Tıp, hemşirelik ve sağlık meslek yüksekokulu öğrencileri Hepatit B’den korunuyor mu: Hatay’dan kesitsel bir çalışma, Türkiye

Abstract

Amaç:  Hepatit B önemli bir halk sağlığı sorunudur ve sağlık çalışanları dahil pek çok grup hepatit B açısından risk altındadır. Bu çalışmada tıp, hemşirelik ve sağlık meslek yüksekokulu öğrencilerinin anti-hepatit B antikor düzeylerini ve iğne batması sıklığını belirlemek amaçlanmıştır. Yöntem: Çalışmanın evreni ve örneklemi 2015 yılında Mustafa Kemal Üniversitesi Tıp, Hemşirelik ve Sağlık Meslek Yüksek Okulu ilk ve son sınıfında okuyan 973 öğrencidir. Öğrencilerden % 63’üne ulaşılabildi ve bunların % 67.7’sinden kan örneği alındı. Serum örneklerindeki hepatit B yüzey antikoru değerleri “enzyme-linked immunosorbent assay”  yöntemiyle çalışıldı, antikor titresi 10 mIU/mL üzeri pozitif kabul edildi. Bulgular: Öğrencilerin yaş ortalaması ve standart sapması 20.9±2.7 olup % 68.5’i kadın idi. Anti-HBs pozitifliği % 54.5 olarak elde edildi. Anti-HBs pozitifliğindeki farklılık cinsiyet, yaş grubu ve okul açısından farksız iken, aşılı olanlarda diğerlerine göre daha yüksek idi (p<0.05). Katılımcıların % 29.0’unda iğne batması öyküsü vardı. En yüksek sıklık sağlık acil ve anestezi bölümü öğrencilerinde idi (p<0.001). Son sınıf öğrencilerinde iğne batması daha sık gözlendi. Sonuç: Öğrencilerin yaklaşık yarısında anti-HBs negatiftir ve çalışma ortamında yaralanma riskleri yüksektir. Buna karşın hepatit B’den korunmak amacı ile staj yapmakta olan öğrenciler için açık bir politika yoktur. Sağlık kuruluşlarında staj yapan öğrencileri işyeri risklerinden koruyacak bir politika gereklidir.  

Keywords

• Hepatit B Antikor
• sağlık meslekleri öğrencileri
• iğne batması
• sağlık politikası

Are the students in medicine, nursing and allied health higher schools protected from Hepatitis B: A cross-sectional study from Hatay, Turkey

Abstract

Aim:  Hepatitis B is an important public health problem and many groups, including health workers, are at risk for hepatitis B.  We aimed to determine the hepatitis B surface antibody levels and frequency of needlestick injury among health occupations students. Method: The study population and sample were 973 students in Mustafa Kemal University, Medical, Nursing and Health Vocational High School in 2015. Of the students, %63 were reached, and 67.7% of them gave blood samples. Anti-HB_S values were calculated by enzyme-linked immunosorbent assay and an antibody titer over 10 mIU/mL was accepted as positive. Results: The mean age was 20.9 ± 2.7 and 68.5% were female. Anti-HBs positivity was 54.5%, and 37.3% of the vaccinated group was still anti-HB_S negative. The difference in anti-hepatitis B positivity was not significant in terms of sex, age group and school, but it was higher in vaccinated students than in others (p <0.05). 29.0% of participants had a history of needle-stick injury. The highest percentage was in health emergency and anaesthesia departments (p <0.001). Needle-stick injury was observed more often in senior students.

Conclusion: Approximately half of the students were negative in terms of anti-HBs and injury risk at working places is extremely high. However, there is no clear hepatitis B policy for the students.  There is a policy need for all students in healthcare settings.

Keywords

• health policy
• Hepatitis B antibodies
• health occupations students
• needle-stick injury
• immunization history

References

1. World Health Organization. Global Hepatitis Report.; 2017. http://apps.who.int/iris/bitstream/10665/255016/1/9789241565455-eng.pdf?ua=1. Accessed May 4, 2017.
2. World Health Organization. Global health sector strategy on viral hepatitis 2016-2021. Glob Hepat Program Dep HIV/AIDS. 2016;(June):56.
3. WHO. Hepatitis B vaccines: WHO position paper-Recommendations. Vaccine. 2010;28(3):589-590. doi:10.1016/j.vaccine.2009.10.110.
4. WHO. Hepatitis B vaccines: WHO position paper – July 2017. Wkly Epidemiol Rec. 2017;27(92):369-392.
5. International Labour Office. List Of Occupational Diseases (revised 2010) Identification and recognition of occupational diseases: Criteria for incorporating diseases in the ILO list of occupational diseases. http://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---safework/documents/publication/wcms_150323.pdf. Accessed May 4, 2017.
6. CDC. Which workers in the health care setting need hepatitis B vaccine? http://www.who.int/occupational_health/activities/3hepatiti.pdf. Accessed March 31, 2017.
7. Schillie S, Murphy T V, Sawyer M, et al. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recomm Rep. 2013;62(RR-10):1-19. doi:rr6210a1 [pii].
8. Health Ministery of Tukish Republic. Sağlik Personelinin Bulaşici Hastaliklara Yönelik Tarama Protokolü. https://www.saglik.gov.tr/Eklenti/2867,bdk-kararlaripdf.pdf?0. Accessed March 28, 2017.

9. Zanetti AR, Van Damme P, Shouval D. The global impact of vaccination against hepatitis B: A historical overview. Vaccine. 2008;26(49):6266-6273. doi:10.1016/j.vaccine.2008.09.056.
10. Nayagam S, Thursz M, Sicuri E, et al. Requirements for global elimination of hepatitis B: a modelling study. Funding Med Res Counc. 2016. doi:10.1016/S1473-3099(16)30204-3.
11. Toy M, Önder FO, Wörmann T, et al. Age- and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: a systematic review. BMC Infect Dis. 2011;11(1):337. doi:10.1186/1471-2334-11-337.
12. Tozun N, Ozdogan O, Cakaloglu Y, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clin Microbiol Infect. 2015;21(11):1020-1026. doi:10.1016/j.cmi.2015.06.028.
13. Ay P, Torunoglu MA, Com S, et al. Trends of hepatitis B notification rates in Turkey, 1990 to 2012. Gen Dir Heal Res Minist Heal Euro Surveill. 1990;18(47). www.eurosurveillance.org:pii=20636. Accessed April 1, 2017.
14. De Schryver A, Claesen B, Meheus A, Hambach R, van Sprundel M, François G. Hepatitis B vaccination policies for student healthcare workers in Europe. J Hosp Infect. 2014;86(2):147-150. doi:10.1016/j.jhin.2013.11.005.
15. OSHA. Fact Sheet, Protection, Hepatitis B Vaccination. 1910.
16. Irmak Z, Ekinci B, Akgul a F. Hepatitis B and C seropositivity among nursing students at a Turkish university. 2010:365-370.
17. Aygin D, Yucel O, Sen S, Yucel T. The investigation of hepatitis B seropositivity in Sakarya University Students. Pakistan J Med Sci. 2011;27(3):668-672.
18. Oncu S, Oncu S, Sakarya S. Hepatitis A and B seropositivity among medical students. Health Policy (New York). 2005;74(1):39-45. doi:10.1016/j.healthpol.2004.12.004.
19. Kader C, Yolcu S, Erbay A, Kilic Akca N, Yuzer S, Polat S. Bozok Üniversitesi Sağlık Yüksek Okulu Öğrencilerinde Hepatit-B ve C SeroprevelanslarınınAraştırılması. Viral Hepatit Derg. 2013;19(2):49-53. doi:10.4274/Vhd.70288.
20. Sernia S, Ortis M, Antoniozzi T, Maffongelli E, La Torre G. Levels of anti-HBs antibody in HBV-vaccinated students enrolled in the faculty of medicine, dentistry and health professions of a large Italian university. Biomed Res Int. 2015;2015:1-7. doi:10.1155/2015/712020.
21. Dumaidi K, Al-jawabreh A. Persistence of Anti-HBs Among Palestinian Medical Students After 18 - 22 Years of Vaccination : A Cross-Sectional Study. Hepat Mon. 2015;15(11):e29325. doi:10.5812/hepatmon.29325.
22. Chaouch H, Hachfi W, Fodha I, et al. Impact and long-term protection of hepatitis B vaccination: 17 years after universal hepatitis B vaccination in Tunisia. Epidemiol Infect. 2016;144(16):3365-3375. doi:10.1017/S0950268816001849.
23. Batra V, Goswami A, Dadhich S, Kothari D, Bhargava N. Hepatitis B immunization in healthcare workers. Ann Gastroenterol. 2015;28(2):276-280.
24. Bookstaver PB, Foster JL, Lu ZK, et al. Hepatitis B Virus Seroconversion Rates Among Health Sciences Students in the Southeastern United States. J Am Coll Health. 2015;64(1):69-73. doi:10.1080/07448481.2015.1042876.
25. Cárdenas-Perea ME, Gómez-Conde E, Santos-López G, et al. Hepatitis B surface antibodies in medical students from a public university in Puebla, Mexico. Hum Vaccin Immunother. 2016;12(7):1-6. doi:10.1080/21645515.2016.1151587.
26. Patterson JMM, Novak CB, Mackinnon SE, Ellis RA. Needlestick injuries among medical students. Am J Infect Control. 2003;31(4):226-230. doi:10.1067/mic.2003.44.
27. Schmid K, Schwager C, Drexler H. Needlestick injuries and other occupational exposures to body fluids amongst employees and medical students of a German university: incidence and follow-up. J Hosp Infect. 2007;65(2):124-130. doi:10.1016/j.jhin.2006.10.002.
28. Deisenhammer S, Radon K, Nowak D, Reichert J. Needlestick injuries during medical training. J Hosp Infect. 2006;63(3):263-267. doi:10.1016/j.jhin.2006.01.019.
29. Lee LK, Ismail NH. Implication of the Prevalence of Needlestick Injuries in a General Hospital in Malaysia and Its Risk in Clinical Practice. Environ Health Prev Med. 2005;10(March):33-41. doi:10.1265/ehpm.10.33.
30. Talas MS. Occupational exposure to blood and body fluids among Turkish nursing students during clinical practice training: Frequency of needlestick/sharp injuries and hepatitis B immunisation. J Clin Nurs. 2009;18(10):1394-1403. doi:10.1111/j.1365-2702.2008.02523.x.
31. Shiao JSC, Mclaws ML, Huang KY, Guo YL. Student nurses in Taiwan at high risk for needlestick injuries. Ann Epidemiol. 2002;12(3):197-201. doi:10.1016/S1047-2797(01)00303-9.
32. Askarian M, Shaghaghian S, McLaws M-L. Needlestick Injuries Among Nurses of Fars Province, Iran. Ann Epidemiol. 2007;17(12):988-992. doi:10.1016/j.annepidem.2007.07.106.
33. Gülen B, Serinken M, Hatipoğlu C, et al. Work-related injuries sustained by emergency medical technicians and paramedics in Turkey. doi:10.5505/tjtes.2015.94224.
34. World Health Organization. WHO UNICEF coverage estimates WHO World Health Organization: Immunization, Vaccines And Biologicals. Vaccine preventable diseases Vaccines monitoring system 2017 Global Summary Reference Time Series: HEPB_BD. http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragehepb_bd.html. Accessed January 26, 2018.
35. Yükseköğretim Bilgi Yönetim Sistemi. https://istatistik.yok.gov.tr/. Accessed January 26, 2018.
36. Ozcirpici B, Sahinoz S, Ozgur S, et al. Vaccination coverage in the South-East Anatolian Project (SEAP) region and factors influencing low coverage. Public Health. 2006;120(2):145-154. doi:10.1016/j.puhe.2005.04.008.
37. World Health Organization. WHO | Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. WHO. 2017.