Knowledge, attitudes and practices related to sharp injuries prevention and access to post exposure prophylaxis of HIV infection among health facility workers in Jinja District
Serebe, John Bosco
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Introduction: Worldwide, sharp injuries are the most common source of occupational exposures to blood-borne infections among health workers. WHO estimates that the factors responsible for occupational exposures to contaminated sharps by health workers are based on the number of health workers at risk of exposure, the annual number of sharps injuries, and the prevalence of blood borne infections, Jules M. (2003) Despite the risk of sharps injuries, several studies in Sub- Saharan Africa have highlighted that knowledge and compliance among health workers is inadequate regarding their prevention and management. Some health workers are vulnerable to accidental exposures to sharps injuries because they lack experience and skill, Elliott et al, (2005). Sharp injuries are a common occupational and Public health problem in Uganda: 57% of health workers had experienced at least one sharp injury in the previous year, (MOH Uganda 2003). Doctors, Specialists who perform invasive procedures, nurses and cleaners are groups that have high rates of sharp injuries. Lack of safe devices in health facilities, a low expenditure on health care and occupational safety, and a high ratio of patients to health care workers contribute to a work environment that predispose them to a great risk of sharp object injuries, and consequently to blood borne infections like HIV, Hepatitis B and C, Jagger et al.(2004) Objective: This study assessed health workers knowledge, attitudes and practices related to sharp injury prevention and access to post exposure prophylaxis of HIV among health workers in Jinja district. Methodology: The study was a cross-sectional study employing both quantitative and qualitative methods of data collection. Interview administered questionnaires to 377 respondents and 37 facility based observation checklists were used to collect quantitative data. Qualitative data was collected through 3 Focus group discussions held with cleaners. Quantitative data was analyzed using Stata/SE 10.0 for windows software and MS Excel 2007. Univariate analysis was done. The level of significance used was p< 0.05. Qualitative data was analyzed manually. Results: The magnitude of having had a sharp injury among health facility workers was (62.3%) in Jinja district, 86.4 % of them were related to needle sticks and 52.3% were associated with health workers giving injections. Healthfacility workers of age group 30-39 had a higher adds of having a sharp injury (OR= 1.8, 95% CI 1.13- 3.11) and use of auto disposable needles and syringes (OR= 1.9, 95% CI 1.26- 2.95). Health facility workers awareness about the risk of infection to HIV following exposure to sharps injury was 98.7%, knowledge about the common sharps injury prevention practices was generally low, only 22.2% of health workers had familiarized themselves with the recommended safety precautions. Personal protective equipment, safety devices were inadequate, and the method of disposing of sharps was inappropriate in most health facilities. Reporting, monitoring and follow-up of health facility workers who sustained sharp injuries was minimal. Knowledge about PEP in health facility workers was 78.2%, Nursing assistants had less odds of accessing PEP services than clinicians (OR= 0.38, 95% CI 0.18 – 0.83), Health facility workers in the age group (40-50) years had less odds of accessing PEP services compared to clinicians (OR= 0.1, 95%CI 0.06-0.48), Health facility workers in Hospitals had higher odds of accessing PEP services than those in lower health facilities(OR= 2.1, 95CI 1.64-2.89), Health facility workers in Health center IVs had higher odds of accessing PEP services than those in lower health facilities (OR=2.5, 95CI 2.36 - 4.58),Health facility workers with tertially education had higher odds of accessing PEP services compared to those with secondary education (OR= 6.4, 95CI 2.26 – 18.7). Health facilities with HIV testing services were 86.4%, half of them (42.9%) offered PEP services. Only 10.8% of health facility workers actually accessed PEP services. The barriers to accessing PEP services were inadequate health facility workers knowledge (OR= 1.3, 95CI 1.28-1.65) and lack of drugs in health facilities (OR= 1.6 95 CI 1.12-1,37) Conclusion: The prevalence of sharp injuries among health facility workers was high ( 62.3%), it was related to needle sticks and associated with health workers giving injections. Although the knowledge about the risk of occupational exposure to HIV infection was high, very few health workers had familiarized themselves with the recommended safety measures. Age range 30-39 years, and use of auto disposable needles and syringes had higher odds of exposure to sharp injuries. There was limited application and use of sharps preventive measures, the methods of reporting sharp injuries were minimal. Health facility workers of age range 40-50 years, and Nursing assistants had less odds of accessing PEP services, health facility workers in hospitals, health center IVs, workers (1-5) years in service, had higher odds of accessing PEP services . Lack of drugs and inadequate knowledge on PEP were the barriers for not accessing PEP services. Recommendations: The Ministry of Health and the District health team should identify training needs for health facility workers, focused on the burden of sharp injuries, the dangers of acquiring HIV and other blood borne infections, adherence to safety measures and the benefits of PEP. The Ministry of Health and the District health teams should regularly monitor and evaluate compliance with standards and guidelines The district Health Management information system (HMIS) should be streamlined to capture and report about sharp injuries and access to PEP. The Ministry of Health in collaboration with district health team should prioritize a constant supply of safer medical protective devices and PEP drugs in all health facilities, through NMS.