Knowledge, attitude and practices about hepatitis B in paramedical and supporting staff at a tertiary care hospital: a cross sectional study

INTRODUCTION

Hepatitis B is a major public health problem worldwide and is the 10^th leading cause of death.¹ The common modes of transmission include from mother to child during delivery, contact with blood or body fluids during unsafe sexual intercourse with an infected partner, unsafe injections or exposure to sharp instruments. In India, the prevalence of hepatitis B infection is about 4% with a disease burden of about 50 million.² Hospital staff including nurses, lab technicians and multi-purpose workers (MPWs) are at a high risk for contracting the infection as they are involved in the handling of potentially infectious material such as needles, sharps, blood and body fluids and other biomedical waste thus the knowledge about hepatitis B infection and its prevention is essential.

The aim of the study was to compare the awareness among the two study groups, nurses and lab technicians versus MPWs.

The information about the knowledge gap between the two study groups will aid in devising suitable awareness strategies in the future.

METHODS

This was a cross sectional observational study which includes 256 nurses and lab technicians (230 nurses and 26 lab technicians) versus 159 multipurpose workers (ward boys, janitors and garbage handlers) of a tertiary healthcare centre. After obtaining informed consent from the participants, data regarding awareness of hepatitis B infection, its transmission and prevention was collected by a close ended questionnaire. Identity of the participants was not disclosed. The data was collected in the months of April 2021 to June 2021. The data was analysed statistically using JASP version 0.16.0.0 analysis software. Analysis of categorical data was represented as percentages and of continuous data as mean±standard deviation.

RESULTS

The study groups comprised of 159 MPWs and 230 Nurses and 26 lab technicians (total 256). A Chi-square test of independence was performed to compare the risk perception of contracting infectious diseases between the two study groups. The difference between these groups was not significant, p=0.943. 100% of the nurses and lab technicians had heard about hepatitis B infection, whereas the knowledge about the same was seen only in 59.12% of the MPWs. A Chi-square test of independence showed a significant difference between the awareness about the hepatitis B infection between the two groups, p<0.001.

Awareness about transmission of hepatitis B virus

The participants had to choose from the following options: Direct contact with blood and other body fluids; needle stick injuries/sharing needles; unprotected sexual intercourse; From mother to child during birth. Of these options, all of the above were correct. A Chi-square test of independence showed a significant difference between the awareness of modes of transmission of hepatitis B between the two groups, p<0.001. A Chi-square test of independence performed to compare the difference between the two groups showed significant difference in the awareness about liver diseases caused by hepatitis B infection, p<0.001. A Chi-square test of independence showed that the difference between awareness regarding the preventability of hepatitis B infection in the two study groups is significant, p<0.001.

Awareness about preventive measures

The participants had to choose from the following options: use of personal protective devices; safe handling of sharp instruments; safe injection practices; use of sterile instruments and devices; vaccination. Each correct answer was awarded one point and a total of score out of 5 was calculated for each participant. Assumption checks for normality and variance were done and there exists a statistically significant difference between the test score of the two study groups as determined by the Welch version of the independent samples t-test, (263.842=-5.010, p<0.001). Nurses and lab technicians had higher level of awareness about the methods of prevention. The vaccination status of nurses and lab technicians is depicted in (Figure 1). 51.572% (82 out of 159) MPWs had taken the hepatitis B vaccine whereas the percentage of nurses and lab technicians who had taken the vaccine was 93.359 (239 out of 256). A Chi-square test of independence showed a significant difference between the vaccination rates of the two study groups p<0.001. The most common reason for not getting vaccinated in both study groups was “procrastination” (68.52% i.e., 37 out of 54 MPWs and 64.71% i.e., 11 out of 17 nurses).

DISCUSSION

Hepatitis B is a major yet preventable public health problem worldwide and is the 10^th leading cause of death.¹ In India, the prevalence of hepatitis B infection is about 4% with a disease burden of about 50 million.² The common modes of transmission include from mother to child during delivery, contact with blood or body fluids during unsafe sexual intercourse, unsafe injections or exposure to sharp instruments. The spectrum of diseases caused by the virus range from acute infection, which may be asymptomatic or symptomatic to chronic (5-10% of the cases).^3,4 The presentations of chronic hepatitis B infection can vary from an asymptomatic carrier state, chronic hepatitis, cirrhosis to hepatocellular carcinoma.³ Hospital staff including nurses, lab technicians and MPWs. MPWs are at a high risk for contracting the infection as they come in contact with the infectious materials like blood, body fluids, needles and sharps. In our study, we found that 54.72% of the MPWs believed that they were at a risk of contracting infectious diseases because of their profession whereas 55.08% of the nurses and lab technicians believed the same.

In a similar study, 95% of all participants were aware of their increased risk of contracting hepatitis B due to their profession.⁵ In another study, it was found that there was a self-perceived risk of contracting infections among the nurses and they believed that this was an unavoidable occupational hazard.⁶ With respect to awareness about the hepatitis B infection, our study showed that all the nurses and lab technicians were aware about the infection, whereas only 59.12% of the MPWs were aware about the same. In similar studies it was found that majority of the participants were aware of the infection.^6,7 The results of our study showed that only 30.19% of the MPWs correctly knew all the modes of transmission of Hepatitis B, whereas 73.83% of the nurses and lab technicians were aware of all the correct modes. In a similar study conducted on healthcare workers, it was found that most of the participants believed that hepatitis B can be transmitted from mother to child, unprotected sex, needle stick injury and blood transfusion.^7,8 The current study showed that 79.30% nurses and lab technicians whereas only 20.76% MPWs believed that the risk of hepatitis B leading to liver disease or liver cancer was high. In this study 98% of the nurses and lab technicians were of the opinion that hepatitis B virus infection can be prevented, whereas only 71.1% of the multipurpose workers believed the same. A similar study showed that 80.7% of the nurses felt that hepatitis B is preventable.⁹ The knowledge about preventability of the infection is better among the nurses and lab technicians surveyed in our study. Infectious diseases can be prevented by practicing the universal safety precaution.¹⁰ The participants were asked to mark the correct options from the modes of transmission relevant to hepatitis B. Nurses and lab technicians were found to have a higher level of awareness about the same. Our study showed that 93.4% of the nurses and lab technicians were vaccinated against hepatitis B. The results are similar to those found in another study which showed that 92.4% of the nurses were vaccinated.⁶ The vaccination rate among the MPWs was 51.6%.

Similar results were found in another study which showed that 40% of the housekeeping staff was completely vaccinated and a further 11% (total 51%) was partially vaccinated against hepatitis B.¹¹ The most common reason stated for not getting vaccinated by participants in both the study groups of our study was “procrastination”.

Other studies have highlighted the main reasons for not getting vaccinated as lack of awareness about the existence of the vaccine, lack of knowledge about Hepatitis B infection and lack of knowledge about the necessity of vaccination.^11,12

Limitations

Limitations of current study were that the study involved participation of healthcare workers from a tertiary care hospital from an urban area, and the staff of such a hospital is likely to be more aware of the disease than the staff in rural hospitals, hence the results of this study cannot be extrapolated to the general population. The survey data collected was self-reported which establishes a recall bias. It is also possible that participants chose socially acceptable answers.

CONCLUSION

This study will help to address the knowledge gap about hepatitis B infection and its prevention among the MPWs. Regular and repeated training programs for the healthcare workers and making the hepatitis B vaccine mandatory can help tackle this issue.

ACKNOWLEDGEMENTS

Authors would like to thank Dr. (Col) Parvinder Singh Chawla, Dr. Jitendra Ingole, Mrs. Khyati Kalra and Mr. Suhrud Panchawagh for their support and guidance.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Hepatitis B. WHO, 2021. Available at: http://www.who.int/median/index.html. Accessed on 20 November 2012.
2. 2. Ray G. Current Scenario of Hepatitis B and Its Treatment in India. J Clin Transl Hepatol. 2017;5(3): 277-96.
3. 3. Tripathi N, Mousa OY. Hepatitis B. Treasure Island, FL: StatPearls Publishing; 2022.
4. 4. Shah SM, Rodin H, Pogemiller H. Hepatitis B awareness and vaccination patterns among healthcare workers in Africa. Am J Trop Med Hyg. 2020;103(6): 2460-8.
5. 5. Koh Y, Hegney D, Drury V. Nurses' perceptions of risk from emerging respiratory infectious diseases: a Singapore study. Int J Nurs Pract. 2012;18(2):195-204.
6. 6. Kaur A, Gambhir RS, Singh S, Goyal J. Awareness, attitude and vaccination status regarding hepatitis B among staff nurses of a teaching hospital in North India. Oral health Dent Manag. 2016;2:256-60.
7. 7. Saroshe S, Pandey D, Dixit S, Bansal SB. A comparative study to assess knowledge, attitude and practice for Hepatitis B vaccination among Nurses of Government and Private Hospital of Central India. Int J Public Health Res. 2014;1:25-31.
8. 8. Hang Pham TT, Le TX, Nguyen DT, Luu CM, Truong BD, Tran PD, et al. Knowledge, attitudes and medical practice regarding hepatitis B prevention and management among healthcare workers in Northern Vietnam. PLoS One. 2019;14(10):e0223733.
9. 9. Potdar P, Potdar A, Vivek R. Title: Knowledge, Attitude and Practice Regarding Hepatitis B Infection among Nursing Staff of Tertiary Care Hospital in South India. Indian J Public Health Res Develop. 2019;10:564.
10. 10. Infection control standard precautions in health care. Available at; https://www.who.int/. Accessed on 20 November 2021.
11. 11. Akshatha R, Aruna A, Deepashree R, Apurba S, Rahul D. Educational Intervention to Increase Hepatitis B Vaccination among Housekeeping Staff. J Clin Diagn Res. 2019;13(2):DC01-6.
12. 12. Dev K, Abhay G, Gajanan K, Akash S, Bisure K. Knowledge and awareness of the health care workers about the hepatitis B infection and their vaccination status in a newly started medical college. J Assoc Physici. 2018;66(12):27-30.