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Les accidents avec exposition au sang chez les soignants: connaissances, attitudes, pratiques et prévention dans la région de Gharb au Maroc
Abstract
Les accidents avec exposition au sang chez les soignants: connaissances, attitudes, pratiques et prévention dans la région de Gharb au Maroc [ Occupational exposure to blood among health-care workers: knowledge, attitude, practice and prevention of the Gharb region in Morocco ] ABSTRACT: Objective. – This study had for aim to evaluate practices and knowledge of infectious hazards, to reduce to a minimum the number of occupational exposures to blood for all health-care workers and all people in contact with the hospital wastes. Through the prevention which is based on the respect of standard hygiene precautions for all patients and all cares. Workers and methods. – This study descriptive and transversal was carried during 2011 in the regional hospital EL IDRISSI of the Gharb region in Morocco on 170 health-care workers form 275, with anonymous questionnaire. Results. – the participation rate was 94, 12% (160/170).the population was mainly female (72, 5%) with a mean age of 43 years and seniority of 15 years, during their career 64, 38% of the personnel underwent at least one occupational blood exposure, 7, 77% was reported to occupational health departments. approximately 96% of these accidents involve the handling of blood-soiled and instruments and 4% relate to the elimination of these instruments. Only 51, 9% of the personnel were adequate vaccine against hepatitis B. a lack of knowledge of HIV seroconversion and hepatitis C (16.9% and 11.2% respectively). Only 20% of health-care workers reported the regular use of preventive measures. Conclusion. – The study shows that there is a need to improve occupational hygiene and safety conditions for health-care workers and lead to more information and education in order to reduce occupational exposures to blood hazards.
... The average working experience of the respondents was 9.14±6.78 years, lower than that reported by Ebatetou et al., of 13.7±6.5 years [7] and Younes et al., of 15 years [11]. This further proves that a younger population of healthcare personnel have been recruited by MINSANTE in the last ten years because of the ageing population of HCWs. ...
... Women were predominant in this setting and represented 54.7% of the study population (sex ratio = 0.72). This has equally been observed in other studies including: 54.70% in another study from Cameroon, 57, 50% in Congo Brazzaville, and 72, 50% in Morocco [5, 7,11]. This high percentage of women is probably because they represent the majority of Cameroon's population and are implicated in education and science, more now than in the past. ...
... In Morocco, Moussa et al. found a predominance of the surgical pole (48.7%) [8], during the course of their work, 62.80% of the HCWs claimed to have been victims of at least one BEA. Similar frequencies have been reported by several authors in sub-Saharan Africa [1, 9,11,14]. According to occupational category, BEA were more frequent among paramedical staff than among medical staff (p <0.1%). ...
Abstract
Introduction: Blood exposure accidents (BEA) are a major public health problem, especially in developing
countries such as Cameroon. Evaluating the knowledge and practices among healthcare workers (HCWs) of the
Ngaoundere Regional Hospital (NRH), in relation to BEA, was a logical step towards addressing this concern in
Cameroon.
Design: From 1 March to 30 April 2021, a descriptive cross-sectional study was conducted at the NRH in the
Adamawa region of Cameroon. The study population consisted of the HCWs of the NRH. A total, 218 health care
personnel were contacted to participate in the study and 172 (78.89%) HCWs agreed. Data were collected using an
anonymous, self-administered questionnaire.
Results: A total of 172 HCWs were surveyed and the predominant gender was female (54.7%), the average age
was 35.55±7.46 years, and the average longevity was 9.14±6.78 years. Approximately 62.80% of the respondents
claimed to have had at least one BEA. The most common BEA was needle stick injury (87.5%), followed by infected
blood splashed into the mouth and/or eyes (52.0%) and contact with a wound containing infected blood (48.7%).
Conclusions: This study revealed a poor knowledge of interventions after BEA, demonstrated in the practices of
HCWs of the NRH, especially according to their professional category, with medical staff having a better knowledge
of BEA than paramedical staff.
... The variability of the mechanisms involved can explain this estimate: hand maladjustment of syringes (16), transferring blood from a mounted syringe into a tube (17), mouth pipetting of specimens (18) picking up sharps placed on benches, in a tray, or trash bags (19), and recapping needles (20). ...
... On the other hand, the shortage of waste sorting equipment (D19) and the shortage of waste carriers (D20) reflect frequently reported ergonomic constraints in hospital settings, where the likelihood of being contaminated by an infectious disease depends on many associated factors such as the source patient's viremia, the depth of the wound Health professionals as well as the actors of the waste sector can be confronted with it, in particular when the hygiene precautions are badly respected. The waste from care activities with infectious risks is badly conditioned (19). ...
Occupational exposure to blood among medical students in Casablanca (Morocco): Analysis of knowledge and practices
Occupational exposure to blood (OEB) is associated with a significant risk of transmission of bloodborne viruses to medical students. The objective of this study was to evaluate the knowledge and practices of Casablanca medical students concerning OEB preventive measures and their behaviour after accidental exposure. A cross-sectional study was carried out at the Ibn Rochd University Hospital in Casablanca using stratified cluster sampling ; data from this study were collected by means of an anonymous self-administered questionnaire. The mean age was 22.38 years (SD = 1.69) with a female predominance (56.0%). About 17.5% of students had experienced at least one OEB, and only 38.3% were familiar with the standard precautions to prevent these accidents. Accidental exposure was significantly associated with needle recapping (p = 0.002) and ignorance of standard precautions (p = 0.028).
These results illustrate the insufficient knowledge and poor compliance with preventive measures of occupational exposure to blood, indicating the need for awareness-raising and training activities for medical students.
Personnel at risk for occupational blood exposure in a university hospital in west Algeria
The accidental occupational exposure of health care workers to blood or other body fluids after skin injury or mucous contact, constitutes a risk for the transmission of the hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency viruses (HIV). This paper presents the results of a survey carried out over two years (January 2005 – December 2006) on reported occupational blood exposures (OBE). The study aimed to determine incidence, workers and professional categories at risk, and circumstances of OBE occurrence in order to identify avoidable cases and to orient prevention measures. Personal and professional data, immunization status, circumstances of OBE incidents, preventive measures, workers’ behaviour post-exposure, and serology surveillance were collected. 108 exposures were reported by 70 women and 38 men. In total, 44 accidents were reported in 2005, and 64 in 2006. Needle stick injuries represented 81% of cases. Source patient serology was unknown in most of the cases, negative in 9% of cases and positive in 10% of cases. 62% of exposed health workers received immediate serology, follow up and screening as of the first day of exposure, 12% after 3 months and 36% after 6 months. No sero-conversion case was noted. Cleaning staff and hygiene workers are at high risk of blood contamination as well as nurses, and more than one-third of injuries occurred because of mismanagement of healthcare waste produced in the hospital environment, where needles were not disposed of appropriately in a hard container. Thus, 41,66% of injuries could be avoided if objects were thrown away correctly in specific containers. It is urgent to raise awareness of health care personnel and strengthen adherence to standard precautions as well as to provide suitable containers for the collection and disposal of needles and sharp objects
Purpose of the study
The objective of our study is to identify the characteristics of accidental exposure to blood in trainee doctors’ and to determine their mechanisms, so as to envisage preventive measures.
Method
We conducted a retrospective study, which lasted 2 years (1st January 2007–31December 2008) on all blood exposure accidents (BEA) reported by trainee doctors’ at the two university hospitals of Sfax.
Results
During these 2 years we compiled 107 blood exposure accidents reported by 102 trainee doctors’, including 69 females. The most frequent mechanism of occurrence was through contaminated needlesticks in 85% of cases, 59 of which (64.8%) had occurred following blood glucose finger-prick test by 57 trainee doctors’ (eight men and 49 women). The victims are divided into 50 interns (students in their 6th and 7th years of medical studies) in 87.7% of cases, a resident in medicine in 1.8% and six medical students (students in the 2nd cycle of medical studies) in 10.5%. The mechanism of needlestick injuries was recapping contaminated needles in 46 cases (78%). Two interns had two blood exposure accidents by this same mechanism.
Discussion
More than half of the blood exposure accidents occurred following a blood glucose finger prick-test. The interns are most at risk since this act is essentially practiced by this professional category. The most frequent occurrence of contaminated needlestick injury was during recapping the needle, which is in accordance with the study conducted in Strasbourg in medical students and which showed that 67% still resheath needles prior to their disposal. Sessions of training and information about BEA prevention are regularly organized for trainee doctors’ before their recruitment. At the same time a permanent follow-up with the administrators of safety equipment supply and the acquisition of secure equipments to carry out blood glucose finger prick-tests has been implemented.
Conclusion
As a result of the study, a training policy on the prevention of blood exposure accidents was started for trainee doctors’ to reduce the frequency of occurrence of blood exposure accidents among this professional category. A reassessment will be scheduled later.
Aim of the study
The frequency of occupational exposure to blood among health care workers was unknown for the whole country. It appeared important to determine the prevalence and the mechanisms of occurrence of this event to organize the prevention of HIV, HBV and HCV contamination.
Methods
A descriptive study was realized in 207 people, 136 men and 71 women, from all the sanitary formations in Togo: medical doctors (38), nurses (49), midwives (39), laboratory workers (35), medical assistants (36) and hygiene assistants (10). The information was obtained by means of a questionnaire.
Results
Occupational exposure to blood was observed in 62.3% of the studied population with a significant difference between men and women (52.9 and 80.2%). The analysis pointed out that the value of prevalence was different according to the occupational status: medical doctors: 62.6%, nurses: 83.7%, midwives: 82%, laboratory workers: 34.3%, medical assistants: 58.3% and hygiene assistants: 30%. The number of blood exposure events was significantly related to the duration of occupational activity. The variations going from the north to the south of the country were not statistically significant. Among the mechanisms, needlestick injuries and body fluid exposure occurred more frequently than sharp injuries, respectively 68, 63 and 14% of the cases. In the matter of prevention, 69% of the subjects were not protected against hepatitis B viral infection and only glove supply was adequate. At last, blood exposure accidents were underreported: only 22.4% of the cases; this insufficiency was above all the fact of medical doctors and midwives.
Conclusion
The prevalence of occupational exposure to blood was important in Togo like in numerous countries and especially related to hazardous behaviours of the healthcare workers, owing to a lack of training and of safety-engineered devices.
The incidence of accidental exposures of healthcare workers to bloodborne pathogens, when expressed over the number of care procedures performed, is higher in intensive care units than in other hospital wards. The rapid turnover of staff members, and subsequently sometimes their lack of experience, emergency situations, and the wide diversity of care procedures performed are important factors contributing to the increased risk of occupational exposure to blood and body fluids in intensive care units. Haemodialysis, and by extension, possibly other procedures that use an extracorporeal blood circulation, are known to put healthcare workers at risk of exposure to bloodborne pathogens, and particularly to blood projections when disconnecting the circuit at the end of the procedure. Although numerous safety devices to protect against blood and body fluids exposure during a wide range of care procedures are available, such devices specifically designed for circuit disconnection are still lacking. Therefore, education, training, the strict application of standard/universal procedures (protective gown, gloves, mask, glasses, etc.), and also the implementation of local standardized procedures are of paramount importance.
Objective. – As in other countries, Moroccan health-care workers are exposed to occupational blood exposure (OBE) hazards. The purpose of this study was to estimate the occupational safety and hygiene conditions determining the OBE risk for health-care workers.Workers and methods. – In March 2000, a multicentric study was carried out in Morocco on 420 health-care workers, with an anonymous questionnaire. The study included health-care workers in the Taza and Temara hospitals and health centers, as well as in a Rabat public medical analysis laboratory.Results. – The participation rate was 67.8% (285/420). The population was mainly female (61%) with a mean age of 41.4 years (±7 years). Health-care workers answered that: occupational hygiene and safety were inadequate (55.1%); wearing single-use gloves was rare (34.5%); resheathing used needles was frequent (74.5%); safe containers were often missing (67%). In 1999, the annual average incidence of OBE was 1.5 (±4.3) per capita. If we consider the whole career of health-care workers, the incidence reached about 14.3±28.1 per capita. The absence of post-exposure chemoprophylaxis was the rule.Conclusion. – The study shows that there is a need to improve occupational hygiene and safety conditions for Moroccan health-care workers in order to reduce OBE hazards.
Objective. – This study was carried out among nurses in the occupational medecine service of the Dijon university hospital in France. It had for aim to identify individual factors associated with the report of occupational exposure to blood (OEB).Method. – One hundred fifty-six nurses having reported an OEB over the 1 year period were compared to a random sample of 155 nurses who did not reported any OEB over the same period. The study concerned data on age, overall seniority, seniority in the last unit, professional status, address, pregnancy, children over 2 years of age, illness, occupational accidents, sick leave, and history of OEB over the 2 years before the onset of the study. A logistic model and univariate analysis was used to identify risk factors.Results. – After ajustement, the results present an association between seniority inferior to 2 years and an OEB. Furthermore, there is also an association with nurses having had at least one OEB over the 2 years period before the onset of the study. But since there might be an autoselection bias, these results must be confirmed by other studies.
Hepatitis C virus (HCV) is mainly a blood-borne pathogen. Its transmission in health care facilities has remained partly unexplained until now. Two modes of transmission have been suggested, either through medical devices reused in invasive procedures and incorrectly cleaned or disinfected, or through accidental blood contacts generating a risk of contamination between health care workers and patients. Prevention of HCV transmission is based on the respect of standard precautions for all patients and all cares. These precautions need to be reinforced in facilities where patients are frequently exposed to invasive procedures, such as haemodialysis units, interventional radiology, surgery, intensive cares or transplant units. Specific disinfecting measures should be implemented according to material, including endoscope or dialysis generator. Health care workers protection against accidental blood exposure includes to avoid high risk tasks and to use protective material during cares or discarding cares waste (protective gowns and clothes, containers for sharp objects, etc).
Health care workers (HCW) in haemodialysis units are confronted with a significant risk of occupational exposure to blood and body fluids. The prevalence of bloodborne viruses is high among haemodialysis patients. The data presented here relates to the extraction of 121 occupational exposures notified to occupational health departments by haemodialysis HCW, documented between January 1995 and December 1999 in a network of 54 volunteer hospitals in Northern France. The exposures notified in haemodialysis wards were needlestick injuries in 85 cases (70.2%), splashes to the eyes or non-intact skin in 30 cases (24.8%) and cuts in 6 cases (5.0%). Connection and disconnection of dialysis catheters to fistulae, blood sampling procedures and injections alone were involved in approximately 3 notified exposures out of 4 (46.3, 14.9 and 11.6% respectively for a total of 72.8%). The principal mechanisms for exposure were the handling of blood-soiled needles and instruments or involved the handling of sharps containers. Haemodialysis fistula needles were involved in only 12 (13.2%) of notified percutaneous injuries. Nearly 2/3 (63%) of 91 notified percutaneous injuries could have been avoided by the observance of universal/standard precautions alone and the use of safety devices whiche were available at the time. The collection and analysis of occupational exposures can serve as basis for an assessment of practices, devices and safety equipment to increase HCW safety in haemodialysis wards.
Objective – The authors wanted to assess the knowledge of health care workers on management procedures, and infection control measures for accidental exposure to blood (AEB), in the 3 Abidjan teaching hospital.Methods – A cross-sectional study was made from February to April 1999. Physicians, nurses and medical students were requested to answer anonymously a questionnaire on their demographic profile and past percutaneous and mucocutaneous exposure to blood.Results – Nine hundred and thirty six people were solicited but only 707 (75.5%) answered. Four hundred and six (57.4%) were nurses, 184 (26%) were physicians, and 117 (16.6%) were medical students. Overall, 60% of them reported AEB. Needlestick injuries accounted for 44% of reported accidents. The highest frequency of accidents was observed among nurses (22.5%), and physicians (18%). 86.5% of workers having reported an incident claimed to have disinfected the lesion and only 15% reported the accident after injury. 16% had HIV testing performed before the incident. 84.6% agreed with the reporting procedure for occupational exposures and 70% knew about the universal measures of hygiene. 298 of them suggested antiretroviral prophylaxis after exposure to HIV infected blood (HAART 28%), 2 NRTI (16%), and Zidovudine in monotherapy (44%).Conclusion – The risk of AEB is high among health care workers in Abidjan but most accidents were not reported. The importance of compliance with universal precautions, of an occupational exposure reporting procedure, of knowing about source patients' HIV status and prophylactic antiretroviral drugs need to be emphasized.
An anonymous survey of 149 resident doctors was conducted to estimate the ex tent of accidental exposures to blood and body fluids of patients over a one-year period. There was a total of 1142 exposures. Ninety-three percent of respondents reported one or more exposure incident(s).
Analysis of events and procedures leading to accidental exposures revealed that recapping needles was involved in 17%, suturing accounted for 14%, setting up intravenous lines 11%, cuts with scalpel 9% and phlebotomy 9%. Surgical residents had a threefold greater risk of exposure compared with medicine residents. No trend was found for accidental expo sures by level of residency training. Seventy-four percent of the residents used universal precautions 50% or less of the time. Only half of the doctors could recall formal instruction on correct course of action after exposure and 5% of them had as undergraduates hepatitis B vaccine prior to the commencement of venepuncture duties. All but one of the residents' exposures were not reported to the Staff Medical Services Department. The doctor who reported was neither tested for hepatitis B virus or human immunodeficiency virus nor was he properly treated. Only 5 (4.6%) of the contaminating patients were evaluated serologi cally for their status of these viruses.
These data emphasize the need for increased efforts toward improved early and continu ing education, prevention and correct management of accidental exposures to blood or body fluids of patients by resident doctors in Nigeria. No recent study exists that exclusively addresses this problem in doctors in tropical Africa.
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