Compliance with Universal/Standard Precautions among health care workers in rural north India.

BACKGROUND: Universal Precautions (UPs) and more recently Standard Precautions have been widely promoted in high-income countries to protect health care workers (HCWs) from occupational exposure to blood and the consequent risk of infection with bloodborne pathogens. In low-income countries, the situation is very different: UPs are often practiced partially, if at all, thereby exposing the HCWs to unnecessary risk of infection. The aim of this study is to describe rural north Indian HCWs knowledge and understanding of UPs and identify predictors of compliance to target intervention programs appropriately. METHODS: A cross-sectional survey was undertaken, involving 266 HCWs (response rate, 87%) from 7 rural north Indian health care settings. Information was gathered regarding compliance with UPs and a range of other relevant variables that potentially influence compliance (eg, demographic information, perception of risk, knowledge of bloodborne pathogen transmission, perception of safety climate, and barriers to safe practice). RESULTS: Knowledge and understanding of UPs were partial, and UPs compliance was suboptimal, eg, only 32% wore eye protection when indicated, and 40% recapped needles at least sometimes. After controlling for confounding, compliance with UPs was associated with being in the job for a longer period, knowledge of bloodborne pathogen transmission, perceiving fewer barriers to safe practice and a strong commitment to workplace safety climate. CONCLUSION: Interventions to improve UPs compliance among HCWs in rural north India need to address not only their knowledge and understanding but also the safety climate created by the organizations that employ them.

HIV-related knowledge, attitudes and risk perception amongst nurses, doctors and other healthcare workers in rural India.

BACKGROUND AND OBJECTIVE: People with HIV in India frequently encounter discrimination while seeking and receiving healthcare services. The knowledge and attitudes of healthcare workers (HCWs) influences the willingness and ability of people with HIV to access care, and the quality of the care they receive. Previous studies of HIV-related knowledge and attitudes amongst Indian HCWs have been conducted primarily in large urban hospitals. The objective of this study was to asses HIV-related knowledge, attitudes and risk perception among a group of rural north Indian HCWs, and to identify predictors of willingness to provide care for patients with HIV infection. METHODS: A cross-sectional survey of 266 HCWs (78% female) from seven rural north Indian health settings was undertaken in late 2002. A self-administered written questionnaire was made available in English and Hindi, and the response rate was 87 per cent. Information was gathered regarding demographic details (age, sex, duration of employment, job category); HIV-related knowledge and attitudes; risk perception; and previous experience caring for HIV-positive patients. Logistic regression modelling was undertaken to identify factors associated with willingness to care for patients with HIV. RESULTS: The HCWs in this study generally had a positive attitude to caring for people with HIV. However, this was tempered by substantial concerns about providing care, and the risk of occupational infection with HIV was perceived by most HCWs to be high. After controlling for confounding, HCWs willingness to provide care for patients with HIV was strongly associated with having previously cared for patients with HIV (P = 0.001). Knowledge of HIV transmission and perception of risk were not associated with willingness to provide care. INTERPRETATION AND CONCLUSION: The findings of this study showed a general willingness of HCWs to provide care for patients with HIV, tempered by concerns regarding provision of such care. Strategies to address HCWs concerns are likely to ameliorate the discrimination experienced by people with HIV when accessing healthcare services. These include the development of programmes to promote occupational safety of HCWs and involving people with HIV in awareness training of HCWs.

Safer injections, fewer infections: injection safety in rural north India.

BACKGROUND: Unsafe injection practices result in a substantial burden of preventable blood-borne viral disease (BBV). The reasons are complex and include structural, economic and socio-cultural factors. OBJECTIVE: To describe injection-related practices in two rural north Indian health settings including the contextual factor, highlight some of the challenges facing those endeavouring to translate injection safety policies into safe injection practice, and to identify appropriate intervention strategies. METHOD: Qualitative data collection (participant observation and in-depth interviews) in two rural north Indian hospitals with affiliated community-based programmes over a 4-month period. A total of 130 h of observation took place in a range of clinical areas characterized by frequent use of needles and other sharps, and 40 healthcare workers were interviewed. Field notes and interview transcripts were thematically analysed. RESULTS: Managers in these health settings were clearly endeavouring to promote injection safety by implementing the widespread use of disposable needles and syringes and attempting to address the difficult issue of safe healthcare waste management. However, some unsafe practices were still occurring: reuse of syringes (with and without sterilization) was relatively common, and use of multi-dose vials, blood sampling, sterilization and disinfection, and healthcare waste management were sub-optimal in some instances, placing both staff and patients at unnecessary risk of BBV infection. CONCLUSION: Strategies for promoting injection safety are necessary if the risk of nosocomial transmission of BBV diseases via unsafe injection practices in rural north India is to be minimized.