Abstract

A total of 100 Health Care Workers (HCW) including MBBS students, interns, Resident doctors and staff nurses were interviewed with a detailed questionnaire about the awareness of Hospital Infection Control (HIC) practices. Each category comprised 25 randomly selected individuals.

Of these 100 HCWs, 55% had attended HIC / HIV-AIDS training programme. 64% of HCWs had received complete vaccination against Hepatitis B and 13% were undergoing it. The number of HCWs not vaccinated for Hepatitis B was 23%, of which 14% had not undergone HIC training.

Amongst the HCWs, who have attended the HIC training programme, 60-75% were aware about the use of gloves, apron and other personal protective devices (mask/ eye shield) for its prevention. 52% of HCWs were aware of proper hand washing practices and its importance in hospital infection control. 40-50% of HCWs, who had undergone training, had knowledge about the care of spillage and the use of Sodium hypochlorite in adequate concentration for its good efficacy. Also, the awareness about the availability of Post Exposure prophylaxis (PEP) and immediate measures to be taken following needle stick injury was 40-52% in this group.

The knowledge about Bio Medical Waste disposal practices, including segregation of waste at the point of generation and colour-coding of bags was 41% and 38% respectively as compared to 34% and 26% respectively who did not attend the HIC training. Use of needle cutter and proper method for disposal of sharps was observed by 67% of HCWs.

Thus the survey conducted implies that training in hospital infection control practices and HIV-AIDS should be regularly carried out for all categories of HCWs to minimize risk of Hospital Associated Infection to patients as well as to the HCWs.

Background

Hospital Associated Infections continue to be major worldwide public health problem, despite advances in our understanding and control of these infections. Hospital associated infections are the infections acquired during the patient's stay in hospital and not in incubation period at the time of admission to the hospital. This also includes occupational infections in health care providers due to occupational hazard.¹

Health care facilities and providers, in administering health care to patients, should also consistently incorporate measures to prevent hospital-associated infections in their patients and occupational infections in their HCWs.

In our institute Hospital Infection Control training programme is conducted regularly along-with the HIV-AIDS training programme every 6 months for all categories of Health Care Workers (HCWs) with emphasis on awareness and training regarding infection control practices, biomedical waste disposal practices and the guidelines for universal safety precautions in health care facilities.

Design

The survey was carried out to evaluate the impact of hospital infection control training on the health care workers. This cross sectional survey included the MBBS students attending the clinical rotations, interns, the resident doctors and the nursing staff. Twenty-five individuals from each category were randomly selected and interviewed with the help of detailed questionnaire.

The questionnaire comprised

1. Whether and when the HCW had attended the training programme
2. The status of Hepatitis B vaccination
3. Awareness about the modes of transmission and prevention of HIV
4. Knowledge of Universal Safety precautions like Hand washing, Use of Personal Protective Equipments, Care of spillage of blood and body fluids; Use of disinfectants.
5. Knowledge about the immediate measures to be taken in case of accidental exposure to blood and body fluids
6. Awareness about post exposure prophylaxis (PEP) i.e availability and when to use PEP.
7. Knowledge of Biomedical waste Disposal practices – Segregation of waste, colour-coding of the bags and disposal of sharps.

Results

Among the 100 HCWs: 20% (5) MBBS students, 80% (20) interns, 60% (15) RMO and 60% (15) staff nurse had attended the training programme. A total of 45% of HCWs had not attended the training programme.

Hepatitis B can be an occupational hazard in the health care workers; protection can be achieved with vaccination. The 9 HCWs were not vaccinated for Hepatitis B despite of attending the training as compared to 14 amongst the non-attendees. Staff nurses were maximum amongst not vaccinated for Hepatitis B (Table 1).

Knowledge of routes of transmission of HIV was observed maximum i.e. 100% is RMOs followed by interns (90%), Staff nurses (92%) and MBBS students (84%). The use of personal protective equipments i.e. use of gloves was seen in 54% of HCWs who has taken the training while use of apron in 40% HCWs. 82% of them used mask for personal protection. In a study by Madan et al, studying the noncompliance of health care workers with universal precautions during trauma resuscitations, the compliance rates for gloves were 98%; eyewear 52%; gowns 38%; masks 10%.⁴

In spite of the guidelines of Universal Safety Precautions to be taken during patient care, accidents do happen. Immediate measures to be taken after sharp injury includes letting the site bleed, washing with dequate soap and water, application of antiseptic. Compliance with all items of universal safety precautions among physicians was low (31% to 38%).3 In our study, among the HCWs who attended the training the positive responses for the immediate measures to be taken were: Allow the site to bleed 44%; Wash with adequate soap and water 50%; Use of antiseptic 39%.

Forty per cent of the MBBS students, 24% interns, 36% RMOs and 12% staff nurses were unaware of the immediate measures to be taken after a sharp injury. The knowledge about post exposure prophylaxis (PEP) i.e availability and when to use PEP was seen in 52% of the trained HCWs which include 20% (5) MBBS students, 68% (19) interns, 60% (15) RMOs and 52% (13) staff nurses.

Hand washing is the simplest way to prevent hospital-associated infections. 84% of HCWs including 17% MBBS students, 22% interns, 21% RMOs and 24% staff nurses were following it and were aware of proper hand-washing practices and its importance in hospital infection control.

Fifty one per cent of HCWs who had attended training had knowledge about care of spillage and the use of Sodium hypochlorite in adequate concentrations for its efficacy. Among the 16 of HCWs not aware about the care of spillage 12 had not attended the training.

There has been recent concern from the public, media over perceived inadequacies in biomedical waste disposal. There is 10 tonnes of untreated biomedical waste daily in Mumbai as per Maharashtra Pollution Control Board (Published in Times of India, August 2004).

The knowledge about proper Biomedical Waste disposal practices was seen in 75% of HCWs (19 MBBS students, 22 interns, 19 RMOs and 15 Staff Nurses) who were following the practice of segregation of waste at the point of generation and use of colour-coded bags for the disposal. Proper disposal of sharps was carried out by 67% of HCWs. A report from Henry et al mentions recapping of needles by 34.4%, which suggests low compliance of HCWs for disposal practices.2

Conclusion

The training programme is conducted regularly still the implementation is by less number of HCWs. Continued Medical Education for all HCWs in terms of strict implementation of the Hospital Infection Control Practices is needed. This could be reinforced with supervision of seniors and will go a long way in improving the scenario.

References

1. Bennett J. Hospital Infections, 4th Edition, 2000.
2. Henry K, Campbell S, Collier P, Williams CO. Am J Infect Control. 1994; 22 (3) : 177-8.
3. Michalson A, Delclos GL, Felknor SA, Davidson AL, Johnson PC, et al. J Occup Environ Med 1997; 39 (2) : 130-37.
4. Madan AK, Rentz DE, Wahle MJ, Flint LM. South Med J 2001; 94 (3) : 277-80.