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MR. YATHISHA. H.S
1ST YEAR MSc NURSING
MEDICAL AND SURGICAL NURSING
2013-2015
SHREE SIDDAGANGA INSTITUTE OF
NURSING SCIENCES AND RESEARCH
CENTRE, B.H.ROAD,
TUMKUR-572102
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE.
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MR.YATHISHA.H.S
I YEAR M.SC.NURSING
SHREE SIDDAGANGA INSTITUTE OF
NURSING SCIENCES AND RESEARCH
CENTRE, B.H.ROAD, TUMKUR-572 102.
SHREE SIDDAGANGA INSTITUTE OF
NURSING SCIENCES AND RESEARCH
CENTRE, B.H.ROAD, TUMKUR.-572 102.
MASTER OF SCIENCE IN NURSING
MEDICAL AND SURGICAL NURSING.
29/07/2013
“ A STUDY TO EVALUATE THE
EFFECTIVENESS OF SELF INSTRUCTIONAL
MODULE ON KNOWLEDGE REGARDING
PREVENTION OF BLOOD BORNE INFECTIONS
AMONG LABORATORY TECHNICIANS IN
SELECTED LABORATORIES AT TUMKUR”
1
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
“Health is NOT mainly an issue of doctors, social services and hospitals.
It is an issue of social justice.”
K.Park, 2005
Health is a common theme in most cultures. In fact all communities have their
concept of health, as part of their culture. Among definitions still used probably the
oldest is that health is the “absence of disease” in some culture, health and harmony
are considered equivalent, harmony being defined as “being at peace with the self, the
community, god and cosmos”. The widely accepted definition of health is that given
by the world health organization [1948] in the preamble to its constitution, which as
follows: “Health is a state of complete physical, mental, and social wellbeing and not
merely an absence of disease or infirmity”. In recent years this statement has been
amplified to include the ability to lead a “social and economically productive life”. 1
Infection: Invasion of host an organisms bodily tissues by disease causing
organisms, their multiplication and the reaction of host tissues to these organisms and
the toxins they produce. Infections are caused by micro-organisms such as viruses,
prions, bacteria, and viroids and larger organisms like parasites and fungi. 2
"Blood" means human blood, human blood components and products made
from human blood. The term "human blood components" includes plasma, platelets,
2
and serosanguinous fluids (e.g., exudates from wounds).
Also included are
medications derived from blood, such as immune globulins, albumin.
"Blood borne Pathogens" means pathogenic microorganisms that are present
in human blood and can cause disease in humans. While Hepatitis B Virus (HBV)
and Human Immunodeficiency Virus (HIV) are specifically identified in the standard,
the term includes any pathogenic microorganism that is present in human blood or
OPIM (other potentially infectious materials) and can infect and cause disease in
persons who are exposed to blood containing the pathogen. Pathogenic
microorganisms can also cause diseases such as hepatitis C, malaria, syphilis,
babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, CreutzfeldtJakob disease, adult T-cell leukemia/lymphoma (caused by HTLV-I), HTLV-I
associated myelopathy, diseases associated with HTLV-II, and viral hemorrhagic
fever. 3
Health care facilities around the world employ over 59 million workers who
are exposed to a complex variety of health and safety hazards every day including:
biological hazards, such as TB, Hepatitis, HIV/AIDS, SARS; The WHO global
burden of disease from sharps injuries to health-care workers showed that 37% of the
hepatitis B among health workers was the result of occupational exposure. Infection
with the hepatitis B virus is 95% preventable with immunization but less than 20% of
health worker in some regions of the world have received all three doses needed for
immunity. While less than 10% of the HIV among health workers is the result of an
exposure at work, needle stick injuries, the cause of 95% of the HIV occupational
3
seroconversions, are preventable with practical, low-cost measures and have the cobenefit of preventing exposure to other blood borne viruses and bacteria. 4
Hepatitis is an inflammation of the liver, most commonly caused by viral
infection. There are five main hepatitis viruses, referred to as types A,B,C,D, And E,
These five types are of greatest concern because of burden of illness and death they
cause and potential for out breaks and epidemic spread. In particular type B and C
lead to chronic disease in hundreds of millions of people and together are the most
common cause of liver cirrhosis and cancer.5
Hepatitis B virus [HBV]: Is a DNA virus that is transmitted through expose to
infective blood, semen, and other body fluids, perinatal transmission from mother to
infant can occur. Approximately 90% of infants infected at birth go on develop
chronic hepatitis B or from family members to infant in early child hood.
Transmission may also occur through transfusion of HBV contaminated blood and
blood products, contaminated injections during medical procedures and through
injection drug use. HBV also poses a risk to health care workers who sustain
accidental needle stick injuries while caring for infected- HBV patient. Hepatitis B is
sexually transmitted disease. Approximately 30% of HBV cases are related to
heterosexual activity [un protected sex with an infected person]. 5.6
Immunization with hepatitis B vaccine is the most effective method of
preventing HBV infection. Recommendations from the Centers for Disease Control
and Prevention [CDC], Immunization practices advisory committee include making
hepatitis B vaccine is a part of routine vaccination schedules for all newborns and
4
adolescent. In addition that it is important to vaccinate adult in major risk group.
Hepatitis B vaccines are Recombivax-HB and Engerix-B. The vaccine is given in a
series of three intramuscular injections in the deltoid muscle. The second dose is
administered with in the 1 month of the first one; the third one is within 6 months of
the first. The vaccine is greater than 95% effective. It is hoped that universal
vaccination will lead to eventual prevention and control of hepatitis B.6
Some of preventive measures are: Wear appropriate personal protective
equipment [PPE] includes mask, gown, gloves, coveralls, shoe covers, pocket of CPR
mouth to mouth resuscitation mask, goggles. Wear gloves whenever there is
possibility of contact with blood or other body fluids. Assume that all blood and body
fluids are infected [Standard precaution]. Dispose of all waste properly. Report any
exposure to potentially infectious materials immediately and undertake the necessary
medical review and treatment [PEP-post exposure prophylaxis].3
6.2 NEED FOR THE STUDY
Hepatitis is a potentially fatal disease that affects 1 in 12 people worldwide.
Worldwide nearly 350 million people are infected with hepatitis B virus [HBV].of
these approximately 50% to 75% have active viral replication or chronic active
infection. There are an estimated 80,000 new cases of hepatitis B annually in the
United States. Today the highest rate of the disease occurs in those 20 to 49 years of
age. Currently 1.25 million Americans are chronically infected with HBV, 20% to
30% of whom acquired the infection in childhood. Hepatitis is far higher than the
prevalence of HIV or CANCER.5.6
5
In the World 2 billion people have been infected (1 out of 3 people) with
hepatitis B. 400 million people are chronically infected. 10-30 million will become
infected each year. An estimated 1 million people die each year from hepatitis B and
its complications. Approximately 2 people die each minute from hepatitis B. Hepatitis
B In the United States 12 million Americans have been infected (1 out of 20 people).
More than one million people are chronically infected .Up to 100,000 new people will
become infected each year. 5,000 people will die each year from hepatitis B and its
complications. Approximately 1 health care worker dies each day from hepatitis B.
Hepatitis B is 100 times more infectious than the AIDS virus.7
Asian and Pacific Islanders are at higher risk for Hepatitis B, which can lead
to liver cancer. Asian and Pacific Islanders (APIs) make up less than 5% of the total
population in the United States, but account for more than 50% of Americans living
with chronic Hepatitis B. They are unaware of their infection As a result, chronic
Hepatitis B and associated liver cancer in APIs is one of the most serious health
disparities in the United States. Nearly 70% of APIs living the US were born, or have
parents who were born, in countries where Hepatitis B is common. Approximately 1
in 12 APIs are living with chronic Hepatitis B, but most do not know it. Hepatitis Brelated liver cancer incidence is highest among APIs. It is a leading cause of cancer
deaths in this population. The death rate from Hepatitis B among APIs is 7 times
greater than rates among whites.8
The prevalence of chronic hepatitis B virus (HBV) infection varies by
geographic region. Most of North America is a low-prevalence (< 2%) area. Certain
high-prevalence pockets exist, especially areas with a high proportion of Asian
6
immigrants and Alaskan and northern Canadian native populations, where rates of
chronic HBV are as high as 5% to 15%. In most low-prevalence areas, HBV infection
is acquired mainly during adolescence and mid adulthood, whereas perinatal
transmission is the main route in high-prevalence (≥ 8%) areas. Up to 40% of patients
with chronic HBV infection develop liver complications. Age at acquisition affects
the likelihood of chronicity and the development of liver complications. The risk of
each is greatest with perinatal transmission.9
A cross sectional study was carried out, in four public hospitals in Wad
Medani, Sudan. to assess health care providers' knowledge, attitude and practice
towards hepatitis B virus infection (HBV).Anonymous pre-tested questionnaire was
completed by 295 different health care providers. The study revealed that, 97.2% of
doctors, 98.6% of nurses, 94.8% of laboratory technicians and 95.7% of other
paramedical knew that HBV transmitted via blood. For hygienic precautionary
measure; the current study disclosed that (81%) of the responding providers were
routinely used to recap needles after use and only (33%) of doctors were always
wearing gloves. More than 50% (p < 0.001) of health care workers were not
vaccinated against HBV. Study concluded that Healthcare workers had poor
knowledge about Universal Standard Precautions Guidelines, and do not fully
appreciate their occupational risk regarding hepatitis B infection. Set of
recommendations was proposed for formulation and implementation of standard
precautions guidelines.10
The average estimated carrier rate of hepatitis B virus (HBV) in India is 4%,
with a total pool of approximately 36 million carriers. Professional blood donors
7
constitute the major high risk group for HBV infection in India, with a hepatitis B
surface antigen positivity rate of 14%. Blood transfusions represent the most
important route of HBV transmission among adults. However, most of India's carrier
pool is established in early childhood, Acute and sub acute liver failure are common
complications of viral hepatitis in India and HBV is reckoned to be the etiological
agent in 42% and 45% of adult cases, respectively. HBV is reported to be responsible
for 70% of cases of chronic hepatitis and 80% of cases of cirrhosis of the liver. About
60% of patients with hepatocellular carcinoma are HBV marker positive. In
conclusion, hepatitis B is a major public health problem in India and will continue to
be until appropriate nationwide vaccination programmes and other control measures
are established.11
A study was conducted at the blood bank of a tertiary care hospital serving
predominantly the people of coastal Karnataka. A retrospective analysis of blood
donors over a period of three years was done to assess the seroprevalence and the
trend of hepatitis B infection. ELISA was used to detect the hepatitis B surface
antigen in the donors as a marker of infection. A total of 30,428 blood donors were
studied. 189 (0.62%) were positive, which comes under the "low prevalence (< 2%)
zone" per World Health Organization (WHO) guidelines. A decreasing trend over
three years was seen. Replacement donors and male blood donors showed higher
seropositivity compared to voluntary donors and female donors. Chi-square test was
used
to
calculate
the
significance
of
difference
between
the
groups.
Coastal Karnataka has a low prevalence of hepatitis B in blood donors with a
decreasing trend over the last three-year period.12
8
A Survey was conducted by BGS Global Hospitals in association with
Integrated Liver Care (ILC) Foundation launched the ‘Bangalore Hepatitis Project’ an
on-going survey to collect data on hepatitis B and hepatitis C infections among the
urban population. Conducted the study which revealed that one in 50 in Bangalore
have hepatitis B and one in 200 have hepatitis C. The results are indicative of the
magnitude of the disease burden and to sound an alert to the people to take preventive
measures for hepatitis B and hepatitis C infections. About three core people in India
have chronic hepatitis B or C infection, far higher than the prevalence of HIV or any
cancer. However chronic viral hepatitis does not have the level of awareness seen
with other communicable diseases such as HIV/AIDS, tuberculosis and malaria, there
is a high incidence of hepatitis B viral infection reported from the rural Karnataka.13
In the light of above, the investigator found it desirable to evaluate the
knowledge of Laboratory Technicians about Blood borne infections. The
investigator’s decision for selecting the topic on blood borne infections for the study
grew of his clinical experience during his Hospital working period with Laboratory
Technicians who had limited awareness regarding the precaution, prevention and
treatment measures of blood borne infections. There for it is very clear that the Lab
Technicians must need to update their knowledge regarding blood borne infections.
This study will be a great benefit to improve the knowledge of blood borne
infections among laboratory technicians. So that it helps to control and prevent many
blood borne infections. In the past no such study has been conducted in this area and
hence this study is taken.
9
6.3 REVIEW OF LITERATURE
A Literature review is a description and analysis of the literature relevant to a
particular field or topic. It gives an overview of what has been said, who the key
writers are, what are the prevailing theories and hypotheses, what questions are being
asked, and what methods and methodologies are appropriate and useful. As such, it is
not in itself primary research, rather, it reports on findings of other.
A cross sectional study was conducted to assess the risk of blood-borne
infection among health care workers in two Kuala Lumpur hospitals Malaysia. This
cross-sectional study involved pre-tested questionnaires that were completed by 625
HCW and undergraduate students undergoing clinical attachments. The respondents
were separated into two groups: i) HCW from Hospital Kuala Lumpur, HKL (n=241)
and Hospital University Kebangsaan Malaysia, HUKM (n=153) ii) Medical students
from University Kebangsaan Malaysia, UKM (n=171) and HUKM student nurses
(n=60).The results shown that the risk of transmission of blood-borne infections
varied significantly according to professional ranks (p<0.05) and to hospital units
(p<0.05). The medical intensive care (ICU), haemodialysis, and nephrology and
urology units had the highest scores for the risk of infection while the diagnostic
laboratory had the lowest risk of infection (p<0.05).14
A cross-sectional design study took place in Central Israel. To examine the
relationship between nurses' knowledge of blood-borne pathogens (BBPs), their
professional behaviour regarding hand washing, compliance with standard
precautions (SPs), and avoidance of therapeutic contact with BBP-infected
patients.180 participants, 159 (88.3%) were women with an average educational level
of 16.40 years (SD=2.66). The mean age of the sample was 39.41 (SD=10.1).level of
knowledge concerning three BBPs ([HIV], [HBV], [HCV]), Levels of HIV-related
10
knowledge were significantly higher than were those of HBV- and HCV-related
knowledge. Only 96 participants (54.5%) stated that all patients should be treated as
BBP-carriers.77.3% of the sample reported that they avoid therapeutic contact with
BBP-infected patients. Study concluded that level of perceived knowledge did not
contribute to the nurses' avoidance of care of BBP carriers. Perceived knowledge of
BBPs has a weak effect on compliance with SPs and willingness to care for BBPinfected patients.15
A cross-sectional comparative community-based study carried out in
Khartoum state, Sudan. To assess the awareness of shop barbers and roadside barbers
in regarding knowledge and modes of transmission of Hepatitis B virus, Hepatitis C
virus and Human immunodeficiency virus and to observe their practice regarding
proper use and disposal of razors and blades. The study included two groups of
barbers-shop barbers and roadside barbers. Basic knowledge and modes of
transmission of HBV, HCV and HIV, their knowledge about HBV vaccine and their
vaccination status. Results showed that, X 2 and t-tests. P value was taken at a
significant level of <0.05. Barbers in both groups had good basic knowledge about
HIV infection and its modes of transmission, while in both groups knowledge about
hepatitis and its modes of transmission were poor. In both groups standard cleaning
and sterilization of equipment procedures were not followed and special sharps'
disposal containers were not used.16
A cross-sectional study was conducted in Rawalpindi and Islamabad. To
assess the knowledge and practices of barbers regarding transmission risk of HBV and
HCV viruses. 95% confidence intervals were computed.96 barbers approached, 12
(13%) knew that hepatitis is a disease of the liver, causing jaundice; it is transmitted
through parenteral route and could also be transmitted by razor. During the actual
11
observation of 192 clients, razors were cleaned with antiseptic solution for 22 (11.4%)
and reused for 88 (46%) shaves. Study concluded that Level of awareness among
barbers about hepatitis and risks of transmission is very low, and their practice of
razor reuse that may spread hepatitis is very common. Messages about hepatitis need
to be incorporated in media campaigns, in addition to regulation of practices.17
A study was conducted on Work safety among Polish health care workers in
respect of exposure to blood borne pathogens in Poland. Total of 1138 Polish
healthcare workers were interviewed to evaluate the efficacy of methods promoting
work safety in healthcare settings, only in 146 cases these incidents were reported to
authorities. Exposure incidents were associated with self-perception of high risk of
exposure (OR = 3.69, p = 0.0027), employment in out-patient (vs. hospital-based)
healthcare setting (OR = 1.71, p = 0.0089), study concluded that the level of
information about blood borne infections conveyed at work was insufficient, lack of
both exposure reporting system and knowledge about the ways of reporting. More
attention should be given to education, especially in regard to the risk of infection,
advantages of post-exposure prophylaxis and reporting exposure incidents.18
A cross-sectional study was conducted involving various levels of health-care
workers in Serdang Hospital, Selangor, Malaysia on Knowledge of bloodborne infectious diseases and the practice of universal precautions amongst healthcare workers in a tertiary hospital in Malaysia. Two hundred fifteen respondents
participated in this study; 63.3% were staff nurses. The mean knowledge score was
31.84 (SD 4.30) and the mean universal practice score was 9.0 (SD 2.1). There was a
small, positive correlation between knowledge and actual practice of universal
precautions (r = 0.300, n = 206, p < 0.001) amongst the cohort studied. Result shown
that Factors such as age and years of experience did not contribute towards
12
acquisition of knowledge about blood-borne illnesses or the practice of universal
precautions.19
A study was conducted on Knowledge, Attitude, and Practice of Iranian
Surgeons About Blood-Borne Diseases in Iran. 575 surgeons are participated. 430
(75%) returned completed forms. Concern about being infected with blood-borne
diseases was more than 70 (from a total score of 100). Only 12.9% of surgeons
always used double gloves. Complete vaccination against HB was done in about 76%
of surgeons and only 56.8% had checked their HB surface antibody (anti-HBs) level.
Older surgeons never used double gloves (P = 0.001). Study concluded that Iranian
surgeons were not aware of the correct percentage of infected patients with and
seroconversion rate of blood-borne diseases, do not use double gloves adequately, do
not report their needle stick injuries, vaccinate against HB, and check anti-HBs after
vaccination. Educational meetings, pamphlets, and facilities must be provided to
health care workers, informing them of hazards, prevention, and post exposure
prophylaxis to needle stick injuries, vaccination efficacy, and wearing double
gloves.20
A descriptive cross-sectional study was conducted on awareness on prevention
of blood borne diseases and preventive practices among dental practitioners in and
around Dhanmondi area of Dhaka City. With a sample size of 200 dentists, only 20%
of the dental practitioner told that the diseases spread through saliva. 20% had the
practice of taking the history of blood transfusion and only 16% of past surgical
interventions in the past. 88% had the practice of taking the history of whether the
patient had suffered from hepatitis B or C infection. 74% said they wore gloves and
mask during all kinds of treatment procedures but 40 % does not practice autoclave of
instruments regularly. 76% dispose the used needles and other sharp wastes along
13
with the other waste materials in one same container. Study concluded that the
dentists are aware of the threat of spread of blood borne diseases among the dental
practitioner but they do not avail all the necessary steps needed for prevention of
transmission of blood borne diseases from the patients.21
A study was conducted in Hong Kong, China. To assess the knowledge on
hepatitis B virus (HBV) infection and associated factors among expectant mothers in
an endemic region. A questionnaire was administered to pregnant Chinese women
(n=1623) attending the antenatal clinic to examine their knowledge on HBV infection.
47.1% did not know that HBV is transmissible by sexual intercourse. Over 75%
respondents misunderstood the fact that HBV cannot be transmitted through food, or
prevented by a balanced life style and nutrition. Study concluded that Misconceptions
about HBV transmission are still common among the obstetric population, and the
provision of appropriate and correct information is warranted to improve further the
control of HBV infection to the target group.22
A cross-sectional survey was conducted in U.S to assess the knowledge of
dental school student about the transmission of blood borne pathogens and
management. Overall, 220 students (72.1 percent) responded to the survey, and 215
(70.5 percent) answered questions about exposures. The prevalence of BBPE was
19.1 percent and was greater among clinical than preclinical students (p<0.01).
Percutaneous injuries occurred in 87.5 patients with HIV. All students answered more
survey questions correctly about transmission of blood borne pathogens (66.7 percent)
than about post-exposure management (25.0 percent). Fewer than half reported
adequate knowledge of transmission and management (47.5 percent and 37.3 percent,
respectively). In this context, 8.2 percent of the respondents acknowledged an
unwillingness to perform procedures on report incidents and delays in appropriate
14
exposure management and some negative attitudes towards treating individuals with
HIV persist, these findings justify improving Blood Borne Pathogens education at
U.S. dental schools.23
A study was conducted on knowledge attitude and practices concerning
hepatitis B among secondary school children in Alexandria. The aim of the study was
to assess secondary school students level of knowledge about hepatitis B and to
record their perception attitude and practices towards it. The sample includes 643
students of both sexes representing different senior level of education. Technique used
was self administered questionnaire. The results revealed 55.2% of students sample
had fair level of education about hepatitis B. Girls have more negative attitude
towards hepatitis B than boys. 50.4% were not vaccinated towards against disease.
Study recommended integrating knowledge about hepatitis B within formal and
informal school programs. Community campaigns for vaccinating the adolescents
against the disease should be carried out.24
A study was conducted on knowledge beliefs and behaviors’ regarding
hepatitis B among adolescents in Okemos, Michigan. Three types of data were
collected Questionnaires completed by 17,063 adolescents and young adults. Results
shown that Adolescents and young adults know very little about vaccinations in
general or hepatitis B in particular. Adolescents exhibit low levels of perceived
susceptibility severity response efficacy and self-efficacy toward hepatitis B and the
hepatitis B vaccine. On average these adolescents engage in 2.36 high-risk behaviors’
(the most frequent of which include sexual activity, body piercing, and tattooing).
Study recommended that there is a clear need for additional educational efforts
regarding both vaccinations in general and hepatitis B in particular. Though
15
adolescents are engaging in a variety of high-risk behaviors’ and many are not taking
the necessary precautions to protect themselves because of lack of knowledge.25
A study was conducted on Hepatitis B and liver cancer knowledge and
preventive practices among Asian Americans in the San Francisco Bay Area,
California. Knowledge questionnaire was administered regarding Hepatitis B virus
transmission, prevention, symptoms, and risks to 199 adults in the Asian-American
community. Fewer than 60% reported having been tested for Hepatitis B virus. Only
31% reported having been vaccinated against Hepatitis B virus and only 44% reported
having had their children vaccinated. Study concluded that Hepatitis B virus and liver
cancer knowledge among Asian Americans especially Chinese Americans is poor and
that better knowledge is associated with increased preventive practices. Asians
especially those born in China or Southeast Asia had significantly poorer knowledge
regarding Hepatitis B virus and liver cancer than non-Asians. Thus, there is a need for
increased Hepatitis B virus education and improved community-based interventions
to prevent Hepatitis B virus related liver disease in the high-risk Asian-American
community.26
A community based study was conducted on Hepatitis B knowledge and
practices among Chinese American women in Seattle, Washington. Less than half
(46%) of the respondents knew that Hepatitis B virus could cause liver cancer. Only
35% reported that they had been serologically tested for Hepatitis B virus, and most
of those who knew they were susceptible (61%) had not been vaccinated. The study
concluded that low levels of Hepatitis B virus knowledge screening and vaccination
among Chinese immigrants. Targeted interventions are needed to reduce the burden of
Hepatitis B virus infection and liver cancer in this community.27
16
A study was conducted on Hepatitis B knowledge and practices among
Cambodian American women in Seattle, Washington. Survey of Cambodian women
(n = 320) knowledge questionnaire was administered about Hepatitis B virus. only
about one-half (56 percent) of our respondents had heard of Hepatitis B virus
infection. Less than one-quarter (23 percent) of the study group thought that
asymptomatic individuals can transmit the disease to others. Most thought that
Hepatitis B virus infection can cause liver cancer (54 percent) and death (72 percent).
However a minority thought that infection can be lifelong (24 percent) and incurable
(15 percent). Only 38 percent reported they had been serologically tested for Hepatitis
B virus. Study concluded that Cambodian immigrants have low levels of Hepatitis B
virus knowledge, serologic testing, and vaccination, and demonstrate a need for
targeted educational interventions aimed at reducing Hepatitis B virus related liver
cancer mortality among Southeast Asian communities.28
A Community-based study was conducted on Hepatitis B knowledge and
practices among Chinese immigrants to the United States. Study sample included 395
individuals. Results shown that less than one-half (48%) had received a hepatitis B
blood test and about one-third (31%) indicated had been vaccinated against hepatitis
B. The proportions of respondents who knew Hepatitis B virus can be spread during
childbirth, during sexual intercourse, and by sharing razors were 70%, 54%, and 55%,
respectively. Less than one-quarter of the study group knew that Hepatitis B virus
cannot be spread by eating food that was prepared by an infected person (23%) and by
sharing eating utensils with an infected person (16%). Recommendation given for
continued efforts should be made to develop and implement hepatitis B educational
campaigns for Chinese immigrant communities.29
17
A study was conducted among medical students of a Medical College in Delhi
to assess their knowledge regarding Hepatitis B. A questionnaire was administered to
the first, third and final year medical students regarding Hepatitis B vaccine, disease,
and mode of spread, sequel and prevention. Study concluded that knowledge
regarding all aspects was maximum amongst the final year students as compared to
first and third years. Knowledge regarding the booster dose of vaccine, transmission
through for mites, universal precautions for prevention was not good. There is need
for strengthening in these areas and training in these should be started at the earliest.30
A cross-sectional study was conducted in rural north India on occupational
exposure to blood and risk of blood borne viruses Infection among health care
workers total of 266 HCWs returned questionnaires (response rate, 87%). Sixty-three
percent reported at least 1 percutaneous injury (PI) in the last year (mean no. = 2.3)
and 73% over their working lifetime (mean no. = 4.2). Predictors of PI during the last
year were hospital site, job category, perception of risk, and compliance with
Universal Precautions. Study concluded that high level of occupational exposure to
blood found among this group of rural north Indian HCWs highlights the urgent need
for interventions to enhance their occupational safety to prevent unnecessary
nosocomial transmission of Blood Borne Viruses. 31
A study was conducted in Tamilnadu, India. to determine the prevalence of
Hepatitis B virus infection in a southern State of India, Tamilnadu and to describe the
important factors related to transmission of the virus in the community.1981 subjects
were screened in the study. HBsAg prevalence was 5.7 per cent (CI 4.6- 6.8) with
23.5 per cent (25/106) of these having positive HBe-antigen. Community
seroprevalence (HbsAg + anti-HBs) of hepatitis B infection was 27.4 per cent (CI:
25.3-29.5) with the highest prevalence of 32.7 per cent (CI: 30.2-35.2) noted in the
18
15-20 yr age group. This community based study shown that high prevalence of
hepatitis B infection in the state of Tamilnadu with the highest prevalence being in the
younger (15-20 yr) age group. High prevalence rate in childhood with e-antigenemia
seen in 23.5 per cent of HBsAg positive subjects suggest childhood transmission.
Poor injection practices and high-risk sexual behaviour were found to be additional
risk factors for transmission of the disease in the community.32
A study was conducted on Community-based epidemiology of hepatitis B
virus infection in West Bengal, India: prevalence of hepatitis B e antigen-negative
infection and associated viral variants. The present study was planned to outline the
magnitude and pattern of Hepatitis B virus infection, hepatitis B e antigen infection
and the associated viral mutants in India. 7653 people included in the study, 227
(2.97%) tested positive for hepatitis B surface antigen of whom 204 (90%) were
HBeAg-negative and hepatitis B e antibody positive, and 78% had normal alanine
aminotransferase (ALT) levels. HBV-DNA could be detected by PCR in only 32% of
people. (70%) of the HBeAg-negative infections were associated with wild type
sequences in these regions. This first general population-based epidemiological study
of Hepatitis B infection from India suggests that Hepatitis B acquisition starts in early
childhood and peaks in adulthood. 33
A cross sectional study was conducted in civil hospital Ahmadabad Gujarat.
To assess the knowledge, attitude and practice [KAP] of Hepatitis B among the
laboratory technician. Total 60 laboratory technicians from different departments
were enrolled. A pre-tested questionnaire was used to collect information. Result
shown that More than half of laboratory technicians (66.7%) know that hepatitis B is
an infectious disease and 88.3% believe that it is spread by infected blood. 96.7%
know that it affects the liver. 86.7% were wearing gloves and taking precaution while
19
handling the sample.13.3% were exposed to infectious material during their job. Only
35% were fully immunized. Study concluded that Majority of laboratory technician
know that hepatitis B is infectious and preventable but knowledge about the disease
and protective measures are still needed in laboratory technicians.34
A study was conducted in Bangalore Karnataka Every 1,000 blood samples
tested at the Individual Donor-Nucleic Acid Testing (ID-NAT) blood bank at
Bowring and Lady Curzon Hospital here, the detection of HBV cases was more than
that of HIV. HBV, known as a “silent killer”, is more infectious than HIV. Statistics
[2013]: According to Technical director of the laboratory, the detection of HBV was
the highest in March when 134 cases of the total 9,000 samples tested were found to
be positive. In comparison, only two cases were found to be HIV positive. Of the
12,000 samples in January, 54 tested positive for HBV and four for HIV. In February,
of 8,500 samples, 58 were found to be HBV positive. The number of HBV positive
cases raise to 134 in March and came down to 95 in April and 91 in May when 8,000
and 8,500 samples were tested respectively. The cases reduced to 54 in June when
10,000 samples were tested, and again raise to 87 from10,000 samples.35
20
6.4 STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of self instructional module on knowledge
regarding prevention of blood borne infections among laboratory technicians in
selected laboratories at Tumkur”
6.5 OBJECTIVES OF THE STUDY
 To assess the knowledge regarding prevention of blood borne infections
among laboratory technicians.
 To assess the effectiveness of self instructional module on knowledge
regarding prevention of blood borne infections among laboratory technicians.
 To find out an association between the level of knowledge with the selected
demographic variables.
6.6 OPERATIONAL DEFINITION
 Effectiveness: In this study it refers to the extent to which the self
instructional module on knowledge regarding prevention of blood borne
infections among laboratory technicians achieved its objective in improving
knowledge in laboratory technicians.
 Self Instructional Module: In this study it refers to a booklet prepared by the
investigator which contains information regarding blood borne infections and
its prevention according to standard protocol.
 Knowledge: In this study, the knowledge refers to the correct responses given
by the laboratory technicians regarding blood borne infections and its
prevention as it is elicited through self administered knowledge questionnaire.
 Blood borne infections: In this study it refers to Hepatitis-B infection only.
21
 Laboratory Technicians: In this study Laboratory Technicians refers to both
Male and Female having Diploma, Degree or Master Degree in Lab
Technician course and working in selected diagnostic laboratories at Tumkur.
6.7 ASSUMPTIONS
1. Laboratory technicians may have limited knowledge regarding blood borne
infections and its prevention.
2. Self instructional Module is one of the best teaching strategies in imparting
knowledge regarding prevention of blood borne infections.
6.8 HYPOTHESIS
H1: There will a be significant difference between pre test and post test
knowledge scores.
H2: There will a be significant association between the level of knowledge with
their selected demographic variables.
6.9 VARIABLES
Independent variable - Self instructional module.
Dependent variable - Knowledge scores.
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA
Informations provided by Laboratory Technicians regarding blood borne
Infections.
7.2 METHOD OF DATA COLLECTION
7.2.1 Research design
Pre experimental one group pre-test, post test design will be used.
22
7.2.2 Setting of the study
Both private and government Diagnostic Laboratories at Tumkur.
7.2.3 Population
Lab Technicians, both Male and Female who are working in diagnostic
Laboratories at Tumkur.
7.2.4 Sample
Lab Technicians, both Male and Female who are working in selected diagnostic
Laboratories at Tumkur.
7.2.5 Sampling technique
Non probability convenient sampling technique will be used.
7.2.6 Sample size
It consists of 6O Laboratory technicians.
7.2.7 Sampling Criteria
a) Inclusion criteria
1. Laboratory Technicians who are working in both private and government
selected laboratories, at Tumkur.
2. Laboratory Technicians who are willing to participate in the study.
b) Exclusion criteria
1. Laboratory Technicians who are not available at the time of data collection.
7.2.8 Tool for data collection
Data will be collected by using self administered knowledge questionnaire.
Section A - Demographic data such as Age, Sex, Educational Status, Experience
and Protective Devices use.
Section B - Self administered Knowledge questionnaire regarding Prevention of
blood borne infections.
23
7.2.9 Method of data collection
The data will be collected from laboratory technicians of both private and
government laboratories by using Self Administered Knowledge questionnaire after
obtaining permission from the concerned authority. On the day first, pre test will be
given to the Lab technicians, on the same day Self instructional module will be given.
After one week the post test will be given to same Lab technicians to evaluate the
effectiveness of self instructional module.
7.3. Data analysis and interpretation
1. Descriptive statistics
Descriptive statistical techniques such as frequency, percentage, Mean, Median,
Mean deviation,
2. Inferential statistics

Chi-square test: will be used to find out an association between the level of
knowledge with their selected demographic variables.

Paired‘t’ test: will be used to compare difference between pre test and post test
knowledge scores.
7.4 ETHICAL CLEARANCE
7.4.1 Does the study require any investigation or intervention to be conducted on
Samples?
Yes, Self instructional module will be given to both Male and Female
laboratory technicians regarding prevention of blood borne infections.
24
7.4.2 Has ethical clearance has been obtained from your institution in case of
7.4.1?
YES, Ethical clearance will be obtained from the concerned authority.
25
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9.0
10.
Signature of the candidate
Remarks of the guide
Name and designation of
(In block letters)
11.1 Guide
11.
11.2 Signature
11.3 Head of the
department
11.4 Signature
12.1 Remarks of the
principal
12.
12.2 Signature
31
32