|Year : 2017 | Volume
| Issue : 2 | Page : 296-298
Prevalence of transfusion-transmitted viral pathogens among health-care workers and risk mitigation programme in a paediatric tertiary care hospital
Charu Nayyar, Rushika Saksena, Vikas Manchanda
Department of Clinical Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya, New Delhi, India
|Date of Web Publication||5-Jul-2017|
Department of Microbiology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi - 110 002
Source of Support: None, Conflict of Interest: None
The health-care workers (HCWs) are at an occupational risk of exposure to blood-borne pathogens, mainly, HIV, hepatitis B virus (HBV) and hepatitis C virus. HBV is currently the only blood-borne virus for which a vaccine is available. All health-care institutions must encourage the HCWs to undergo screening for blood-borne pathogens.
Keywords: Health-care workers, occupational risks, viral pathogens
|How to cite this article:|
Nayyar C, Saksena R, Manchanda V. Prevalence of transfusion-transmitted viral pathogens among health-care workers and risk mitigation programme in a paediatric tertiary care hospital. Indian J Med Microbiol 2017;35:296-8
|How to cite this URL:|
Nayyar C, Saksena R, Manchanda V. Prevalence of transfusion-transmitted viral pathogens among health-care workers and risk mitigation programme in a paediatric tertiary care hospital. Indian J Med Microbiol [serial online] 2017 [cited 2019 Nov 19];35:296-8. Available from: http://www.ijmm.org/text.asp?2017/35/2/296/209563
| ~ Introduction|| |
Health-care workers (HCWs) are defined as persons (including students and trainees) working in health-care facilities or laboratory where they are in direct contact with patients or with their blood and body fluids. The HCWs are at an occupational risk of exposure to blood-borne pathogens, mainly, HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV).,, All HCWs should have access to regular confidential testing, appropriate treatment and management for these blood-borne pathogens. They should be encouraged and supported to undergo regular testing for these pathogens.
Health-care facilities must ensure that HCWs are fully educated about the infection risks in case of occupational exposure and their prevention, they should comply with recommended infection control practices and they should be encouraged to adopt standard precautions. They must follow the recommended guidelines for sterilisation and disinfection of instruments and equipment. They must be educated about safer procedures and proper vaccinations for all HCWs.,
HBV is currently the only blood-borne virus for which a vaccine is available. HBV immunisation is available and has been recommended for all HCWs since 1982. Successful HBV vaccination protects a person from HBV infection and eliminates the possibility of its transmission to others. It is strongly recommended that all HCWs should be immunised against HBV during the course of their training or completion of the training for their own protection as well as for patients protection.,
Complete vaccination schedule (three-dose series) should be followed by the assessment of hepatitis B surface antibody (anti-HBs) to determine immunogenicity. Protection (defined as anti-HBs level ≥10 mIU/ml) following first, second and third doses of the recombinant vaccine has been reported to be 20%–30%, 75%–80% and 90%–95%, respectively.
| ~ Methods|| |
The present study was conducted to determine the prevalence of blood-borne pathogens (HIV, HBV and HCV) in HCWs and to monitor the vaccination and immunisation status for HBV among HCWs. In the present study conducted from 2008 to 2014 in New Delhi, all HCWs were asked about exposures and sero-status of blood-borne pathogens and were subjected to testing for HIV, HBV and HCV at the time of induction to hospital. Anti-HBs titres were also carried out for those vaccinated for HBV. HIV testing was done using standard National AIDS Control Organisation guidelines. HCV was detected using immunochromatographic test, and HBV and anti-HBs titres were detected using immunochromatography and miniVIDAS (enzyme-linked fluorescent assay).
| ~ Results|| |
HCWs in our hospital consist of 156 (21.1%) doctors, 277 (37.4%) nurses, 95 (12.8%) technical staff, 116 (15.6%) nursing orderlies, 86 (11.6%) housekeeping staff and others 9 (1.2%).
All HCWs were screened for HIV, HBV and HCV infection. Five (0.6%) HCWs were tested positive for HBV (two nurses, three nursing orderlies), two (0.2%) for HCV (both laboratory technical staff) and one (0.1%) for HIV (one nurse).
All the health-care institutions should support the HCW who is infected with a blood-borne pathogen. They should be provided with a work environment that minimises the risk of transmitting the infection to patients. At our hospital, the HCWs who tested positive for blood borne infections were assigned non-clinical work. For example, in the laboratory, their work excluded phlebotomy and was restricted to bench tests or in the outpatient department it was restricted to paper work. Other duties assigned were Biomedical waste surveillance, in medical records department, in library etc.
At our hospitals, there were 4 (0.5%) HCWs identified as 'non-responders' to HBV vaccine. There were a total of 269 occupational exposures during the study period, out of which four required hepatitis B immunoglobulin administration. There were no cases of sero-conversion at our hospital due to occupational exposure for the three blood-borne viral infections.
All the HCWs were asked about their HBV vaccination status. A total of 588 (79.5%) HCWs were completely vaccinated for HBV, who had taken three doses of vaccination. Among these completely vaccinated HCWs, 526 (89.4%) were screened for protective anti-HBs antibodies. A total of 482 (91.6%) had a protective antibody level (>10 IU/ml) [Table 1].
Immunisation was initiated for those who were not vaccinated. A booster dose was given to those who were completely vaccinated but did not have a protective anti-HBs titre. The anti-HBs titre was checked 6 weeks after the booster dose. If the titres did not rise, revaccination was considered and complete schedule of vaccination was administered. Titre levels were again checked after 6 weeks of completion of re-vaccination. Those who still did not have protective levels were labelled as 'non-responders'.
Eight HCWs left the institution without completing the course of vaccination. Seven of them were doctors and one was a technical staff. It was found that the number of housekeeping vaccinated was low as compared to other groups. This could be because of unawareness of the occupational risks among this group. Immunisation was started for all those who had not been vaccinated.
| ~ Discussion|| |
In a study conducted in Delhi in 2009, the vaccination status varied from 52 to 59% among different categories of HCWs. Chaudhari et al. reported vaccination status of 57.5% in an Armed Force Institute in India. In another study conducted in Delhi on microbiology laboratory workers, 47.3% of laboratory workers were completely vaccinated. Our study reported a higher percentage of vaccine compliance (79.5%). This could be attributed to the increased awareness of the disease among HCWs over the years. However, it is observed that although overall immunisation coverage among HCWs has been increased compared to previous studies, immunisations levels among nursing orderlies and housekeeping staff remains dismal [Table 1].
There is difference in the percentage of vaccines in different groups of HCWs. This is because of difference in the level of education and awareness in these groups. Hence, we need to target these groups individually to improve the overall vaccine compliance.
We observed an increased percentage of vaccine compliance as compared to other studies conducted in Delhi. This is attributed to increased awareness in the HCWs over the years. The other studies were cross-sectional studies. However, we conducted a progressive study and ensured vaccination of maximum employees by repeated follow-up.
| ~ Conclusions|| |
All efforts were done to improve the immunisation coverage among HCWs at our hospital. Our experience revealed that there are certain groups. However, there are certain groups that need to be targeted to improve overall compliance. Hence, efforts should be made to educate individual groups. The robust hospital infection control programme has helped in increasing compliance at our institution. HCW immunisation screening survey at the time of induction of employees supported larger coverage for vaccination against HBV. All those who are vaccinated but are not protected for HBV infection are timely identified and are explained the higher risk of transmission. Hence, it is important to find out anti-HBs titre among HCWs. Those with unprotected levels should be followed up with a booster dose or re-immunisation.
All health-care institutions must encourage the HCWs to undergo screening for blood-borne pathogens and appropriate support should be available for those tested positive. All HCWs and student HCWs must be vaccinated against HBV at the completion of their training at medical/training schools. The study highlights variation in the prevalence of vaccination status among different categories of HCWs [Table 1]. Study emphasises that housekeeping staff and nursing orderly group, which is at higher risk due to stray sharps and biomedical waste handling still has lower rates of immunisation. Thus, these groups must be targeted through improved immunisation coverage to reduce transmission risk in such cases.
All HCWs must strictly report any incidence of blood or body fluid exposures to the concerned authorities so that appropriate management can be provided. Authorities should ensure a well-organised system for prompt reporting, evaluation, counselling, treatment and follow-up of all occupational exposures. Appropriate post-exposure prophylaxis should be available in the hospitals at all work hours. The prompt reporting is important for immediate management as well as for identification of workplace hazards and evaluation of preventive measures.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| ~ References|| |
Chaudhari CN, Bhagat MR, Ashturkar A, Misra RN. Hepatitis B immunisation in health care workers. Med J Armed Forces India 2009;65:13-7.
Singhal V, Bora D, Singh S. Hepatitis B in health care workers: Indian scenario. J Lab Physicians 2009;1:41-8.
] [Full text]
Centers for Disease Control and Prevention (CDC). Updated CDC recommendations for the management of hepatitis B virus-infected health-care providers and students. MMWR Recomm Rep 2012;61:1-12.
Guidelines on HIV Testing. National AIDS Control Organisation, MoHFW, Government of India; 2007. p. 75-84.
Jha AK, Chadha S, Bhalla P, Saini S. Hepatitis B infection in microbiology laboratory workers: Prevalence, vaccination, and immunity status. Hepat Res Treat 2012;2012:520362.
Beltrami EM, Williams IT, Shapiro CN, Chamberland ME. Risk and management of blood-borne infections in health care workers. Clin Microbiol Rev 2000;13:385-407.