Abstract
Occupational exposures predispose health workers (HWs) to a risk of HIV infection. When properly used, HIV Post Exposure Prophylaxis (PEP) can significantly reduce this risk. Th purpose of this study was to determine the extent and types of occupational exposures, availability of PEP guidelines, and utilisation of PEP amongst HWs. A cross-sectional mixed methods baseline study was conducted between March and May 2014 using a structured questionnaire administered to 236 HWs from Shinyanga, Sengerema and Musoma hospitals in Tanzania. Relationships between variables were determined using the chi-square test. Qualitative data was gathered during interviews with key informants and walkthrough observations in the hospital wards, and analysed using the framework method. Majority of respondents were nurses (53%), over 40 years old (61%) with more than 20 years (40%) of hospital experience. Needle stick and sharp injuries were experienced by 31% of respondents whilst 26% experienced splashes. Only 28% of splashes were reported compared to 80% and 68% of needle sticks and sharp injuries, respectively. Those who experienced needle sticks were more likely to report the incident (p < 0.001), receive testing (p < 0.003) or PEP (p = 0.005). Although 66% reported the availability of PEP guidelines, only 39% of exposed HWs received PEP. Occupational exposures are common in these hospitals. HWs under-report and suboptimally use PEP services. Health worker safety programmes should establish functional systems for reporting and adherence to PEP procedures. Future research should establish factors that determine compliance with PEP procedures.
Highlights
Background and literature reviewHealth workers (HW) are potentially exposed to Human Immunodeficiency Virus (HIV) infection at their workplace as a result of exposures to potentially infectious materials in the course of performing their duties (Cardo et al 1997; Kuhar et al 2013; Lee 2009; Sagoe-Moses et al 2001)
The World Health Organization (WHO) estimates that 3 million percutaneous exposures amongst HWs occur every year resulting in 200 to 5000 HIV infections, with over 90% occurring in low-resource countries (Varghese, Abraham & Mathai 2003) where HWs suffer two to four needle-stick injuries per year (Prüss-Üstün et al 2005)
The presence of percutaneous exposures in this study could be attributed to the fact that being public hospitals (SRH and MRH) and public or private hospital (SDDH) with low staffing levels, the three hospitals have a high patient load per HW, a factor that was reported to be associated with occupational injuries in a previous study (Rapiti et al 2005)
Summary
Background and literature reviewHealth workers (HW) are potentially exposed to Human Immunodeficiency Virus (HIV) infection at their workplace as a result of exposures to potentially infectious materials in the course of performing their duties (Cardo et al 1997; Kuhar et al 2013; Lee 2009; Sagoe-Moses et al 2001). Evidence shows that occupational injuries account for an average of 4.4% (ranging from 0.8% to 18.5%) of all HIV infections amongst HWs (Prüss-Üstün & Rapiti 2003; Prüss-Üstün, Rapiti & Hutin 2005). The estimated risk of HIV transmission ranges between 0.09% and 0.3% when one is exposed to infected body fluids (splashes) and percutaneous injuries (needle sticks and sharp injuries) respectively (Gold & Tomkins 2005). The observed differences might be a result of the challenges faced by developing countries in provision of health care These challenges include crowded hospitals, high patient load per HW, inadequate personal protective equipment (PPE), lack of sharps containers, limited knowledge of risks and utilisation of Post Exposure Prophylaxis (PEP), low adherence to universal precautions (UP), and high prevalence of patients with blood borne infections (Prüss-Üstün & Rapiti 2003; Sultan, Benn & Waters 2014). Sub-Saharan Africa has both the highest prevalence of HIV infection and the highest incidence of occupational exposures which, on average, was reported to be 2.10 injuries per HW per year (Lee 2009; Prüss-Üstün & Rapiti 2003; Prüss-Üstün et al 2005)
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