Introduction

Worldwide, healthcare workers experience needlestick, sharp cuts and splashes with biological fluids while providing health care [1,2]. Three million HCWs are exposed each year resulting in approximately 170 000 HIV, two million viral hepatitis B (HBV), and 0.9 million viral Hepatitis C (HCV) infections [3,4]. Percutaneous exposures caused by needles and sharps items that are contaminated with body fluids, constitute the fourth cause of medical errors [5,6].

While developed countries have set up institutional frameworks to monitor and address issues related NSI, less economically advanced countries are challenged with poor resources allocation for the prevention of healthcare associated infections, including post exposure prophylaxis [7]. Further, developing countries face higher prevalences of AIDS, HBV infections, thus a greater risk of infection transmission [6]. Two thirds of HCW in Africa experience at least one exposure to body fluids during their career [7].

Occupational exposure to blood is associated with work environment factors including stress, workload, availability of health and security information and training; clinical service (surgical ward); professional experience; availability of Personal Protective Equipment (PPI) and supplies [8-11].

Healthcare workers related conditions such as age, gender, professional status, hepatitis B vaccination status, needle recapping practices influence the occurrence of accidental exposure to body fluids [8,12]. Besides, poor adherence to infection control and prevention measures such as handwashing and systematic use of PPI during care also drive exposure. Moreover, poor patient compliance during care, such as the jerky movement during blood sampling is associated to occupational exposure [9,10].

The risk of infection transmission from blood varies with epidemiological and contextual factors. Epidemiological factors include infection prevalence at the community level. Among contextual factors, the depth of the injury, nature of the accident (prick, cut, projection), absence of PPI (googles, gloves), healthcare worker vaccination status, nature of the fluid associated to the exposure, the serological and clinical status of the source patient [4,13].

Healthcare workers are four times at greater risk of contracting the healthcare associated infection [14]. The burden is even higher in sub-Saharan African countries that bear a high prevalence of blood borne infections [7,15].

Within the health system, district level health services provide implementing partners with governance and technical support through training, mentoring, monitoring and supervising of satellite facilities for the delivery of quality healthcare, including the prevention of care associated infections [16]. The present investigation was designed to assess the level of implementation of infection prevention guidelines and the burden of injuries related to poor compliance. Observations on care associated injuries and weaknesses in vaccination coverage provide guidance for strengthening district healthcare institutions in the safe delivery of services.

Methods

Study design

We conducted an institution based cross-sectional study in the six (6) district hospitals of Yaounde from January to April, 2022.

Setting

Yaounde, Cameroon’s capital is host to a population of 3.2 million. It is the country’s second largest city [17]. The Cameroonian health system is organized around health districts as operational level of implementation. A district hospital is the first level of reference in the health pyramid and is responsible for providing primary health care [18]. The Yaounde DHs (Biyem - Assi, Cite - Verte, Djoungolo, Efoulan, Mvog - Ada and Nkolndongo) cumulate nearly 400 health personnel, 330 beds and 153 543 consultations in 2020 [19].

Participant

The study participants were  workers whose activities included contact with patients and potential exposure to body fluids. They were doctors, nurses, midwives, nursing assistants, laboratory technicians and cleaners.

Sample size

An exhaustive sampling method was adopted in each clinical department, including all consenting personnel.

Data collection

The study instrument was a structured self-administered questionnaire consisting of 17 items covering sections related to socio-professional characteristics, experience of exposure to body fluids and hepatitis B vaccination status.

Data processing and analysis: All filled questionnaires were cross-checked, entered and analyzed using IBM SPSS Statistics (Statistical Package for Social Sciences) 2019 Version 26.0.0.0 software. The Chi-square (X2) test or Fisher’s exact test for proportions were used to compare proportions. Multivariate logistic regression was used to assess the strength of the association between variables. A p-value < 0.05 was considered statistically significant.

Results

Out of the 279 HCW contacted, 217 returned the completed questionnaire, representing a 78% response rate. Most of our study participants were female (81%). Participants aged 25-39 years were the most represented (73.7%). They were mostly nurses (32.3%) and laboratory technicians (21.2%). (Table 1).

Table 1: Socio-demographic characteristics  of participants in the assessment of Accidental Exposure to Body fluids (AEB) in Yaounde District Hospitals (DH), April 2022 (n=217).

Experience of needlestick injury

More than half of our participants (54%) had experience at least one AEB in the last 12 months. Most exposures resulted from percutaneous stings (29.5%) and splashes (46.5%) (Table 2). The Nkolndongo DH had the highest prevalence (51.6%) while the CiteVerte DH had the lowest (12.8%). The Nkolndongo DH (67.7%) had the highest proportions of HCW with no routine training on infection control and prevention (Table 3).

Table 2: Accidental exposure to body fluids among healthcare workers in Yaounde District Hospitals, April 2022 (n = 217).

Table 3: Experience of exposure to blood and training on infection control within Yaounde District Hospitals, April 2022.

There was no significant difference in exposure between sex (p-value=0.849). Health personnel affected by AEB were mainly nurses (42.9%), students (33.3%) and laboratory technicians/dentists (23.9%). These differences were not statistically significant (p-value=0.084) (Table 4). The surgery department recorded the most cases of exposure to blood (47.1%) (Table 5).

Table 4: Experience of exposure according to participants’ sociodemographic characteristics in Yaounde District Hospitals, April 2022 (n = 217)

Table 5: Experience of exposure according to socio-professional characteristics in Yaounde District Hospitals April 2022 (n=217).

Our investigation did not identify any existing infection control committee in all visited health facilities. Moreover, no participant was aware of the necessity of this health care related organism in the functioning of the health facility.

Hepatitis B vaccination

More than half of our participants were unvaccinated (53%) while one third were fully vaccinated (34%) (Figure 1).

Figure 1: Compliance with hepatitis B vaccination among healthcare workers in Yaounde District Hospitals, April 2022 (n=217).

Most hygiene personnel (90%) and paramedics (66.2%) were not fully vaccinated. Nearly two-third of participants (64.8%) who had percutaneous exposure to blood were not fully immunized against HBV (Table 6).

Table 6: Hepatitis B vaccination status, socio-professional category and percutaneous exposure among healthcare workers in Yaounde

District Hospitals, April 2022 (n=217)

Single participants were less likely to be vaccinated than their counterparts (p-value=0.041) (Table 7). The high cost of vaccine was the most reported reason (39%) for non-compliance with hepatitis B vaccination (Figure 2).

Table 7: Multivariate analysis of factors associated with non-compliance to hepatitis B vaccination among healthcare workers in Yaounde District Hospitals, April (n=217).

Figure 2: Reasons for non-vaccination against hepatitis B virus in Yaounde District Hospitals, April 2022 (n=115).