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

• The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, anybody fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids.68

• Any unfixed tissue or organ (other than intact skin) from a human (living or dead);68 and

• HIV – containing cell  tissue cultures, organ cultures, and HIV or HBV – containing culture medium or other solutions, and blood, organs, or other tissues from experimental animals infected with HIV or HBV.68

The Blood-borne pathogens standard allows for hospitals to use acceptable alternatives to universal precautions.69 Alternative/concepts in infection control are called Body Substance Isolation (BSI) and standard precautions.69 These methods define all body fluids and substances as infectious.69  These methods incorporate not only the fluids and materials covered by the blood borne pathogens standard but expands coverage to include all body fluids and substances.69

 These concepts are acceptable alternatives to universal precautions, provided that facilities utilizing them adhere to all other provisions of the standard.69 For compliance with OSHA standards, the use of either universal precautions or standard precautions are acceptable.69

Since it is not feasible or cost-effective to test all patients for all pathogens prior to giving care, and identification of patients infected with blood borne pathogens cannot be reliably made through medical history and physical examination, standard precautions are therefore recommended for use on all patients by the United states Centres for Disease Control (CDC), regardless of diagnosis and treatment setting.70, 71

Statement of the Problem

Healthcare workers (HCWs) are at risk of occupational hazards as they perform their clinical activities in the hospital.72  The occupational health of the health care workforce of about 35 million people representing about 12% of the working population has been neglected.72  They are exposed to blood borne infections by pathogens such as HIV, hepatitis B and hepatitis C viruses, from sharps injuries and contacts with deep body fluids.4, 5, 58 In an era of HIV epidemic in sub-Saharan Africa,73 this occupational risk is real and significant.  It has been found that the risk of transmission of HIV/AIDS via needle stick incidents is                  0.3 %;4,15,27,29;  i.e, 1 case per 300 needle stick incidents.   

The Occupational Safety and Health Administration estimates that 5.6 million HCWs worldwide who handle sharp devices, are at risk of occupational exposure to blood borne pathogens.74  These injuries are usually under-reported for so many reasons such as stigmatization, should HIV result from such incidents.15 The sero-prevalence of HIV varies widely from country to country and from one region to another within the same country.75  Sub-Saharan Africa (SSA) has the highest HIV sero-prevalence in the world.75 The 2005 sero-sentinel survey conducted in Nigeria reported an overall HIV sero-prevalence of 4.4%.75 This high prevalence in the country poses an occupational risk to HCWs.  HIV/AIDS constitutes a major health problem in Nigeria.76 Nigeria is one of the countries worst hit by the HIV/AIDS epidemic, with about 2.99 million people currently infected.76  Over a million people (? 1.70 million) have already died from AIDS76 since it was first reported and confirmed in Nigeria in 1986.77

The health consequences of these infections are enormous; symptoms of HCV infection may not manifest until 20-30 years after viral transmission.78 Also, about 60-85% of HCV infections result in liver cirrhosis and liver cancer.61 There is no immunization for HCV and HIV, it becomes important to prevent infection by preventing exposure.7  

The rising prevalence of morbidity and mortality following exposure to blood borne infections is due to the lack of knowledge, wrong attitude towards and non-compliance to standard precautions as well as bad practices such as bending of needles, recapping of needles, detachment of needles, reuse of needles and lack of adequate sharps containers and disposal facilities, shortage of supply of injection equipment and unwarranted and unsafe use of injections, that put both patients and HCWs at risk of occupational exposure.  The improper disposal of used sharps and needles is known to cause needle stick injuries.81

WHO estimates that annually, 16 billion injections are given each year in developing and transitional countries with an annual mean 1.5 injections per person per year.17  70 to 99% of these injections are unnecessary, while 50% are unsafe in 14 of 19 countries in five developing world regions with data.18,19,20  In Nigeria, the annual mean was found to be 4.9 injections per person per year.21  The socio-economic and psychological burden of unsafe injections occur at individual, family, community and national levels.  It is estimated that each year, the annual global burden of indirect medical cost due to hepatitis B and C and HIV/AIDS is estimated to be US $535 million.83 

Globally, in 2000, unsafe injection was responsible for an estimated 21 million cases of Hepatitis B virus (HBV) infection, 2 million cases of Hepatitis C virus (HCV) infection and 260,000 cases of HIV infection, making up 32%, 40% and 5% of infections due to unsafe injection practices respectively.84 

It is estimated that 9.18 million DALYs would be lost between 2010 and 2030 although interventions implemented in the year 2000 for the safe and appropriate use of injections could reduce it. 22, 84