Neglecting injuries from needles while attending to patients exposes 73% of doctors to blood transmitted diseases, revealed a recent study by All India Institute of Medical Sciences (AIIMS), New Delhi.
While the observations listed inexperienced doctors, below 25 years of age, in the high risk category, resident doctors in Maharashtra agreed that there was minimal awareness about needle stick injuries. They also said that there was excessive workload in emergency wards and carelessness in vaccinations.
The researchers, stressing on awareness, said an immediate action plan needed to be in place to avoid exposure of Hepatitis B, Hepatitis C and Human Immunodeficiency Virus (HIV) among health care workers who serve in government-run facilities.
Dr Sarman Singh, professor and head of clinical microbiology and molecular medicine at the department of laboratory medicine of AIIMS, said that a total of 476 workers were a part of the study that focused on self-reported injuries between January 2011 and December 2013. The health care workers filled in a questionnaire prepared by the researchers and their blood samples along with that of unidentified source were collected for baseline HBV, HCV, and HIV diagnosis.
The study found that a large number of the affected were doctors (351, 73.7%). Among them, resident doctors were the highest in number again (321, 91.4%), followed by interns (26, 7.4%), and faculty members (4, 1.1%). Interestingly, only 91 (19.1%) nurses reported injuries, while 15 (3.2%) of the workers were hospital waste disposal staff, not involved directly in patient care or surgical procedures.
“We realised that the prevalence is definitely more in resident doctors, who are inexperienced in handling the needle in operation theatres or emergency rooms. But again, the numbers are much more in reality as the participants were only those who voluntarily reported the injuries to the hospital,” said Singh. “Occupational exposures are common and it is believed that 40–75% of these injuries are not reported.”
Singh and his colleagues, quoting data from The Centers for Disease Control and Prevention (CDC), added that the risk of infections because of needle stick injuries range as low as 0.2–0.5% for HIV to as high as 3–10% for HCV and 40% for HBV. “Of the workers, 12 (2.5%) were not vaccinated against HBV. Of the vaccinated, 24 (5%) had completed three doses of the vaccine in a year, while 19 (3.9%) were vaccinated more than 10 years back,” mentions the study.
Singh added that the team noticed a large number of resident doctors not adhering to their yearly vaccination schedules, putting their lives at risk of infection. Dr Sagar Mundada, former president of Maharashtra Association of Resident Doctors (central) agreed to the findings and said that while tertiary care hospitals in Mumbai follow a stringent system for vaccination of doctors, the issue lies with the lack of awareness about HBV .
“In the first year of our internship after completing MBBS, we are counselled and directed by our senior doctors to take the first three doses of the HBV vaccine within six months. Most of the time, doctors tend to miss the doses, exposing themselves to the risk of HBV that is more likely to transmit through open wounds and cuts,” said Mundada.
Out of 24 respondents who were found to be exposed to HBV positive sources, eight were either non-responders to HBV vaccination or did not receive the vaccination, the study reveals, pointing out the prevalence status. Major issues were revealed in locating the source of the infection as the serological status for three major viral infections (HIV, HBV, and HCV) was unknown in 137 (31.4%) sources.
“Overall, the exposure had taken place from 32 sources but further tests revealed 12 new sources that can carry highly potent viral infections,” said Singh.
Officials from tertiary care centres in Mumbai said that a number of systems were already in place to drill in the importance of prevention techniques into new doctors. “After the first year vaccine doses, the doctors follow a five-yearly booster dose schedule. In the meanwhile, their serological levels are checked to identify if anybody has been exposed to infections. Even the induction period constitutes training and counselling on the risk of such injuries,” said Dr Avinash Supe, dean of KEM Hospital and director of tertiary care (hospitals), BMC.
However, resident doctors said that there was no monitoring on the part of the higher officials or senior doctors to check if the resident doctors were following the vaccination schedule. “Though the vaccination program can’t be made mandatory, we do need a system in place to advise doctors to take their vaccines in time. We have come across the lot of cases where resident doctors miss the dose, thus lowering their immunity levels against the blood transmitted diseases,” said Dr Swapnil Meshram, General Secretary of Maharashtra Association of Resident Doctors.
Resident doctors are not following any vaccination schedule for HCV as of now.