clinical specimens, human and animal tissues, animal biological products [12], [30], [31].
High-risk occupational groups include surgeons, dentists, nurses, health workers working in the care and treatment of infectious diseases, emergency resuscitation, obstetrics, dialysis, testing in hospitals, and those working in morgues. Health workers can be infected with blood-borne viruses through direct contact with blood or body fluids containing the virus through skin scratches; through areas of skin inflammation or exudation or through mucous membranes. In particular, they are susceptible to HBV, HCV and HIV infection due to frequent contact with blood and biological fluids of patients [32], [33]
Studies have shown that there are approximately 20 different types of bloodborne pathogens that are occupationally transmitted by HCWs, the most common being hepatitis B, hepatitis C, and HIV. A WHO study reported that the estimated global prevalence of HCWs exposed to blood containing pathogens was 5.9% for hepatitis B virus, 2.6% for hepatitis C virus, and 0.5% for HIV [34].
Ndejjo et al. (2015), a study assessing occupational health risks of healthcare workers, found the following results: 50% of respondents reported experiencing an occupational health risk. Of these, 39.5% were exposed to biological risks, 21.5% were injured by sharp objects, 9% were respiratory-related illnesses, 10.5% were exposed to direct exposure to contaminants/pathogens, while 31.5% were exposed to non-biological factors such as stress, injury, violence, etc. Scientists identified risks to healthcare workers' health as not using necessary personal protective equipment, working overtime, work pressure, and overwork in many healthcare facilities [35].
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Research on working conditions and health of medical staff by Nguyen Bich Diep (2009) shows that at medical facilities for treatment and prevention at the central, provincial and district levels in Hanoi, Nam Dinh, Hai Phong, Hue, Khanh Hoa, etc., 59.3% of
The working environment sample did not meet the permitted hygiene standards. Many health facilities were contaminated by pathogenic microorganisms. 71.7% of health workers were regularly exposed to pathogenic microorganisms and 81.6% were exposed to blood and body fluids of patients. 8.0% of health workers in the treatment system were infected with respiratory diseases, 2.9% were infected with digestive diseases and 6.1% were infected with blood-borne diseases. 2.7% of health workers in the prevention system were infected with respiratory diseases, 1.4% were infected with digestive diseases and 5.2% were infected with blood-borne diseases [8].
* Risk of exposure to medical waste and injury from sharp objects
Hospital waste is a major source of harm to the health of health workers. Contact with medical waste can cause illness or injury to the body due to sharp objects such as needles, scissors and surgical instruments and transmit diseases caused by microorganisms that are harmful to health workers. Sharp objects used in health facilities are considered hazardous medical waste because they have a double impact on the health of health workers, causing both injury and infectious diseases such as hepatitis B, C, HIV, etc. Harmful microorganisms can enter the body through scratches, puncture wounds, through mucous membranes, through the respiratory tract or through the digestive tract. Hospital wastewater is also a place that contains pathogenic bacteria, especially wastewater from hospitals or infectious disease departments. Wastewater from health facilities has the potential to spread infectious diseases through the digestive tract when this water source is used for irrigation, drinking, etc. [36], [37], [38].
In Vietnam, according to Dinh Huu Dung's research, in 6 provincial general hospitals, the average total amount of waste discharged/bed/24 hours is 0.62-1.27 kg, of which clinical waste accounts for 18.2-18.9% and chemical waste is 0.3-0.5%. The microbiological and physicochemical indicators of untreated wastewater in hospitals are much higher than the TCCP. The number of aerobic bacteria, hemolytic bacteria, and mold spores near the research hospital area is also higher than the permitted standard. The rate of people with
The rate of medical injuries in one year is 19.2-20.6% [39].
According to the 2003 WHO report on the global burden of disease, approximately 3 million HCWs are injured by exposure to blood-borne viruses each year. WHO estimates that each year, approximately 16,000 HCWs are infected with HCV; 66,000 are infected with HBV and approximately 200-5000 are infected with HIV [39], [40].
An estimated 350,000–500,000 exposures to blood and body fluids occur in the health care sector each year in the United States. Occupational exposure to bloodborne viruses in health care workers can be divided into two groups: cutaneous (sharp object injury) and mucosal, open wound, or eye splash. A study of four hospitals in the United Kingdom found that 170 incidents (140 cutaneous, 82.3%, and 30 mucosal, 17.7%) were reported in 2006. Physicians were exposed 37.6% of the time, and nurses 41.7%. The most common site of exposure was the ward (39.4%), followed by the operating room (26.4%). The source of exposure was from patients: 65.9% of the sources were negative; 4.1% were positive for hepatitis C, 3.5% were positive for HIV, and 0.6% were positive for hepatitis B [41].
A 2014 study recorded the number of needlestick injuries at 1.4-9.5/100 people/year, with an average of 3.7/100 people/year. Injuries related to the transmission of infectious diseases from patients to healthcare workers were 0.42 cases of HBV infection, 0.05-1.30 cases of HCV infection, and 0.04-0.32 cases of HIV infection/100 injuries per year [42].
The results of Saulat Jahan's study in Saudi Arabia on 323 healthcare workers showed that there were 73 cases of injuries due to sharp objects, of which nurses were injured by sharp objects accounting for 65.8%, doctors 19.2%, technicians 9.6%. Most injuries occurred during the recovery of used needles (29%), during surgery (19%) and due to collision with sharp objects (14%). Causes related to the handling of medical waste accounted for 11%; 5% of healthcare workers were injured by sharp objects.
Sharps occur when bed linens or trash containers containing needles are improperly disposed of [43].
A study by Rahul Sharma et al. at a hospital in Delhi, India, found that 79.5% of healthcare workers had suffered a VSN injury. The causes of injuries among these healthcare workers were fatigue (50.4%), lack of support (27%), haste (11.7%), and other causes (10.9%). Most injuries occurred during needle disposal (31.7%), during surgery (21.6%), when collecting blood samples for testing (13.8%), during intravenous injection (13.4%), and during injection (13.2%). Among the cases of sharps injuries, 37% of healthcare workers were infected with hepatitis B virus, and less than 10% of healthcare workers were infected with HIV [44].
Unsafe injection is one of the risk factors for patients and health care workers. According to the results of a study on the infection rate of health care workers due to unsafe injection, it was 77.1% in China [45]. Another study by Pandit and Choudhary in 2008 suggested that the infection rate of health care workers due to unsafe injection in developing countries was 15-50% [46].
Research in Iran and Uganda has shown that injecting drugs, taking blood samples, collecting and disposing of needles, and handling waste are activities that pose a high risk of sharps-related infections in healthcare workers [47]. The high rate of infections in healthcare workers related to unsafe injections accounts for 90% of all sharps-related infections. Many studies have shown that invasive and non-invasive procedures increase the risk of infection in healthcare workers [48], [49], [50].
As in the world, in Vietnam, medical staff suffering from injuries due to VSN during work is also very common. This problem has been recorded and reported according to statistics of units, independent studies and is often mentioned in terms of infection prevention, hospital hygiene, and infectious diseases.
blood sugar, safe injection practices [13]. The incidence of VSN injuries varies between health facilities and departments within the same health facility, depending on the nature of the specialty and the number of patients in each facility. The incidence of VSN injuries in health facilities nationwide in 2010 was 48%, with an average of 3.2 ± 4.7 times/healthcare worker/year [51].
Duong Khanh Van (2012), the number of health workers who suffered occupational accidents due to VSN within 12 months was 64.8%, of which the highest was in nurses (19/100 people/year), followed by doctors (11/100 people/year), the lowest was in nurses/medical workers/technicians (9/100 people/year). Characteristics of VSN injuries: 46.0% occurred after injection, 14.9% due to washing instruments, 14.0% due to procedures, 13.5% due to surgery, 8.8% due to throwing and collecting waste [13].
In Can Tho city, in the period of 2011-2015, 103 health workers were reported to have occupational accidents, of which 35.9% were male, 64.1% were female; doctors accounted for 20.4%, physicians and nurses accounted for 58.3%, nurses, technicians and midwives accounted for 21.3%; injuries caused by VSN were 83.5%, blood and body fluids from patients were splashed on the body of 16.5%. Test results of patients who exposed health workers showed that 22.3% were positive, 26.2% were negative, 51.5% were suspected of having HIV. In 2016 alone, 17 cases of occupational exposure were reported, of which 5 were male, 12 were female (3 doctors, 7 physicians, 7 nurses), 15 cases of injuries caused by VSN and 2 cases of splashes; Regarding patient status, there were 3 positive cases, 6 negative cases, and 8 suspected cases [10].
1.2.2.3. Factors affecting the transmission of microbial infections in healthcare workers
There are many factors that affect the transmission of infectious diseases caused by microorganisms in health care facilities such as the rate of patients with infectious diseases, the implementation of occupational safety and health at health care facilities, the working position of health care workers, the knowledge and practice of health care workers on the prevention of infectious diseases caused by microorganisms, the frequency of occupational accidents and risks, etc. According to WHO, the risk of infection caused by microorganisms in health care workers
Depending on the disease pattern and disease incidence of patients they are exposed to in health facilities, it also depends on the nature and frequency of exposure. Occupational exposures with a high risk of causing diseases caused by microorganisms are occupational accidents such as injuries caused by microorganisms (surgical knives, needles or IV fluids) or by bodily fluids splashing or splashing into the mucous membranes of the eyes, nose, mouth, scratched skin or open wounds. Health care workers working in emergency rooms, operating rooms, laboratories, pathology departments, medical waste processing departments... are at high risk of contracting diseases caused by microorganisms [4], [6], [34], [52].
Nguyen Thuy Quynh's (2008) study on the current situation and factors related to occupational hepatitis B in the health sector showed that the risk of health workers contracting hepatitis B is directly proportional to the frequency of contact with patients; health workers who come into contact with more than 30 patients per day have a risk of occupational hepatitis B twice as high as that of health workers who come into contact with less than 30 patients; VSN injuries at night are 2.7 times higher than during the day. Health workers who have been injured by VSN during work have a risk of occupational hepatitis B 4.1 times higher than those who have not been injured. Health workers who have been exposed to blood and body fluids of hepatitis B patients and have suffered VSN injuries have a risk of contracting hepatitis B 3 times higher than those who have not had an occupational accident when exposed to hepatitis B patients [9].
The working environment always contains potential hazards that affect health and cause accidents and injuries. Environmental hygiene factors that do not meet the permitted standards such as microclimate, light, and microorganisms in the air can affect the health of health workers, leading to reduced concentration at work, poor observation, and occupational accidents.
Knowledge, attitudes and practices on OSH of health workers, especially understanding of occupational risk factors and practicing standard precautions as prescribed by WHO and the Ministry of Health, play a very important role.
important in preventing the transmission of microbial diseases during work in health care facilities. Sadoh et al. (2006) conducted a study to assess the handling of used needles, use of protective equipment, hand washing and screening of transfused blood by health care workers. The results included 433 respondents, 211 (48.7%) of whom were trained nurses. About one-third of the respondents always recapped used needles, <63.8% always used personal protective equipment, 56.5% never wore goggles during transport and during surgery. A high proportion (94.6%) of health care workers were observed washing their hands after handling patients. The reuse of used needles was common in the health care facilities studied. Non-compliance with universal precautions puts Nigerian health care workers at significant health risk. Training programs and other relevant measures need to be put in place to promote the appropriate use of personal protective equipment by HCWs at all times [53].
A study by Litsitso Nkoko et al. in sub-Saharan Africa (2013) on knowledge and practice of health workers on exposure to blood and body fluids at work showed that 46.4% of knowledge was correct and 53.5% of practice was correct. Nurses and doctors were exposed to blood and body fluids more than other occupational groups in health facilities [54].
Cross-sectional study by Mary Y. Afihene et al. in 2013-2014 on knowledge, attitudes, and practices of health workers working in Bantama, Ghana. Regarding knowledge, Mary Y. Afihene interviewed 19 questions, each correct answer was worth 1 point, subjects with general knowledge were considered to have achieved when answering more than 10 questions correctly. The results showed that the average knowledge score of the subjects was 13.691 ± 2.81, the rate of correct answers to questions about HBV transmission routes was 71-91.4%, preventive measures were 74.9-89.1%,... Regarding attitude, 89.3% of participants believed that HBV vaccination should be mandatory and 25.13% were afraid of vaccination, while nearly 2.28% of participants did not trust HBV vaccination. The study results also showed that the majority of medical staff actually
poor practice in preventing HBV infection with a mean score of 2.23 ± 1.19 [55].
According to a study by Le Thi Minh Nguyet and Bui Thi Hanh (2015), at the Son Tra District Medical Center, Da Nang City, the number of medical staff with correct infection control knowledge was 54.56%, and practice was 81.1%. Regarding practice, supervision of routine hand washing practice was 74.1%, hand disinfection with alcohol solution was 74.6%, and dressing change procedure was 90.26% [56].
According to Nguyen Thanh Dung's (2012) study in hospitals in Vinh Long province, the knowledge and practice of medical staff on infection prevention and control reached 78.8% and 43.4%. Of which, knowledge and practice on hand hygiene reached 93.3% and 48.5%, personal protective equipment reached 93.9% and 53.4%, isolation precautions reached 48.8% and 4.3%, epidemic prevention reached 57.5% and 4.2%, disinfection and sterilization reached 90.2% and 47.3%, medical textiles reached 89.9% and 51.7%, medical waste management reached 74.8% and 54.6%, environmental sanitation reached 53.4% and 25%, occupational safety reached 79.2% and 42.8% [57].
Quach Thi Sau's (2013) study at health stations in some districts and cities of Can Tho showed that health workers had general knowledge and practice of 46.5% and 84.7%. Regarding knowledge, the risk of HIV/AIDS infection reached 11.5%, infection prevention reached 66.7%, handling and treatment of exposure reached 72.2%. Regarding practice, personal protection at the workplace reached 66.8%, control of the environment of blood and body fluids of patients reached 59.7%, management of VSN reached 16.3%, and post-exposure treatment reached 38.2% [58].
1.3. Hepatitis B and C in health care workers
1.3.1. Hepatitis B virus
1.3.1.1. Definition of disease, transmission route and diagnosis of hepatitis B
Hepatitis B is a dangerous infectious disease caused by the hepatitis B virus (HBV). After entering the body, these viruses will cause inflammation and damage to liver cells, disrupting liver function.