The accidents of blood exposure are a real threat to the health personnel. According to our knowledge, in both hospitals, some actions in the prevention of accidents of blood exposure have been implemented. We have therefore conducted a survey about knowledge, attitudes and practices during the month of May 2013 in order to assess the current situation, to measure the overall level of knowledge an d practices of personnel exposed. A survey was sent to 384 people using the interview technique directly. The salient results indicate that 81.3% of them admitted to having suffered from an accident of blood exposure and the results showed a good knowledge of the risk of contamination three HBV, HCV and HIV. The rate of vaccination against hepatitis B is 21.6%. 61.2% of accidents of blood exposure were occurred during recapping of needles, a gesture considered at risk. What to do in case of accidents of blood exposure appears to be insufficiently known by our sample. Accidents of blood exposure are still a concern in our community. Regular information and education office to best practice campaigns are needed to reduce the impact of these preventable incidents by simple measures.
Any percutaneous contact (sting, cut) or mucous (eye, mouth) or injured skin (eczema, wound) with blood or a biological product containing blood for which the viral risk is proved is defined as an accident with exposure to blood. For other fluids, the risk of transmission of human immunodeficiency virus (HIV) and hepatitis B viruses (HBV) is considered to be possible for cerebrospinal, synovial, pleural, peritoneal, pericardial and amniotic. It seems therefore logical to consider risk exposures to these products, even if they are not visibly contaminated with blood such as blood exposure accidents [
The place of accidents of blood exposure and biological fluids in the transmission of HIV/AIDS is not negligible. In industrialized countries, the majority of contamination and accidental seroconversions with HBV and HCV predominantly involve nurses (47%) and laboratory workers (22%) when injured by a sting. The cases of contamination by cutaneous-mucosal projection are much rare [
This is a cross-sectional descriptive study carried out during the month of May 2013, with the staff of two hospital structures (Jason Sendwe General Hospital and Polyclinic Saint-Luc) in the city of Lubumbashi in the Democratic Republic of Congo. The target population was selected for all occupational categories at risk, working in both hospitals. General practitioners in public health were excluded from the study because they performed few practical acts exposing them to blood. Were Included all health professionals present on the days of the survey, after a free and informed consent. The information was collected by means of an anonymous survey with questions either closed or open. The variables studied were: socio-occupational characteristics, past experience of the accidents of blood exposure, knowledge of the accidents of blood exposure, measures to prevent or exposure to biological fluids and post-exposure management. In order to reduce the risk of disseminating survey content among those not yet interviewed, data collection was carried out over a very short period of time (6 hours for each healthcare professional). The survey was first tested on a few professionals to assess the understanding of the questions, the quality of the answers and estimate the time for each survey. The survey was distributed to all persons present on the days of the survey among the total number of 788 people, using the technique of face-to-face direct interview and allowing time for reflection for each reply. The number of health professionals responding was 384 (50% of the total), including 302 at the Jason Sendwe Hospital and 82 at Polyclinic Saint-Luc. The agreement of the two doctors of the hospital before the investigation was carried out was obtained. Each record was identified by a number, thus ensuring the anonymity of the interviewee. The data was entered and evaluated using the Epi Info 2011 software (version 7.0.8.3). Analysis and interpretation used the calculation of proportion, mean and standard deviation.
Eighty-one point three percent (312/384) of the respondents were victims of at least one the accidents of blood exposure during their professional practice, of which 77.6% were due to a needle bite. The projection of blood and/ or biological fluid contaminated with blood only concerns 9.3% of the accidents of blood exposure (29/312). Ninety point four percent (256/281) of the accidents of blood exposure that were due to a sting or cut were of a nature superficial. Sixty-one point two percent (191/312) of the accidents of blood exposure occurred during
Variable | Effective (n = 384) | Percentage data |
---|---|---|
Age | ||
<20 years | 28 | 7,3 |
20 - 29 years | 107 | 27,8 |
30 - 39 years | 168 | 43,6 |
40 - 49 years | 74 | 19,2 |
≥50 years | 7 | 2,0 |
Sex | ||
Famale | 166 | 43,2 |
Male | 218 | 56,7 |
Professional category | ||
Nurse | 243 | 63,3 |
Doctor | 101 | 26,3 |
Laboratory technician | 23 | 6,0 |
Maids | 17 | 4,4 |
Service | ||
Dispensary | 63 | 16,4 |
Surgery | 61 | 16,0 |
Obstetric gynecology | 61 | 16,0 |
Internal Medicine | 43 | 11,1 |
Pediatrics | 44 | 11,4 |
Neonatology | 31 | 8,0 |
Laboratory | 23 | 6,0 |
Other | 58 | 15,1 |
Seniority | ||
<1 year | 44 | 11,4 |
1 - 10 years | 241 | 62,7 |
11 - 20 years | 67 | 17,5 |
>20 years | 32 | 8,3 |
*other: emergency, dentistry, ophthalmology.
needle recapture, 21.1% (66/312) during work overload due to reduced staffing, and 2.3% ( 9/312) when the health professional was inexperienced. Thirty-one point one percent (122/312) of accidents of blood exposure occurred during injections, 20.5% (64/312) during surgery, 5.4% (17/312) during maintenance of premises and leaching. Antiretroviral prophylaxis was initiated to 37 agents (11.9%) of accidents of blood exposure victims (
All respondents were aware that they were at risk for blood-borne infections. For
Variable | Effective | Percentage data |
---|---|---|
Antecedent of exposure accidents to blood (n = 384) | ||
Present | 312 | 81.3 |
Absent | 72 | 18.7 |
Nature of the exposure accidents to blood (n = 312) | ||
Needle sting | 242 | 77.6 |
Cutting a knife blade | 41 | 13.1 |
Projection of blood or biological fluid contaminated with blood | 29 | 9.3 |
Nature of the sting or cut (n = 283) | ||
Superficial | 256 | 90.4 |
Deep | 27 | 9.6 |
Post-exposure prophylaxis (n = 312) | ||
Antiretroviral | 37 | 11.9 |
Nothing | 275 | 88.1 |
Circumstances of occurrence of exposure accidents to blood (n = 312) | ||
When recapping needles | 191 | 61.3 |
More work / less staff | 66 | 21.1 |
Inexperienced health professional | 9 | 2.3 |
When disposing of medical waste | 17 | 5.4 |
In some very difficult care situations | 29 | 9.3 |
Task in progress at exposure accidents to blood (n = 312) | ||
Injection | 122 | 39.1 |
Drip | 19 | 6 |
Transfusion | 34 | 10.9 |
Blood sample | 19 | 6 |
Delivery | 37 | 11.9 |
Surgery | 64 | 20.5 |
Maintenance of premises and leaching | 17 | 5.4 |
the infectious agent transmitted by blood, all respondents were aware that HIV was transmissible; The transmission of HBV and HCV by blood was known respectively in 82 (316/384) and 89.9% (345/384) of the respondents. Of the 384 respondents, 89.4% (343/384) felt that reporting should be done in the case of exposure accidents to blood, and in 45% (155/343) cases the referring physician was the most cited referent followed by staff Administrative officer (36%) and the head of department (19%). According to 30% of respondents, the declaration must be made within 48 hours to the administration as an industrial accident. However, 88.1% (275/312) of those who had had an accident of blood exposure had not reported their accidents (
Variable | Effective | Percentage data |
---|---|---|
Knowledge of risk of transmitted bloodborne infections (n = 384) | ||
Yes | 384 | 100 |
No | 0 | 0 |
Knowledge of bloodborne infectious agents (n = 384) | ||
HIV | ||
Yes | 384 | 100 |
No | 0 | 0 |
HBV | ||
Yes | 316 | 82 |
No | 68 | 18 |
HCV | ||
Yes | 345 | 89.9 |
No | 39 | 10.1 |
Declaration of exposure accidents to blood (n = 312) | ||
Yes | 275 | 88.1 |
No | 37 | 11.9 |
Most respondents (85.6%); victims of accidents of blood exposure had disinfected the wound during the accident, 8.6% had wound dressings compared to 5.8% who had done an abundant wash with soap and water. According to the respondents, disinfection was based on several products: 63% of accidents of blood exposure victims disinfecting the wound during the accident used denatured alcohol, 19.9% used Bétadine against 1.9% who used bleach. Ninety-seven point eight percent (97.8%) of the source patients were HIV-negative versus 2.2% HIV-positive. Ninety-seven point eight percent (97.8%) of the source patients were unaware of their serology for HBV, 1.3% were HBV-negative versus 0.9% who were positive HBV discovered. Ninety-eight point eight percent (97.8%) of the source patients were unaware of their serologic status for HCV, 1.3% were HCV-negative compared to 0.9% who were positive HCV detected. One hundred percent (100%) of accidents of blood exposure victims had at least one initial serological test. A prophylactic ARV treatment was established in 37 agents, 11.9% of the victims against 275 agents or 88.1% who had not had an- ARV prophylactic treatment. Eighty-six percent (81%) of ARV victims had discontinued treatment, compared to 19% who had not stopped treatment. Eighty- six point seven (86.7%) of ARV-treated patients had discontinued prophylactic treatment because of unbearable side effects, compared with 13.3% who discontinued it because of the HIV-negative serologic status of the source patient (
Seventy-eight point four percent (301/384) of our respondents used gloves satisfactorily when administering care, compared with 21.6% (83/384) who did not have a satisfactory use of gloves. One hundred percent (384/384) of our respondents used soaps when washing hands. One hundred percent of our respondents used decontamination procedures for care equipment. Thirty-two decimal five percent (125/384) of our respondents had procedures for decontaminating health care equipment posted in their service against 67.5% (259/384) who had not posted. Ninety-six percent (96%) of our respondents used the incinerator for the treatment of biomedical waste, compared to 4% of those who land filled. Recycling and composting were not practiced by our respondents. The hygiene of the premises and daily cleaning are 100% good at the Saint-Luc polyclinic against 0.7% at the HGR Sendwe. Eighty-two decimal five percent (82.5%) of our respondents were wearing protective equipment against bloodshed, compared with 17.5% who did not. Among the respondents, 78.4% were unvaccinated against hepatitis B compared with 21.6% who were vaccinated. The efficacy of vaccination with an anti-HBS antibody assay was not tested in any of the respondents
Almost all respondents (92%) reported that they had never received training in accidents of blood exposure and did not know how to prevent them. Everyone wants to know more about this subject.
Variable | Effective | Percentage data |
---|---|---|
Immediate care in case of accidents of blood exposure (n = 312) | ||
Wound disinfection | 267 | 85.6 |
Abundant washing with soap and water | 18 | 5.8 |
Pansement de la plaie | 27 | 8.6 |
Products used for wound disinfection (n = 267) | ||
Betadine | 53 | 19.9 |
Denatured alcohol | 168 | 63 |
Bleach | 5 | 1.9 |
Soap | 41 | 13.3 |
HIV source serology for HIV (n = 312) | ||
Positive discovery | 7 | 2.2 |
Negative | 305 | 97.8 |
Serology of source patients for HBV (n = 312) | ||
Positive discovery | 3 | 0.9 |
Negative | 4 | 1.3 |
Unknown | 304 | 97.8 |
Serology of source patients for HCV (n = 312) | ||
Positive discovery | 7 | 2.2 |
Negative | 305 | 97.8 |
Prophylactic treatment of NSA victims (n = 312) | ||
Arvs | 37 | 11.9 |
Nothing | 275 | 88.1 |
Interruption of ARV treatment (n = 37) | ||
Yes | 30 | 81 |
No | 7 | 19 |
Reasons for discontinuing treatment (n = 30) | ||
HIV negative patient source | 4 | 13.3 |
Unbearable side effects | 26 | 86.7 |
Variable | Effective | Percentage data |
---|---|---|
Satisfactory use of gloves (n = 384) | ||
Yes | 301 | 78.4 |
No | 83 | 21.6 |
Use of soap during washing (n = 384) | ||
Yes | 384 | 100 |
No | 0 | 0 |
Existence of decontamination procedures for nursing equipment (n = 384) | ||
Yes | 384 | 100 |
No | 0 | 0 |
Displays of procedures for the decontamination of health care equipment (n = 384) | ||
Yes | 125 | 32.5 |
No | 259 | 67.4 |
Treatment of biomedical waste (n = 384) | ||
Incineration | 368 | 96 |
Burying | 16 | 4 |
Room hygiene and daily cleaning for HGR Sendwe (n = 302) | ||
Respected (good) | 2 | 0.7 |
Not respected (bad) | 67 | 22.1 |
± respected (average) | 233 | 77.2 |
Hygiene of premises and daily cleaning for polyclinic saint Luc (n = 82) | ||
Respected (good) | 82 | 100 |
Not respected (bad) | 0 | 0 |
± respected (average) | 0 | 0 |
Use of blood-sprayed and/or blood-borne splash materials (n = 384) | ||
Yes | 317 | 82.5 |
No | 67 | 17.5 |
Hepatitis B Vaccine Status (n = 384) | ||
Vaccinated | 83 | 21.6 |
Not vaccinated | 301 | 78.4 |
Of the 384 respondents, 218 or 56.8% were male compared to 166 or 43.2% of the female. These findings are similar to those of Rabaud among health care workers, where 60% were male and 40% female [
The mean age is 32 ± 10 years and the most common age range is 30 - 39 years with 43.6% of respondents joining the Koné study In Mali who had found an average age of 35.4 ± 9 years [
In our study, more than 80% of respondents were already victim of less than one The accidents of blood exposure, joining a study carried out in Casablanca in 1988 which had found a rate of 81% of the victims of the accidents of blood exposure; While a cross-sectional survey in Abidjan in 1999 and 2002 showed this history of the accidents of blood exposure in 60% of cases [
Concerning the circumstances of the occurrence of the accidents of blood exposure, needle recapture was the most frequent, accounting for 61.2% of accidents of blood exposure victims, which is close to the study by Bouvet For whom recapping is a very usual gesture in 2/3 of the caregivers [
As regards knowledge of the blood transmission of these three viruses, our study showed a good knowledge of HIV transmission is 100% of respondents, 82% of HCV and 89.9% of HBV joining the study Binard and Ennigrou [
In the work of Lymer, 91% of the accidents of blood exposure were not reported, whereas this rate was 35% in the Nalsing study, despite the fact that it was an infectious disease service taking Patients with HIV [
Despite high levels of BSE, vaccination against hepatitis B remains insufficient in the Democratic Republic of Congo. Our results show that only 21.6% of respondents reported having been vaccinated against hepatitis B. While the study by Ennigrou shows that 2/3 of those surveyed were vaccinated, as was a national study French among 5000 health workers shows that 79.2% of them were also [
In our survey, abundant washing with soap and water was cited only by 5.8% of respondents, the priority use of disinfectant is 85.6% corresponding to the recommendations in force, the dressing is reported by 8.6% of respondents against 21.2% in the ennigrou study [
Regarding the care of the accidents of blood exposure, it should be noted that 37 victims, or 12% were treated with ARV, compared with 88% who were not in care. However, in the study by Eholie et al., in our study, 30 victims or 81% had stopped their prophylactic treatment against 19% who had completed their ARV cure; 86.7% of the victims had interrupted it because of unbearable side effects compared with 13.3% who had done so because of the negative HIV serology of the source patient. Thus, the recommendations of management appear to be poorly followed in our context. This is all the more worrying since it proves insufficient since in France as an illustration, victims are advised to protect their sexual intercourse during the month following accidental exposure in order to avoid confounding factors. It is also advisable to avoid blood donation by exposure accidents to blood victims during the next 6 months of the accident [
In our study, almost all respondents (92%) said they had never received training in ESA and did not know how to prevent them. Everyone wants to know more about this subject.
Even without formally demonstrating this, this study suggests disparities in knowledge and practice of the accidents of blood exposure between different occupational categories. The need for targeted training and education between categories of health professionals was also mentioned by Chevalier and his team in a study carried out in Senegal [
The risk of transmission of diseases due to accidents of exposure to blood although very low is very real. Moreover, cases of transmission of HIV, HBV and HCV have been reported in the literature.
Apart from hepatitis B vaccination, the prevalence of accidents of blood exposure and the awareness of risk by healthcare professionals remain the best protection. The reduction in the incidence of the accidents of blood exposure requires the respect of standard precautions and the proper use of safety equipment. The prevention of the accidents of blood exposure is part of the improvement of the working conditions of health personnel and epidemiological surveillance is the key to this, since it is an indispensable complement to the prevention efforts undertaken and makes it possible to identify circumstances of occurrence of the accidents of blood exposure and to determine the actions to be taken (Information-Training, organization of work, preparation of protocol of care including staff security and choice of equipment). The results of this work must nevertheless be interpreted in the limits of this work, its transversal nature and restricted to the two health facilities that allow an extrapolation to the whole city. This study has the advantage of having reported the actual level of the accidents of blood exposure risk knowledge of health professionals from our above-mentioned study setting. It reinforces the professional interest of education in all occupational categories through real change in behavior.
HIV: Human Immunodeficiency Virus;
HBV: Hepatitis B virus;
HCV: Hepatitis C virus;
AIDS: Acquired Immunodeficiency Syndrome.
All authors contributed in the different phases of the research.
Babidi, B.L., Bakadia, B.M., Kalenga, M.P., Kimuni, K.C., Ndaya, K.A., Kasongo, P.C., Tshibanda, T.V., Mwewa, K.I., Matala, H.E., Kamb, A.R., Numbi, M.G., Sande, W.G., Banza, K.P., Kibuluk, K.J., Ngolo, K.M., Kasamba, I.E. and Ekwalanga, B.M. (2017) Evaluation of Knowledge, Attitudes and Practices of Health Professionals in Front of the Exposure Acci- dents to Blood in Two Hospital Structures of Lubumbashi. Open Access Library Journal, 4: e3823. https://doi.org/10.4236/oalib.1103823