1. Report on procedures involving the risk of transmitting blood-borne infectious diseases
The first step of the research process related to qualitative assessment of risk of hepatitis C virus (HCV) infections was laying theoretical foundations for development of the research tools. The report provides an analysis of the epidemiological situation and risk factors for transmission of HCV infections in health care institutions, based on:
- data available in the reports of the National Institute of Public Health – National Institute of Hygiene,
- data from the inspection of sanitary conditions in health care institutions obtained by the Chief Sanitary Inspectorate in Lublin, Kielce and Rzeszów, pursuant to which epidemiological situation in Lubelskie, Świętokrzyskie and Podkarpackie provinces was assessed, where practical part of the project shall be implemented,
- data from reported studies conducted in Poland,
- analyses of nosocomial HCV infections available in the international literature
Table of contents of the document drawn up in project 4 is as follows:
I. Introduction
II. Incidence of HCV infections in the global and Polish population
III. Literature review methods
IV. Critical control points
V. Discussion of the risk of disease transmission in specific types of medical institutions
V.1. HCV transmission in medical treatment wards
V.2. Transmission during endoscopic examination
V.3. HCV transmission at the dentist’s office
V.4. HCV transmission in surgical wards
V.5. Transmission of HCV infections at outpatient haemodialysis centres
VI. Assessment of data obtained from Polish health care institutions and during performance of tasks by the Chief Sanitary Inspectorate
VII. Conclusions
VIII. Literature (142 items)
Literature review has shown that despite large volumes of available data on risk factors related to iatrogenic HCV infections, widespread patterns of thinking and common views on the matter prevailing in the medical circles may contribute to misinterpretation of the actual risks of virus transmission, as e.g. infections contracted during endoscopic examination are often unrelated to the use of contaminated endoscope during the examination. In contrast, these infections result from improper observance of procedures followed during administration of multiple-dose anaesthetics. In a number of sections of the abovementioned report, the issue of risks of contracting HCV infections is presented in an astonishing manner.
2. Research tools
Literature review served as the grounds for development of the research tools:
- basic questionnaires to be completed in health care institutions: hospitals, outpatient clinics and dentist’s offices;
- report files – for recording observed phenomena related to:
- providing the wards, doctor's offices and dentist's offices with protective devices and equipment reducing or eliminating the risk of transmitting blood-borne infectious diseases,
- work of the nursing staff, observing procedures related to their professional duties, such as blood collection, drug administration, that is activities involving the highest risk of contracting HCV infectious diseases both by patients and by health care professionals,
- visual examination of endoscopic equipment, dental units, surgical, gynaecological instruments and their use by staff responsible for their decontamination and use during the diagnostic and therapeutic process;
- questionnaires for hospital-acquired infection control teams.
Questionnaires completed in hospitals include all critical control points related to the increased risk of transmitting HCV infections in all directions (patient-patient, staff-patient, patient-staff). Among routine questions included in the questionnaires evaluating observance of protective procedures, special attention was paid to:
- Use of gloves and their replacement after each patient examination/procedure and potential contact with infectious material
- Contact with any disposable components of equipment for medication and diagnostic preparations, and replacement thereof.
- Application of multiple-dose preparations and use of the same syringes in different patients, even after assuming sterility of the procedure.
- Initial examination for the presence of HCV infection in patients and staff in selected wards (whether conducted or not).
- Use of personal protective measures specific for a given field of medicine (protective gloves, reinforced gloves, gowns).
- Handling of contaminated medical equipment, especially by paramedical staff.
- Reporting accidents and instances of exposure to infectious materials.
- Cleaning and disinfection procedures for multiple-use devices, including diagnostic instruments
- Providing trainings and provision of written procedures to be followed.
Questions included in the questionnaires for outpatient clinics and dentist's offices refer to observance of procedures directly related with the risk of HCV infection transmission.
3. Selection of the studied sample
The project study covers 4 health care institutions in three provinces (voivodeships): Lubelskie, Podkarpackie and Świętokrzyskie provinces. In hospitals, outpatient clinics and doctor’s offices the total of 1580 questionnaires shall be completed, followed by observation activities.
Randomized, proportional stratified sampling was conducted, involving in the first place specification of the groups of entities according to their form of business activity in every province, followed by randomization of a specific number of entities from each group directly proportionate to the share of these units in the total number of institutions belonging to a given stratum, individually in each province.
The number of questionnaires completed in three provinces, with stratum specification, is as follows:
- Lubelskie province:
- 21 basic questionnaires in hospitals
- 187 basic questionnaires in outpatient clinics
- 477 basic questionnaires in dentist’s offices
- 21 questionnaires for hospital-acquired infection control teams.
- Podkarpackie province:
-18 basic questionnaires in hospitals
-207 basic questionnaires in outpatient clinics
-257 basic questionnaires in dentist’s offices
-18 questionnaires for hospital-acquired infection control teams.
- Świętokrzyskie province:
-11 basic questionnaires in hospitals
-129 basic questionnaires in outpatient clinics
-223 basic questionnaires in dentist’s offices
-11 questionnaires for hospital-acquired infection control teams.
4. Selection of interviewers
Contractors warranting successful implementation of environmental studies (examination of blood contamination routes) in project 4 shall be selected from employees of the Chief Sanitary Inspectorate. Due to their professional experience, they have proper knowledge regarding protection of public health against harmful environmental impacts, preventing development of diseases including infectious and occupational diseases, prevention activities and anti-epidemic activity regarding infectious diseases, also including undertakings and research works, drawing up epidemiological analyses and evaluations.
In view of the above, Medical University of Lublin and the Project Leader National Institute of Public Health – National Institute of Hygiene, pursuant to an agreement, have invited Provincial Sanitary and Epidemiological Stations in Lubelskie, Podkarpackie and Świętokrzyskie provinces to participate in implementation of the environmental study.
Chief Sanitary Inspectorate employees, who shall undertake to implement the study, shall be trained in the use of the research tools.
5. Implementation of the study
Collection of the material by means of the research tools is planned to be completed by the end of June 2014. Data from the questionnaires and report files will be entered into the database and subject to statistical analysis. On this basis, a study report shall be drawn up, which will be used for the development of the “National Strategy for Hepatitis C vVirus Infections Prevention and Control for the years 2015-2020”.