ASSESSMENT OF THE APPLICATION OF UNIVERSAL PRECAUTIONS BY HEALTH WORKERS IN PUBLIC AND PRIVATE HEALTH FACILITIES IN UYO
Introduction: Blood borne pathogens are increasingly gaining prominence as major killers globally. The high HIV sero-prevalence in Akwa Ibom State necessitated that this study be conducted to assess the application of Universal Precautions (UP) in both the private and government hospitals in Uyo with the intention of making information available to management/policy makers in the hospitals to ensure more effective application of these precautions in the health facilities.
Methodology: A comparative cross sectional survey of health workers in public and private health facilities in Uyo, Akwa Ibom State was carried out between July and August 2008. A self or interviewer administered semi-structured questionnaire was used to obtain information on knowledge, attitude and practice of UP and availability of precautionary measures. Respondents’ knowledge of UP was scored and grouped into 3, Good (≥14), fair (10-13) and poor (<10). Maximum score was 20.The use of UP was also scored. Maximum score was 18. Data obtained was analysed using the Statistical Package for the Social Sciences (SPSS) version 11.
Result: A total of 360 respondents were interviewed, 240 (66.7%) in the public hospitals and 120 (33.3%) in the private hospitals. Majority of the health workers in both the private and public hospitals had practised their profession for 6-15 years. Respondents in the public hospital had greater awareness of UP, 212 (88.3%), compared to those in the private hospitals, 69 (57.5%), (χ2= 44.4; p < 0.05). The study showed that 154 (64.2%) of the health workers in the public facilities compared to 65 (54.2%) in the private facilities had good knowledge of UP (χ2= 8.09, p< 0.05) with a mean of 14.5 in the public and 12.3 in the private facilities. Up to 160 (66.7%) of respondents in the public hospitals knew that health workers should not break or bend used needles before disposal compared to 67 (55.8%) from the private hospitals (χ2= 4.03; p<0.05) Similarly, more health workers in the public hospitals, 146 (60.8%), knew that used needles should not be detached from syringe compared to 61(50.8%) from the private hospitals. One hundred and fifty
seven (65.4%) health workers in the public facilities compared to 69 (57.5%) in the private facilities knew that the blood of all patients were potential sources of infection (χ2=12.9; p<0.05). Only 43 (17.9%) and 5 (4.2%) in the public and private facilities felt that all patients should not be screened for HIV just to protect the health workers (χ2=13.09; p < 0.05). A higher proportion of respondents, 98 (81.7%), from the private compared to 133 (55.4%) from the public hospitals had sustained injury by sharps at their health facilities (χ2=23.97; p < 0.05).Ninety two (93.9%) respondents in the private, compared to 99 (74.4%) in the public facilities did not report the last sharps injury at their facilities (χ2=14.90; p <0.05). Only 113 (53.3%) and 28 (40.6%) of respondents who had heard about UP in the public and private facilities respectively were aware of specific policies guiding the practice in their institution. Health workers in the public facilities had a compliance score to use of UP materials of 11.86 out of a total score of 18 which was significantly higher than 9.54 in the private hospital (t=6.01; p<0.05). A higher proportion of health workers in the public facilities, 116 (54.7%) had received training on UP at their facilities compared to 22 (31.9%) in the private facilities (χ2= 10.86 p<0.05).UP materials were reported to be more available in the public compared to the private facilities. Non-availability of UP materials was the commonest factor identified by health workers as affecting the use of UP measures by health workers in public facilities (60.4%) and private facilities (69.2%) followed by lack of staff training on practice of UP, (public 17.5%, private 15.0%).
Conclusion and Recommendation: The knowledge, attitude to and practice of UP was therefore generally better in the public compared to the private facilities and a key factor identified by health workers to affect use of protective equipments was non-availability. Based on the above findings the following recommendations were made: Every health facility should have defined policies on practice of UP. Seminars should be organised in public and private health facilities and UP should be taught in detail. Management of all health facilities should provide adequate UP materials and make it accessible to every health worker who needs to use them.