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ASSESSING KNOWLEDGE AND AWARENESS OF RISK FACTORS AND IMPACTS OF OCCUPATIONAL INJURIES AMONG PRIMARY HEALTH CARE WORKERS IN ORON LOCAL GOVERNMENT AREA, AKWA IBOM STATE
1.1 Background of the Study
Health workers in health institutions (hospitals, clinics, health centres, etc) are faced with numerous health problems which impact seriously on their status. The hospital environment by its nature is full of hazardous problems. The problems could be classified into endogenous and exogenous (Asogwa, 2007).
- Exogenous problems are such that were brought into the hospital environment by the health worker suffering from such a condition such as tuberculosis, human immunodeficiency virus (HIV), chicken pox and other conditions that have long incubation period and cannot be diagnosed early for preventive measures to take place.
- Endogenous problems are those acquired within the hospital from patients, patients’ relations or even from workers. Example of such problems include Hepatitis B, HIV, other blood sera (that is hazardous due to exposure to infected blood and other body fluids). Other problems include protozoa infections such as malaria parasites. The hazard could occur through needle stick injuries, lacerations from razor or lancet or scalpel blades that were infected and other sharp instruments.
Asogwa (2007) stated that workers mostly at risk of health problems include doctors, nurses, laboratory staff, radiographers, mortuary attendants, cleaners, physiotherapists, community health practitioners and many others. The major sources of the health problem could be hospital wards, hospital clinics, theatres, laboratories, mortuaries and other areas where patients are being treated and blood and other body fluids and specimens are taken for investigations.
Occupationalinjuries remains a major occupational health hazard among healthcare workers in Nigeria, where the risk is hyperendemic. Primary healthcare workers are at an even greater risk due to poorer compliance with standard/safety precautions by them. The list and figures according to Reich and Okubo (1992), are not certain because of reporting irregularities. But they confirm the existence of serious and increasingly diversified problems.
A needlestick injury is a percutaneous piercing wound caused by a sharp instrument commonly encountered by people handling needles in the medical setting, such injuries are anoccupational hazards for healthcare professionals. Needlestickinjuries are particularly dangerous because they may transmit blood-borne diseases, including hepatitis B, hepatitis C and HIV/AIDS.
Despite their seriousness, it is estimated that half of all needlestick injuries go unreported. On the other hand, as needlesticks have been recognized as occupational hazards, their prevention has become the subject of regulations, (Wikipedia, the free encyclopedia).
Accidental injuries caused by sharp instruments and muscosal exposure to blood and body fluids of the patients present a high risk for healthcare workers. These incidents potentially predispose healthcare workers to infection with blood-borne pathogens. The most important of which are hepatitis C virus (HCV), hepatitis B virus (HBV) and human immune deficiency virus (HIV), (Shokuhi et al, 2012).
The American Centre for Disease Control (CDC) has estimated an annual rate of 385,000 needlestick and sharp injuries showing an increasing trend.
In November 2002, the World Health Organization (WHO, 2002) reported that 2.5% of HIV contaminations as well as 40% of HBV and HCV positive cases among Healthcare workers resulted due to occupational exposures.
Lack of documentation and reporting either the cutaneous injuries caused by sharp instruments or mucosal exposure to patients’ body fluids are considered as a major pitfall to protect the healthcare workers. Such an attitude mainly resulted for lack of knowledge regarding the importance of the issue, the wrong belief of the individual that he is knowledgeable enough to handle the case, the presupposition that no follow-up and support will be provided by the management and fear of losing situation. This eventually results in deprivation from receiving care and the necessary treatments; the efficacy of which have been proven beneficial. For instance, the post-exposure prophylaxis (PEP) for HIV was found to be effective in approximately 80% of cases (WHO, 2002).
Considering the increasing rate of blood-borne infections and economical and psychological burden of occupational exposure to the blood and body fluids of the patients highlight the immediate need for provisional training of the healthcare workers, such training includes awareness of the mechanisms leading to the infection, preventive measures, and the proper management of post exposure problem. Furthermore, safe equipment and protective instruments should be provided to all healthcare workers, and their utilization should even be made mandatory (Shokuhi et al, 2012).
According to World Health Organisation (WHO, 2008), more than 2 billion people alive today have been infected with hepatitis B virus (HBV) at some time in their lives. Of these about 350 million remain infected chronically and become carriers of the virus. Three quarters of the world’s population live in areas where there are high levels of infection. Hepatitis B (HB) infection is therefore one of the leading infectious diseases in the world and an important public health challenges.
National and regional prevalence rates of HB infection vary widely. It is reported to be 8-10% in South East Asia and sub Saharan Africa, 2-7% in eastern and southern Europe, Middle East and Japan, and 0.5 to 2% in the United States and Northern Europe. An estimated 600,000 persons die each year due to the acute or chronic consequences of hepatitis B. About 25% of adults who become chronically infected during childhood later die from liver cancer or cirrhosis caused by the chronic infection. The hepatitis B virus is 50 to 100 times more infectious than HIV (WHO, 2008).
Routes of infection include vertical transmission (such as through childbirth) and horizontal transmission (occupational exposure, sexual contact and intravenous drug use). The primary method of transmissions reflects the prevalence of chronic HBV infection in a given area. In low prevalence areas, injection drug use, drug abuse and unprotected sex are the primary methods, although other factors may also be important. In high prevalence areas, transmission during childbirth is the most common, although in other areas of high endemicity such as Africa, transmission during childhood is a significant factor. The prevalence of chronic HBV infection in areas of high endemicity is at least 8% (Fatusi et al, 2000).