|Year : 2012 | Volume
| Issue : 3 | Page : 109-113
Preventive practices against Hepatitis B: A cross-sectional study among nursing students of Kathmandu, Nepal
Dillee P Paudel1, Shree K Prajapati2, Damaru P Paneru3
1 Department of Public Health, KLE University, Belgaum, India
2 Immunization Section, District Public Health Office, Dolakha, Nepal
3 Department of Public Health, Pokhara University, Kaski, Nepal
|Date of Web Publication||11-Jan-2013|
Dillee P Paudel
Kapan 1, Sungava tol, Adarshanagar, Kathmandu, Nepal
Source of Support: None, Conflict of Interest: None
Background: Hepatitis B is an acute systemic infection caused by Hepatitis B virus. It is transmitted through direct contacts and iatrogenics. Health professionals (laboratory technicians, nursing staffs, medical professionals and surgeons) are most at risk population for Hepatitis B. This study was conducted during January 2010 to May 2010, to examine Hepatitis B prevention practices among nursing students. Materials and Methods: A cross-sectional study was conducted in five randomly selected Nursing Colleges (out of total 16 Colleges) of Kathmandu, Nepal. All 385 students studying in Proficiency Certificate Level (first, second, and third year) nursing were the participants. Data were collected by interview using structured questionnaire and an observation checklist was filled. Data were analyzed by SPSS (version 13). Descriptive and inferential statistics were applied; results were presented in tabular and narrative forms. Results: All participants were female (mean age 18.54 ± 2.01 years). About 39.5% participants were studying in 1 st , 31.7% in 2 nd , and 28.8% were in the 3 rd year. Almost all (97.7%) were unmarried and 87.5% were Hindus. About 96.4% participants heard about Hepatitis B and Radio/Television (83.6%) were common sources of information. Almost all (99.7%) reported; vaccination followed by avoidance of needles sharing (93.5%) is the most effective preventive measures. Three-quarters of the participants were vaccinated against Hepatitis B and 12.2% tested their blood for Hepatitis B. About 96.4% participants avoided the sharing of needle after using syringes after patient care, 82.6% used sterilized instruments, 81.8% used gloves, and only 27.2% used mask during patient care. Conclusion: Only two-thirds of nursing students had good Hepatitis B prevention practices, a quarter of the participants were not vaccinated against Hepatitis B, and rather poor practice of using mask during their service time skill imparting trainings and supervision of the practices are recommended for good prevention practices.
Keywords: Hepatitis B, nursing students, practice, prevention
|How to cite this article:|
Paudel DP, Prajapati SK, Paneru DP. Preventive practices against Hepatitis B: A cross-sectional study among nursing students of Kathmandu, Nepal. J Sci Soc 2012;39:109-13
|How to cite this URL:|
Paudel DP, Prajapati SK, Paneru DP. Preventive practices against Hepatitis B: A cross-sectional study among nursing students of Kathmandu, Nepal. J Sci Soc [serial online] 2012 [cited 2020 Jan 25];39:109-13. Available from: http://www.jscisociety.com/text.asp?2012/39/3/109/105911
| Introduction|| |
Hepatitis B is an acute systemic viral infection More than two billion (1/3) people infected with hepatitis B Worldwide; of those, 350 million remained chronic carriers. Estimated one million people die each year due to complication of Hepatitis B. , Hepatitis B virus is transmitted mainly via blood and body secretions. Potential complications of the Hepatitis B include cirrhosis of liver and hepato-cellular carcinoma.  The risk of infection by Hepatitis B virus (HBV) ranges from 6% to 30% if no prophylactic measure is adopted. Moreover, combination of vaccines and gamma globulin can reduce this risk by 90-95%. 
In the healthcare settings, mainly HBV is transmitted by skin prick by contaminated needles/syringes and through accidental inoculation of minute quantities of blood during surgical and dental procedures. Blood borne and iatrogenic transmission of Hepatitis B is commonly reported from some of the South East Asian countries like Nepal and India. The carrier rate of Hepatitis B Surface Antigen (HBSAg) in hospital personnel, particularly operating room staff, dialysis unit staff, laboratory technicians, and nurses are more prone to occupational risk. Furthermore, the risk of accidental parenteral exposure to Hepatitis B virus has been reported to be higher (10.87%) than in voluntary blood donors (6.00%) and in the general population (5.00%). ,
Health personnel including nursing students are more vulnerable to needle stick injuries and associated infection as they come in direct contact with the patients during blood transfusions, injections, medications, surgical instrumentation services, etc.  Hence, knowledge regarding Hepatitis B transmission and safety precautions is needed to minimize potential infection which has an utmost importance in Hepatis B prevention. Considering the essentiality of precautionary measures, this study was carried out to examine Hepatitis B prevention practices of nursing students in Kathmandu, Nepal.
| Materials and Methods|| |
A Descriptive cross-sectional study was carried out in five (33% of total 16) randomly selected Nursing Colleges of Kathmandu of Nepal. Kathmandu is the capital and the largest city of Nepal. It is the cosmopolitan heart of Himalaya kingdom, which is situated as a bowl-shaped valley in the central development region of Nepal. There are in total 16 nursing colleges registered in Council for Technical Education and Vocational Training (CTEVT), of which five colleges were randomly selected as study sites. All 385 Nursing students of Proficiency Certificate Level (PCL) in nursing (first, second, and third year) of the course were study participants and the study was conducted from January 2010 to May 2010. The sample size was calculated by using the proportion-based statistical formula; n = z2p (1-p)/d2 with a consideration of 5% tolerable error at 95% confidence interval (CI) level. On the basis of 35% proportionate level of good knowledge in previous similar type of study, the minimum sample size was 349. Considering the benefits of the study, all 385 nursing students of these colleges were considered to be the study participants. Questionnaire and observation checklist were used as study tools. Data were collected by face-to-face interview using pretested structured questionnaire and non-participant observation was done during patient care (injection, instrumentation, and medications) using observation checklist. Pretesting of the questionnaire was performed among 10% of the study samples and voluntary informed consent was obtained. Data were analyzed by, Statistical Package for Social Science (SPSS-13 version). Preventive practices were categorized into poor (incorrect) and good (correct procedure). Percentage, mean, chi square, and Fisher's Exact test were applied wherever required and a P value < 0.05 was considered significant. Results were presented in tables, graphs, charts, and narrative forms.
| Results|| |
A total of 385 students participated in the study and all were females. About 60.5% were 18-20 years old (mean age ± SD =18.54 ± 2.001 years) and almost one-third (31.2%) were below 18 years. Nearly two-fifths (39.5%) of the participants were studying in the first year, one-third (31.7%) in the second year, and the remaining 28.8% were studying in the third year of PCL Nursing. Most of the students (97.7%) were unmarried and 87.5% were Hindus followed by Buddhists (1/10). About 42.3% had a monthly family income between NRs 10 000-15 000 followed by 35.3% had less than 10 000. Nearly three-quarters (71.42%) of the participants were living in nuclear families [Table 1].
Understanding on Hepatitis B
Most of the respondents (96.4%) had heard about the Hepatitis B and the most common source of information was radio/television (83.6%). Almost all (97.4%) participants replied that infected blood receivers followed by babies born to the infected mothers (84.2%), intravenous drug user (81.3%), health workers (69.1%), and person with multiple sexual partners (67.5%) were considered most at risk population. Similarly, almost all (99.7%) told that Hepatitis B vaccination is the effective preventive measure followed by avoiding sharing needle (93.5%), using sterile needles for tattooing and piercing (81.3%), screening before blood transfusion (80.8%), avoiding unsafe sex (72.2%), and avoiding sharing razor and tooth brush (69.9%). Likewise, almost all (98.9%) replied that three doses of vaccine are essential for the prevention of HB; more than half (56.9%) reported that the infancy period is an ideal age of vaccination as shown in [Table 2].
Preventive practices related to Hepatitis B
[Table 3]a summarizes preventive practices claimed by the participants against Hepatitis B. The study revealed that three-quarters (75.8%) were vaccinated against Hepatitis B while only 12.2% had tested their blood for possible Hepatitis B infection. About 84.4% claimed that they did not recap needle after use, 96.4% did not share needle once it is used, 82.6% used sterilized instruments, and 81.8% claimed the wearing of gloves during the time of injection and surgical procedure but very few (27.2%) had used mask during patient care. Item-wise preventive practices added together to identify the average practices and then it was categorized into the poor (incorrect procedure) and good (correct procedure) practice according to the standard norms developed for infection prevention practices in Nepal. Only 57.66% had a good preventive practice against HB.
Similarly, [Table 3]b shows the findings of the observations realted to practices offered by participants during the patient care. Individual's practices on the given infection prevention practices areas were observed by the investigators during their procedures. Observations showed that only 35.05 percent performed the partient care practices with washed hands whereas almost nine out of every ten (92.70%) washed their hands after the procedures. Slightly more than one-tenth of the participants did recap of the needles after use and almost same numbers of the participants had bent the syringe needles before disposing. Less than half of the participants used puncture-proof containers for the disposal of sharp materials. Meanwhile, 94.42 percent of them had disposed other waste products into the containers and nine out of every ten participants disposed infectious wastes in the recommended containers. Surprisngly, only half of the participants performed preocedures after using sterile gloves and slightly three-quarters of them had used sterile instruments for the procedures.
Factors related to peventive practices
[Table 4] shows association between socio-demographic characteristics and level of preventive practices. Preventive practice was highly significant with the academic grade of the students and their age while marital status, income, and religion were insignificant factors affecting their preventive practices.
|Table 4: Association between socio-demographic characteristics and level of preventive practice |
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| Discussion|| |
The mean age of the participants was 17.54 ± 2.01 years. A study conducted in North India showed that the mean age of the study population (medical and Nursing Student) was 22.36 ± 23.  Most of the participants (96.4%) heard about Hepatitis B. Mostly (4/5), radio/TV was the chief source of information followed by nearly half (46.6%) heard from books and newspaper (2/5), etc., A similar study from Pakistan revealed books (85%) and media/Internet (85%), followed by teachers (84%) and friends/relatives (70%) were the chief sources of information about the Hepatitis B.  Most of the students (97.4%) reported that the infected blood receivers were the high-risk population followed by babies born from the infected mother (84.2%), intravenous drug users (81.3%), health workers (69.1%), and person with multiple sexual partners (67.5%). A study in Bangladesh showed that prostitutes are the high risk group of Hepatitis B (20%) followed by health workers including doctors and nurses (15%).  A study from Karachi, Pakistan, reported that the risk of getting Hepatitis B is high among poor people living in unhygienic conditions (34%) followed by surgeons (32%), barbers (12%), intravenous drug users (8%), blood recipients (6%), uneducated people (6%), and sex workers (2%).  Almost all (99.7%) in this study reported that vaccination against Hepatitis B is the effective preventive measure, followed by avoiding needle sharing, use of sterile needles for tattooing and piercing, screening before blood transfusion, avoiding unsafe sex and avoidance of sharing razor and tooth brush (93.5%, 81.3%, 80.8%, 72.2%, and 69.9%), respectively. Previous studies showed that 46.8% of the medical students had understanding on preventive measures; provision of clean water, improvement in hygiene, restriction to single-sex partner, avoidance of sharing syringes and needles, screening blood before transfusion and vaccination (24%, 27%, 6%, 19%, 9%, and 15%), respectively. , Similarly, almost all (98.9%) replied that three doses of vaccination is essential for the prevention of Hepatitis B and more than half (56.9%) reported an infancy period as an ideal age of vaccination.
Majority of the participants (three-fourths of the total) were vaccinated against Hepatitis B; however, very few (≈1/10) had tested their blood for Hepatitis B. A similar study in Greece showed that 80.7 percent of the students were vaccinated before their clinical practices  and 66% students in Pakistan were vaccinated against Hepatitis B.  This study showed better vaccination rate than Pakistan and poorer than Greece. Most of the participants had the good practice of recapping of needle; 85% of them did not recap the needle after using the syringe and 94.6% had the good practice of single use. Four out of every five (82.6%) students in the present study had a practice of using sterilized instruments and 81.8% had practice of wearing gloves during the time of injection and surgical procedure; nevertheless, slightly more than a quarter of the participants (27.2%) used mask during service time. There were differentiation/similarity personal claim practices and observed practices of the participants where recapping (15.6 vs. 12.99%), bending (14.28 vs. 12.21%), use of sterile instruments (82.6 vs. 78.44%), and use of sterile gloves (81.2 vs. 50.2%) were reported, respectively.
There was a statistically significant difference in the preventive practice of Hepatitis B among different age groups (P < 0.05) and a good preventive practice has been significantly increased (P < 0.01) according to the academic grades (27.6% in the first year vs. 38.4% in the third year). A study conducted among medical students in Gujrat, India, showed poor knowledge and practices for Hepatitis B prevention among I and II year students than III years students.  On the other hand, marital status, religion, and monthly family income were not statistically significant factors affecting their preventive practices.
| Conclusion|| |
This study concludes that all the students were not vaccinated against Hepatitis B. Very few had tested blood for Hepatitis B and very rare used mask during service time. Though the level of understanding was high, the overall preventive practices were not satisfactory. Appropriate skill imparting trainings and supervision of the practices are recommended to enhance the good infection prevention practices among nursing students.
| Acknowledgement|| |
The authors are thankful to study participants, college, and hospital authority for their kind support to complete this study.
| References|| |
|1.||Kyriazopoulou DV, Papapanagiotou I. Medical Microbiology and Virology. 2 nd ed. Thessaloniki: University Studio Press;2004. |
|2.||Hepatitis B Foundation. Hepatitis B. Available from http://www.hepb.org/hepb [accessed on 2012 Aug 12]. |
|3.||Georgia G, Vasilakis T, Vassiliadou D, Xanthopoulos K, Triantafyllaki E, Vasiliki KD. Knowledge of medical students about Hepatitis B. Aristotle University Medical Joural. 2008;35(3):55-8. Available at aumj.med.auth.gr. |
|4.||Viral hepatitis B. Fact sheet [online] October 1, 2004. (Available from: http://www.cdc.gov/ncidod/diseases/hepatitis/b/. [accessed on 2012 Aug 12]. |
|5.||World Health Organization. Health situation in the South-East Asia Region: 1994-97. New Delhi: South-East Asia Region;1999. |
|6.||Tierney L. Current medical diagnosis and treatment. 39 th ed. New York: Lange Medical Books;2000. |
|7.||Shiao J, Guo L, Mclaws ML. Estimation of the risk of blood borne pathogens to health care workers after a needle stick injury in Taiwan. Am J Infect Control 2002;30:15-20. |
|8.||Maroof KA, Bansal R, Parashar P, Sartaj A. Do the medical, dental and nursing students of first year know about Hepatits B? A study from a university of North India. J Pak Med Assoc 2012;62:25-7. |
|9.||Anjum Q, Siddiqui H, Ahmed Y, Rizvi S R, Usman Y. Knowledge of Students regarding Hepatitis and HIV/AIDS of a Private Medical University in Karachi. J Pak Med Assoc 2005;55:285-8. |
|10.||Hossain ZM. Knowledge and Attitude among the nurse as Hepatitis B and HIV/AIDS infection in selected Medical College Hospitals. Mohakhali, Dhaka: Journal of National Institute of Preventive and Social Medicine (JNIPSOM); 2000. p. 11-5. |
|11.||Daud S, Manzoor I, Hashmi NR. Prevention of Hepatitis B: Knowledge and Practice among first year MBBS students. Professional Med J 2007;14:634-8. Available at http://www.theprofesional.com/?p=303 |
|12.||Singh A, Jain S. Prevention of Hepatitis B; Knowledge and Practices among Medical students. Healthline. 2011 July-December; 2 (2): 8-11. ISSN 2229-337X. Available at http://www.iapsmgc.org/OA2V2I2. |
[Table 1], [Table 2], [Table 3], [Table 4]