O029: Reporting and case management of bloodborne pathogen exposures among health care workers in Tanzania

Introduction: In sub-Saharan Africa, bloodborne pathogens exposure (BPE) is a serious risk to health care workers (HCW). Reporting BPE is necessary for effective post-exposure prophylaxis (PEP), an important element of workplace safety in health facilities. Limited data are available on factors associated with BPE reporting among HCW. Methods: We conducted a cross-sectional study assessing experiences of occupational BPE, history of BPE reporting, and use of PEP among health care workers at three public hospitals in Tanzania. From August to November 2012, HCW were interviewed using Audio-Computer Assisted Self-Interview. All HCW at risk for BPE were invited to participate. Factors associated with reporting BPE were identified using logistic regression. Results: Of the 1,102 eligible HCW, 973 (88%) completed the interview. Of these, 690 (71%) were female and 387 (40%) were nurses. Of 357 HCW who had a BPE in the past 6 months, 120 (34%) reported it. Among these 120 reported exposures, 93 (78%) HCW reported within 2 hours of exposure, 98 (82%) received pre- and post-HIV test counseling, and 70 (58%) were offered PEP; 68 (97%) of these 70 HCWs completed PEP. Independent risk factors associated with reporting BPE were being female (adjusted odds ratio (AOR)=2.0 [95% confidence interval (CI) 1.2-3.5), having ever-received BPE training (AOR=2.0, CI 1.2-3.5), knowledge that HCW receive PEP at another facility (AOR=2.6, CI 1.5-4.4) and HIV testing within the past year (AOR=2.3, CI 1.2-4.4). Conclusion: Despite the significant proportion of HCW with a recent BPE, only one in three reported it. Our results highlight the importance of appropriate and continuous training on the prevention and reporting of occupational exposures to increase acceptance of HIV testing after BPE. Disclosure of interest: None declared

The Clean pilot study: evaluation of an environmental hygiene intervention bundle in three Tanzanian hospitals.

BACKGROUND: Healthcare associated infections (HAI) are estimated to affect up to 15% of hospital inpatients in low-income countries (LICs). A critical but often neglected aspect of HAI prevention is basic environmental hygiene, particularly surface cleaning and linen management. TEACH CLEAN is an educational intervention aimed at improving environmental hygiene. We evaluated the effectiveness of this intervention in a pilot study in three high-volume maternity and newborn units in Dar es Salaam, Tanzania. METHODS: This study design prospectively evaluated the intervention as a whole, and offered a before-and-after comparison of the impact of the main training. We measured changes in microbiological cleanliness [Aerobic Colony Counts (ACC) and presence of Staphylococcus aureus] using dipslides, and physical cleaning action using gel dots. These were analysed with descriptive statistics and logistic regression models. We used qualitative (focus group discussions, in-depth interviews, and semi-structured observation) and quantitative (observation checklist) tools to measure why and how the intervention worked. We describe these findings across the themes of adaptation, fidelity, dose, reach and context. RESULTS: Microbiological cleanliness improved during the study period (ACC pre-training: 19%; post-training: 41%). The odds of cleanliness increased on average by 1.33 weekly during the pre-training period (CI = 1.11-1.60), and by 1.08 (CI = 1.03-1.13) during the post-training period. Cleaning action improved only in the pre-training period. Detection of S. aureus on hospital surfaces did not change substantially. The intervention was well received and considered feasible in this context. The major pitfalls in the implementation were the limited number of training sessions at the hospital level and the lack of supportive supervision. A systems barrier to implementation was lack of regular cleaning supplies. CONCLUSIONS: The evaluation suggests that improvements in microbiological cleanliness are possible using this intervention and can be sustained. Improved microbiological cleanliness is a key step on the pathway to infection prevention in hospitals. Future research should assess whether this bundle is cost-effective in reducing bacterial and viral transmission and infection using a rigorous study design