Transcript Level of health care service

THE PREVALENCE OF
BLOODBORNE INFECTION
AMONG HEALTHCARE
WORKERS
Munkhnasan Myagmarjav
Yerkubulan Muxtar
Davaalkham Dambadarjaa
BACKGROUND
 They are at risk of infection by more than 30 pathogens through
airborne, blood borne, fecal- oral transmission and direct contact.
 Mongolia is highly endemic country for viral hepatitis and l the
highest rate of HCC in the world.
 There is many studies have been conducted among general
population
 There is no enough study conducted among health care workers in
our country, covering both urban and rural areas and all level of
health care settings.
GOAL
This study aims to determine seroprevalence of HBV, HCV and HIV
infection and evaluate occupational risk factor among all levels of
healthcare workers within Mongolia.
OBJEVTIVES
 To determine the prevalence of HBV, HCV and HIV infections
among HCWs in Mongolia
 Assess the risk factors and occupational exposures
METHODS
 This study was conducted in 2010-2012
 Cross-sectional design using stratified
multistage, random cluster sampling
 17 soums of 4 aimags and Ulaanbaatar
 Questionnaire
• General information
• Risk factor
• Occupational exposure
 Testing for HBV, HCV and HIV:
Serologic markers
Markers
ELISA
Anti – HBc
Ortho VITROS Anti-HBcore
assay
HBsAg
Ortho VITROS HBsAg assay
Anti – HBs
Ortho VITROS Anti-HBs assay
Anti –HCV
Ortho VITROS Anti-HCV
assay
Anti –HIV
Ortho VITROS Anti-HIV1+2
assay
Real time- PCR
COBAS® Taqman HBV test v
2.0
COBAS® Taqman HCV test v
1.0
Sociodemographic characteristic
GENDER : 7 % (n=71 ) male
93% (n=949 ) female
AGE: 22-61 mean age 42.7 ± 9.4
Mean working year : 17.17±10.5 жил
Occupation: Doctors 25.9%(n=261)
Nurses 37.1%(n=378)
Medical technicians 19.9%(n=202)
Other 17.2%(n=175)
Level of health care service:
Primary 36.9% (n=375)
Secondary 41.7%(n=424)
Tertiary 21.4%(n=217)
Serologic marker results
Interpretation
Anti – HBc
HBsAg
Anti – HBs
HBV infection
+
+
+/-
78 / 7.6 /
Recovered from past infection
and not immune, low level
carrier
+
-
+/-
619/60.7/
Immune
-
-
>10 IU/ml
179 /17.5/
Вакцины дараах дархлаа
үүсээгүй
-
-
<10 IU/ml
21 /2.1/
Never infected and no
evidence of immunization
-
-
-
Total
N
123/12.1/
1020
HBV- DNA
anti-HBc (+), HBsAg (+)
10.4%
anti- HBc (+), HBsAg (-)
4.0%
89.6 %
96.0%
HBV-DNA (+)
HBV-DNA (-)
HCV infection
53.8
21.9
78.1
46.2
HCV-RNA (+)
anti- HCV (-)
anti- HCV (+)
HCV-RNA (-)
Prevalence of HBV and HCV by region
HBV infection by occupation and health
care service level
120.0
100.0
80.0
7.4
13.3
19.4
33.3
20.0
19.4
60.0
40.0
20.0
33.3
33.3
25.9
27.8
primary
secondary
46.7
20.0
0.0
doctor
nurse
medical technicians
tertiary
other
HCV infection by occupation and health
care service level
120
100
12
18
22
32
19
14
34
44
22
19
primary
secondary
80
60
40
38
20
26
0
doctor
nurse
medical technicians
tertiary
other
Multiple regression analysis
Characteristics
Age
Gender
female
male
Health care service level (ref = primary)
Secondary
tertiary
Occupation (ref = other)
Medical technicians
Nurse
Doctor
Working year
Admission at hospital
Surgery
Blood transfusion
History of reusing the syringe
Abortion
Needle stick injury
Sharp injury
HBV
OR
1.049
P-value
0.001
HCV
OR
P-value
1.092
0.001
0.578
0.042
1.245
1
1.228
1.054
0.483
0.885
1.150
1.249
0.507
0.381
1.645
1.144
1.010
1.041
7.466
2.01
2.349
2.537
1.243
1.007
1.272
0.256
0.739
0.981
0.001
0.05
0.015
0.022
0.021
0.455
0.983
0.363
1.287
1.045
0.761
1.067
4.300
2.015
4.012
1.991
1.544
1.103
1.248
0.415
0.873
0.353
0.001
0.004
0.001
0.001
0.039
0.033
0.682
0.240
1
2.329
Needle stick injury by occupation
81.4% (n= 830) HCWs had had at least one needle stick injury
at some point in their career
A total of 563 HCWs had needle stick injury in the last one year,
average number of injury 2.33 times/year
12.4
25.8
20.2
41.6
doctor
nurse
medical technician
other
Reporting occupational exposure
Medical
other
technicians
Characteristics
n (%)
n (%)
n (%)
n (%)
Do you understand these procedures, such as the immediate first aid measures to
take, who to report the injury to, where to obtain medical treatment, options for
follow up consultation and post-exposure treatment
yes
137 (54.6)
190 (52.6)
125 (64.8)
70 (41.7)
Doctor
no
114 (45.4)
Nurse
171 (47.4)
68 (35.2)
Р
value
0.001
98 (58.3)
Did you report the injury to the hospital?
0.03
yes
26 (13.8)
72 (23.6)
30 (20.0)
17 (14.9)
no
162 (86.2)
233 (76.4)
120 (80.0)
97 (85.1)
CONCLUSION
 Among urban and rural healthcare workers 28.8% had single
or co-infection of HBV and HCV, furthermore 89.7% and
46.2% were positive for HBV-DNA and HCV-RNA,
respectively.
 There was no positive case of HIV among participants
enrolled in this study.
 Multiple regression analysis demonstrate that previous
surgical procedure,history of blood transfusion and working
year at hospital were statistically significant risk factor to HBV
and HCV infection.
CONCLUSION
 Although not significant, there was high prevalence HBV and
HCV among medical technicians and nurses
 This study demonstrates a need for occupational safety
training including needle stick injury prevention, a need for
more widespread hepatitis B vaccination campaigns, and
evaluate the effectiveness of immunization.
ACKNOWLEDGEMENT
Pagvajav Nyamdawa, Mongolian Academy of Medical Sciences (MAMS)
Narnygerel Erdenebileg., Infectious Disease and Immunogenetics Section (IDIS), Department of Transfusion
Medicine, Clinical Center, and Center for Human Immunology (CHI), National Institutes of Health, USA
Meredith Potts, FIRE, USA
Munkhjargal Ayurzana., FIRE, USA
Yerkubulan Muxtar., 1 Department of Epidemiology and Biostatistics, School of Public Health, MNUMS
Lorenzo Uccellini, Infectious Disease and Immunogenetics Section (IDIS), Department of Transfusion Medicine,
Clinical Center, and Center for Human Immunology (CHI), National Institutes of Health, USA
Scott Patlovich, FIRE, USA
Krista Patlovich, FIRE, USA
Thomas O’Brien, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of
Health, USA
Maria Teresa Landi, Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National
Cancer Institute, National Institutes of Health, USA
Stefano Bertuzzi, Office of Science Policy Analysis, National Institutes of Health, USA
Samuel So, Asian Liver Center, School of Medicine, Stanford University
Harvey J. Alter, Infectious Disease and Immunogenetics Section (IDIS), Department of Transfusion Medicine,
Clinical Center, and Center for Human Immunology (CHI), National Institutes of Health, USA /
Francesco M. Marincola /Infectious Disease and Immunogenetics Section (IDIS), Department of Transfusion
Medicine, Clinical Center, and Center for Human Immunology (CHI), National Institutes of Health, USA/
Davaalkham Dambadarjaa , 1 Department of Epidemiology and Biostatistics, School of Public Health, MNUMS
THANK YOU FOR YOUR
ATTENTION