“HEPATITIS B AND C PREVALENCE AND PREVENTION AWARENESS AMONG HEALTH CARE PERSONNEL IN TERTIARY CARE MEDICAL COLLEGE HOSPITALS IN BANGALORE CITY”

Dr. V. Channaraya 1 , Dr. Chaitanya H. Balakrishnan 2 , Dr. Ravi K 3 and Dr. Chandrasekhara P 4 . 1. M.D., D.N.B., F.I.C.C., F.I.C.P., Professor and Head, Department of General Medicine, K.I.M.S. Hospital and Research Centre, V.V. Puram, Bangalore560004. 2. M.B.B.S., (M.D.), Post Graduate, Department Of General Medicine, K.I.M.S. Hospital And Research Centre, V.V. Puram, Bangalore560004. 3. M.D., Professor And Head, Department Of General Medicine, Bowring And Lady Curzon Hospital, Lady Curzon Road, Shivajinagar, Bangalore-560001. 4. M.D., Professor, Department Of General Medicine,M.V. J. Medical College Hospital, Hoskote, Bangalore560214. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Worldwide, an estimated 80 million people are hepatitis B virus (HBV) carriers. India has the intermediate endemicity of hepatitis B surface antigen prevalence between 2% and 10%. The number of carriers in India has been estimated to be over 40 million. Objective:-To establish the prevalence of Hepatitis B and C infections and to assess the awareness about the diseases in health care personnel in tertiary care medical college hospitals in Bangalore. Methodology:-Study was conducted in 686 health care perosnnel (H.C.P.) from August 2014 to December 2014.Health care personnel at risk of exposure to Hepatitis B and C such as doctors, nurses, support staff and lab technicians were included . 5 ml of blood was drawn and sent for testing. Result:-Out of 686 personnel, 5 personnel tested positive for HBsAg (0.73%) and three for anti HCV antibodies( 0.44%). 204 personnel had exposure to blood/blood products out of which only 10 took post exposure prophylaxis. 158 personnel had needle stick injuries out of which 14 took post exposure prophylaxis. A total of 456 were vaccinated against Hepatitis B of which only 74 had taken the full course. Out of the 230 unvaccinated personnel, 88.7% were unaware of the vaccination available. Only 33.3% of the personnel were aware of post exposure prophylaxis, 23.47% did not know about universal precautions and 33.05% were unaware about the vaccinations available.
Conclusion:-This study shows the greatest risk of exposure to infected blood and blood products, needle stick injuries occurred among nurses and doctors in high risk areas of the health care centre. Our study reflects the need for increased awareness and knowledge about these diseases in health care personnel with strict vaccination programmes and post exposure prophylaxis regimens. Physicians, dentists, nurses, laboratory staff, and chair side assistants are at high-risk of acquiring infection via contact with blood (and other body fluids) in the course of their work by skin prick with infected/ contaminated needles and syringes or through accidental inoculation of minute quantities of blood during surgical and dental procedures.
HBV and HCV transmission can be prevented by strict adherence to standard microbiological practices and techniques, and routine use of appropriate barrier precautions to prevent skin and mucous membrane exposure while handling blood and other body fluids of all patients in health-care settings and also by adopting pre-exposure vaccination practices.
As health-care personnel (HCP) remain at a high-risk of transmission by skin prick with infected, contaminated needles and syringes or through accidental inoculation of minute quantities of blood during the surgical and dental procedures, it is very important for them to follow proper measures of infection control and prevention.
Knowledge and attitude of health care personnel play a key role in preventing the spread of these infections. Therefore, the objectives of the present study were to assess the prevalence of Hepatitis B and C infections among health care personnel as well as to assess the knowledge, awareness and practices of health care personnel regarding Hepatitis B and C.
Objectives:-1. To establish the prevalence of hepatitis B and C infections in high risk health care personnel in 3 tertiary care medical college hospitals in Bangalore. 2. To evaluate the awareness among health care personnel about the diseases, modes of transmission, complications, management and prevention.

Materials and Methods:-
The present study was conducted among 686 health care personnel from August 2014 to December 2014. Institutional Ethics Committee approvals were taken before the study was started. A select group of health care personnel at high risk of exposure to Hepatitis B and C such as doctors, nurses, support staff and lab technicians were included in the study. Past history of jaundice, blood transfusions, cases of chronic liver disease with known HbsAg/HCV status, individuals on anti-retroviral therapy/anti-tubercular therapy/prolonged steroid therapy and patients with documented immunosuppression were excluded from the study.

Methodology:-
Counselling of the health care personnel by a doctor and the need for the study were explained. Personal health assessments were obtained by the standard self-assessment questionnaire after written informed consent. Questionnaires were assessed on data such as age and sex, past history of hepatitis B or C, blood transfusions, immunosuppressive drugs, pregnancy, history of exposure to blood/blood products or needle stick injuries with details of the event if present such as occurrence, use of universal precautions, post exposure prophylaxis. History of vaccination against hepatitis B was sought including vaccination schedule and antibody titres. Knowledge about hepatitis B and C in the form of modes of transmission, complications, drugs available, vaccination schedule, post exposure prophylaxis(P.E.P.) and universal precautions were also assessed. Sample of 5 ml blood were drawn and sent for testing from each of the individual. HbsAg estimated by ELISA method (QUALPRO DIAGNOSTICS, Manafactured in Goa, India) and anti-HCV antibodies by ELISA method (QUALPRO DIAGNOSTICS, Manafactured in Goa, India). Strict confidentiality was maintained throughout the study period regarding test results. 172

Statistical analysis:
Proportions were compared using the chi square test. Data analysis was carried out using Statistical Package for Social Science (SPSS ver 10.5) package.

Results:-
A total of 686 health care personnel were subjected to testing of which 248 were males (36.15%) and 426 were female (63.85%). Out of the 686 health care personnel, 132 were doctors (19.24%), 325 were nurses (47.38%), 61 were lab technicians (8.89%) and 159 were support staff (23.18%) Fig 1. 204 health care personnel had history of contact with blood and blood products (29.74% of the total). of which 29 were exposed to HbsAg positive patients (14.21%), 6 to HCV positive patients (2.94%) and 91 to patients whose status was unknown (44.61%) Fig 2. A total of 10 health care personnel exposed to blood/blood products took post exposure prophylaxis (4.90%).
158 health care personnel had history of needle stick injuries (23.03% of the total) of which 26 were exposed to HbsAg positive patients (16.46%), 1 to a HCV positive patient (0.63%) and 68 to patients whose status was unknown(43.04%) Fig 3. A total of 14 health care personnel exposed to needle stick injuries took post exposure prophylaxis (8.87%).
Exposure to blood/ blood products and needle stick injuries were reported in 362 individuals during which on only 24 occasions were universal precautions being practiced (9.39%). A total of 5 personnel were found to be HbsAg positive (0.73%) and 3 were anti HCV antibody positive(0.44%) in our study.   Our study revealed that the greatest risk of exposure to blood and blood products/needle stick injuries occurred in nurses( 57.32%) followed by doctors ( Our study revealed that out of the H.C.P. exposed to blood and blood products/needle stick injuries, only 4.9% and 8.87% took P.E.P. after exposure to blood and blood products and needle stick injuries respectively which was greater than in a study by Varsha Singhal 5 in AIIMS, New Delhi which revealed a P.E.P. in 4% of H.C.P.
We also found that in our study, only 9.39% of the H.C.P. used universal precautions while in a study by S Setia et al 1 in Punjab, 66.3% of the H.C.P. practiced universal precautions. This showed a great deficiency in the practice of simple precautions to prevent the disease transmission.
Knowledge about P.E.P. after exposure to blood or blood products/needle stick injuries in our study was 33.67% compared to a study by Vipul Khakhkhar 7 in Gujarat where 41% were aware of P.E.P.

Conclusion:-
This study shows that the greatest risk of exposure to infected blood and blood products as well as needle stick injuries occurred among nurses and doctors in high risk areas of the health care centre.
It also reflected the lack of awareness about the vaccination schedule including dosing and availability as well as post exposure prophylaxis among H.C.P. -highlighting the need to introduce compulsory vaccination programmes against HbSAg and a strict P.E.P. regimen in any health care centre.

KNOWLEDGE AND AWARENESS(N=686)
175 The study also emphasizes the need for regular C.M.E. and training programmes for H.C.P. to educate them about Hepatitis B and C and the prevention strategies especially vaccination, P.E.P. and universal precautions.