Abstract: Health Care Workers (HCWs) are the backbone for any functional health care facility. While contributing to the right to health for all, they also must enjoy a healthy and safe working environment. US Occupational Safety and Health Administration (OSHA) estimated a rate of 3.2% work related injuries/illness for every full time HCW employee, leading to significant physical, emotional, social, behavioral and financial suffering. In occupational health, blood borne pathogens have received more attention worldwide and its transmission mainly happens through percutaneous or muco-cutaneous injuries. CDC estimated in past, that every year around 3,85,000 Needle Stick Injury (NSI) are sustained by HCWs, with an average of 1000 sharp injuries per day and this situation is worsened by gross under reporting of NSI among HCWs. Infections acquired through such occupational exposures are largely preventable by achieving adequate HBV immunization level with strict adherence to infection control measures. As the entire post exposure prophylaxis against HBV infections revolves around hepatitis B vaccination, it become important for various categories of health care staff to understand vaccine immunology for hepatitis B. 

Material & Methods: A prospective cross-sectional survey-based study was conducted at two cancer institutions, a total of 377 HCWs (Nurse 35.01%, Housekeeping (HK) staff 28.65%, Laboratory technical staff 15.12%, Doctors 13.26%, Administrative staff 3.71%, Phlebotomists 2.92%, Pharmacists 1.33%) have participated. Their knowledge and attitude towards NSI handling and concept of HBV vaccination was assessed by the well-structured questionnaire.

Results: A total of 60.2 % (227/377) HCW were vaccinated against Hepatitis B, of which 90% doctors, 76.5% of nurses, 70.2 % of technicians and only 28.7% of HK staff have completed the vaccinated schedule. Majority of them were not aware about their own anti -HBsAg titre (antibody against hepatitis B surface antigen). Around 65.8% (248/377) surveyed staff were not aware about the significance of anti-HBsAg titres. Around 28.4% (107/377), 16.2% (61/377) and 10.9% (41/377) HCWs considers >10 mIU/ml, >100 mIU/ml, >1000 mIU/ml respectively as a protective cut-off for anti HBsAg titre and around 44.5% (168/377) of HCWs were not aware about the concept of protective anti HBsAg titre. Around 41% (155/377) of HCW answered correctly for accurate timing of testing the anti HBsAg titre; 1- 2 months after complete HBV vaccination. Significant difference (p value 0.001) was observed for knowledge about correct transmissibility order for HBV, HCV and HIV for any NSI event, in which only 20.2% (76/377) of HCW answered correct order of transmissibility as HBV > HCV > HIV and majority 71.88% (271/377) gave incorrect answer of which 56% (28/50) were doctors and 72% (95/132) were nurses.

Conclusion: Institutional policy for testing anti-HBsAg titer at the time of joining institution and during occurrence of NSI may have led to achieve around 60 % vaccination level in our cancer institutes. It also highlights the fact, that hospital administration and hospital infection control committee needs to give special attention to improve vaccination status among HCWs including HK staffs and create policy to check anti-HBsAg titre of candidates after completing their HBV vaccination schedule. Healthcare professionals not attaining protective antibody level after HBV vaccination, must be recalled for revaccination or for HBV booster dose. This observation again highlights the importance of requiring more attention towards targeted and effective training among various categories of HCWs towards immunology of HBV vaccination; especially towards concept of protective levels for anti-HBsAg titer and ideal time for testing for its level after HBV vaccination. Though administrative staff may not be directly involved in patient care and management of health issue of HCWs, but still administrative staff must be aware about various strategies to preventive NSI, appropriate management of NSI, importance of HBV vaccination and testing of its antibody level (anti-HBsAg), as they are mainly involved in framing, implementing, coordinating and supervising institutional NSI management protocols.

Rahul Sarode, MD, DNB in Microbiology, working as Associate Professor and Officer In-charge in the department of Microbiology at tertiary care cancer institute, HBCH and MPMMCC, a unit of Tata Memorial Centre. He has a total of 10 years of experience in the field of Clinical Microbiology. He has special interest in diagnostic and antimicrobial stewardship along with focusing on basic, effective and affordable infection prevention measures in a clinical setup. He is also engaged in academic activities at the level of MD and technical candidate in the field of Microbiology.