Health care workers (HCWs) are at a
high risk of needle stick injuries and blood borne pathogens, such as HIV, and
Hepatitis B and C viruses, as they perform their clinical activities in the
precautions are a set of guidelines that aim to protect HCWs from infections
from blood, body fluids, secretions, excretions except sweat, non-intact skin,
and mucous membranes while providing care to patients.54 Compliance with universal precautions has
been shown to reduce the risk of exposure to blood and body fluids.64
Aims and objectives
study was aimed at assessing the level of knowledge, attitude and practice of
standard precautions among HCWs in Central Hospital, Warri, Delta State,
The study was carried out between
June and December, 2011 at Central Hospital, Warri, Delta State, Nigeria. The respondents were doctors, trained nurses,
laboratory scientists, laboratory technicians, health assistants and waste
handlers. They were selected through a
stratified sampling technique. The
instrument was an interviewer administered 98-item semi-structured
questionnaire that assessed the knowledge, attitude and practice of standard
A total of 200 respondents were
studied. The age of the respondents (in
years) ranged from 22 – 60, with a mean age of 38.3 +
9.1. The modal age was 30. There were more females 144 (72.0%) than males
56 (28.0%). The respondents with
tertiary level 160 (80.0%)
of education were more represented. Some 124
(62.0%) of all respondents had good knowledge of standard precautions, 140
(70.0%) had good attitude of standard precautions, and 138 (69.0%) had good
practice of standard precautions. The higher the educational level, the higher
the level of knowledge, attitude and practice of standard precautions. Some 87
(43.5%) reported always recapping needles after use, 52 (26.0%) always detach
needles from syringes, 74 (37.0%) had needle stick injuries in the last one
year. Compliance with non-recapping of needles by the HCWs was however good 113
(56.5%). A high percentage usually washed their hands after handling patients.
A large proportion of respondents (80.0%) were not immunized, only (40.0%) had
hepatitis B virus vaccine.
level of knowledge attitude and practice of standard precautions was influenced
by certain variables such as age, sex, occupation, level of education. In this study, there is need to increase
awareness and further improve on compliance with standard precautions in this
present day scourge of HIV pandemic .It is recommended that staffs should be
trained regularly on standard precautions, hepatitis B virus immunization should
be made compulsory, though free, needle recapping should be prohibited, unsafe
and unwarranted use of injections should be minimized and a PEP protocol should
be in place with a well-known designated PEP focal person.
precautions, knowledge, attitude, practice, blood-borne infection, needle stick
injury, health care workers, compliance.
Title page - - - i
Declaration - - - ii
Certification - - - iii
Dedication - - - iv
Acknowledgement - - - v
Abstract - - - vi
Key words - - - vii
Table of contents - - - viii
List of tables - - - ix
List of figures - - - xi
Definition of terms - - - xii
ONE: Introduction - - 1
TWO: Literature review - - 14
THREE: Methodology - - 43
Results - - 55
FIVE: Discussion - - 88
SIX: Conclusion and recommendations - 97
References - - - 101
letter from ethical committee and score-
schedules for Knowledge, Attitude and
Practice of Standard Precautions) - - - 111
Table 4.1: Socio-demographic characteristics of respondents showing age
group, sex, marital status, religion.
Table 4.2: Socio-demographic characteristics of respondents showing
ethnicity, educational level, occupation, years of service.
Table 4.3: Occupation of respondents by sex distribution.
Table 4.4: Source of information on standard precaution.
Table 4.5: Diseases transmitted by needle stick injury.
Table 4.6: Facilities methods of disease prevention.
Table 4.7: Attitude towards standard precaution.
Table 4.8: Attitude following needle stick injuries.
Table 4.9: Willingness to perform the procedures on HIV positive
Table. 4.10: Ways to protect self if managing HIV positive patients.
Table 4.11: Frequency of needle stick injuries in the last one year.
Tale 4.12: Practice following spill of blood and body fluids.
Table 4.13: Injection safety practices.
Table 4.14: Methods of needle disposal.
Table 4.15: Methods of handling used reusable instruments.
Table 4.16: Duration of been immunized with HBV immunization.
Table 4.17: Scores for knowledge, attitude and practice towards standard
Table 4.18: Knowledge of standard precautions and socio-demographic
variables of respondents.
Table 4.19: Attitude towards standard precautions and socio-demographic
variables of respondents.
Table 4.20: Practice of standard precautions and
socio-demographic variables of respondents.
Table 4.21: Knowledge, attitude and practice of
standard precautions and ever had needle stick injury.
Table 4.22: Ever had needle stick injuries and
recapping of needles after use.
Table 4.23: Ever had needle stick injuries and
detaching of needles after use.
Figure 4.1: Respondents who have heard of standard precautions.
Figure 4.2: Knowledge of HIV immune status of respondents.
Figure 4.3: Prevalence of needle stick injuries.
Figure 4.4 Respondents immunized against HBV
DEFINITION OF TERMS
Attitude: Way of feeling, thinking or
behaviour. In this study, the same
infections : Occupation Safety and Health Administration (OSHA)
defines blood-borne infections as infections from pathogenic micro-organisms
that are present in human blood and can cause diseases in humans. These pathogens include, but not limited to
HBV, and HIV. In this study, the same
Compliance: Practice of obeying rules or request made by
people in authority. In this study, it
is the extent, to which the HCWs obey or implement the definitions and
recommendations of standard precaution laid down by the Centres for Disease Control
Knowledge: The Oxford Advanced Learner’s Dictionary
(2001:658) defines knowledge as the information, understanding and skills that
one gains through education or experience.
It also defines knowledge as the state of knowing about a particular
fact or situation. In this study,
knowledge refers to the awareness of basic principles of standard precautions.
Practice: Is the usual or expected way of doing
something in a particular organization or situation. In this study, practice refers to the extent
that the HCWs implement or comply with recommended strategies of standard
(sharps) container or box: A
puncture/liquid proof container designed to hold used sharps safety during
collection, disposal and destruction.
injury: An injury, which occurs
when a sharp object penetrates the skin or mucous membranes.
precautions: Care taken in advance to avoid a
risk. In this study, it is an approach
to infection control to treat all human blood and certain human body fluids as
if they were known to be infectious for HIV, HBV and other blood borne
pathogens, by use of barrier equipment like hand gloves, face masks, gowns,
Infection is one of the most
important problems in health care services worldwide. It constitutes one of the most important
causes of morbidity and mortality associated with clinical, diagnostic and
Health care workers (HCWs) are at a
high risk of needle stick injuries and blood-borne pathogens as they perform
their clinical activities in a hospital.3 They are exposed to blood borne pathogens,
such as human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C
(HCV) viruses, from sharp injuries and contacts with blood and other body
fluids.4,5 According to a WHO
estimate, in the year 2002, sharp injuries resulted in 16,000 hepatitis C
Virus, 66,000 hepatitis B virus and 10,000 HIV infections in health care
workers worldwide.6 There is
no immunization for HIV and hepatitis C.7 It becomes important to prevent infection by
preventing exposure. Recapping,
disassembly, and inappropriate disposal increase the risk of needle stick
injury.8,9 The incidence rate
of these causative factors is higher in developing countries for the higher
rate of injection with previously used syringes.10 Developing countries where the prevalence of
HIV-infected patients is very high, record the highest needle stick injuries
too.10 Needle stick injuries
were also reported as the most common occupational health hazard in a Nigerian teaching
hospital.11 The World Health
Organization (WHO) estimates that about 2.5% of HIV cases among HCWs and 40% of
hepatitis B and C cases among HCWs are the result of these exposures.12 Irrational and
unsafe injection practices are rife in developing countries.13 The practice of recapping needles has been
identified as a contributor to incidence of needle stick injuries among HCWs.5,
14 It is believed that only one out of three needle stick injuries are
reported in the US, while these injuries virtually go undocumented in many
Unsafe injections and the consequent transmission of blood borne
pathogens are suspected to occur routinely in the developing world.16 It was estimated that each person in
developing countries receives an average of 1.5 infections per annum. 16,
19 About 90-95% of injections are therapeutic, while 5-10% is given for immunization.17
It has been shown that between 70% and 99% of these injections are
unnecessary, while at least 50% are unsafe in 14 of 19 countries in five
developing world regions with data. 17, 18, 19, 20.
Hauri et al of the Department of
Essential Health Technologies, WHO estimates 3.4 injections per person per year
in developing countries.16, 18
In Nigeria, the annual mean was found to be 4.9 injections per year.21 Injection over use and unsafe practices
account for a substantial burden of death and disability worldwide.16 Eighteen studies reported a convincing link
between unsafe injections and the transmission of hepatitis B and C., HIV,
Ebola and Lassa virus infections and malaria.19 Injuries from sharp devices have been
associated with the transmission of more than 40 pathogens, including HBV, HCV,
HIV, haemorrhagic fevers, malaria and tetanus, thereby increasing the risk and
burden of infectious diseases.22, 23, 24, 25 Contaminated sharps such as needles, lancets,
scalpels, broken glass, specimen tubes and other instruments, can transmit
blood borne pathogens such as HIV, Hepatitis B (HBV) and Hepatitis C viruses
(HCV).26 The circumstances
leading to needle stick injuries depend partly on the type and design of the
device and certain work practices.27
Also, the level of risk depends on the number of patients with that
infection in the health care facility and the precautions the health care
workers observe while dealing with these patients.27 It is documented that 10 – 25% injuries
occurred while recapping a used needle.5 The recapping of needles has been prohibited
under the Occupation Safety and Health Administration (OSHA) blood-borne
A data combined from more than 20
prospective studies worldwide of health care workers exposed to HIV infected
blood through percutaneous injury revealed an average transmission rate of 0.3%
per injury,4, 15, 27, 29 and after a mucous membrane exposure
approximately 0.09.30 The
commonest mode of transmission of HIV –contaminated blood to health care
workers is via needle stick injury.27 The greater the size and depth of the blood inoculation,
the greater the risk.4
Transmission through the conjunctiva and open lesions in the skin can
also occur when in contact with HIV containing fluids.4
An increasing number and variety of
needle devices with safety features are now available. Needleless or protracted needle I.V. systems
have decreased the incidence of needle – stick injuries by 62% - 88%.31Some
of these injection devices are; Auto-disable syringe, manually retractable,
automatically retractable, standard disposable and needle remover.31
The World Health Organization
defines a safe injection as one that is given using appropriate equipment, does
not harm the recipient, does not expose the provider to any waste that is
dangerous to the community.32 A safe injection is only given when
there is no other suitable alternative. Developing countries, especially those
in sub-Saharan Africa, that account for the highest prevalence of HIV-infected
patients in the world also report the highest incidences of occupational
exposure.12, 25, 33 HCV and
HBV infections are generally considered endemic in sub-Saharan Africa.33
Occupational safety of HCWs is often
neglected in low-income countries in spite of the greater risks associated with
occupational exposure to blood, inadequate supply of personal protective
equipment (PPE), and limited organizational support for safe practices.33