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OJHAS Vol. 8, Issue 4: (2009
Oct-Dec) |
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| Impact of Educational Intervention Measures on Knowledge regarding HIV/ Occupational
Exposure and Post Exposure
Prophylaxis among Final Year Nursing Students of
a Tertiary Care Hospital in Central India |
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Sanjay Dixit, Professor & Head, Dept. of Community Medicine,
Khatri AK, Assistant Professor,
Dept. of Community Medicine,
Gunjan Taneja, Post-graduate student,
Dept. of Community Medicine,
Satish Saroshe, Post-graduate student,
Dept. of Community Medicine,
Siddharth Singh Baghel Final Year MBBS Student
Shruti Jaiswal, Final Year MBBS Student
Sona Soni, Final Year MBBS Student
Sunil Singh Sengar, Final Year MBBS Student
MGM Medical College, Indore, Madhya Pradesh, India |
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Address For Correspondence |
Professor & Head, Dept. of Community Medicine,
MGM Medical College, Indore,
Madhya Pradesh, India
E-mail:
communitymedicineindore@gmail.com |
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Dixit S, Khatri AK, Taneja G, Saroshe S, Baghel SS, Jaiswal S, Soni
S, Sengar SS. Impact of Educational Intervention Measures on Knowledge regarding HIV/ Occupational
Exposure and Post Exposure
Prophylaxis among Final Year Nursing Students of
a Tertiary Care Hospital in Central India. Online J Health Allied Scs.
2009;8(4):6 |
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Submitted: Oct 2, 2009; Accepted:
Nov 18, 2009; Published: Apr 30, 2010 |
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| Abstract: |
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Amongst the
different Health Care Personnel nurses are at a greater risk of being
accidentally exposed to HIV and other Blood Borne Pathogens. The present
study was conducted among 50 final year nursing students of a Medical
College Hospital to assess the knowledge regarding HIV, occupational
exposure and Post Exposure Prophylaxis (PEP) among the students and
analyses the impact of educational intervention measures on the issues
amongst the study subjects. A Pre-designed and Pre-tested
semi-structured
questionnaire was used to evaluate the level of knowledge before and
after educational intervention sessions. Knowledge regarding risk of
transmission of HIV by needle-stick injury and body fluids against which
universal precautions were mandatory increased by 72% following the
intervention sessions (χ2
= 53.202, p <0.001). 72% and 36% respondents correctly knew the
duration
within which to start PEP and the drugs available for PEP, post
educational
sessions 98% and 96% students were aware of it: the difference being
statistically significant (χ2
= 11.294, p <0.001) and (χ2
= 37.748, p <0.001) respectively. The mean pre-intervention score
was 8.32; mean post-intervention score was 14.40: statistical analysis
showed the results to be significant (t= 13.857, p< 0.001). The study
reflects that there is a dearth of knowledge among the study group.
Incorporating the concerned issues in the academic curriculum to provide
the students with adequate knowledge and information during their
formative
years is needed.
Key Words: Nurses,
Occupational
exposure, Post Exposure Prophylaxis
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Occupational
exposure to Blood or other body fluids presents a small but definite
risk of transmission of Human Immunodeficiency Virus (HIV) and other
Blood Borne Pathogens.(1,2) Worldwide the first case of documented seroconversion after a specific occupational exposure to HIV was
reported
in 1984 (3) and an approximate number of one thousand cases occur each
year due to accidental exposure.(4) Among various groups of Health
Care Personnel (HCP), nurses have a greater risk of being exposed to
needle stick and other occupational injuries. Drexler, H
et al in a study reported that approximately
half of nursing students have experienced an exposure to Blood and Body
fluids during the final two years of study.(5) The present study
assesses
the knowledge regarding HIV, occupational exposure and Post Exposure
Prophylaxis (PEP) among nursing students and analyses the impact of
educational intervention measures on the issues amongst the study
subjects.
The study was
conducted among final year BSc. nursing students of Maharaja Yaswantrao
Hospital, Indore which is the biggest public health care setting in
the state of Madhya Pradesh, India and is attached to MGM Medical
College
Indore. Permission was obtained from the Superintendant of the Hospital
and the Principal of the Nursing College before initiation of the study.
The entire class of 50 students provided consent to participate in the
study; which was conducted over a period of three months (October –
December 2008). Pre-designed and Pre-tested Semi-structured
questionnaire
was used to evaluate the existing level of knowledge on HIV,
Occupational
Exposure and PEP among the study participants. Following the initial
assessment an Educational Intervention Programme was conducted among
the students using posters, pamphlets, Audio-visual aids and group
discussions
by four Undergraduate students of the Department of Community Medicine,
MGM Medical College, Indore. The intervention sessions focused on HIV
epidemiology, risk factors, routes of transmission, chances of
occupational
exposure, factors associated with exposure, the exposure codes, the
protocol for PEP and adequate and timely use of PEP .
Post-interventional
assessment was performed among the study participants using the same
questionnaire one month after the educational session. A total of 19
questions were included in the questionnaire: each question carried
one mark with no negative marking. Pre and post intervention scores
were analyzed using SPSS version 17 and appropriate statistical tests
applied to detect improvement in the level of knowledge (if any).
All the
participants
were female, in the age group of 19-20 years. Everyone in the study
group was aware that HIV is a virus. The participants were asked to
expand some commonly used abbreviations like HIV, AIDS (Acquired
Immunodeficiency
Syndrome), ART (Anti Retroviral Therapy), Prevention of Parent to Child
Transmission (PPTCT), O.I (Opportunistic Infection) and PEP. The
increase
in awareness for HIV following educational intervention was 24%, which
was statistically significant (χ2
= 6.25, p = 0.012), for O.I the awareness level increased by 64% (χ2
= 44.71, p <0.001) and a 28% increase was observed for PEP (χ2
= 9.265, p = 0.003). 90% of the participants knew of the routes of
transmission
of HIV, 56% about the most common route of transmission while 14% (7)
were aware of the route with the maximum risk of transmission, post
intervention this increased to 70% (35 students became aware)
(χ2 = 32.184, p <0.001). 12% participants had information
of at least three O.I occurring in AIDS patients during the
pre-intervention
assessment, post intervention a 64% increased awareness was noted (χ2
= 41.558, p <0.001). 60% of the study subjects became aware about
the window period for HIV post educational sessions (χ2
= 36.232, p <0.001). 32 (64%) respondents knew that occupational
injury with damage to skin carried the greatest risk of transmission
of the virus; following the intervention 42 (84%) were aware of the
fact (χ2 = 4.21, p = 0.04). In the pre intervention analysis
23 students reported that amount of blood loss following exposure, viral
load of the patient and use of PEP affected the chances of getting
infected
following exposure, post intervention 27 responded correctly. Knowledge
regarding risk of transmission of HIV by needle-stick injury and body
fluids against which universal precautions were mandatory increased
by 72% following the intervention sessions (χ2
= 53.202, p <0.001). 17 (34%) and 32 (64%) students had information
about body fluids against which universal precautions were not necessary
prior to and following the intervention sessions (χ2
= 9.004, p = 0.003). Pre intervention 36 (72%) respondents correctly
knew the duration within which to start PEP and 18 (36%) knew about
the drugs available for PEP, post educational sessions 49 (98%) and
48 (96%) students had correct information on the two issues. The
difference
was statistically significant (χ2
= 11.294, p <0.001) and (χ2
= 37.748, p <0.001) respectively.(Table1)
Table 1:
Analysis
of study results before and after educational intervention (n=50)
|
Study variable |
Pre-intervention correct
response |
Post – intervention correct
response |
Increased awareness |
p value |
| Full form of HIV |
12 |
24 |
24% |
0.012 |
| Full form of AIDS |
44 |
48 |
08% |
0.269 |
| Full form of ART |
15 |
23 |
16% |
0.099 |
| Full form of PPTCT |
00 |
03 |
06% |
0.241 |
| Full form of O.I. |
02 |
34 |
64% |
<0.001 |
| Full form of PEP |
31 |
45 |
28% |
0.002 |
| Routes of transmission |
45 |
48 |
06% |
0.433 |
| Most common route of
transmission |
28 |
36 |
16% |
0.145 |
| Route of transmission with
maximum possible risk |
07 |
35 |
56% |
<0.001 |
| O.I occurring in AIDS (at
least three) |
06 |
38 |
64% |
<0.001 |
| Window period in HIV |
12 |
42 |
60% |
<0.001 |
| Maximum risk of HIV
transmission
following occupational exposure |
32 |
42 |
10% |
0.04 |
| Factors determining risk of
HIV transmission following occupational exposure |
23 |
27 |
08% |
0.549 |
| Risk of HIV transmission
following
needle stick injury |
03 |
39 |
72% |
<0.001 |
| Body fluids against which
Universal Precaution is mandatory |
03 |
39 |
72% |
<0.001 |
| Body fluids against which
Universal Precaution is not mandatory |
17 |
32 |
50% |
0.003 |
| Duration within which PEP
is to be started |
36 |
49 |
26% |
<0.001 |
| Drugs available for PEP |
18 |
48 |
60% |
<0.001 |
The mean
pre-intervention
score was 8.32 (S.D= 2.65, Range= 12) while the mean post
intervention score was 14.40 (S.D= 2.52, Range= 10), a 73% increase
in the mean scoring. Paired t test was applied to the mean scores pre
and post intervention and the difference was found to be statistically
significant (t= 13.857, p< 0.001).
The study
results
clearly show a lack of proper information and knowledge on the concerned
issues among the study participants. A study by Avachat S et al (6)
conducted among nursing students reported that only 44% of the students
were aware of infectious body fluids, 37% had no information on the
factors affecting the chances of getting infected and just 2% of the
third year students correctly knew the duration of PEP. A study at AIIMS
conducted among doctors of private hospitals stated that 62.8% of the
participants were unaware of PEP measures to be undertaken following
occupational exposure.(7) Imran Ahmed et al in their study among
pharmacy
students revealed that almost 80% of the participating students were
unaware of the use of PEP following accidental occupational exposure
and only 18.5% had awareness regarding O.I.(8) The above findings from
across the health care fraternity imply immediate formulation of
policies
wherein HCP are imparted adequate training regarding PEP and
occupational
exposure, with special emphasis on hands on training to the health
workers.
Incorporating these particular issues in the academic curriculum of
the medical, nursing and pharmacy students is important so that they
imbibe adequate and proper knowledge during their formative years. To
ensure easy accessibility to proper information charts and posters
depicting
the PEP guidelines should be hung in every ward, Out Patient
Departments,
Operation Theatres and nursing stations in both public and private
hospitals;
also guidelines should be framed wherein early and essential reporting
of accidental occupational exposures amongst staff in health care
settings
is made mandatory so that appropriate measures can be undertaken at
the earliest.
The authors
would like to thank the Superintendant Maharaja Yashwantrao Hospital,
Principal Nursing College for granting permission for the study and
all the nursing students for participating in the study.
- Updated U.S. Public
Health Service Guidelines for the Management of Occupational Exposures
to HBV, HCV, and HIV and Recommendations for Post exposure Prophylaxis
MMWR Recomm Rep. 2001;50(RR-11):1-52.
- Sagoe-Moses
C, Pearson RD, Perry J, Jagger J. Risks to health care workers in
developing
countries. N Engl J Med 2001;345(7):538-541.
- Anon. Needlestick
transmission of HTLV III from a patient infected in Africa. Lancet
1984;2:1376-1377.
- Pruss-Ustun A, Rapiti
E, Hutin Y. Estimation of the global burden of disease attributable
to contaminated sharps injuries among health-care workers.
Am J Ind Med 2005, 48(6):482-490.
- Drexler H, Schmid
K, Schwager C. Needlestick injuries and other occupations exposures to body
fluids amongst employees and medical students of a German university:
Incidence and follow-up. Journal of Hospital Infection.
2007;67:124-130.
- Avachat S, Phalke
DB, Dhumale GB. Awareness regarding pre- and postexposure prophylaxis
for human immunodeficiency virus/acquired immunodeficiency syndrome
among nursing students. Indian J Community Med [serial online] 2007
[cited 2007 Nov 30];32:159. Available from: http://www.ijcm.org.in/text.asp?2007/32/2/159/35671.
Accessed on 17/09/09.
- Wig N. HIV: awareness
of management of occupational exposure in health care workers. Indian
J Med Sci [serial online] 2003;57:192-8. Available from: http://www.indianjmedsci.org/text.asp?2003/57/5/192/11910. Accessed on 17/09/09.
- Ahmed IS,
Hassali AM, Aziz AN. An Assessment of the Knowledge, Attitudes, and
Risk Perceptions of Pharmacy Students Regarding HIV/AIDS. Am J Pharm
Educ. 2009 February 19;73(1):15. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2690879. Accessed on 17/09/09.
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