CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY

Infection is one of the most important problems in health care services worldwide. It constitutes one of the most important causes ofmorbidity and mortality associated with clinical, diagnostic and therapeutic procedures. Health care workers are at a high risk of needlestick injuries and blood-borne pathogens as they perform their clinical activities in a hospital. They are exposed to blood-borne infectionsby pathogens, such as human immunodeficiency virus (HIV), hepatitis B and hepatitis C viruses, from sharp injuries and contacts with bloodand other body fluids. According to a World Health Organization (WHO) estimate, in year 2002, sharp injuries resulted in 16 000 hepatitis Cvirus, 66 000 hepatitis B virus and 1000 HIV infections in health care workers worldwide. Recapping, disassembly, and inappropriatedisposal increase the risk of needle stick injury. The incidence rate of these causative factors is higher in developing countries for the higherrate of injection with previously used syringes. Developing countries where the prevalence of HIV infected patients is very high, record thehighest needle stick injuries too. Needle stick injuries were also reported as the most common occupational health hazard in a Nigerianteaching hospital. Interventional measures have been proposed to minimize exposure of health care workers and patients to infection withthe implementation of universal precautions as one of the strategies. In 1983, the US Centre for Disease Control and Prevention (CDC)published a document that recommended blood and body fluid precautions when a patient was known or suspected to be infected withblood borne pathogens. In 1987, the CDC recommended that regardless of patient’s infection status, the precautions must be consistentlyused. This extension of blood and body fluid precautions to all patients is referred to as “universal blood and body fluid precautions” orsimply “universal precautions.” These precautions include set of precautions devised to prevent transmission of all known blood-bornepathogens including HIV, hepatitis B virus, and hepatitis C virus to/from health care personnel when providing first aid or other health careservices. This applies to blood and other body fluids containing visible blood and also to vaginal secretions and semen. In 1996, the CDCincluded the universal precautions in a new prevention concept the so-called “safety precautions.” The “safety precautions,” which aredevised to be used for the care of all patients in hospitals regardless of their diagnosis or presumed infection status, now replace the“universal precautions.” The fact that “safety precautions” are recommended for the care delivery to all patients, regardless of theirpresumed infection state, is important when handling equipment and devices that are contaminated or suspected of contamination, and insituations of contact risk with blood, body fluids, secretions and excretions except sweat, without considering the presence or absence ofvisible blood and skin with solution of continuity and mucous tissues. Safety precautions include hand washing; use of barriers (e.g., gloves,gown, cap, mask); care with devices, equipment and clothing used during care; environmental control (e.g., surface processing protocols,health service waste handling); adequate discarding of sharp instruments including needles; and patient’s accommodation in accord torequirement levels as an infection transmission source. Another important measure is adequate professional immunization, as thisguarantees anticipated protection against immune-preventable diseases. The level of practice of universal precautions by health careworkers may differ from one type of health care worker to another. The divergences in knowledge of universal precaution by health careworkers may be influenced by their different type of training. Various studies carried out among different categories of health care workersfound that exposure to blood or other body fluids was approximately 9.3%.A similar study conducted in Ibadan found a higher exposurerate of 25.1%. Several factors ranging from personal to organizational causes were responsible for non-adherence to the basic principles ofuniversal precautions among health care providers. Universal precaution awareness education has not been pronounced among healthcare workers, particularly in developing countries. According to the most recent guideline published by the Healthcare Infection ControlPractices Advisory Committee (HICPAC) in 2007, it has been recommended to apply safety precautions (SPs) for all people during healthcareirrespective of their disease status. These SPs include but not limited to hand hygiene, use of personal protective equipment, andinstrument processing. In many studies, compliance with safety precautions among healthcare professionals was reported to beinadequate with regard to eye protection, avoidance of needle recapping, glove use when required, and washing hands before and afterpatient contact, use of face masks, and avoidance of a used needle that is disassembled from a syringe and in implementation ofprecautions for all patients. According to the literature, major reported factors that affect compliance with safety precautions include butnot limited to lack of understanding and knowledge among healthcare workers on Safety Precautions, shortage of time to implement theprecautions (work overload), limited resources, lack of proper training, uncomfortable equipment, skin irritation, forgetfulness, distancefrom the necessary facilities, and insufficient support from management in creating a facilitating work environment. Moreover, certainsocio-demographic variables such as age, sex, job category, marital status, working site in the hospital and work experience were found tobe associated with compliance with safety precautions. Interventions tried in other countries to increase the compliance of healthcareworkers with Safety Precautions include but not limited to in-service training on Safety Precautions beyond ordinary level, pre-servicetraining by inclusion of Safety Precautions in educational curricula, and availability of personal protective equipment. We, therefore,conducted this study to assess the knowledge, and compliance with safety precautions among health facilities in Oruk Anam L.G.A, AkwaIbom State.

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