Data from: Risk factors for blood borne viral hepatitis in health care workers of Pakistan; a population based case control study

Objectives: High prevalence of viral hepatitis B and C was found among the health care workers during a province wide screening in Sindh Province, Pakistan. A follow up study was undertaken to identify risk factors for this high prevalence in health care workers. Design: Population based case control design. Setting: Public sector health care facilities in a rural district of Pakistan Participants: Health care workers who were screened for hepatitis B surface antigen (HBsAg) and hepatitis C antibodies (HCV). 178 health care workers employed at the public sector clinics and hospitals of district were approached, 14 refused to participate. Cases had detectable serum antibodies against HCV and presence of HBsAg. Health care workers non-reactive to HCV antibodies and with no HBsAg were controls. These were matched in a ratio of 1:1. Outcome measure: Detectable serum HBsAg, HCV antibody titer was taken as outcome. Odds ratio for various exposures was calculated; those with p<0.25 were entered in a multivariate logistic regression model to find out significant predictors. Results: Needle stick injury (OR= 6; C.I.95 = 1.4- 23), recapping the needle (OR= 5.7; C.I.95 = 1.1- 28), wound care at accident and emergency of a hospital (OR= 5.5; C.I.95 = 1- 28), female gender (OR= 3.4; C.I.95 = 1- 12) and more than 10 years of formal education (OR= 0.25; C.I.95 = 0.07 – 0.8) were associated with hepatitis C. Hepatitis B was found to be associated with trying to bend or break a needle after use (OR= 4.9; C.I.95 = 1 - 24). Conclusions: Health care workers in Pakistan are at additional risk of exposure to blood borne pathogens. Bi-dimensional risk factors present at individual and broader health systems level are responsible. Occupational safety and health trainings and redesigning of curriculum for allied health professionals is required.研究目的：巴基斯坦信德省全省范围内的筛查结果显示，当地医护人员中乙型、丙型病毒性肝炎患病率居高不下。本研究旨在明确该群体高感染率的危险因素。 研究设计：基于人群的病例对照研究设计。 研究场景：巴基斯坦某农村地区的公立医疗卫生机构。 研究对象：曾接受乙型肝炎表面抗原（hepatitis B surface antigen, HBsAg）与丙型肝炎病毒抗体（hepatitis C antibodies, HCV）筛查的医护人员。本研究共联系该地区公立诊所与医院的178名医护人员，其中14人拒绝参与。病例组为血清抗-HCV阳性且HBsAg阳性的医护人员；对照组为抗-HCV阴性且无HBsAg携带的医护人员，两组按1:1比例匹配。 结局指标：以血清HBsAg阳性、丙型肝炎抗体滴度可检出作为研究结局。计算各类暴露因素的比值比（odds ratio, OR），将P<0.25的因素纳入多因素logistic回归模型（multivariate logistic regression model），以筛选具有统计学意义的预测因子。 研究结果：与丙型肝炎感染相关的因素包括针刺伤（OR=6；95%置信区间（confidence interval, CI）：1.4~23）、回套针帽（OR=5.7；95%置信区间（confidence interval, CI）：1.1~28）、医院急诊伤口护理（OR=5.5；95%置信区间（confidence interval, CI）：1~28）、女性性别（OR=3.4；95%置信区间（confidence interval, CI）：1~12）以及接受10年以上正规教育（OR=0.25；95%置信区间（confidence interval, CI）：0.07~0.8）。与乙型肝炎感染相关的因素为使用后弯折或掰断针头（OR=4.9；95%置信区间（confidence interval, CI）：1~24）。 研究结论：巴基斯坦医护人员面临更高的血源性病原体暴露风险，该风险由个体层面与医疗卫生系统层面的双向危险因素共同导致。亟需开展职业安全与健康培训，并重新修订辅助医疗卫生专业人员的培养课程。