HEPATITIS B: ITS AWARENESS, PRACTICE AND FREQUENCY OF VACCINATION AMONG SELECTED HIGH RISK HEALTH-CARE WORKERS AT TERTIARY CARE HOSPITAL

: Foundation: Hepatitis B infection (HBV) contamination is a worldwide issue and >350 million HBV transporters on the planet. Destinations: The point was to evaluate mindfulness, routine with regards to chosen high hazard human services laborers (HCW) in regards to chance for contracting hepatitis B and self-revealed immunization status. Materials and Methods: A cross-sectional investigation was led among 300 chose HCW of Holy Family Hospital Rawalpindi Jan to March 2018. Results: About 72.1% respondents were females with by and large mean period of 24.10 (standard deviation ±7.011). 67.5% females were inside the age gathering of 18-23 years. Lion's share (70.4%) of the members were nursing understudies and (92.5%) family units (54.6%). Lion's share (69.3%) of them knew that hepatitis B transmission was conceivable through perilous sex, tainted blood/body liquid, sullied syringe, needle and surgical tool, 19.6% knew through tainted blood and body liquids, 5.7% knew through defiled syringe, needle and surgical tool, 1.8% knew through risky sex. 59.3% had a past filled with contact with known hepatitis B case. 62.2% were inoculated with three portions of hepatitis B immunization. Dominant part of the members had presented to hepatitis B positive case while at work (P = 0.001). The uncovered people with known hepatitis B cases have counseled specialist, immunized and treated with prescriptions (P = 0.002); utilized needle destroyer (P = 0.012); inoculated with 3 portions of hepatitis B immunization (P = 0.001); and utilized sterile gloves while performing work (P = 0.000), particularly while managing blood and body liquid. End: notwithstanding having great information, the manner in which they practice for aversion of hepatitis B diseases were lacking and need further improvement.


INTRODUCTION
Hepatitis B virus (HBV) infection is a global pandemic, and there are >350 million HBV carriers in the world and with low, nonprofessional attitudes and practices. [1]HBV is a DNA virus and one of many unrelated viruses that cause viral hepatitis and can lead to liver cirrhosis and hepatocellular carcinoma. [2,3]More than three quarters of its infections occur in Asia, Middle East and Africa. [4,5]ccording to a WHO estimate, >2 billion people in the world have serological evidence of prior HBV infection. [6]Of the world's carriers of HBV, 75% are from Asia. [7]Globally, more than a million people die annually from its related causes. [8]This high prevalence rate with its sequels like liver cirrhosis and hepatocellular carcinoma makes HBV infection a disease of major public health importance worldwide. [9]The prevalence of HBV inadequate policies and inconsistent enforcement of carriers varies from lowest in Japan (<0.00005%), [10] to highest (10-20%) in areas like southeast Asia, China and sub-Saharan Africa. [11]According to a study from Lahore, prevalence of HBsAg in normal subjects was 2.6%, [12] and 3.37% in blood donors of Multan. [13]By virtue of occupation, the health care workers (HCW) are placed in constant danger of acquiring HBV from the infected patients. [14,15]t is the most commonly transmitted as blood-borne infection. [16]Nosocomial transmission can be prevented by the vaccination of healthcare workers. [17]The hepatitis B vaccine provides protection International Journal of Medicine and Public Health | Apr-Jun 2015 | Vol 5 | Issue 2 against the infection. [18]The HCW and laboratory workers generally faced with many occupational risks at work and his/her health and safety may be severely jeopardized if adequate preventive measures are not taken.The prevention of occupational hazards requires a thorough knowledge of the risks and practical measures to be taken. [19]They should familiarize themselves with "universal work precautions," as defi ned by Center for Disease Control, are a set of precautions designed to prevent transmission of HBV/hepatitis C virus (HCV), human immunodefi ciency virus (HIV), and other blood borne infections when providing fi rst aid or health care.Under universal precautions, blood and certain body fl uids of all patients are considered potentially infectious for HIV, HBV/HCV and other blood borne pathogens. [20]It is recommended that all HCW take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices. [21]is system of infection control is, therefore, very important if the risk of transmission of infections in working places are to be minimized, as they may not be aware of the outcome of blood and fl uid specimens until they are investigated. [20] Tripura, Hepatitis Foundation of Tripura (HFT) a Non Governmental Organization (NGO) is actively working for combating hepatitis B infection in the state.Till 2011, a total of 69, 8811 persons have been vaccinated with a population coverage of 19.41%. [22]It needs to be mentioned that hepatitis B positivity rate in Tripura is between 4% and 5%. [23]Further, 12% of the state's total Muslim population and 8% of the total tribal population suffer from hepatitis B infection. [24]e purpose of this study is therefore to determine knowledge of HBV and hepatitis B vaccine, frequency of vaccination, and understanding the risk factors for HBV infection among nursing staff, nursing students, nursing interns, and laboratory technicians who are considered high risk and are working in tertiary care hospitals in Agartala city.

MATERIALS AND METHODS
A cross-sectional study was conducted among selected HCW of Agartala Government Medical College and Govinda Ballabh Pant Hospital; Tripura Medical College and Dr BR Ambedkar Memorial Teaching Hospital; and Indira Gandhi Memorial Hospital (a state referral hospital), located at Agartala city during Jan to March 2014.A sample size of 300 was calculated based on 60% prevalence [25] with an absolute error of 6% including 10% nonresponse.Individual sample was selected by convenience sampling and data were collected by pre tested structured questionnaire.The questionnaire had three parts, the fi rst part included the general information related to the participants, and the second part contained the questions related to knowledge and third part related to practice/self-reported vaccination status on HBV.There were 15-item questions related to knowledge and response was binary, recorded as either yes or no.Each item with the correct answer was given 1 (one) with a maximum score of 15 and wrong answer 0 (zero) with a minimum of 0 (zero).The knowledge part had been scored into three categories, that is, poor (0-5), average (6-11) and good (12-15).The participants were asked to complete the questionnaire without leaving any un-attempted or incomplete questions, which were relevant.Verbal informed consent was obtained from the participants and strict confi dentiality maintained.Workers who had a history of HBV infection, unlikely to come in contact with blood/body fl uid, and those who did not agree were excluded from the study.High-risk HCW were defi ned as hospital staff exposed to greater risk of acquiring HBV infection due to the specifi c nature of job including residents, house offi cers, nursing staff, nursing assistants, sanitary workers, and lady health workers working in surgery/allied, medicine/allied and gynecology/ obstetrics operation theatres, emergency reception, Intensive Care Units, hemodialysis department and dental unit. [25]Effectively vaccinated subjects were defi ned as those who had received three doses of hepatitis B vaccine according to the schedule (0, 1 and 6 months). [25]Data were entered in the computer after preparing master chart and analyzed using Epi info version 6.0, CDC, Atlanta, Georgia, USA.Microsoft Corporation, Redmond, Washington, USA.

RESULTS
In the present study, majority of the respondent's (72.1%) were females and within the age group 18-23 years (67.5%) with an overall mean age of 24.10 (standard deviation [SD] ±7.011), ranging from 18 to 57 years.Majority (70.4%) of the participants were nursing students and remaining were nursing staff (21.1%), lab technician (4.6%) and nursing internees (3.9%).Among them, 92.5% were Hindu, 2.9% Muslim, 2.9% Christian, 1.8% Buddhist and majority of them (54.6%)belonged to the nuclear family.Majority (98.2%) of them responded that hepatitis B as a virus and the remaining (1.8%) of them responded that hepatitis B as a bacteria.Among them, 259 (92.5%) participants knew about HFT (an NGO) initiated the hepatitis B vaccination in the whole state (in subsidized rate) of Tripura.Majority (69.3%) of them knew that hepatitis B transmission was possible through unsafe sex, blood/ body fl uid, syringe, needle and scalpel, 55 (19.6%) knew through blood and body fl uids, 16 (5.7%)knew through infected syringe, needle and scalpel, 5 (1.8%) knew through sexual route only and the remaining 3.6% could not explain.Seventy-fi ve participants (26.8%) wrongly reported that specifi c curative treatment was available, whereas 73.2% of them reported no such treatment was available.According to 251 (89.6%) participants, transmission was possible from infected mother to child and 245 (87.5%) were aware that mother to child transmission was preventable possibly through vaccination (91.8%) at birth.Analysis of the knowledge of hepatitis B infection revealed that 171 (61.5%) respondents knew that hepatitis B vaccine could be given to pregnant mother, while majority of them (62.1%)knew that the vaccine should be avoided to acutely febrile patient.Among the respondents, 245 (87.5%) knew about three doses of the vaccine while 223 (79.6%) of them were aware that the vaccine International Journal of Medicine and Public Health | Apr-Jun 2015 | Vol 5 | Issue 2 was effective for the life time.Majority of the respondents (52.9%) correctly knew about the modes of prevention of hepatitis B infection.Almost half (51.1%) of the respondents were aware of the possible cause of transmission; (55.7%) could explain that hepatitis B infection leads to liver cirrhosis, 36 (12.9%) persons explained for liver cancer and 64 (22.9%) persons explained for both liver cirrhosis and cancer.The occupation of the participants was an important associated factor for awareness regarding hepatitis B infection (P = 0.005).The age, religion, type of family and income did not play any role in awareness of hepatitis B infection among the sampled population [Table 1].
One hundred and sixty-six (59.3%) participants reported the history of contact with known hepatitis B case.Among the respondents who had contacted with known hepatitis B case 34.9% had consulted a doctor, vaccinated and treated.155 (53.6%) respondents recapped needles after use and 89.6% of respondents used needle destroyer.267 (95.4%) of the respondents were vaccinated with hepatitis B vaccine but 168 (62.2%) participants had completed three doses of hepatitis B vaccine till the time of carrying out of this survey.271 (96.8%) used sterile gloves while injecting or drawing blood, 96.8% used sterile equipments and 84.6% discarded the used needle and syringe in the safe puncture proof container [Table 2].The analysis of knowledge with practice revealed that majority of respondents had contacted with hepatitis B positive case while at work (P = 0.001); consulted doctors, vaccinated and treated with medicines (P = 0.002); used needle destroyer (P = 0.012); 3 doses of hepatitis B vaccinated (P = 0.001); and used sterile gloves before performing work (P = 0.000), especially while dealing with blood and body fl uid [Table 3].

DISCUSSION
The present study was conducted among 300 HCW in tertiary care hospitals in Agartala city.Among the participants 72.1% were females and within the age group 18-23 years (67.5%) with a mean age of 24.10 (SD ±7.011), ranging from 18 to 57 years.It was in concurrence with a study from Islamabad, Pakistan where nurses were 72% and lab workers were 27.5%.Their age ranged from 17 to 59 years with a mean age of 34.38 years. [26]Nurses made up the majority of the respondents in the present study.It The knowledge score of (0-5) was clubbed with average knowledge score (5-11)  while performing Chi-square test was also in concurrence with a study in Kuwait where majority of the respondents were participated from nurses and doctors. [27]he availability in the working place during working hours and greater numbers positioned in different wards and clinics in the hospitals might be the reason for more participation from this group compared to laboratory and others technicians.
Majority (98.2%) of them responded that hepatitis B as a virus.A study from Sindh, Pakistan showed that 67.76% women correctly responded that virus was a cause of hepatitis. [28]We found that the majority of them knew that hepatitis B transmission was possible through unsafe sex, infected blood/body fl uid, contaminated syringe, needle and razor blade.Bakry et al. reported that, 98.6% of nurses, 94.8% of laboratory technicians and 95.7% of other paramedical knew that HBV transmitted via blood. [29]A study from Sindh, [28] Pakistan showed that 33.88% transmission of HBV via infected blood transfusion, 40.49% contaminated needles, 38.0% un-sterilized instruments, and 19.0% mentioned sexual intercourse.
According to participants, transmission was possible from an infected mother to child and was aware that the mother to child transmission was preventable possibly through vaccination (91.8%) at birth.A study among Pakistani women from Sindh showed that transmission could be possible from the mother to child (17.35%).Only 42.14% women knew that the vaccine was available for prevention. [28]The knowledge level we found in the present study was quite high.This could be due to fact that the IEC activities carried out by NGOs like HFT might have contributed in this regards, over and above the public health sector activities.
In the present study, 87.5% knew that three doses of the vaccine as a full course while 79.6% of them were aware that the vaccine was effective for the life time.168 (62.2%) participants had taken three doses of hepatitis B vaccine.Shagufta et al. [26] reported that 57.6% were completely vaccinated, 18.3% partially vaccinated and 24% were not vaccinated at all.More than 50% (P < 0.001) of HCW were not vaccinated against HBV. [29]Jitendra and Jignai reported that 91.5% were not immunized against HBV among the study participants. [21]Lack of awareness and unfavorable attitude was identifi ed as the main factor responsible for the lack of vaccination. [26]In the present study, 53.6% respondents recapped needles after use and 89.6% used needle destroyer.Bakry et al. reported that 81% of the respondents were routinely used to recap needles after use. [29]Recapping of needle was crucial for accidental fi nger prick injury leading to contracting blood borne disease including hepatitis B. Majority of respondents had contacted with hepatitis B positive case while at work; consulted doctors, vaccinated and treated with medicines; vaccinated with 3 doses of hepatitis B vaccine.Shagufta et al. (2010) [26] reported that 53.5% had been exposed to needle stick injury at least 1-5 times in their whole professional life; 48.1% (99) of the needle stick injury exposed personnel were aware of post exposure prophylaxis whereas 51.9% of them were ignorant of standard prophylaxis.
Two hundred and seventy-one (96.8%) wear sterile gloves while injecting or drawing blood, 96.8% used sterile equipments and 84.6% NB: The knowledge of (0-5) for *, ** and *** were clubbed together with average score (6-11) and 0 cells were also clubbed with adjacent row while performing Chi-square test discarded the used needle and syringe in the safe puncture proof container.Jitendra and Jigna reported that all lab technicians (100.0%)among the study participants wore gloves while performing work in the health facility. [21]It was in concurrence with our study results.

CONCLUSION
In spite of having good knowledge, the way they practice for the prevention of hepatitis B infections were inadequate and needed further improvement.Reorientation training for the HCW is to be carried out regularly to increase awareness and changes of attitude among them.Further research is recommended including all level of HCW.

Table 2 : Distribution of participant's according to their practice regarding hepatitis B infection
International Journal of Medicine and Public Health | Apr-Jun 2015 | Vol 5 | Issue 2