How safe are health workers?

By Kenfrey Kiberenge

A patient assaulted a nurse at the Kenyatta National Hospital earlier this week, kicking off a discussion on the safety of health workers.

The incident is said to have occurred on Monday night at the orthopaedic ward after the patient was told to stop making noise.

But it is now emerging that medical staff are constantly exposed not just to physical abuse by patients, but also to the danger of contracting deadly diseases while carrying out their duties.

Health workers are prone to contracting various infections while carrying out their duties. Photo: File/Standard

The commonest, however, is needle sticks where nurses accidentally prick themselves with used needles. This exposes them to the risk of contracting HIV – the virus that causes Aids, hepatitis B virus (HBV) or hepatitis C virus (HCV), among other infections.

Pricked herself

Last year, IRIN/PlusNews reported how a paediatric nurse at Pumwani Hospital 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 the child and the mother," she told IRIN/PlusNews.

"Even though I was given post-exposure prophylaxis (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."

PEP is short-term antiretroviral treatment to reduce the likelihood of HIV infection after exposure, either occupationally or through sexual intercourse.

A similar story is told of how a nurse accidentally pricked herself with a needle she had just used to inject a HIV-positive patient at a Meru Missionary Hospital. The nurse was not as lucky as she later tested positive for the virus.

Another doctor contracted the virus when he handled an accident patient without gloves as he tried to save the patient’s life.

Mr Luke Kodambo, the chairman of the National Nurses Association of Kenya, says incidents of medical personnel contracting HIV and other diseases from their patients are widespread.

The World Health Organisation (WHO) reports that American health workers suffer between 800,000 and one million needle sticks annually, excluding the vast number that go unreported.

In the UK, about 100,000 such cases are reported annually. The WHO’s Nursing Matters fact sheet authored by Mireille Kingma, however, observes that needle sticks are virtually undocumented in developing countries, but probably equal or exceed those in the industrialised world.

Kenyan Government statistics show that about 2.5 per cent of new HIV infections annually are health-facility related.

"Needle prick is very common but the Kenyan nurses and doctors are not very keen to remember at what point they contracted a disease … that poses a serious health risk to medical staff," admitted Mr Kodambo.

But needle pricks are not the only risk workers in hospitals are exposed to.

During the typhoid outbreak that hit Embu municipality and its environs between February and April 2001, two medical officers and four nursing staff involved directly in patient care contracted the fever.

Contracted cholera

In May of same year, a hospital cleaner contracted cholera and died when there was an outbreak of the disease in Wajir.

And at a hospital in Nyeri, Kodambo says nurses were caught in crossfire of an incident involving a patient and members of an illegal gang who had trailed him to the hospital. But what concerns the nurses more is the increasingly high exposure to needle sticks and cuts from used scalpels and other sharp objects.

"More than 20 blood borne diseases can be transmitted as a result of exposure to blood," says the WHO.

WHO adds that inadequate waste disposal systems also put cleaners, laundry workers, porters, ‘rag pickers’ and the general community at risk of contracting such infections.

"There are instances where even the cleaners are pricked by these needles in the dustbins," Mr Kodambo said.

But what is telling is the revealation that in some countries, healthcare providers feel obliged to give injections to satisfy their clients. This unnecessarily exposes nurses to the risk of needle sticks.

Unnecessary injections

"Three studies in Sub-Saharan Africa and Asia found that between 60 and 80 per cent of all injections given were unnecessary and sometimes dangerous. The most frequently injected medications were antibiotics," argues Kingma.

"You see Kenyans are so obsessed with negligence of the medical staff and no one wants to talk about when a nurse or a surgeon contracts a disease from the patient," decried the chairman.

Kodambo says a nurse who has been pricked by a needle should be put on antiretroviral treatment within 72 hours to reduce the chances of contracting the virus.

Preventive measures are also in place but have largely been ignored.