The Kenyan government is working to reduce health workers’ risk of HIV infection but experts say there is need for greater focus on providing them with proper safety equipment and education.
According to government statistics, an estimated 2.5 per cent of new HIV infections annually are health-facility related.
Poor medical waste disposal, needle stick injuries and unsafe blood transfusion are some of the factors that put medical workers at risk.
While most government health facilities adhere to safety guidelines, private practitioners in poor areas may not be so strict, and patients themselves may not be knowledgeable enough to question unsafe practices.
“In poor or rural set-ups, health workers often provide injections at home (but) do not have access to either PEP (post-exposure prophylaxis — a short course on antiretrovirals to prevent HIV infection after potential exposure to the virus), or proper medical waste disposal facilities,” said Andrew Suleh, medical superintendent at Mbagathi District Hospital in Nairobi.
Leonida Murunga, a self-employed community health worker in Nairobi’s Gomongo slum, said she frequently gives patients injections in their homes and assists in home births, but rarely has all the proper safety equipment.
“When I inject somebody, I just carry the needle and syringe in my bag and dispose of them in the latrine where I stay; I don’t have gloves because I can’t afford them... it is dangerous because I even don’t know the HIV status of many of my patients,” she told IRIN.
According to the World Health Organisation, nearly 10 per cent of the world’s 35 million health workers are exposed to blood-borne diseases every year; 90 per cent of the resulting infections occur in the developing world.
The Kenyan government has sought to reduce the risk of HIV infection in health facilities, improving the availability of PEP, medical waste disposal and gloves in government hospitals and clinics.
The US government has also partnered with the government in improving general blood safety and the blood collection skills of the workers.
Mr Suleh said that in addition to ensuring proper provision of safety equipment and PEP, there was a need for health workers to receive regular re-education on safety measures.
“Having these measures is one thing but adhering to them is another; (many) injuries that occur in healthcare settings... are out of carelessness,” he said.
However, Viviane Mutai, a nurse at Kenyatta National Hospital said despite knowledge of safety standards, occasional medical injuries were inevitable.
“We take care as health workers and even though the government has made strides in improving the safety conditions for health workers, people still prick themselves with needles and this causes a lot of fear among health workers,” she said.
About one year ago a paediatric nurse at Pumwani Hospital, a government maternal hospital in Nairobi, accidentally pricked herself with a needle while treating an HIV-positive child.
“I was trying to put the cap on the needle after the injection and I pricked my finger. I was afraid because I knew the HIV status of both the child and the mother,” she told IRIN/PlusNews.
“Even though I was given PEP I am still afraid and I am not that confident as before when handling children who are living with HIV... I went for HIV tests for the following six months just to be sure.”
Ms Mutai said additional counselling was necessary to ensure that health workers did not stigmatise patients known to be HIV-positive.
“The fear of accidentally coming into contact with such a patient’s blood does cause fear, which then leads to stigma, which at times might affect the way you handle such people,” she noted.
Recently, PEPFAR (The US President’s Emergency Plan for AIDS Relief), Beckton and Dicknson together with the National Aids and STI Control programme (NASCOP) rolled out an initiative dubbed safer blood collection that was aimed at promoting safe blood drawing practices.
Safe blood drawing
The initiative, launched earlier this year, aims at training as many medical personnel as possible on safe blood drawing methods in a bid to reduce instances of disease transmission to health workers through unsafe blood drawing.
“The initiative aims at training medical personnel especially those who are involved in drawing blood from patients on the best ways of using the existing technology without the risk of disease transmission at the same time promoting the use of safer blood collection technology,” said Rachael Kamau, head of prevention of HIV in healthcare settings at NASCOP.
Laboratory technologists and other medical personnel involved in drawing blood risk contracting HIV and Hepatitis among other diseases. However, Kenyan health analysts say the risk of transmission of HIV through needle pricks is estimated at 0.1 per cent, compared to the risk of contracting Hepatitis B which is between 10 to 30 per cent.