risk group is about 40%.45  The prevalence of HIV sero-positivity has been reported to be about 0.09% in the Kingdom.46  These figures suggest that a sizable 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.27, 47

Recognizing this threat, the U.S. Centers for Disease Control and prevention (CDC) proposed a series of procedures for preventing occupational exposures and for handling potentially infectious materials such as blood and body fluids.48  These procedures, known as standard precautions (SPS), advise health care workers (HCWS) to practice regular personal hygiene; use protective barriers such as gloves and gown whenever there is contact with mucous membranes, blood and body fluids of patients; and dispose of sharps, body fluids, and other clinical wastes properly.48, 49, 50

The potentially infectious nature of all blood and body substances necessitates the implementation of infection control practices and policies. 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 immunodeficiency syndrome (AIDS) due to human immuno-deficiency virus (HIV).51 In order to minimize the risk of HIV/AIDS, HBV and HCV through unsafe injection, practices, the Federal Ministry of Health has phased out the use of sterilizable injection equipment in Nigeria.51 Standard precautions apply to blood; all body fluids, secretions and excretions (except sweat) regardless of whether or not they contain visible blood; non-intact skin, and mucous membranes,22, 23, 52, 53, 54 any unfixed tissue or organ (other than intact skin) from human (living or deed), human immunodeficiency virus (HIV) or hepatitis B virus (HBV) containing culture medium or other solutions.54

Universal precautions are a set of guidelines that aim to protect health care workers (HCWs) from blood-borne infections.55  In 1981, the CDC proposed the concept of “universal precautions, originally designed to protect HCWs from exposure to blood-borne pathogens.56, 57 The definition and recommendations of universal precautions was revised by the Centres for Disease Control and prevention (CDC) and given the new name of standard precaution,58 which combines the major features of universal precautions and Body Substance Isolation (BSI)59, 60.  Under the Standard precautions, blood and body fluid of all patients are considered potentially infectious for HIV, HBV and other blood borne pathogens.54,58 In addition, standard precautions stipulate that HCWs take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices during procedures and disposal.5 The term “Standard precautions” is replacing “Universal precautions”, as it expands the coverage of universal precautions by recognizing that any body fluid may contain contagious and harmful micro-organisms.60  Standard precautions is regarded as an effective means of protecting HCWs, patients, and the public, thus reducing hospital acquired (nosocomial) infections.51

The components of standard precautions include; hand hygiene, personal protective equipment (PPE) such as use of gloves, cap, gowns, mask, safe waste disposal system, correct sterilization and disinfection processes, appropriate use of instruments and equipment, vaccination, education, screening of blood for transfusion and post exposure protocol (PEP).62 To reinforce the above existing components, three other areas of practice have been added and include; respiratory hygiene/cough etiquette, safe injection practices, and use of masks for the insertion of catheters or injection of materials into spinal or epidural spaces via lumbar puncture (e.g. myelogram, spinal or epidural anaesthesia).62

Reports indicate that standard precautions are effective in preventing both occupational exposure incidents and associated infections.25, 63  Compliance with universal precautions has been shown to reduce the risk of exposure to blood and body fluids.64  However, studies have extensively reported suboptimal and non-uniform adherence to standard precautions by HCWs in both developed and developing countries.12, 55, 65, 66  Standard precautions are designed to reduce the risk of transmission of infectious agents from both recognized and unrecognized sources of infection in health care settings.

The incidence of infection with Hepatitis B virus has declined in health care workers in recent years largely due to the widespread immunization with hepatitis B vaccine.67 In many health facilities, even though the personnel are vaccinated, the sero-conversion status after vaccination is not assessed.27  Standard precautions is also intended to protect the patient by ensuring that health care personnel do not transmit infectious agents to patients through their hands or equipment during patient care.62  

Employee exposure to blood borne pathogens from blood and other potentially infectious materials (OPIM) occur because employees are not using universal precautions.68 OPIM is defined as: