The current status and occupational health risk factors of Vietnamese healthcare workers also indicate a high risk for healthcare workers of exposure to pathogenic microorganisms, especially hepatitis B and C viruses [7], [8], [9].
In Can Tho city, during the period 2011-2016, there were 103 cases of medical staff suffering from occupational accidents due to sharp objects and occupational exposure reported [10]. In 2012, the rate of medical staff infected with hepatitis B virus in some hospitals in Can Tho city was 16.2% [11]. However, currently, occupational safety and hygiene for medical staff has not received due attention, many medical facilities have not fully implemented legal regulations on occupational safety and hygiene such as establishing occupational hygiene records, periodic health check-ups, occupational disease detection examinations, measures to prevent occupational diseases caused by microorganisms, especially prevention of occupational hepatitis B and C for medical staff. With 23 public health facilities in the area, for many years in Can Tho City, there has been no research assessing the risk of occupational diseases caused by microorganisms in medical staff. Therefore, the topic "Research on the current situation and risk of occupational diseases caused by microorganisms in medical staff in Can Tho City and evaluation of the effectiveness of intervention measures" was implemented with the following objectives:
Research objectives:
1. Assessment of risk factors for occupational diseases caused by microorganisms in medical staff in Can Tho city;
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2. Describe the current status of hepatitis B and C virus infection among medical staff at some hospitals in Can Tho city in 2016 - 2017;
3. Evaluate the effectiveness of some intervention solutions.
Chapter 1 OVERVIEW
1.1. Concepts
1.1.1. Medical facilities (HCF)
Medical facilities are establishments providing services, management, and training in the medical field that are established and managed by competent authorities, including: disease prevention, medical examination and treatment, training, scientific research, state management of health, pharmaceutical and medical equipment enterprises under the Ministry of Health, other ministries and localities (including private and joint venture medical facilities) [12].
1.1.2. Medical staff (HCW)
Medical staff are workers currently working in medical facilities (including public and private, permanent and contract) [12].
1.1.3. Occupational safety and health (OSH)
Occupational safety and health are solutions to prevent and combat the impact of occupational hazards to ensure that they do not cause illness, injury, health problems or death to people during the work process [13].
1.1.4. Occupational hazards:
Occupational hazards are factors in the production process and working conditions that have a negative impact on the health and working capacity of workers, causing pathological disorders or occupational diseases for those exposed. All factors related to work in the workplace that limit the ability to work, cause injuries or have adverse effects on the health of workers, even causing death to workers, are called occupational hazards or risk factors. There are 2 groups of occupational hazards, including:
- Hazardous factor: is a factor that causes unsafety, injury or death to people during the working process.
- Harmful factors: are factors that cause illness and reduce human health during the work process [ 13].
1.1.5. Occupational diseases (OCDs):
Occupational diseases are diseases caused by harmful working conditions of the occupation affecting the worker. Occupational diseases are diseases that are characteristic of the occupation or related to the occupation. The cause of occupational diseases is due to the frequent and long-term effects of poor working conditions. Occupational diseases are the object of prevention in the field of occupational safety and health. Occupational diseases can be prevented by measures: technical, medical, personal, propaganda, training, monitoring of the working environment, ...
1.1.6. Occupational diseases caused by microorganisms (VSV):
Microbial diseases are diseases caused by microorganisms that can threaten the health of workers, especially health workers. Common diseases are HIV/AIDS, hepatitis B, hepatitis C, SARS, tuberculosis, dengue fever, adenovirus, diphtheria, influenza, Ebola, measles, rubella, mumps, cholera, dysentery, typhoid... In particular, the most notable are diseases caused by microorganisms transmitted through blood such as hepatitis B, C and HIV [7], [13].
1.1.7. Occupational hepatitis B
Hepatitis B is a dangerous infectious disease transmitted through blood caused by the hepatitis B virus (HBV). Occupational hepatitis B is a hepatitis caused by the hepatitis B virus during work. Health care workers can be infected with HBV during the process of providing medical services such as patient care, testing, and disease prevention. After entering the body, these viruses will cause inflammation and damage to liver cells, leading to disruption of liver functions such as nutrient synthesis and food digestion, blood filtration, and infection prevention [1], [14].
1.1.8. Occupational hepatitis C:
Occupational hepatitis C virus (HCV) is an occupational infection similar to tuberculosis, hepatitis B, HIV... Hepatitis C is a viral infection that invades the liver and can cause acute and chronic hepatitis. The virus is transmitted through contact with blood or body fluids of an infected person and not through casual contact. The disease causes a high risk of death from cirrhosis and liver cancer [1], [15].
1.2. Workers in medical facilities and occupational risk factors
1.2.1. Labor in medical facilities
Health care workers are among the groups at high risk of occupational and occupational diseases due to exposure to many risk factors and specific working conditions in terms of time and intensity of work. Currently, there are about 59 million health care workers worldwide who provide health care services to patients, including doctors, nurses, caregivers, laboratory staff, technicians, cleaning staff, administrators, emergency transport staff, and medical equipment repair and maintenance staff [16].
In Vietnam, according to general statistics on human resources in the health sector, the country currently has 441,446 medical staff, of which 73,567 are doctors, 54,466 are nurses, 54,466 are nurses, 1,000 are technicians, and 1,000 are midwives.
148,098 [17].
In 2016, Can Tho City had 134 health facilities including: 26 hospitals, 20 regional polyclinics, 3 maternity homes and 85 commune and ward health stations; including 109 state health facilities and 25 non-state health facilities. With over 5,545 health workers, including 1,918 doctors, 652 physicians, 2,531 nurses and 444 midwives; among
5,150 hospital beds, including 4,636 hospital beds in hospitals, 50 hospital beds in regional polyclinics, 13 hospital beds in maternity homes and 451 hospital beds in commune and ward health stations. With a large workforce in the health sector, occupational safety and health and occupational health care
for medical staff of our country in general and of Can Tho city in particular is extremely important in the current period [18].
1.2.2. Occupational risk factors in medical facilities
The health sector is a special labor sector with heavy labor intensity, psychological stress, and working environment conditions that generate occupational hazards, including many harmful factors that affect the health and cause illness for health workers. Harmful factors in the working environment of health workers can be divided into 2 groups:
Non-communicable risk factors:
- Physics, electromagnetic field.
- Chemistry.
- Labor organization.
- Labor psychology and ergonomics.
Risk factors for VSV infection:
- Contact with blood, body fluids of patients, specimens, medical waste.
- Injuries due to occupational accidents [19], [20].
1.2.2.1. Non-communicable risk factors
* Exposure to ionizing radiation
Ionizing radiation (radioactivity) is a phenomenon of changes within the nucleus of a substance that emits continuous radiation with different wavelengths. These radiation rays, when irradiated on matter, ionize them, so they are called ionizing radiation. The main sources of radiation in medical facilities are in the departments of diagnostic imaging, nuclear medicine, testing, ... using X-ray machines, CT-scanner, PET-CT scan, radiotherapy equipment and chemicals, radioactive isotopes. Employees exposed to low doses of radioactive elements can cause biological damage, alter genes and chromosomes, slow down or destroy cell division and interfere with
into metabolic processes or causing cancer of the blood, bones, skin and thyroid [5], [21].
* Electromagnetic field
Electromagnetic fields in medical facilities are generated from high-voltage power grids or short-wave generators. Workers exposed to electromagnetic fields are usually electrical workers and doctors in physical therapy departments. Electromagnetic fields cause health problems such as electromagnetic sickness, electromagnetic burns, electric shock, nervous breakdown, and even long-term exposure to high-intensity electromagnetic waves can cause infertility.
* Exposure to chemicals
Common chemicals in medical facilities are antiseptics and disinfectants such as chlorine, iodine, formaldehyde, etc.; Contact with some other chemicals such as chlorine, formaldehyde and glutaraldehyde causes dermatitis as reported. Chemicals used in biochemical, hematological and cytological laboratories; medicinal herbs and drugs of all kinds used in medical examination and treatment are also chemical in nature such as anesthetics, anticancer chemicals, sedatives, antibiotics, many of which are toxic drugs in group A [5], [22].
* Factors of labor organization and labor psychology:
Most medical staff working in hospital departments are exposed to stress factors at work, especially medical staff in intensive care units, burn units, emergency units, surgery units, infectious diseases units, obstetrics units, etc.
Stressful working conditions for healthcare workers include the increasing number of patients coming for medical examination and treatment, along with the large number of daily test samples that overload the hospital. Contact with patients with many potentially dangerous diseases makes healthcare workers always worry about being infected when exposed to occupational accident risks. In addition, healthcare workers must always be on guard against violence from patients' relatives and patients because negative reactions when encountering stressful situations during treatment are also a factor causing stress.
in the working conditions of medical staff. According to the requirements of the job, most medical staff, especially in hospitals, have to work in shifts and at night to ensure a 24/24 working regime. Medical staff in the preventive health system also have to be on duty regularly to fight epidemics and monitor infectious disease outbreaks in the community. The combination of lack of sleep and working at a time when the body's functions are limited and nervous tension can cause severe fatigue and insomnia, making it difficult to perform well at work and increasing the risk of accidents [23], [24].
* Ergonomic factors
Due to the specific nature of treatment, emergency care, and patient care, medical staff often have to work in many different positions. Surgical medical staff often have to work in a standing position for long periods of time when performing surgeries; dentists always have to bend and twist when examining and treating patients; doctors and nurses always have to bend or twist when giving injections or caring for wounds on hospital beds; technicians work in a sitting position for long periods of time to perform tests, etc. This is the cause of musculoskeletal disorders in medical staff during work [23], [25].
According to Barbini's study of nurses and physical therapists, back pain was the most common (81%), followed by hand (39%) and foot (54%). Ergonomic analysis of work showed that patient care work created unfavorable postures such as bending over 45 degrees and twisting for long periods of time (up to 5 hours continuously). In addition, musculoskeletal disorders were mainly related to work organization characteristics and work pressure [26]. In a study of 298 female nurses in a hospital in Tokyo, it was shown that transporting patients without lifting aids was the most stressful job, patient weight was the highest risk factor, and musculoskeletal pain was most common in the lower back [27].
1.2.2.2. Risk factors for microbial infection
Health care workers are a workforce that is regularly exposed to many infectious factors, especially pathogenic microorganisms. This is the group of occupational diseases most commonly found in health care workers because they are the ones who directly contact patients, contact blood and blood products, infected secretions (saliva, sputum, pus, urine, feces) through examination, treatment, testing, contact with outbreaks (health care workers working in epidemic areas; staff disinfecting and sterilizing outbreaks; staff collecting and processing medical waste), staff in animal laboratories, vaccine production, ... [28]. Researchers estimate that the risk of contracting occupational diseases caused by microorganisms in the workplace is the cause of about 320,000 deaths each year worldwide and about 100,000 deaths per year.
5,000 deaths in the European Union. Health care workers whose work involves frequent contact with pathogenic microorganisms have a prevalence of 65.21% and about 0.8% of total deaths due to microorganisms [29].
Pathogenic microorganisms can enter the body through many routes: skin, mucous membranes, respiratory tract, digestive tract and blood. For health care workers, the most common and dangerous way is through the bloodstream when in contact with blood or body fluids carrying pathogens. Pathogens can directly enter the bloodstream through mucous membranes, through inflamed skin areas, through skin wounds, especially wounds caused by sharp objects.
* Contact with blood, body fluids carrying infectious pathogens
The biggest risk factor for health workers is exposure to pathogenic microorganisms. Health workers are at high risk of contracting diseases caused by infectious microorganisms when, during work, they are frequently exposed to blood, body fluids, and medical waste of patients with infectious diseases such as hepatitis B, C, HIV, tuberculosis, etc., or are exposed to sharp objects, or have skin and mucous membrane injuries caused by sharp, infected objects. Health workers are infected with dangerous microorganisms from daily contact with patients, with unsterilized medical equipment, and