ENVIRONMENTAL HEALTH --- BUI THI LE UYEN STUDY THE SITUATION AND THE RISK OF OCCUPATIONAL DISEASES CAUSED BY MICROORGANISMS IN HEALTH WORKERS IN CAN THO CITY AND EVALUATE THE EFFECTIVE
Trang 1ENVIRONMENTAL HEALTH
-
BUI THI LE UYEN
STUDY THE SITUATION AND THE RISK OF OCCUPATIONAL DISEASES CAUSED BY
MICROORGANISMS IN HEALTH WORKERS IN CAN THO CITY AND EVALUATE THE EFFECTIVENESS
Trang 2ENVIRONMENTAL HEALTH
SUPERVISORS
1 Assoc Prof., PhD Ta Thi Tuyet Binh
2 Assoc Prof., PhD Tran Thi Ngoc Lan
Reviewer 1: Assoc Prof., PhD Nguyen Van Son Reviewer 2: Assoc Prof., PhD Nguyen Minh Vuong Reviewer 3: Assoc Prof., PhD Luong Mai Anh
The thesis was presented at the Academy Thesis Evaluation Council met at National Institute of Occupational and Environmental Health,
at … , …… , 2019
The thesis can be found at:
1 National Library of Vietnam
2 National Institute of Occupational And Environmental Health
Trang 3BACKGROUND
During the working process, HCWs must directly contact patients, swabs, hazardous medical wastes that are likely to be exposed to dangerous infectious diseases such as tuberculosis, hepatitis B, hepatitis C, HIV infection, SARS, Among the group of
5 microbiological diseases insured in Vietnam, hepatitis B and occupational disease accounts for the highest proportion, mainly in HCWs [4], [5]
According to WHO, the risk of HBV infection is 18-30%, HCV is 1.8% after occupational exposure in HCWs [6] Studies in Vietnam also indicate that HCWs are at high risk of being exposed to pathogenic microorganisms, especially HBV [8], [9] In Can Tho in the period of 2011-2016, there were 103 occupational health workers reported with occupational accidents, the prevalence of HBV virus was 16.2% [10], [11]
The fact that the cases of occupational exposure are not reported, cared for, properly monitored, occupational safety and health (OSH) have not been given adequate attention in the whole country in general and in the city Can Tho in particular Therefore, the topic
"Study the situation and risk of occupational diseases caused by microorganisms in health workers in Can Tho city and evaluate the effectiveness of interventions" was implemented with the following
Trang 4* New contributions of the thesis:
The thesis is a scientific study that has practical and urgent value The thesis provides new research results about risk factors for occupational diseases caused by microorganisms in health care workers (HCWs); the situation of hepatitis B and C infection among health workers at some Can Tho city hospitals in 2016-2017; and assessment the effectiveness of communication interventions on prevention of occupational diseases by microorganisms for all HCWs at 6 health facilities Besides, researcher has organized vaccination for Hepatitis
B for 293 HCWs who registered voluntarily to participate The results
of the thesis has contributed to suppose the effective interventions in health protection and care for health workers, especially for prevention
of work-related diseases caused by microorganisms Some specific results of the thesis:
- Determining some high risk factors due to exposing of microorganisms of health workers in health facilities of Can Tho city: the frequency and the rate of expose to blood, body fluid is high (61.7%); damage caused by sharp objects (12.5%), knowledge and practice of prevention of work-related diseases, especially work-related diseases caused by micro-organisms of health workers is still low, almost no vaccination against hepatitis B
- The rates of hepatitis B and hepatitis C virus infection in health workers studied were 9.7% and 0.5%, respectively
- Knowledge and practice of health workers on prevention of related diseases significantly improved after the intervention: The right knowledge increased from 62.9% to 91.7%; correct practice increased from 75.4% to 88.8%; 100% of qualified health workers voluntarily vaccinated against hepatitis B
* Structure of the thesis:
The thesis consists of 118 pages with 4 chapters and the following sections: Introduction: 02 pages; Chapter 1 - Literature review: 33 pages; Chapter 2 - Subjects and research methods: 21 pages; Chapter 3
- Result: 28 pages; Chapter 4 - Discussion: 30 pages; Conclusion: 02 pages; Recommendations: 02 pages
References: 130 documents (53 in Vietnamese and 77 in English)
Trang 5Chapter 1 INTRODUCTION 1.1 Labor in health facilities and occupational risk factors
1.1.1 Labor in health facilities
In Vietnam, there are about 441,446 health workers in the health sector, of which the number of doctor is 73,567, the number of physician is 54,466, the number of nurse, technician and midwive are 148,098 [17]
In 2016, Can Tho City has 134 health facilities including: 26 hospitals, 20 regional general clinics, 3 maternity homes and 85 commune health stations; With over 5,545 health workers, including 1,918 doctors, 652 physicians, 2,531 nurses and 444 midwives; Among 5,150 beds, there are 4,636 beds in hospitals, 50 beds in regional general clinics, 13 beds in maternity homes and 451 beds in commune and ward health stations With a large workforce in the health sector, OSH and occupational health care for health workers in our country in general and in Can Tho city in particular are very important in the current period [18]
1.1.2 Occupational harm factors in health facilities
The health sector is a specific labor industry with heavy labor intensity, physiological stress, working environment conditions with many factors of occupational diseases affecting health of health workers Factors of OSH for HCW can be classified into 2 groups:
- Non-contagious risk factors: physical, chemical, labor organization, occupational psychology, ergonomics, etc
- Contagious risk factors: blood, body fluids, swabs, medical waste and injuries caused by sharp objects [19], [20]
1.1.3 Occupational hepatitis B and C virus
Occupational disease HBV, HCV caused by HBV, HCV virus during labor process Currently, in addition to the HBV vaccine, an important preventive measure is health education and adherence to standard precautions Any HCW can be infected with HBV, HCV by contact with patient samples containing virus during working In order
to diagnose HBV and occupational disease, it is necessary to base on occupational exposure, exposure time, guarantee period, clinical and subclinical symptoms as prescribed [4], [14], [15]
Trang 61.2 Actual situation of hepatitis B and C virus in health workers
1.2.1 Studies in the world
According to WHO, every year in Europe, there is 304,000 HCWs will be exposed to HBV, 149,000 HCWs will be exposed to HCV, 22,000 HCWs will be exposed to HIV and the likelihood of infection after occupational exposure will be <0.3–4.4% for HIV, 0.5–39% for HCV and 18–37% for HBV [40], [72] Ogundele's study (2017) conducted on 209 health workers showed that the prevalence of HBsAg was 6.7%, the prevalence of HCV was 8.1%, and the co-infection with HBV and HCV was ± 0.1% [73] The study of Adriana Garozzo (2017) conducted in 10 years, 229 out of 3,138 HCV infected HCV detected (7.3%) [74]
1.2.2 Studies in Vietnam
In Vietnam, there are 34 types of work-related diseases covered, among more than 28,000 workers who were compensated for work-related diseases, there were 397 cases of work-related diseases caused
by microorganisms, accounting for 1.43% [75]:
Table 1.1 Statistics of work-related diseases caused by
Total occupational diseases caused by microorganisms 397 (100,0)
Total occupational diseases caused by microorganisms 397/27.878 (1,43%)
In Vietnam, HCV infection is less than HBV, Nguyen Thuy Quynh (2009) showed that 16.4% of HCWs were HBsAg positive [9];
In the study of Ha The Tan (2010), the proportion of HCWs with HBsAg antibodies accounted for 9.7%, Anti-HBs carriers accounted for 37.8%, HCV infection rates accounted for 1.14% [51]
Trang 71.3 Interventions to prevented infection by microorganisms
From the theoretical framework of occupational risk control interventions (WHO - ILO), it is proposed to take measures to prevent the spread of diseases caused by microorganisms and implementing standard preventive measures, in combination with operational control policies, techniques, environmental sanitation control and policies to minimize risks for individuals (use of labor protection, vaccinations, policies…) [78], [79]
Chapter 2 SUBJECTS AND METHODS OF THE STUDY 2.1 Subject, location and time of study
From September 1, 2015 to December 31, 2017, include:
- Phase 1: From September 1, 2015 to March 30, 2016: Assessing OSH conditions and exposure to microorganisms risk factors of HCWs
- Phase 2: From April 1, 2016 to December 31, 2016: Determining the actual situation of HBV, HCV infection in HCWs; survey knowledge, practice on occupational hygiene, prevention of work-related diseases of health workers at selected health facilities
Trang 8- Phase 3: From January 1, 2017 to December 31, 2017: Implementing and evaluating effective interventions to prevent microorganisms infection in HCWs
2.3 Variables, research indicators
2.3.1 Risk factors for occupational diseases caused by microorganisms
Monitoring the labor environment according to the Technical Routine of the Institute of Occupational Health and Environment [96] Evaluate as follows:
- Microclimate: Circular No 26/2016 / TT-BYT; Lighting: Circular No 22/2016 / TT-BYT
- Aerobic bacteria, mold: Clean room standard of the Ministry
of Environment of Singapore (< 500 cfu/m3) [96]
Working conditions of HCWs through interviews
Trang 9Knowledge and practice of health workers (Using questionnaires and checklists to survey):
- Knowledge has 10 main content with 33 questions, each question correctly answers 1 point, general knowledge is correct when reaching ≥ 70% of the maximum total points (≥ 23 points);
- Practice includes 03 main contents and has 11 evaluation criteria, 1 point for each criterion correctly executed, general right practice for achieving ≥ 70% of the maximum total points (≥ 08 points)
2.3.2 Determining the status of hepatitis B, C virus infection
Perform serum test for HBsAg, Anti HCV according to the Ministry of Health's Technical Routine
2.3.3 Communication intervention and implementation of measures
to prevent occupational diseases caused by microorganisms for health workers
Develop communication materials based on information, results
of implementation of Goal 1 and organize training for health workers Conduct knowledge assessment, practice before - after the intervention by interview questionnaires and checklists to evaluate the effectiveness of the intervention
Vaccinate HBV vaccine for eligible HCWs (HbsAg, anti-HBs negative) and agree to vaccinate
2.4 Methods of controlling deviations, analyzing and processing data
2.4.1 Control of deviations
Provide detailed on content, techniques, and skills used in research Organize the investigation, try adjusting the questionnaire
2.4.2 Processing and analyzing data
Checking the completeness and suitability of the information collection form; Entering and processing data on SPSS 18.0 software; Descriptive statistics, analysis (χ2 test, t-test test)
2.5 Ethical issues in research
All study participants are completely voluntary, and the respondent has the right to refuse to be interviewed
Trang 10This study did not have any effect on local customs and cultural traditions The research protocol was approved by the Ethics Council
of the Institute of Occupational Health and Environment
Chapter 3 RESULTS 3.1 Occupational risk factors by exposing microorganisms in health workers in Can Tho city in 2015-2017
3.1.1 General characteristics of health facilities
The study was conducted at 6 health facilities with 626 health workers The distribution of medical staff at the facilities is as follows: Can Tho Maternity Hospital accounts for 37.5%, Ear-Nose-Throat Hospital 4.8%, Odonto-Stomatology Hospital 7.7% , O Mon District General Hospital 28%, Thoi Lai District Medical Center contributed 11.3% while Phong Dien District Medical Center accounted for 10.7% The actual bed / plan ratio is 1.3 / 1; The average capacity of using beds is 112.1%; Number of doctors / beds: 0.16 (ranges from 0.09
to 0.22); Average number of doctors per day: 42.5 visits (ranging from
Temperature (oC) 28.9 ± 1.8 19.5-39.2 6 2.6 Moisture (%) 68.1 ± 8.8 44.2-83.5 11 4.8 Wind speed (m/s) 0.27 ± 0.10 0.20-1.40 0 0.0 Light (Lux) 779 ± 1844 100-13800 64 27.8
It can be seen in the table that the number of samples does not meet hygienic standards: Temperature 2.6%; Moisture 4.8%; light 27.8%
Trang 11Table 3.7-8 Results of tested aerobic bacteria and molds in the working environment at researched facilities (n = 300)
Environmental factors Mean ± SD Results
(Min-Max)
Number of unstanderdized sample Number TL (%)
Aerobic (cfu/m3) 664 ± 647 86- 5145 119 39.7 Molds (cfu/m3) 560 ± 423 130 - 2230 102 34.0 The table above shows that the number of non-standard samples
is aerobic 39.7%, molds 34%
3.1.3 Working conditions of health workers
The survey showed that 100% of health workers were equipped with masks, hats or goggles / veils; 92.5% equipped with gloves; 97.8% are equipped with robes Health workers have large and stressful workloads of 81.2% and 73.5% respectively; The exposure rate for microorganisms is 63.1%, while the exposure rate for toxic gases and chemicals is 48.9%
Figure 3.2 Risk of exposure to microorganisms due to
an occupational accident (n = 626)
61.7% of health workers are frequently exposed to microorganisms due to occupational accidents 7.2% of employees have been splashed with blood and body fluids 12.5% of employees were hurt by sharp objects (due to 37.2% infusion, 20.5% tests, 26.9% surgical procedures, 15.4% washing tools, medical waste disposal 14.1%);
Trang 123.1.4 Knowledge and practice of occupational prevention due to microorganisms of health workers
Figure 3.4 and 3.6 Knowledge and practice of health workers
Knowledge and practice of 626 subjects reached 62.9% and 75.4% respectively The inadequated knowledge group have the risk
of being pierced by sharp objects as 1.76 times higher as the adequate knowledge group (95% CI: 1.06-2.91) The adequate knowledge has 1.54 times higher than the inadequate knowledge group in terms of good practice (95% CI: 1.06-2.23), p <0.05
3.2 The status of virus B,C infection of health workers
Figure 3.7 Positive rates of HBsAg, Anti-HBs, Anti-HCV of
the study subjects (n = 626)
Trang 13Figure 3.3 describes the positive HBV/ HCV mark rate of 626 health workers Accordingly, HBsAg positive rate was 9.7%, Anti-Hbs positive rate was 43.5% while Anti-HCV positive rate was 0.5%
Table 3.19 The prevalence known and newly discovered HBV,
HCV status of the study subjects (n = 626)
Status of infected HBV/HCV Number Rate (%)
Table 3.20 The prevalence of HBV infected of Health workers (n=626)
Sex
HBV infected
OR (95% CI)
χ2
p Infected Non-infected Total
Male 30 16.3 154 83.7 184 100
2.58 (1.51-4.41)