Nghiên cứu thực trạng và nguy cơ mắc bệnh nghề nghiệp do vi sinh vật ở nhân viên y tế tại thành phố cần thơ và đánh giá hiệu quả biện pháp can thiệp tt tiếng việt

MOET MOH NATIONAL INSTITUTE OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH - BUI THI LE UYEN STUDY THE SITUATION AND THE RISK OF OCCUPATIONAL DISEASES CAUSED BY MICROORGANISMS IN HEALTH WORKERS IN CAN THO CITY AND EVALUATE THE EFFECTIVENESS OF INTERVENTIONS Major: Occupational health Code: 62.72.01.59 SUMMARY OF DOCTORAL THESIS IN MEDICINE Ha Noi, 2019 THE THESIS WAS COMPLETED AT NATIONAL INSTITUTE OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH SUPERVISORS Assoc Prof., PhD Ta Thi Tuyet Binh Assoc Prof., PhD Tran Thi Ngoc Lan Reviewer 1: Assoc Prof., PhD Nguyen Van Son Reviewer 2: Assoc Prof., PhD Nguyen Minh Vuong Reviewer 3: Assoc Prof., PhD Luong Mai Anh The thesis was presented at the Academy Thesis Evaluation Council met at National Institute of Occupational and Environmental Health, at … , …… , 2019 The thesis can be found at: National Library of Vietnam National Institute of Occupational And Environmental Health BACKGROUND During the working process, HCWs must directly contact patients, swabs, hazardous medical wastes that are likely to be exposed to dangerous infectious diseases such as tuberculosis, hepatitis B, hepatitis C, HIV infection, SARS, Among the group of microbiological diseases insured in Vietnam, hepatitis B and occupational disease accounts for the highest proportion, mainly in HCWs [4], [5] According to WHO, the risk of HBV infection is 18-30%, HCV is 1.8% after occupational exposure in HCWs [6] Studies in Vietnam also indicate that HCWs are at high risk of being exposed to pathogenic microorganisms, especially HBV [8], [9] In Can Tho in the period of 2011-2016, there were 103 occupational health workers reported with occupational accidents, the prevalence of HBV virus was 16.2% [10], [11] The fact that the cases of occupational exposure are not reported, cared for, properly monitored, occupational safety and health (OSH) have not been given adequate attention in the whole country in general and in the city Can Tho in particular Therefore, the topic "Study the situation and risk of occupational diseases caused by microorganisms in health workers in Can Tho city and evaluate the effectiveness of interventions" was implemented with the following objectives: Assessment of risk factors for occupational diseases caused by microorganisms in health workers in Can Tho city; Describe the status of hepatitis B and C virus infection among health workers at some Can Tho city hospitals in 2016-2017; Evaluate the effectiveness of intervention solutions * New contributions of the thesis: The thesis is a scientific study that has practical and urgent value The thesis provides new research results about risk factors for occupational diseases caused by microorganisms in health care workers (HCWs); the situation of hepatitis B and C infection among health workers at some Can Tho city hospitals in 2016-2017; and assessment the effectiveness of communication interventions on prevention of occupational diseases by microorganisms for all HCWs at health facilities Besides, researcher has organized vaccination for Hepatitis B for 293 HCWs who registered voluntarily to participate The results of the thesis has contributed to suppose the effective interventions in health protection and care for health workers, especially for prevention of work-related diseases caused by microorganisms Some specific results of the thesis: - Determining some high risk factors due to exposing of microorganisms of health workers in health facilities of Can Tho city: the frequency and the rate of expose to blood, body fluid is high (61.7%); damage caused by sharp objects (12.5%), knowledge and practice of prevention of work-related diseases, especially workrelated diseases caused by micro-organisms of health workers is still low, almost no vaccination against hepatitis B - The rates of hepatitis B and hepatitis C virus infection in health workers studied were 9.7% and 0.5%, respectively - Knowledge and practice of health workers on prevention of workrelated diseases significantly improved after the intervention: The right knowledge increased from 62.9% to 91.7%; correct practice increased from 75.4% to 88.8%; 100% of qualified health workers voluntarily vaccinated against hepatitis B * Structure of the thesis: The thesis consists of 118 pages with chapters and the following sections: Introduction: 02 pages; Chapter - Literature review: 33 pages; Chapter - Subjects and research methods: 21 pages; Chapter - Result: 28 pages; Chapter - Discussion: 30 pages; Conclusion: 02 pages; Recommendations: 02 pages References: 130 documents (53 in Vietnamese and 77 in English) Chapter INTRODUCTION 1.1 Labor in health facilities and occupational risk factors 1.1.1 Labor in health facilities In Vietnam, there are about 441,446 health workers in the health sector, of which the number of doctor is 73,567, the number of physician is 54,466, the number of nurse, technician and midwive are 148,098 [17] In 2016, Can Tho City has 134 health facilities including: 26 hospitals, 20 regional general clinics, maternity homes and 85 commune health stations; With over 5,545 health workers, including 1,918 doctors, 652 physicians, 2,531 nurses and 444 midwives; Among 5,150 beds, there are 4,636 beds in hospitals, 50 beds in regional general clinics, 13 beds in maternity homes and 451 beds in commune and ward health stations With a large workforce in the health sector, OSH and occupational health care for health workers in our country in general and in Can Tho city in particular are very important in the current period [18] 1.1.2 Occupational harm factors in health facilities The health sector is a specific labor industry with heavy labor intensity, physiological stress, working environment conditions with many factors of occupational diseases affecting health of health workers Factors of OSH for HCW can be classified into groups: - Non-contagious risk factors: physical, chemical, labor organization, occupational psychology, ergonomics, etc - Contagious risk factors: blood, body fluids, swabs, medical waste and injuries caused by sharp objects [19], [20] 1.1.3 Occupational hepatitis B and C virus Occupational disease HBV, HCV caused by HBV, HCV virus during labor process Currently, in addition to the HBV vaccine, an important preventive measure is health education and adherence to standard precautions Any HCW can be infected with HBV, HCV by contact with patient samples containing virus during working In order to diagnose HBV and occupational disease, it is necessary to base on occupational exposure, exposure time, guarantee period, clinical and subclinical symptoms as prescribed [4], [14], [15] 1.2 Actual situation of hepatitis B and C virus in health workers 1.2.1 Studies in the world According to WHO, every year in Europe, there is 304,000 HCWs will be exposed to HBV, 149,000 HCWs will be exposed to HCV, 22,000 HCWs will be exposed to HIV and the likelihood of infection after occupational exposure will be