Assessment of vaccination status and other preventive practices among health care workers, Hajj, 1428 H (2007 G).

Contact of health care workers (HCW) such as physicians, nurses, laboratory technicians and administrative staff with patients or infected material of patients, put them at risk of exposure and further transmission of infectious diseases, including vaccine preventable diseases like Hepatitis B, Influenza and Meningococcal Meningitis. Maintenance of safety of health care workers is an essential component of successful employee health program, which can safeguard the health workers and also protect patients from becoming infected through exposure to infected HCWs. A cross-sectional self-administered questionnaire based study was conducted among HCWs in Makkah during hajj season 1428 H, to assess their vaccination status against meningococcal disease, influenza, and hepatitis B; and to assess their knowledge and practices regarding standard protective measures against blood-borne and air-borne infections during their work. A stratified random cluster sampling technique was used to recruit the study sample.

Out of 641 HCWs, 67.9% were from 3 hospitals and 32.1% were from 13 primary health care centers (PHCCs). Ages ranged between 21 and 63 years (mean 36.3 ± standard deviation (SD) 9.9 years); 64.3% were male; and 50.9% were Saudis. Nurses constituted 44.0% of respondents, 39.3% were doctors and 16.7% were other paramedic and administrative staff; 76.0% were originally from Makkah region, and overall 55.0% were participating in hajj for the 4^th time or more.

Of the total, 91.4% had received meningococcal vaccine; among whom 74.7% had a valid meningococcal vaccine (i.e. received more than 10 days to less than 3 years ago) while 12.8% received vaccine more than 3 years ago and 12.5% received vaccine less than 10 days before they reached Makkah. Reasons given by the 92 HCWs who did not receive meningococcal vaccination during the last 3 years included non-availability of vaccine in their health facility (56.6%), not recommended by MoH (18.5%) and being busy (17.4%). Only 29.6% had received influenza vaccination within the previous 6 months. Reasons given for not getting the influenza vaccine included non-availability at their health facility (48.2%), not effective (19.6%), not recommended by MoH (11.3%) and no need (9.2%). As shown in table 1 valid meningococcal vaccination was statistically significantly higher among HCW from PHCCs compared to those from hospitals, and those working in outpatient departments as compared to inpatient departments. Influenza vaccination was significantly higher among females and non-Saudis. Most HCWs (66.8%) had received 3 doses of hepatitis B vaccine, 9.5% had received 2 doses, 7.6% had received 1 dose, and 16.1% had not received any.

Regarding various infection control measures, 70.5% had heard about universal precautions; of whom 48.2% had read about infection control policy from some book, 12.9% from some journal, and only 3.3% from the internet. Regarding training, 33.5% had attended a course on infection control within the previous year, 17.0% had attended a course in the previous 1-5 years, 4.5% had attended a course over 5 years ago, and 44.9% had never attended.

Table 2 demonstrates practices of HCW regarding infection control safety measures. Among those who ever sustained needle pricks during hajj duty (20.0%); only 26.2% were notified to health authorities, of which 70.6% had their blood tested for Hepatitis B, C and HIV.

− Reported by: Dr. Hanan Al Shaikh, Dr. Abdul Jamil Choudhry, Dr. Osamah Al-Hayani (Field Epidemiology Training Program).

Editor’s notes: Vaccination against diseases such as hepatitis B, Influenza and meningococcal meningitis, in addition to optimal personal hygienic practices, such as hand washing, use of protective barriers and safe handling of sharps can minimize the risk of infections associated with patient contact among HCWs .^{1, 2}

Meningococcal disease remains a major public concern and the epidemiology of the disease changes rapidly. Effective protection and control measures with vaccine for major serogroups are recommended to reduce the impact of the disease over the world.³ This study demonstrated that compliance of HCWs to meningococcal meningitis was only 74.7%, which is considered low, especially since the vaccine is freely available (although half of the HCWs who were not vaccinated claimed it to be unavailable at their health facilities), and strongly recommended by the MoH for workers in hajj. Regarding Influenza, vaccinating HCWs against influenza reduces nosocomial infection and worker absenteeism.^4,5 Influenza vaccine is one of the optional vaccinations recommended for hajj. Only a small proportion of HCWs had been vaccinated against influenza, and the main reason given was again non-availability of the vaccine. Both these findings indicate that there is some problem with availability of these vaccines, which need rectification by the authorities to improve the coverage.

Hepatitis B virus infection is a well-known risk for HCWs who perform tasks that require contact with blood, body fluids, and sharps, especially in countries where Hepatitis B is still endemic.^1,6 Although Hepatitis B vaccine is not a specific requirement for hajj, it is expected that all HCWs are vaccinated as a routine, however, the study findings do not conform with this expectation.

Adaptation of universal precautions is an important way to minimize or prevent accidental exposure of HCWs to pathogens.⁶ In this study, the worst practice was for hand washing. However, attending a course or reading on infection control significantly increased the knowledge and practices of HCWs, indicating the importance of education in improving the compliance of HCWs to infection control measures.

It can be concluded that vaccination of HCWs in hajj against meningococcal meningitis, influenza and hepatitis B is poor; moreover, their knowledge and practices regarding safety measures is suboptimal. Administrative actions, training activities and health education strategies should be implemented to improve the situation.

References:

1- Centers for Disease Control and Prevention. Immunization of health-care workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital infection control Practices Advisory Committee (HICPAC). MMWR. 1997;46:1-42

2- Sidhar MR, Boopathi S, Kabra SK. Standard precautions and post exposure prophylaxis for prevention infections. Indian J Pediatr. 2004; 71:617-27..

3- Memish ZA, Al Rajhi AA. Meningococcal disease. Saudi Med J. 2002; 23(3):259-264.

4- Madani TA, Ghabrah TM. Meningococcal, Influenza virus, and hepatitis B virus coverage level among health care workers in Hajj. BMC Infect dis. 2007; (7):80.

5- King WD, Woolhandler SJ, Brwon AF, Jiang L, Kevorkian K, Himmelstein DU, Bor DH. Influenza vaccination and health care workers in the United States. J Gen Intern Med. 2006;21(2):181-184.

6- Motamed N, Baba Mahmoodi F, Khalilian A, Peykaheirati M, Nozari M. Knowledge and practices of health care workers and medical students towards universal precautions in hospitals in Mazandran Province. East Mediterr Health J. 2006;12(5):653-61.

Table 1. Demographic determinants of meningococcal and influenza vaccination among Health Care workers, Hajj 1428 H.

Table 2: Practices of Health Care Workers regarding infection control safety measures, Hajj 1428 H