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PRACTICE OF UNIVERSAL PRECAUTIONS AND OCCUPATIONAL EXPOSURES AMONG HEALTH CARE WORKERS

Tuteja A , Chintamani, Tuteja G, Department of Surgery ,VMMC & SJH, New Delhi.

INTRODUCTION RESULTS AND OBSERVATIONS RESULTS AND OBSERVATIONS

LIMITATIONS

• 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 DEMOGRAPHICSGENDER No. of

Percentages Subject (n = 414)

Female 178 43%

Male 236 57%

AGE (in yrs) 26 (17-59) EDUCATIONAL STATUSMedical 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).

RESULTS AND OBSERVATIONS

PROFESSION No. of Percentages Subject (n = 414)

Medical Students 104 25Nursing Students 52 12.6Doctors 154 37.7Nurses 47 11.4Porters 55 13.3WORK EXPERIENCE < 5 YRS 252 61>5 YRS 162 39HBV VACCINATION YES 272 65.7NO 142 35

RESPONDENTS UNDERSTANDING OF AIMS OFAIMS 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 ?

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OBJECTIVE

MATERIALS AND METHOD

RESULTS AND OBSERVATIONS

SOURCE OF KNOWLEDGE OF RESPONDENTS ABOUT UP

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

DISCUSSION

TAKE HOME MESSAGE

REVIEW OF LITERATURE