The most serious occupational health hazard faced by health care workers worldwide is exposure to blood-borne pathogens. These blood-borne pathogens are mainly Hepatitis B, C, and HIV infection.
Hepatitis B is by far the most dreaded with over 2 billion people affected worldwide and 350 million people suffering from chronic hepatitis B virus infection [
In the United States, the incidence of HBV infection among all health care workers is estimated to be 3.5 to 4.6 infections per 1000 workers, which is 2- to 4-times the level for the general population [
Among health care workers, operating room personnel are at a high risk of infection with blood-borne pathogens through blood contact [
Percutaneous injury is the most efficient mode of hepatitis B transmission among operating room personnel. The risk of developing serologic evidence of HBV infection was 37% to 62% if the blood was positive for both hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) and 23% to 37% if the blood was positive for HBsAg and negative for HBeAg [
The most effective and feasible means of preventing HBV infection is by vaccination and avoidance of exposure to blood. The vaccine was initially by means of a plasma-derived HBsAg subunit which has largely been replaced by recombinant vaccine. This vaccine has been available since 1982 and has generally been described as safe and effective with a protective efficiency of 90–95% [
Complete vaccination against hepatitis B is achieved by administration of a three-dose regimen, with the second and third doses being given one and six months after the initial dose. A test for hepatitis B surface antibody (HBsAb) should be carried out 6–8 weeks following the final dose of the primary course of vaccination [
We aimed to determine, in operating room personnel, their knowledge of the HBV vaccine, perception of vaccination, and understanding of risk factors for HBV infection.
To the best of our knowledge, no similar study has been carried out among operating room personnel in Nigeria.
Four university hospitals were selected for the study by simple random sampling. The hospitals included University of Maiduguri Teaching Hospital, Imo State University Teaching Hospital, University College Hospital, Ibadan and Irrua Specialist Teaching Hospital representing the Northern, Eastern, Western, and Southern Nigeria, respectively. All the institutions are tertiary referral centres for training undergraduate and postgraduate students and for research. All the operating theatre staff including surgeons, anaesthetists, scrub nurses, and auxiliary staff were eligible for the study.
After obtaining informed consent, the participating theatre staff completed a questionnaire which was based mainly on the knowledge and practice of hepatitis B immunization, knowledge of risk of exposure, and practice of postexposure prophylaxis. These questionnaires were distributed and filled in the operating room to ensure the participation of most active operating room personnel.
The following information was requested: demographic and professional characteristics, duration of work experience, status of immunization, perception of hepatitis B vaccine, and their attitude towards recommending hepatitis B vaccine to other theatre users. Awareness of various risks for exposure to blood-borne pathogens and practice of postexposure prophylaxis was explored.
Vaccinated respondents were classified into (a) those who had completed course of vaccination and the antibody test indicating a good response or (b) those who had completed a course of vaccination but defaulted on antibody test after vaccination. Staff who had never been vaccinated or started the course of vaccination but defaulted were considered to be not vaccinated.
The data from all the returned questionnaires were entered into SPSS, version 16, and analysed. Both descriptive and inferential statistics were computed. The level of significance was set at
A total of 228 operating room personnel participated in the study. The majority of staff that participated in the study were surgical residents (trainee surgeons; 32%). Consultants, house surgeons, and nurses accounted for 12.7%, 10.5%, and 21% of respondents, respectively. Others included anaesthetists (12.3%), technicians (5.7%), and others (6.6%). Males accounted for 67.5% while females accounted for 32.5%.
Sixty-one respondents (26.8%) had been vaccinated while 167 respondents had not been vaccinated (Table
Vaccination status.
Vaccination status | |
---|---|
Vaccinated | 61 (26.8%) |
Not vaccinated | 167 (73.2%) |
Total | 228 (100%) |
Of the respondents that had been vaccinated, 39 were males (63.9%) while 22 (36.1%) were females. Respondents practising for 15–20 years had not been not vaccinated. Differences in age, sex, duration of practice, and respondent’s institution between the vaccinated and unvaccinated ORP were not statistically significant (
One hundred and forty-seven (64.5%) respondents of the ORP that had not been vaccinated responded to the reasons for not being vaccinated or for defaulting while on a vaccination schedule. The primary reasons were mainly lack of time to attend (33.9%), not enough information on the vaccination (19.7%), and no idea about existence of immunization (15%).
Regarding knowledge of hepatitis B vaccine, 86.8% of respondents were aware of the existence of the vaccine (Table
Knowledge of hepatitis B vaccine.
Are you aware of vaccination for hepatitis B | |
---|---|
Yes | 198 (86.8%) |
No | 30 (13.2%) |
Total | 228 (100%) |
Hepatitis B vaccine should be given to ORP as part of work place safety | |
Yes | 191 (83.8%) |
No | 13 (5.7%) |
DNK | 24 (10.5%) |
Total | 228 (100%) |
Hepatitis B vaccine can be administered simultaneously with HBIG (the immunoglobulin) when indicated | |
Yes | 102 (44.9%) |
No | 36 (15.9%) |
DNK | 89 ( 39.2%) |
Total | 227(100%) |
When indicated as part of PEP, it should be administered within 24 hrs of exposure | |
Yes | 116 (50.9%) |
No | 27 (11.8%) |
DNK | 85 (37.3%) |
Total | 227 (100%) |
For complete protection, it consists of two doses at 0 and 6 months | |
Yes | 55 (24.6%) |
No | 71 (31.7%) |
DNK | 98 (43.8) |
Total | 224 (100%) |
The majority (83.3%) were of the opinion that the vaccine should be given to operating room personnel as part of work place safety measure while 44.9% thought that hepatitis B vaccine can be administered simultaneously with hepatitis B immunoglobulin (HBIG) when indicated (Table
The majority had good knowledge of the risk factors for HBV infection. Some 91.7%, 83.2%, and 84.6% believed that hepatitis B virus infection can be transmitted through percutaneous injury, mucous membrane contact with blood, and contact of abraded skin with potentially infected tissue, respectively. Seventy-eight point three percent (78.3%) of respondents thought that they were at a greater risk of becoming infected with HBV than the general population (Table
Knowledge of risk factors.
Percutaneous injury with blood | |
---|---|
Yes | 188 (91.7%) |
No | 17 (8.3%) |
Total | 205 (100%) |
Mucous membrane contact with blood | |
Yes | 168 (83.2%) |
No | 33 (16.8%) |
Total | 197 (100%) |
Contact of abraded skin with potentially infected tissue | |
Yes | 170 (84.6%) |
No | 31 (15.4%) |
Total | 201 (100%) |
Contact of skin afflicted with dermatitis with potentially infected body fluid | |
Yes | 146 (78.1%) |
No | 41 (21.9%) |
Total | 187 (100%) |
Do you agree you are at risk more than the general population | |
Agree | 173 (78.3%) |
Disagree | 27 (12.2%) |
DNK | 21 (9.5%) |
Total | 221 (100%) |
Regarding the perception of the hepatitis B vaccine, 76.8% of the respondents agreed that the vaccine is safe. Eighty-one point one percent (81.1%) of respondents would recommend the vaccine to another surgical staff. The relationship between recommending the vaccine to a colleague and perception about the safety of hepatitis virus vaccine was found to be statistically significant (
Perception of HBV vaccine.
Do you agree that HBV vaccine is safe | |
---|---|
Yes | 180 (78.9%) |
No | 14 (6.1%) |
DNK | 34 (14.9%) |
Total | 228 (100%) |
I will recommend HBV vaccine to another surgical staff | |
Yes | 185 (81.1%) |
No | 16 (7.0%) |
DNK | 27 (11.8%) |
Total | 224 (100%) |
How many of your colleagues do you think have received HBV vaccination | |
Yes | 29 (15.8%) |
No | 22 (12.0%) |
DNK | 132 (72.1%) |
Total | 183 (100%) |
In developed countries like the United States, not only are there a significant percentage of health care workers (75%) vaccinated against hepatitis B virus infection, but plans already exist to achieving 98% hepatitis B vaccination coverage among HCWs, providing a benchmark for the elimination of occupationally acquired HBV infection [
This study has clearly shown a poor vaccination status (26.8%) among operating theatre personnel, a subset of health care workers obviously at high risk of occupational exposure to HBV. This is very disturbing as previous studies in the country have consistently shown low vaccination status among health care workers. Adebamowo et al. and Sofola et al. reported that only 18.1% and 37.9% of their respondents were reported to be fully vaccinated against hepatitis B infection in 1998 and 2007, respectively [
We found that many of the staff were unvaccinated due to lack of time to attend to vaccination and not having enough information about hepatitis B vaccine. Other workers have found busy schedule, lack of knowledge about severity and vaccine efficiency, perception of low-risk status as reasons for unvaccination, refusal of vaccine due to fear of getting hepatitis B from the vaccination, and fear of side effects [
Our study revealed that most of the respondents had good knowledge of the risk factors for hepatitis B virus infection. This contrasts others that have demonstrated a very low knowledge of hepatitis B infection and poor safe practices to prevent transmission of the infection [
Our study revealed that a significant percentage of operating room personnel believed the vaccine to be safe and will recommend it to another colleague. This may be attributable to their good knowledge of the vaccine and risk factors for HBV infection. Perception of vaccine safety has been identified as the most important predictor for acceptance and for willingness to recommend HBV vaccination to other heath care workers. Vaccinated HCWs were more likely to recommend vaccination to other healthcare personnel as were those younger than 40 years of age [
One of the important limitations of this study is its reliance on information obtained from the respondents about their vaccination status. There is a possibility of the respondents overreporting vaccination; hence, we may have overestimated the proportion of “adequately” vaccinated respondents. A second limitation is that we asked about the total number of HBV vaccine injections received by the respondent, without considering the time intervals between these injections. The third limitation is that we assumed that all the respondents who had received 3 doses are adequately vaccinated with or without undergoing post-vaccination antibody assay. Five (5%) of individuals have been found not to respond to the initial vaccination series, and this subset of individuals should undergo a second series of three vaccinations [
Hepatitis B virus infection is an important disease, preventable by vaccination and compliance with universal precautions. The vaccination status of the theatre staff in Nigeria is low and unacceptable especially with the availability of the vaccine. To protect the patient, complete HBV vaccination should be a prerequisite for theatre staff to commence work. Programmes designed to increase awareness relating to HBV infection, hepatitis B vaccine, and adherence to universal precautions are required to improve vaccination status.
The authors report no conflicts of interests and did not request or receive any form of financial support for this project.
The authors acknowledge the contributions of Dr. Michael Okorie of University College London who painstakingly edited the final copy.