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      Knowledge, attitude, and practice study on hepatitis B among medical and nursing undergraduate students of an apex healthcare institute at Uttarakhand foothills: A descriptive analysis

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          Abstract

          Background:

          Viral hepatitis is preventable, yet a global health priority. As hepatitis B (Hep B) remains an occupational risk for healthcare workers (HCWs), the Government of India recently mandated universal adult Hep B vaccination for all HCWs. However, in the absence of institutional policy, its real-time utilization in a hospital was dependent on individual's general awareness. Therefore, this study was designed to assess baseline knowledge, attitude, and practices among undergraduate medical and nursing students, the future HCWs, regarding Hep B at an apex healthcare institute at Uttarakhand.

          Materials and Methods:

          A descriptive survey was carried out using self-administered questionnaire among undergraduate medical and nursing students of a medical college between July and September 2018. Statistical Package for Social Sciences (SPSS Ver 22.0) was used for analysis.

          Results:

          The study comprised 180 medical and 183 nursing students. About 55.0% of medical and 33.9% of nursing students were correctly aware about the disease; 98.3% of medical and 86.9% of nursing students were aware about vaccine. About 80.6% of medical and 87.4% of nursing students showed positive attitude, recognizing disease as a public health problem. However, only 82.8% of medical and 70.0% of nursing students underwent vaccination; mere 62.4% and 49.2% of vaccinated completed three-dose vaccination schedule, respectively. Furthermore, around 7% of them checked their titer post vaccination.

          Conclusion:

          Despite comparatively low awareness level about the disease, most students had sufficiently high knowledge about vaccine and underwent vaccination. However, only half of them could complete three-dose vaccination schedule. Only a handful of subjects underwent post-vaccination titer assessment, an instrumental approach to safeguard them against accidental Hep B exposure.

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          Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections.

          Yvan J Hutin, Barbara Stilwell, Anja Hauri … (2002)
          To draw up evidence-based guidelines to make injections safer. A development group summarized evidence-based best practices for preventing injection-associated infections in resource-limited settings. The development process included a breakdown of the WHO reference definition of a safe injection into a list of potentially critical steps, a review of the literature for each of these steps, the formulation of best practices, and the submission of the draft document to peer review. Eliminating unnecessary injections is the highest priority in preventing injection-associated infections. However, when intradermal, subcutaneous, or intramuscular injections are medically indicated, best infection control practices include the use of sterile injection equipment, the prevention of contamination of injection equipment and medication, the prevention of needle-stick injuries to the provider, and the prevention of access to used needles. The availability of best infection control practices for intradermal, subcutaneous, and intramuscular injections will provide a reference for global efforts to achieve the goal of safe and appropriate use of injections. WHO will revise the best practices five years after initial development, i.e. in 2005.
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            Low levels of awareness, vaccine coverage, and the need for boosters among health care workers in tertiary care hospitals in India.

            Sukriti, Manoj Kumar, Nirupma Trehan Pati … (2008)
            The risk of acquiring hepatitis B virus (HBV) infection through exposure to blood or its products is highest amongst health care workers (HCWs). Despite potential risks, a proportion of HCWs never get vaccinated. India is second to China in the numbers of people with chronic HBV. This study aimed to investigate the vaccination practices and the prevalence of HBV infection in HCWs in India. A total of 2162 HCWs were screened for the presence of serological markers of HBV and hepatitis C virus (HCV). Occult HBV infection was tested by detection of HBV-DNA for surface and core regions by nested polymerase chain reaction in HBsAg-negative and IgG anti-hepatitis core antigen-positive subjects. Only 1198 (55.4%) of the 2162 HCWs screened had been vaccinated; and 964 (44.6%) were not vaccination-status conscious; of these HCWs, 600 (27.7%) had never been vaccinated and 364 (16.4%) were unaware of their vaccination status. Protective (> 10 IU/mL) anti-hepatitis B surface (anti-HBs) antigen titers were seen in only 61.7%. The anti-HBs titers were found to be lower with the passage of time; the median anti-HBs titers in subjects who were vaccinated > 10 years ago were significantly lower than those who had been vaccinated 10 IU/mL. Even today, 28% HCWs in India are unvaccinated and 17% are unaware of their vaccination status. This data suggests that use of hepatitis B immune globulin be mandatory in needle-pricked HCWs in India, and that implementation of awareness strategies is urgent. Since the anti-HBs titers decline in a fair proportion, there is justification for giving a booster dose of vaccine 10 years after primary vaccination to HCWs in India.
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              Occurrence of Needlestick and Injuries among Health-care Workers of a Tertiary Care Teaching Hospital in North India

              Varun Goel, Dinesh Kumar Verma, Raghavendra Lingaiah … (2017)
              Introduction: Occupational hazards such as accidental exposure to sharp, cuts, and splashes are common among health-care workers (HCWs). Aims and Objectives: To determine the occurrence of self-reported occupational exposures to these hazards and to know the prevalent practices following the exposure. The second aim was to know the baseline antibody levels against hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) immediately after these accidents. Methods: An observational prospective study was done in the HCWs of a tertiary care academic health organization of North India from January 2011 to December 2013. At the time of self-reporting of injury, a questionnaire was administered. Blood sample of HCWs and of the source, if identified, was collected for baseline HBV, HCV, and HIV serum markers. The exposed HCWs were followed up and repeat testing was done after 3–4 weeks for seroconversion up to 6 months. Results: A total of 476 injuries were reported. Needlestick injury of fingers was the most common. Doctors were found to have the highest exposure rate (73.7%) distantly followed by nurses (19.1%). A significant number of the HCWs (125, 26.3%) vaccinated in past had hepatitis B surface antibody (anti-HBs) titers <10 mIU/mL (protection defined as anti-HBs level ≥10 mIU/ml). Only 44 sources were found to be seropositive (11 for HIV, 9 for HCV, and 24 for HBV). No seroconversion was seen in any of the exposed HCWs after 6 months. Conclusions: The incidence of needlestick and sharp injuries is most often encountered in emergency wards. Anti-HBs titers were suboptimal in many of the HCWs requiring a booster dose of HBV vaccination.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Family Med Prim Care
                Journal ID (iso-abbrev): J Family Med Prim Care
                Journal ID (publisher-id): JFMPC
                Title: Journal of Family Medicine and Primary Care
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 2249-4863
                ISSN (Electronic): 2278-7135
                Publication date (Print): July 2019
                Volume: 8
                Issue: 7
                Pages: 2354-2360
                Affiliations
                [1 ] Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
                [2 ] Department of Community Medicine, Himalayan Institute of Medical Sciences (HIMS), Swami Rama Himalayan University (SRHU), Dehradun, Uttarakhand, India
                Author notes
                Author for correspondence: Dr. Ajeet Singh Bhadoria, Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh - 249 203, Uttarakhand, India. E-mail: ajeetsinghbhadoria@ 123456gmail.com
                Article
                Publisher ID: JFMPC-8-2354
                DOI: 10.4103/jfmpc.jfmpc_331_19
                PMC ID: 6691406
                PubMed ID: 31463256
                SO-VID: 17889c18-cdf6-46ca-b515-b8591ef688dd
                Copyright © Copyright: © 2019 Journal of Family Medicine and Primary Care
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 23 April 2019
                Date revision received : 24 April 2019
                Date accepted : 23 May 2019
                Categories
                Subject: Original Article

                Keywords: hepatitis b,immunization,medical college,prevention,titer assessment
                Data availability:
                Keywords: hepatitis b, immunization, medical college, prevention, titer assessment

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