"Zambian Health Care Worker Exposure to Blood-Borne Pathogens"
The high incidence of exposure to blood-borne pathogens among African health care workers is a largely overlooked consequence of the high HIV, HBV, and HCV infection rates in sub-Saharan Africa. Though some recent studies have begun to address this problem, there is still an alarming scarcity of data concerning health care worker exposure rates as well as mechanisms of exposure in sub-Saharan Africa (1,2). This is a serious concern especially in places where the ratio of the general population to health care providers is as high as 100,000 to 10 and the loss of merely one health care provider exacerbates the already present problem of understaffed hospitals (3). Medical equipment shortages and a higher incidence of blood-borne pathogens in African patient populations compared to American patient populations makes the African situation even more dire; the combination of these factors increases the risk of health care workers developing HIV, HBV, and HCV (4,5,6,7).
The recent successes of the United States in reducing the rates of HIV, HBV, and HCV exposure among health care workers demonstrate solutions do exist. However, these solutions could not have been enacted without first establishing the precise source of the problem. Specifically, data had to be collected on how exposures to blood-borne pathogens were occurring and which procedures were causing exposures. The acquisition of this data allowed specific prevention strategies to be tailored to address the apparent problems.
The next step for sub-Saharan Africa, then, is to gather specific and targeted data - to find out how health care providers are being exposed to blood-borne pathogens and to begin targeting prevention strategies to address problem areas.
Our trip to Zambia provided us with an opportunity to do this. By performing a retrospective study of the health care workers in three hospitals and two clinics in Zambia, we were able to get a picture of not only baseline exposure rates, but also specifics about the mechanisms of exposure.
Due to the aforementioned high prevalence of HIV, HBV, and HCV, overworked health care personnel, insufficient health care supplies, and lack of adequate safety measures, we hypothesized that health care workers in Zambia are at a higher risk for accidental exposure to blood-borne pathogens. In order to evaluate this hypothesis we conducted a retrospective study of the occupational exposure of health care workers to blood-borne pathogens in three hospitals and two clinics in Zambia. We acquired this information using a retrospective survey designed by the International Health Care Worker Safety Center. Specifically, the survey, as outlined above, obtained data on the baseline exposure rates and the mechanisms of exposure to blood. In addition, we developed and used a standardized protocol to characterize the conditions and infection control policies of the hospitals in Zambia. This data will be used to identify which prevention measures would make the greatest difference given the conditions at the surveyed hospital. We also will compare the rates of exposure among different departments of the hospital and among staff within each department (e.g. nurses, doctors, housekeepers, etc.). At the completion of our trip, we analyzed the data and presented our preliminary findings to the managing director of the University Teaching Hospital in Lusaka and the Zambian Ministry of Health.
Data from our study is still in the process of being analyzed. Our sample size was roughly 500. From our preliminary analysis, we found that the majority (roughly > 80%) of health care workers are not vaccinated against Hepatitis B and the devices which caused the highest frequency of injuries included needles on disposable syringes, glass medication ampoules, and suture needles. Further conclusions can not be made until the data is analyzed in its entirety. However, even from this preliminary analysis it can be seen that specific interventions can be taken to improve the safety of health care workers in Zambia.
Resources
1. Vardas, E., et al. (2002). Viral hepatitis in South African health care workers at increased risk of occupational exposure to blood-borne viruses. Journal of Hospital Infection, 50(1):6-12.
2. Kanyama, I., et al. (1993) Risk of occupational exposure to HIV among nurse midwifes and traditional birth attendants. International AIDS Society.
3. Sagoe-Moses, C., et al.. (2001) Risks to Health Care Workers in Developing Countries. New England Journal of Medicine, 345(7):538-541.
4. Newman, M.J. (2001). Infection control in Africa south of the Sahara. Infection Control in Hospital Epidemiology, 22:68-9.
5. Msuya, S.E., et al. (2006). Seroprevalence of hepatitis B and C viruses among women of childbearing age in Moshi Urban, Tanzania. East African Medical Journal, 83(2):91-4.
6. Consten, E. C.J., et al. (1995) A prospective study on the risk of exposure to HIV during surgery in Zambia. AIDS 9:585-588.
7. Habimana, P., et al. (1994). A survey of occupational blood contact and HIV infection among traditional birth attendants in Rwanda. AIDS, 8(5):701-4.