Safety measures for healthcare workers

State governments should enact immunisation laws for healthcare workers.

Anuradha Verma, a nurse with 12 years of experience, had just administered an injection to a patient and was putting the syringe in a sharps container when she accidently pricked her finger. A year later, she was diagnosed with chronic Hepatitis B, a serious but common blood-borne viral infection that attacks the liver and can be life threatening if not treated in time.

Millions of healthcare workers in India, including doctors, nurses and paramedics, make the Indian healthcare system work. They operate in difficult circumstances daily, surrounded by people with various health conditions, some of them infectious. They are exposed to around 20 types of blood-borne infections ranging from HIV/AIDS and hepatitis to syphilis, malaria and herpes. The occupational health of these workers is a big challenge that needs more attention from the government as well as healthcare providers.

WHO estimates the global burden of disease from occupational exposure to be 40 per cent of hepatitis B and C infections and 2.5 per cent of HIV infections among healthcare workers. Each suffers an average of four needle-stick injuries every year in Asia, according to injection safety surveys conducted by the WHO.

The infections that healthcare workers acquire from patients can jeopardise their careers and even their lives. Those working in areas like surgery, gynecology and orthopedic services are particularly at risk. On this Hepatitis Day, the country needs to determine to do more to protect those who take care of our health. This can be done through two measures: vaccination against various diseases and training in safe injection practices.

Healthcare facilities need to make sure that nurses, doctors and other staff who come in regular contact with patients or handle material that could spread infection, such as lab technicians and ward boys, are appropriately vaccinated against vaccine-preventable diseases. These include hepatitis B, flue (influenza), MMR (Measles, Mumps, & Rubella), chickenpox, and Tdap (Tetanus, Diphtheria, Pertussis). State governments need to take the issue seriously and consider enacting immunisation laws for healthcare workers to make the practice mandatory. This would ensure that even if healthcare workers suffer a needle-stick injury by accident, they are protected from the pathogens.

According to WHO, unsafe medical injections led to 340,000 HIV infections, 15 million hepatitis B infections, 1 million hepatitis C infections, and 3 million bacterial infections worldwide in 2008 alone. Unfortunately, no evidence-based guidelines are available for injection providers in India to prevent injection-associated infections, though the Indian Academy of Pediatrics has recently launched recommendations and guidelines based on the WHO framework.

A significant chunk of needle-stick injuries get inflicted on healthcare works due to abrupt physical movement of patients when administering injections. Another important cause is when they try to recap needles after use. A crucial aspect of safe injection practices is sharps collection for safe disposal. Protocol dictates that used syringes and needles need to be collected at the point of use in a sharps container that is puncture and liquid-proof. However, in many healthcare facilities in India, cardboard boxes are used for the purpose, exposing workers to the risk of needle-stick injuries.
As many as 28 per cent of needle-stick injuries are attributed to unsafe sharps waste collection, according to the US-based National Institute for Occupational Safety and Health (NIOSH). Many times, such injuries go unreported. Healthcare facilities have to work towards achieving 100 per cent reporting of needle-stick injuries among staff and establish a protocol for treatment once such an injury has occurred. Many hospitals have taken welcome steps in this direction, but they are few and far between.

The most important and inexpensive way to control infections from spreading is to use sterile syringes and needles for each injection. Unfortunately, in India, the recycling and reuse of injection equipment is rampant, particularly in smaller towns and villages, due to ignorance of the healthcare workers of the cost involved.

Some recent hepatitis B epidemics in India traced to unsafe injections occurred in the Ooramana village in Kerala and the towns of Ratia in Haryana and Modassa in Gujarat. The only solution to curb such incidents is to promote the use of auto-disable injections that can be used only once. This would not only protect patients from blood-borne diseases like hepatitis and HIV, it would also substantially reduce the healthcare burden of the society and prevent many avoidable deaths each year.

(The writer is the chairman, department of gastroenterology and hepatology in a Delhi hospital)