Study setting
The study was carried out in West Shewa Zone which is located in Oromia Regional State, Ethiopia. The zonal capital town, Ambo, is 112 km far to the west of the capital city, Addis Ababa. There are 22 districts in the zone. The zone has one referral, three general, and three primary hospitals; and 91 health centers. Health Center is the primary level of care in Ethiopia’s health tier-system that has been serving around 25,000 in rural and 40,000 in urban catchment population with the aim of improving overall health outcomes, sanitation, maternal health, and infectious diseases. According to the West Shewa Zonal Health Office report [15], there are 1,959 health professionals and 821 supportive staff among the health facilities in the zone.
Study design, participants and period
A cross-sectional study design was used to assess levels of occupational exposure to BBFs and to identify associated factors among the sampled HCWs in selected governmental health care facilities in the West Shewa Zone. The government-employed health professionals like pharmacists, environmental health professionals, and other supportive staff in the selected governmental health facilities were excluded because they were less likely to be 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, and knowledge on occupational exposure
Sample size determination
The sample size was determined by using a single population proportion formula with the assumptions of a 95% confidence level, an error margin of 5%, and the prevalence of occupational exposure to BBFs (65.7%) [6]. Considering a 10% nonresponse rate, the final sample size was 381.
Sampling procedure
A total of 99 governmental health facilities were divided into hospitals and health centers. Twenty-eight (30%) out of 91 health centers; and three (33%) out of nine hospitals were selected randomly. The sampled health professionals were then assigned in proportion to the total number of health care providers in each selected health facility. The register of health care workers in selected governmental health facilities served as a sampling frame; and finally, a simple random sampling method was used to select health care workers.
Data collection tools and procedures
The data were collected through a self-administered questionnaire adapted from previous instruments used in various studies of exposure to blood and body fluids [6, 16, 18]. The questionnaire has been grouped and arranged according to the specific objectives they can address. The questionnaire was originally prepared in English and translated into the local language, Afan Oromo. To check consistency, experts translated Afan Oromo's questionnaires back into English. A supervisor (BSC) was employed in each hospital. Four BSc supervisors were employed for the health centers (one supervisor: seven health centers).
Data quality assurance
The data collectors received one-day training on the objective, data collection process, and field ethics. Each questionnaire was checked daily by the supervisors and the principal investigator. The pre-test was carried out at a non-sampled health center with 38 (5%) of the study. Due to the gaps found in the pretest, the necessary adjustments were made to the questionnaire. At the end of each day, the supervisors and investigators checked the questionnaire for completeness, correctness, and consistency and were discussed with all data collectors and supervisors.
Data processing and analysis
The collected data was cleaned, manually coded, and entered into EPI Info version 7, and exported to SPSS version 21 for analysis. A univariate analysis was done for continuous variables. A frequency distribution was carried out for categorical data. Bivariable analysis was performed to select candidate variables with p<0.25. Then entered multivariate analysis to identify independent predictor variables and control confounders. In the multivariate logistic regression, the adjusted odds ratio (AOR) with its 95% confidence intervals (CI) was computed for the variables retained in the final model, and the statistical significance was declared at p<0.05.
Operational definitions
Health care worker: Those people who do have contact with syringes, needles, other sharp materials, blood, and body fluids by virtue of their duties. Thus, nurses, laboratory technicians, physicians, dentists, health officers, x-ray technicians, cleaners, and laundry workers were considered.
Exposure to blood & body fluids: Exposure of health care workers to blood or other body fluids like semen, vaginal secretions, cerebrospinal, pleural, peritoneal, pericardial, and amniotic fluids via broken skin, eyes, mucous membranes, and sharp materials injury.