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ADHERENCE TO ANTI-RETROVIRAL POST EXPOSURE PROPHYLAXIS FOLLOWING NEEDLE-STICK INJURY AMONG HEALTHCARE WORKERS IN UMUAHIA URBAN ABIA STATE
ABSTRACT
The research study was conducted to assess the level of adherence to anti retroviral post exposure prophylaxis following needle stick injury among the different categories of HCWs (Doctors, Nurses and Medical Laboratory Scientists) in umuahia urban of Abia State South Eastern part of Nigeria. The study was a descriptive (cross-sectional) survey of qualified health care workers in all registered health facilities in Umuahia Urban. Abia State. The sample size of 222 was drawn from the target population of 740. Multi-stage sampling techniques was employed to select the desired sample for the study. Each category of HCWs was taken as a sample unit. Proportional Sample Size of each unit was selected using stratified sampling techniques in order to calculate the overall sample. Data was collected through the use of structured, selfadministered questionnaire. Data collected were analysed using statistical package for social sciences (SPSS). Hypotheses were tested using chi-square (x2) test at Statistical level of significance set at P-value < 0.05. Data were presented using descriptive statistics of frequency distribution tables and charts express in percentages (%). Inferential statistics of chi-square was used to test for association between socio-demographics and level of occurrence of needle stick injury, level of adherence to PEP medication while T-test statistic was used to test for significance of awareness of PEP services. An approval and introductory letter to conduct the study were obtained from Health Research Ethics Committee of study areas and school of Health Technology FUTO respectively. Respondents were allowed to give their consents before participating in the study. Results showed that the work of the respondents involved constant use of needles and other sharp instruments. It also showed that some HCWs had poor knowledge and understanding of the meaning and objectives of PEP services. It also revealed that irrespective of low rate of needle stick injury, a higher percentage of 79.4 of exposed, accessed antiretroviral drugs for 3-4 weeks. There is no significant association between gender and levels of occurrence of needle stick injury, awareness/availability of Post Exposure Prophylaxis services and adherence to anti-retroviral drugs since the calculated chi-square (X2cal) of 1.064 is less than the tabulated chi-square (X2tab) of 5.9914 with degree of freedom = 2, P-value = 0.58742894and α = 0.05. Based on the results/findings, there should be scale up on the level of antiretroviral PEP services available in health facilities in Umuahia Urban, Abia State including the adoption of uniform standards of Post Exposure Prophylaxis procedures for healthcare institutions. Further studies on adherence to antiretroviral Post Exposure Prophylaxis procedures especially on awareness of Post Exposure Prophylaxis. The study should compare level of adherence to anti-retroviral post exposure prophylaxis procedure among healthcare workers between Abia State and another State in Nigeria.
Keywords: Anti-Retroviral; Anti-viral drugs; Exposure Prophylaxis; Needle-Stick; Injury; Healthcare Workers; Umuahia Urban and Abia State
TABLE OF CONTENTS
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv-v
ABSTRACT vi
TABLE OF CONTENT vii-viii
LIST OF TABLES viii
LIST OF FIGURES x
LIST OF ABBREVIATIONS /MEANINGS xi
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of Problem 4
1.3 Objective of the Study 4
1.3.1 General Objectives of the Study 4
1.3.2 Specific Objectives of the Study 5
1.4 Research Questions 5
1.5 Research Hypotheses 6
1.6 Significance of Study 6
1.7 Scope of the Study 7
1.8 Operational Definition of Terms 8
LITERATURE REVIEW
INTRODUCTION
2.1 Conceptual Framework 10
2.1.1 Epidemiology of Needle-Stick Injury 10
2.1.2 Needle Stick Injury 12
2.1.3 Health Care Workers (HCWs) and Blood Borne Diseases 14
2.1.4 Concepts of different Categories of Healthcare Workers 15
2.1.5 Blood-Borne Pathogens 16
2.1.6 Post Exposure Prophylaxis 17
2.1.7 Laboratory Screening under Post Exposure Prophylaxis Schedule 26
2.2 Theoretical framework 26
2.3 Empirical Studies 30
2.4 Summary of Literature Review 35 CHAPTER THREE
MATERIALS AND METHODS
3.1 Study Design 37
3.2 Area of the Study 38
3.3 Study Population 39
3.4 Sample Size and Sampling Method 39
3.4.1 Sample Size 39
3.4.2 Sampling Method 39
3.5 Instruments for Data Collection 40
3.6 Validity of Instruments 41
3.7 Reliability of the Instruments 41
3.8 Method of Data Collections 41
3.9 Method of Data Analysis 42
3.10 Ethical Consideration/Informed Consent 43
CHAPTER FOUR
RESULTS
4.1 Socio Demographic Characteristics of Respondents 44
4.2 Level of Occurrence of Needle Stick Injury 45
4.3 Level of Awareness and Availability of PEP Services 50
4.4 Level of Adherence to Post Exposure Prophylaxis Medication 54
4.5 Result of Hypotheses Testing 59
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATIONS
5.1 Discussion 60
5.1.1 Discussion and Interpretation of Findings 60
5.2 Conclusion 62
5.3 Recommendations 63
5.4 Limitations of Study 63
References 64
Appendices 72
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND TO THE STUDY
A needle stick injury is a percutaneous piercing wound caused by a sharp instrument commonly encountered by people handling needles in the medical setting. Such injuries are occupational hazards for health care professionals. Law enforcement personnel are also at high risk for needle stick injuries at work
(National Institute for Occupational Health and Safety (NIOSH, 2008). According to Efetie and Salami (2009), needle stick injury is an accidental partial introduction into the body of a health care worker (HCW) during work process, a hollow-bore needle or sharp instrument which includes sharp razor, lancets, scalpels and contaminated broken glass. Needle stick and other sharps- related injuries expose workers to blood borne pathogens. Studies in literature showed that 5.6million workers in the health care related occupations are at risk of occupations blood borne pathogens as they are most frequently injured through handling of sharp devices (NIOSH, 2012). Occupational exposure to blood or other body fluids in health facilities constitute a significant risk of transmission of HIV and other blood borne pathogens to health care workers (Ilo, 2011). Needle stick injuries are particularly dangerous because they may transmit blood borne diseases such as HIV/AIDS, Hepatitis B Virus (HBV) and
Hepatitis C.
Needle stick injury and other sharps related injuries expose workers to blood borne pathogens significant hazards for hospital employees. According to NIOSH (2012), exposure to blood and other body fluids occur across a wide variety of occupations. Occupational exposure to blood or other body fluids in health facilities due to needle sticks injuries constitute a significant risk of transmission of Human Immune Deficiency Virus (HIV) and other blood borne pathogens to health workers. These risks associated with the needle stick injuries affect the quality of care delivered as well as health care workers’ safety and well being (Awases, Nyoni, and Chatora, (2004). According to Ilo (2011), HIV in particular is a major threat in the work place. HIV infection can be transmitted through needle stick injury, also preventable through infection control measures as use of personal protective devices to prevent occupational injuries. The risk of transmission of Hepatitis B Virus (HBV) and hepatitis C Virus (HCV) from an occupational exposure is significantly greater than the risk of HIV transmission. The risk of HCV infection following a needle stick is 1.8%, whereas the risk of HBV infection ranges from 1% to 30% depending on the presence of hepatitis e-antigen. The risk of transmission of hepatitis C Virus from a single mucous membrane exposure is negligible. As a result, the exposed workers experience significant fear, anxiety and emotional distress that can result in occupational and behavioural changes (Lee, Botteman, Xaanthakosi, and Nicklasson, 2005).
Consequently the anti-retro viral Post Exposure Prophylaxis should be used promptly and to the stipulated duration of 28 days or 4 weeks to prevent seroconversion of HIV infection. No matter how low the risk of occupational transmission of HIV among health care workers (HCWs) may be, it is of public health significance (Adegboye 1994; Adesunkanmi 2003; Okere, Etesie and Salami, 2009; Nwankwo and Aniegbue, 2011).
The National Guidelines on HIV (2002), stipulates Post Exposure Prophylaxis
(PEP) should be given immediately after exposure to needle stick injury (NSI). It means taking Anti-Retro Viral drugs as soon as possible after exposure to suspected HIV infection. It should be given within 72hours. Treatment with 2 or 3 anti-retro virals should continue for 4 weeks if tolerated to prevent HIV infection using recommended PEP medications are as follows:
- Recommended 2-drug combination such as are Zudovudine (AZT) 300mg 12 hourly plus Lamivudine (3TC) 150mg 12 hourly for 4 weeks for low risk exposure: Solid needle, small volume exposure, intact skin contact, etc
- Recommended 3-drug combination such as AZT, 3TC and Efevirenz (EFV) 600mg or Lipinovir (LPV/r) 400mg 12 hourly for high risk exposure: Large borne needle, large volume exposure, exposure to open wound or mucous membrane
Health care workers of different categories (Doctors, Nurses and Laboratory Scientists) are hospital staff who must attend to all patients. They are at high risk of needle stick injury since they handle needles or other sharp instruments very often. This makes it more pertinent to sample more health care workers in vulnerable setting and places to ascertain the present frequency of injuries and adherence to PEP procedures. Assessment of needle stick injury among health care workers and their level of adherence to use of PEP is vital, hence this research.
- STATEMENT OF THE PROBLEM
Health care workers like people in other occupations have their peculiar occupational hazards. Needle stick or sharp object injury as well as blood or body fluid splash on mucous surfaces such as conjunctiva, oral or nasal cavity and unprotected micro-skin abrasion are few of such very risky hazards. Needle stick injuries are particularly dangerous because they may transmit blood borne diseases including Hepatitis B, Hepatitis C and HIV/AIDS.
The workers attend to all persons including known Human Immune deficiency Virus (HIV) clients. Needle and sharp objects that have entered the skin of such clients or patients can accidentally pierce the health worker’s skin. HIV is one of the infections that can be transmitted through such injury/blood exposure. Anti-retroviral PEP services are only preventive and protect workers against sero-conversion to HIV positive after such exposure. These services are commonly available in tertiary health facilities like Federal Medical Centre Umuahia, PHC Ojike, Madonna Hospital and Abia State Specialist Diagnostic Centre Umuahia etc. This research will assess the level of adherence of health care workers of registered health facilities in Umuahia Urban to anti-retroviral
Post Exposure Prophylaxis.
-
OBJECTIVE OF THE STUDY
- General Objectives
The overall objective of this study is to assess the level of adherence to antiretroviral (ARV) Post Exposure Prophylaxis following needle stick injury among different categories of health care workers (HCWs) in Umuahia Urban
Abia State.
- Specific Objectives of the Study
In order to achieve the overall objectives of the study, the followings are the specific objectives of this study:
- To determine the level of occurrence needle stick injury among of health care workers in Umuahia Abia State.
- To ascertain the level of awareness of anti-retroviral (ARV) Post
Exposure Prophylaxis (PEP) Services in health facilities in Umuahia Urban, Abia State.
- To determine the availability of PEP medication to the health care workers in different health facilities in Umuahia Urban, Abia State.
- To elicit the level of adherence to ARV PEP medications after needlestick injury among HCWs in Umuahia Urban, Abia State.
- To ascertain the level of use of Personal Protective Equipment (PPE) by
HCWs in Umuahia Urban, Abia State while attending to all patients.
1.4 RESEARCH QUESTIONS
- What is the level of occurrence of needle stick injury among health care workers in Umuahia Urban Abia State?
- What is the level of awareness of anti-retroviral of PEP services among
HCWs in health facilities in Umuahia Urban Abia State?
- Are PEP services available in the health facilities in Umuahia Urban
Abia State?
- What is the level of adherence to ARV PEP medications among HCWs in Umuahia Urban Abia State?
- What is the level of use of Personal Protective Equipment (PPE) by Health care workers (HCWs) in Umuahia Urban Abia State while
attending to all patients?
1.5 RESEARCH HYPOTHESES
The following hypotheses guided this study and were tested at 0.05 level of significance.
- There is no significant relationship between socio-demographic characteristics of health workers in Umuahia Urban Abia State and level of occurrence of needle stick injury ii. There is no significant relationship between socio-demographic characteristics of health workers in Umuahia Urban Abia State and level of awareness of ARV PEP.
- There is no significant relationship between socio-demographic characteristics of health workers in Umuahia Urban Abia State and level of availability of ARV PEP.
- There is no significant relationship between socio-demographic characteristics of health workers in Umuahia Urban Abia State and level of adherence to ARV PEP drugs after injury
1.6 SIGNIFICANCE OF STUDY
The findings of this study will contribute to be body of knowledge by revealing the prevalence of needle stick injury exposure to the body fluids of health workers in umuahia Urban Abia State.
The research findings will increase the knowledge on availability and accessibility of PEP services among health workers in Umuahia and invariably increase compliance level. The findings will also ascertain the level of compliance among health workers who are exposed to needle stick on anti retroviral drugs PEP. It will also reveal the degree of use of PEP services by health workers in the health facilities in this area.
It will help X-ray cases of such needle stick injuries that lead to sero-conversion to HIV infection due to non, or poor adherence to PEP services among health workers. It is envisaged that the result of this study will stimulate further studies and increase in knowledge and awareness of needle stick injury acquired
infectious.
The findings will be of immerse benefit to the health facilities and their workers towards improvement of standard universal precaution.
1.7 SCOPE OF THE STUDY
This study covers the different categories of HCWs in registered public and private health facilities in Umuahia of Abia state and how to access their level of Adherence to Anti-Retro Viral Post Exposure Prophylaxis following Needle
Stick Injury. The study covered 12 health care facilities in Umuahia Urban Abia
State which include, one tertiary health facility (FMC Umuahia), one secondary (Abia state specialist hospital), 6 Government Primary Healthcare facilities (Ojike, Amuzukwu, Nkwo-egwu, Nsirimo, Umuopara and Ubakala) all located in Umuahia North and South Areas and 4 major private hospitals ( Obioma,
Overcomers, St. Charles and Madonna) in Umuahia. Sampled HCWs included Nurses, Doctors and Laboratory Scientists. The scope also covers how to asses their level of awareness and adherence to anti retroviral Post Exposure
Prophylaxis
1.8 OPERATIONAL DEFINITION OF TERMS
Heath-care Workers: Healthcare workers are hospital employees or workers who handle needles or other sharp instruments very often while attending to all patients and are exposed to Needle Stick Injury and at risk of occupational blood borne diseases like HIV/AIDs, Hepatitis B virus, Hepatitis C virus etc. The healthcare workers include Doctors, Nurses, Lab Scientists and others.
Needle Stick Injury: Needle stick injury is a percutaneous piercing wound caused by a sharp instrument into the skin, commonly encountered by people handling needles in the medical setting. Such injuries are occupational hazards for health care professionals
Post Exposure Prophylaxis: it means taking ARV drugs as soon as possible after exposure to HIV infection. It should start prophylaxis within 1 hour of exposure and/or within 72hrs. Treatment should be with 2 or 3 combination anti-retrovirals and should continue for 4 weeks if tolerated, will prevent HIV infection (National Guidelines on HIV programme 2013). Example of ARV drugs for PEP is. Zudovudine (AZT), Lamivudine (3TC) Efevirenz (EFV).
Adherence
There is no universal definition. Adherence can be defined as the extent to which a client’s behaviour coincides with the prescribed healthcare regimen as agreed through a shared decision making process between the client and the healthcare provider.
Adherence can also be defined a patient’s ability to follow a treatment plan, take medications at prescribed times and frequencies, and follow restrictions regarding food and other medications, e.g adherence to dosage means number of pills taken as prescribed, adherence to schedule mean taking pills consistently on time and finally dietary adherence is taking pills as prescribed with after or before meal.
ADHERENCE TO ANTI-RETROVIRAL POST EXPOSURE PROPHYLAXIS FOLLOWING NEEDLE-STICK INJURY AMONG HEALTHCARE WORKERS IN UMUAHIA URBAN ABIA STATE
