Occupational infections in healthcare workers

Occupations create many risks to the workers. Occupation related infections are a group of risks that burden workforce. By nature of their job, health care workers are at increased risk of occupational infections. Since health care workers are working closely with patients who are infected with different organisms, they are at increased risk of contact with infections. On the other hand, when health care workers are infected, they may continue to infect many patients that they may come into contact with. This turns on a vicious cycle of infections which may have huge economic and social costs.

It should be noted that health care workers comprise of the whole spectrum of categories ranging from the medical specialist to the sanitary labourer who are performing equally important roles as team players. It is often observed that the facilities available as well as emphasis made on adherence to safety measures by lowest strata of the health team are minimal.

Occupational infections can be transmitted from a patient to health care workers by different means. Droplet as well as air-born spread, spread through contact and spread through blood and body fluids are some of the means by which occupational infections may spread to the health care workers. Respiratory infections such as Severe Acute Respiratory Syndrome (SARS), H1N1 (Swine Flu) and H5N1(Avian Influenza) are some infections that created much interest and attention in the recent times. However, unnoticed respiratory infections continue to occur among health care workers.

Skin infections can spread from patients to health care workers through contact. Bacterial and fungal infections are common examples.

Blood and body fluids can come into contact with the health care workers through their day to day contacts with the patients. These infected substances may be transmitted to the health care worker through needle pricks, splashes and direct contact. HIV/AIDS, Hepatitis B and C are of greatest concern.

Though health care workers are at risk of this gamete of infections, there are methods to prevent them. Simple hygienic measures can prevent the occurrence of such infections. For example, hand washing is the most important strategy to prevent infections among health care workers as well as cross infections. However, in most hospitals of Sri Lanka, offering soap and a clean towel to the consultant after a ward round is a ritual performed by the ward sister; basic utensils needed for hand washing such as soap and clean towels are a luxury even in teaching hospitals of this country.

Safe disposal of needles and other sharps can prevent occupational infections. Wearing of protective equipment such as gloves, masks and gowns can prevent infections. Safe disposal of body fluids and soiled linen is an effective method to prevent occupational infections.

Immunization of health care workers can be an effective strategy to prevent occupational infections. For example, Hepatitis B vaccination can be given for health care workers. Typhoid and hepatitis A vaccinations can be given to health care workers who are working in high risk settings. Post exposure prophylaxis protocols are in place for needle prick injuries in view of HIV/AIDS. Veterinary surgeons that are at risk of Rabies can be given anti-Rabies vaccination as prophylaxis. Vaccination against H1N1 was a good example of use of vaccination to prevent occupational infections.

It is important to increase awareness among healthcare workers about the importance of prevention of occupational infections. However, knowledge alone is not enough. There is a need to inculcate good attitudes towards adherence to standard precautions. For example, during the threat of H1N1 epidemic in Sri Lanka, it was noted that many health care workers were requesting for H 95 masks, however, not much emphasis was given to simple and effective measures such as hand washing.

Disposal of hospital waste needs to be regularized with special emphasis on sharps and blood and body fluids. Simple measures such as proper disposal of used needles into sharps bins can prevent occupational infections. However, it is important that the sharps bins are of good quality and they are emptied when three fourth full.

Health institutions should establish programmes to control infections in their settings which should cover prevention of occupational infections among health care workers. Hospital infection control committees and infection control nurses can play a vital role in this regard. Surveillance of occupational infections among health care workers can be promoted through participation of health trade unions. Strategic measures need to be adopted to identify and minimize hazards in a proactive manner.

Prevention of occupational infections among health care workers is a must. The health administrators, policy makers and health care workers themselves are responsible for creating a culture of safety within their respective roles and responsibilities. Institutional policies, protocols and standards need to be improved. Importance of increasing awareness among health workers cannot be over emphasized. However, an attitudinal change is needed to promote occupational safety to prevent infections among health care workers.