Occupational exposure to blood in selected oral health facilities in Botswana: experiences and practices of oral health staff

• Main Author: Ndlovu, Siphiwo
• Format: Others
• Language: en
• Published: 2014
• Subjects: Occupational Exposure; Blood
• Online Access: http://hdl.handle.net10539/13632

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Public Health. Johannesburg, April 2012 === Introduction: Sub-Saharan Africa has a high burden of HIV and other blood borne pathogens. Botswana’s estimated prevalence of HIV and HBV are between 17-40%, and 14 % respectively. Ninety percent of the three million health care workers exposed annually to blood borne pathogens through injury are in developing countries. Previous studies in Botswana indicate 24%-26% health workers sustain needle stick and other sharps injuries annually, posing a threat to them. Dentistry requires work with sharp objects in a confined space; thus oral health workers (OHWs) are at high risk of infection from occupational blood exposures (OBEs). Universal (Standard) Precautions were first recommended by the Center for Disease Control in the United States of America and were adopted in several countries, including Botswana, to minimize the risk of exposure to, and infection from, blood. However, studies in different health care settings, mainly in developed countries, have shown that these guidelines are not always adhered to. Few studies have been done to evaluate their utilization in developing countries. Aim: To quantify the occupational blood exposure experience of OHWs in Botswana’s public service and determine the infection control practices through self reporting and observation. The Objectives were: 1) To determine the demographic profile of the OHWs in Botswana, 2) To determine self reported blood exposure experience of oral health workers within the 12 months prior to the study, 3) To determine self reported infection control practice of oral health workers within the 12 months prior to the study, 4) To determine the knowledge of risks associated with blood borne pathogens amongst oral health workers at the time of the study, 5) To determine, by observation, which v precautions were practiced by oral health workers to prevent exposure at the time of the study, 6) To assess whether there was a written policy available in the dental facility on the prevention and management of occupational blood exposures. Methodology: A cross sectional descriptive survey was carried out using a combination of self reporting and observation. A total of 85 OHWs in 5 of the 6 main oral health facilities were invited to participate. Knowledge of risks pertaining to blood borne pathogens, frequency of blood exposures and practice of universal precautions were assessed. Documents and posters were also reviewed. Results: Sixty eight (80%) OHWs returned the questionnaires and 51 (60%) observations were carried out. At least 80% of respondents had correct knowledge of occurrences that can contribute to the spread of blood borne pathogens in the dental environment. Over 60% were aware of universal precautions and 75% knew that post exposure prophylaxis (PEP) was available at their facilities. Almost 43% of the respondents had experienced blood splashes in the last year and 35.3% experienced needlestick injuries. Half of these reported the injury and 16.2% took PEP. Predictors of needlestick injuries during the previous year were perception of risk, knowledge of and compliance with, Universal Precautions Personal protective equipment was poorly utilised; only 17.6% were observed to use protective eye wear. Two thirds of the respondents were observed to use double-handed recapping. None of the facilities visited had a written protocol displayed. Conclusion and recommendations: The prevalence and reporting of OBEs amongst vi OHWs were comparable with findings of other studies. Self protection through compliance with universal precautions, immunization and post exposure prophylaxis was not fully utilised. The high burden of disease in the country warrants that further efforts be made to protect oral health workers. Appropriate guidelines should be made available at all dental facilities and staff needs to be retrained regarding standard precautions. Monitoring of exposures and vaccination status should be carried out. Further research should be undertaken regarding the poor uptake of prophylaxis.