Adherence to Hepatitis B Virus Infection Prevention Protocol among Health Care Workers in Selected Public Health Facilities in the Greater Accra Region

Abstract

Introduction: The World Health Organization global disease burden from sharp injuries revealed that 37% of Hepatitis B Virus (HBV) infections among Health Care Workers (HCWs) was as a result of occupational exposures to blood and body fluids. In Sub Saharan Africa alone, about 40-65% of HBV infections among HCWs occur as a result of percutaneous occupational exposures to contaminated blood and body fluids of patients. The prevalence of HBV among the Ghanaian population is high and occupational exposures to blood and body fluids that could potentially result in HBV infection is on a surge among HCWs. International health organizations have made recommendations regarding the prevention of occupational exposure and subsequent acquisition of HBV infection. In Ghana, the occupational health and safety policy guideline for the health sector was developed in accordance with international recommendations with the aim of providing policy direction towards efforts aimed at HCW protection from HBV. Seven years following the development and dissemination of the policy guideline, this present study was undertaken to access the level of adherence to preventive practices among HCWs in the Greater Accra Region. Methods: A hospital based cross-sectional survey involving HCWs drawn from five health institutions in the Greater Accra Region was undertaken between January and April 2018. Stratified random sampling procedure was used to select 363 health care workers for the study. A structured pretested questionnaire was used to collect data from all consenting health care workers. Approximately 5 mls of venous blood was collected from all consenting HCWs and screened qualitatively for the presence of five serological markers of HBV. Enzyme Linked Immunosorbent Assay (ELISA) procedures were subsequently undertaken to detect IgM HBcAb and to quantify anti-HBs. Data were analyzed using SPSS version 20.0. Chi-square test or fisher’s exact were performed followed by binary logistic regression with level of significance set at <0.05. Analysis of variance procedure was undertaken following tests of normality and heterogeneity of variances to determine differences between overall adherence scores and post exposure prophylaxis knowledge. Adherence and knowledge scores were categorized into three levels namely: poor, intermediate and good using three interval scoring system of low (≤50%), intermediate (51-74%) and high (≥75-100%). Results: Complete data were available for 340 out of 363 HCWs sampled for the study giving a response rate of 93.70%. Mean age, height and weight of participants were 34.55 years (SD ±7.68), 162.80cm (SD±7.83) and 72.55 kg (SD±13.83) respectively. Overall HBV vaccination uptake was 60.9% (207/340) (95% CI= 55.7%-66.1%). Complete vaccination measured as adherence to 3 doses regimen was 46.8% (159/340). High risk perception (aOR= 4.0; 95% CI=1.3-12.5) and previous training in infection prevention (aOR= 2.8; 95% CI=1.1-7.5) were both seen to be significantly associated with adherence to receipt of three doses of HBV vaccine. Adherence to recommended vaccination schedule of 0, 1, 6 interval was intermediate 62.3% (159/207). Adherence to post vaccination serological testing was poor 21.3% (44/207) with HCWs working at regional hospital having the least odds of adhering to this vaccination component (aOR= 0.1; 95% CI=0.0-0.6). Overall vaccination adherence mean score was 53.46% (95% CI=49.86-57.05) with no statistically significant difference between the various cadre of staff (F=0.85; P=0.51). Adherence to overall HBV vaccination recommendation was extremely low in the population with 6.2% of the entire HCW population and 3.80% of vaccinated HCWs adhering completely. Post Exposure Prophylaxis (PEP) for HBV knowledge was generally poor (overall mean score was 47.85; 95% CI=44.35-51.35) with significant differences among HCW categories (F=3.11; P=0.010). Exposure reporting was good 76.3% (29/38) with significant difference between the various facility levels (ꭓ 2 =17.990; p=<0.001). All the components of PEP (Evaluation for eligibility for PEP, Timeliness of PEP initiation and post-PEP follow-up visits) were observed to have good level of adherence (adherence was >75%) except PEP usage that was intermediate with a coverage of 70% (7/10). The predominant HBV maker among the population was Anti- HBs; 57.4% (195/340) and the least was HBeAg; 1.5% (5/340). One third (123/340) of the HCWs were naïve to HBV. Lifetime exposure to HBV (Anti-HBc) prevalence was 8.2% (28/340) (95% CI= 5.0%-11.0%). Females had 4 times lower odds of being exposed to HBV (aOR=0.4; 95 % CI=0.1-0.9). HCWs without training in prevention of blood borne infections had almost three times higher odds of being exposed to HBV in their lifetime (aOR=2.6; 95 % CI=1.1-6.4). HCWs in lower level facilities also demonstrated two times higher odds of being exposed to HBV (uOR=2.1; 95 % CI=1.1 -4.7). The overall prevalence of current HBV infection (HBsAg) was 5.9 % (20/340) (95% CI =3%- 8%). Prevalence was highest among males, orderlies and those working at CHPs facility. Conclusions: The findings of this study suggest that despite the high susceptibility to HBV infection among the HCWs, adherence to recommendations regarding HBV vaccination and PEP usage are sub-optimal. Therefore, to avert the serious consequences of HBV infection among HCWs in the Greater Accra Region, immediate interventions are required from employers and all stakeholders. HCWs of all categories working at all the five levels of care would need support to promote adherence to pre and post exposure modalities against HBV infection. Apart from making vaccines and immunoglobulin available to HCWs, training in blood borne infections and programs targeted at increasing risk perception for HBV among HCWs could improve adherence and subsequently prevent new infections.