West Shewa Zone is found in Oromia Regional State. It is located 112 km far away from Addis Ababa, the capital city of Ethiopia, in the western direction. It has 22 woredas and one administrative town. It has one referral, three general and three primary hospitals, and 91 health centers. According to the information obtained from West Shewa Zonal Health Department (15), there are 1,959 health professionals and 821 supportive staff among health facilities in the zone.
Study design and period
A cross-sectional study design was used to assess the extent of occupational exposure to BBFs and determine associated factors among sampled HCWs in selected governmental health care facilities of West Shewa Zone. The government-employed health professionals like pharmacists, environmental health professionals, and other support staff in the selected governmental health facilities were excluded because they were less likely exposed to blood and body fluids. The data were collected from May 19, 2018, to June 25, 2018.
Variables of the study
Dependent variable: Exposure to blood & body fluids (Yes/No)
Independent variables were as follows:
Socio-demographic variables: Age, Sex, Religion, Ethnicity, Educational Status, Current Profession, Work Experience
Working Environment: Supply of Personal Protective Equipment (PPE), Guidelines/ protocols, Training, Number of patients attended daily
Behavioral factors: Use of PPE, Recapping needles, knowledge on occupational exposure
Sample size determination
The sample size was determined by using single population proportion formula with the assumptions of 95% confidence level, the margin of error of 5%, and the prevalence of occupational exposure to BBFs (65.7%) (6). Considering a 10% non-response rate, the final sample size was 381.
A total of 99 governmental health care institutions were stratified into hospitals and health centers. Twenty-eight health centers (30%) out of ninety-one and three hospitals (33%) out of nine were selected randomly. Then sampled numbers of health care workers were proportionally allocated according to the total number of health care providers in each selected health care institution. Registration of health care workers in selected governmental health facilities was used as a sampling frame. Finally, a simple random sampling method was used to select health care workers.
Data collection tools and procedures
The data were collected via a self-administered questionnaire which was adapted from previous tools that were applied in different studies related to exposure to blood & body fluids (6, 16-18). The questions and statements of the questionnaire were grouped and arranged according to the particular objective that they can address. The questionnaire was originally prepared in English and translated into the local language, Afan Oromo. To check for consistency, the questionnaires were further translated from Afan Oromo to English by another person. The questionnaires were self-administered. In each Hospital one supervisor (BSC) was employed and for health centers, four BSc supervisors (one supervisor: seven health centers) were employed.
Data quality assurance
Data collectors were provided with one-day training about the objective, process of data collection, and field ethics. Each questionnaire was checked daily by the supervisors and the principal investigator. Pretest was conducted at Holeta health center by taking 38(5%) of the study population. Necessary modifications were made to the questionnaire based on the identified gaps during the pre-test. At the end of each day, the questionnaire was checked for completeness, accuracy, and consistency by the supervisors and investigator, and discussion was undertaken with all data collectors and supervisors.
Data processing and analysis
The collected data were cleaned and coded manually, and entered into EPI Info version 7, and was exported to SPSS version 21 for analysis. Univariate analysis like measures of central tendency and measures of dispersion for continuous variables was computed. Frequency distribution was done for categorical data. Bivariate analysis was done to select candidate variables with P<0.25. Then entered into multivariable analysis to identify independent predictor variables and control for confounders. In multivariable logistic regression, Adjusted Odds Ratio (AOR) with its 95% Confidence Interval (CI) was computed for variables maintained in the final model, and statistical significance at P < 0.05 was declared by the CI.
A health care worker in this study was operationalized as those people who do have contact with syringes, needles, other sharp materials, blood, and body fluids by the virtue of their duties. So, nurses, laboratory technicians, physicians, dentists, health officers, x-ray technicians, cleaners, and laundry workers working in government health facilities were sampled.