The Open Nursing Journal


ISSN: 1874-4346 ― Volume 11, 2017

Nurses’ Knowledge toward Hepatitis B and Hepatitis C in Guilan, Iran



Farahnaz Joukar, Fariborz Mansour-Ghanaei*, Mohammad Reza Naghipour, Tolou Hasandokht
Gastrointestinal & Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences, Rasht, Iran.

Abstract

Background:

Health care workers (HCWs) represent high risk population for viral hepatitis infection.

Objectives:

This study sought to assess the knowledge of HCWs regarding hepatitis B (HBV) and hepatitis C (HCV) infection.

Methods:

In a multi-center cross sectional study, all HCWs from eight teaching hospitals were invited to participate in the study and to fill in a self-administered questionnaire.

Results:

A total of 1008 eligible HCWs have responded to the study. A high proportion of the study participants (55.4% and 52.9%) had unsatisfactory knowledge about HBV and HCV. Mean knowledge score toward HBV was significantly higher among more educated staff, p <0.001 and vaccinated personnel, P=0.02. Majority of responders answered correctly to transmission questions toward HBV and HCV (90% and 80%, respectively). There was statistically significant difference in only transmission domain score between various hospitals (p<0.05). The highest scores were related to surgical hospital.

Conclusion:

Although more than ninety percent of our participants were educated about HBV and HCV, knowledge about nature of disease, prevention, treatment and vaccine availability was unsatisfactory. Continuous training program toward viral infection is a matter of necessity.

Keywords: Nurse, Hepatitis B, Hepatitis C, Knowledge, WHO, HIV/AIDS.


Article Information


Identifiers and Pagination:

Year: 2017
Volume: 11
First Page: 34
Last Page: 42
Publisher Id: TONURSJ-11-34
DOI: 10.2174/1874434601711010034

Article History:

Received Date: 08/12/2016
Revision Received Date: 05/02/2017
Acceptance Date: 13/02/2017
Electronic publication date: 17/04/2017
Collection year: 2017

© 2017 Joukar et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences, Razi Hospital, Sardar-Jangle Ave. Rasht, Iran; Tel: +98-131–5535116; Fax: +98-131-5534951; E-mails: ghanaei@gums.ac.ir, ghanaie@yahoo.com




INTRODUCTION

Hepatitis B (HBV) and C (HCV) are two common, serious causes of chronic liver disease and liver damage. The World Health Organization (WHO) has reported that more than 500 million people are living with chronic viral hepatitis in the world [1Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1995; 90(2): 206-10.
[PMID: 7847286]
, 2Organization WHO. Prevention and control of viral hepatitis infection, 2012.]. Since,50% to 80% of HCV infection leads to chronic hepatitis [3Mansour-Ghanaei F, Sadeghi A, Mashhour MY, et al. Prevalence of hepatitis B and C infection in hemodialysis patients of Rasht (Center of Guilan Province, Northern Part of Iran). Hepat Mon 2009; 9(1): 45-9., 4Waheed Y, Shafi T, Safi SZ, Qadri I. Hepatitis C virus in Pakistan: a systematic review of prevalence, genotypes and risk factors. World J Gastroenterol 2009; 15(45): 5647-53.
[http://dx.doi.org/10.3748/wjg.15.5647] [PMID: 19960560]
], the increasing burden of HCV infection is considerable. In addition, an estimate of 57% of liver cirrhosis and 78% of liver cancer are considered due to hepatitis B virus (HBV) or hepatitis C virus (HCV) infections [1Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1995; 90(2): 206-10.
[PMID: 7847286]
, 2Organization WHO. Prevention and control of viral hepatitis infection, 2012.]. The Middle East country and Iran located in the intermediate endemicity with a carrier rate between 2% and 8% [5Organization WHO. Department of communicable disease surveillance and response. 2002.]. Percutaneous injuries are one of the most common routes of HBV and HCV [6DSouza RF, Glynn MJ, Alstead E, Osonayo C, Foster GR. Knowledge of chronic hepatitis C among East London primary care physicians following the Department of Healths educational campaign. QJM 2004; 97(6): 331-6.
[http://dx.doi.org/10.1093/qjmed/hch060] [PMID: 15152106]
, 7Joukar F, Mansour-Ghanaei F, Soati F, Meskinkhoda P. Knowledge levels and attitudes of health care professionals toward patients with hepatitis C infection. World J Gastroenterol 2012; 18(18): 2238-44.
[http://dx.doi.org/10.3748/wjg.v18.i18.2238] [PMID: 22611318]
]. According to the WHO, about three million individuals are injured per year due to needle stick or sharps injuries [8Zaidi MA, Beshyah SA, Griffiths RF. Needle stick injuries: An overview of the size of the problem, prevention and management. Ibnosina J Med Biomed Sci 2009; 2(2): 53-61.]. Health-care workers(HCWs) including nurses are potentially at high risk of blood-borne diseases such as HBV or HCV. Studies reported the risk of pathogens transmission HCWs by a needle stick injury (NSI) has been estimated to be between 6% and 30% for HBV and between 3% and 10% for HCV [9Askarian M, Ghavanini AA. Survey on adoption of measures to prevent nosocomial infection by anaesthesia personnel. East Mediterr Health J 2002; 8(2-3): 416-21.]. An average seroconversion rate for HCV in occupational exposure has been estimated 1.8% (range: 0-7%) [10Alter MJ. The epidemiology of acute and chronic hepatitis C. Clin Liver Dis 1997; 1(3): 559-568, vi-vii.
[http://dx.doi.org/10.1016/S1089-3261(05)70321-4] [PMID: 15560058]
]. Although NSI hepatitis seroconversion is somewhat rare, the costs of treatment and anxiety about the possible consequences of an exposure are serious. In this area, prevention through immunization and increasing knowledge are the safe strategy against the high prevalence of viral hepatitis among HCWs. For this reason, some HCWs refuse to service patients with blood born disease such as HIV/AIDS, HBV and HCV [11Alubo O, Zwandor A, Jolayemi T, Omudu E. Acceptance and stigmatization of PLWA in Nigeria. AIDS Care 2002; 14(1): 117-26.
[http://dx.doi.org/10.1080/09540120220097991] [PMID: 11798411]
-14Reis C, Heisler M, Amowitz LL, et al. Discriminatory attitudes and practices by health workers toward patients with HIV/AIDS in Nigeria. PLoS Med 2005; 2(8): e246.
[http://dx.doi.org/10.1371/journal.pmed.0020246] [PMID: 16022564]
]. On the other hands, several studies reported the nurses who are informed about the mode of HBV and HCV transmission will have a positive attitude and confidence in treating or handling patients [11Alubo O, Zwandor A, Jolayemi T, Omudu E. Acceptance and stigmatization of PLWA in Nigeria. AIDS Care 2002; 14(1): 117-26.
[http://dx.doi.org/10.1080/09540120220097991] [PMID: 11798411]
-15Richmond J, Dunning T, Desmond P. Health professionals’ attitudes toward caring for people with hepatitis C. J Viral Hepat 2007; 14(9): 624-32.]. Hence, HCWs should familiarize themselves with guideline designed to prevent transmission of HBV, HCV and other blood-borne pathogens. The purpose of this study was to assess knowledge towards HBV and HCV among nurses in different hospitals of Guilan University of Medical Sciences, Rasht, Iran.

MATERIALS AND METHODOLOGY

A questionnaire based cross- sectional study was conducted in various teaching hospitals setting of Rasht, the capital city of Guilan province, North of Iran. All study hospitals provide tertiary health-care level to a large population of Guilan province. All HCWs agreed to participate and filled in the questionnaire were included in the study. The participants were asked to complete a Self-report questionnaire separately under supervision of a trained research assistant. Sample enrollment, data gathering and data entry were supervised by aresearch assistant.

We used the Richmond et al. [15Richmond J, Dunning T, Desmond P. Health professionals’ attitudes toward caring for people with hepatitis C. J Viral Hepat 2007; 14(9): 624-32.] self report questionnaire with some modifications. In our previous research, the face and content validity of the developed and standardized questionnaire was determined by a panel of experts of Gastrointestinal and Liver Diseases Research Center (GLDRC) of Guilan University of Medical Science (GUMS) [7Joukar F, Mansour-Ghanaei F, Soati F, Meskinkhoda P. Knowledge levels and attitudes of health care professionals toward patients with hepatitis C infection. World J Gastroenterol 2012; 18(18): 2238-44.
[http://dx.doi.org/10.3748/wjg.v18.i18.2238] [PMID: 22611318]
]. This specifically designed questionnaire has been reported to be acceptable to almost all responders in a pilot study, with a cronbach's alpha coefficient of 0.7 for HBV knowledge and alpha = 0.8 for HCV knowledge. The questionnaire consisted of 70 questions and 3 main parts (including 22 questions on demographic data, job category, HBsAb, vaccination status, family history of HCV or HBV and history of NSI, 26 questions on the knowledge about HBV and 22 about level of knowledge on HCV infection. Knowledge section for HBV and HCV included the following category focusing on :A) nature of disease, consisted of 5 statements B) modes of transmission consisted of 11 statements for HBV and 10 statements for HCV C) Ways of preventing HBV and HCV infection consisted of 5 statements and D) treatment of HBV and HCV consisted of 2 statements . Hepatitis B questionnaire had an additional three questions about the availability of vaccine. Knowledge questions were propositions to which true/false/do not know could be replied. The total knowledge score of the participants was calculated by giving one point to each correct answer with a maximum possible score of 26 for HBV and 22 for HCV and minimum score of zero. The aim of the study was explained to participants, and were asked namelessly responded to the questionnaire.

The study design and written informed consent (per the Helsinki declaration) were approved by the ethics committee of the gastrointestinal and liver diseases research center of Guilan University of Medical Sciences.

Statistical Analysis

Mean knowledge score toward hepatitis B and C was reported. Final results were explained based on the different sex groups, work experience, education level, education of NSI, history of vaccination, having history of NSI and source of information. Also, the mean knowledge score was determined based on each demographic group. Total score less than mean was considered as unsatisfactory whereas higher than mean was considered as satisfactory knowledge. A P value of <0.05 was taken as significant for independent T test and one way ANOVA. Data were analyzed by Statistical Package for Social Sciences (SPSS) Version 16.0.

RESULTS

Sociodemographic Characteristics

A total of 1008 nurses from different hospitals were recruited for the study and response rate were 55%. The sociodemographic characteristics of the responders and non-responders were similar (p>0.05).

The majority of participants 947(93.9%) were female (p< 0.05) with the mean age 34.7 (8.2%) years old for women and 39.2 (8.1%) years old for men. More than 94.2% of responders had history of immunization. Fifty seven percent of nurses reported history of NSI and 946 (93.8%) receive education program focusing NSI. The major source of their information was from book/educational class (71.7%). (Table 1).

Table 1
Comparison of demographic characteristics and mean knowledge scores (N = 1008).


Demographic Characteristics and Mean Knowledge Scores

A significant difference was found between the nurses’ knowledge on HBV concerning the education level (P=0.001) and history of vaccination (P=0.02). As shown in (Table 1), there was no statistically significant difference between nurses’ knowledge toward HCV and the sociodemographic variables.

Assessment of Knowledge Towards Hepatitis B & C

In general, the mean knowledge score for the entire study subject toward HBV and HCV was 15.2(±2.5) and 12.5(±3.6) respectively. The scoring range and mean obtained score toward knowledge domains are shown in (Table 2). Approximately 50 percent of responders obtained unsatisfactory score toward HBV and HCV (55.4% and 52.9%, respectively).

Table 2
Responses to hepatitis B and C knowledge items.


More than 80% of responders correctly answer to 2 questions related to the nature of HBV and HCV, 7 questions about mode of transmission of HBV and HCV, only two questions in area of the prevention strategy about HBV. More than 90% of responders knew that vaccine develop immunity toward HBV infection. Fortunately 81% of participants knew the correct answer about HBV vaccination schedule. (Table 2).

Demographic Characteristics and Knowledge Scores in Each Domain

As seen in (Table 3), a significant difference was found between the nurses’ knowledge about transmission, vaccine, prevention and treatment toward HBV concerning the education level (P<0.005). There was a significant difference in mean score of transmission, availability of vaccine and treatment domains regarding history of vaccination (P<0.005). Also, statistically significant difference was seen between mean score of treatment domain and vaccine availability with work experience (P<0.005). The mean score about vaccine availability was significantly better in men than women (P<0.005).

Table 3
Comparison of demographic characteristics and mean knowledge scores in each domain.


The mean score of the nature of disease and treatment toward HCV were statistically significant different based on the history of education about NSI and sex group, respectively (P<0.005).

Demographic Characteristics and Knowledge Scores in Eight Hospitals

Although, total knowledge score toward HBV and HCV between all eight various hospitals of Guilan University were relatively similar (p>0.05), there was a statistically significant difference in knowledge score in transmission domain of HBV and HCV (p<0.05). The highest scores in mode of transmission domain about HBV and HCV were related to Guilan surgical hospital (7.5±1.4) and internal medicine hospital (7.3±2) respectively.

DISCUSSION

In the present study, among all study participants less than half had satisfactory knowledge about HBV and HCV. In the same way, in several study HCWs’ knowledge toward HBV and HCV were relatively low [16Mansour-Ghanaei R, Joukar F, Souti F, Atrkar-Roushan Z. Knowledge and attitude of medical science students toward hepatitis B and C infections. Int J Clin Exp Med 2013; 6(3): 197-205.
[PMID: 23573351]
-20Samuel S, Aderibigbe S, Salami T, Babatunde O. Health workers’ knowledge, attitude and behaviour towards hepatitis B infection in Southern Nigeria. Int J Med Med Sci 2009; 1(10): 418-24.]. Majority of responders reported good knowledge about mode of transmission toward HBV and also HCV. A small percentage of respondents actually knew about nature of disease, prevention and treatment strategy. Our results are in line with the findings from studies reported majority of medical students and HCW had correct knowledge on transmission mode [16Mansour-Ghanaei R, Joukar F, Souti F, Atrkar-Roushan Z. Knowledge and attitude of medical science students toward hepatitis B and C infections. Int J Clin Exp Med 2013; 6(3): 197-205.
[PMID: 23573351]
, 17Mesfin YM, Kibret KT. Assessment of knowledge and practice towards hepatitis B among medical and health science students in Haramaya University, Ethiopia. PLoS One 2013; 8(11): e79642.
[http://dx.doi.org/10.1371/journal.pone.0079642] [PMID: 24278151]
, 21Singh A, Jain S. Prevention of Hepatitis B; knowledge and practices among Medical students. Healthline 2011; 2(2): 8-11.]. Yamazhan et al. in a multi-centre cross-sectional study showed that nursing students had a low level of knowledge about nature of the disease and its complications [22Yamazhan T, Durusoy R, Tasbakan MI, et al. Nursing students immunisation status and knowledge about viral hepatitis in Turkey: a multi-centre cross-sectional study. Int Nurs Rev 2011; 58(2): 181-5.
[http://dx.doi.org/10.1111/j.1466-7657.2010.00869.x] [PMID: 21554290]
].

The most important source of information was through book and educational class and unsurprisingly HCWs with higher educational level were more aware about HBV. Responders’ knowledge score in all domains were higher than among advanced educational level. Our results are in line with the findings from studies reported more educated worker related with more knowledge toward HBV and HCV [15Richmond J, Dunning T, Desmond P. Health professionals’ attitudes toward caring for people with hepatitis C. J Viral Hepat 2007; 14(9): 624-32., 23Shehab TM, Sonnad S, Gebremariam A, Schoenfeld P. Knowledge of hepatitis C screening and management by internal medicine residents: trends over 2 years. Am J Gastroenterol 2002; 97(5): 1216-22.
[http://dx.doi.org/10.1111/j.1572-0241.2002.05708.x] [PMID: 12014731]
, 24Setia S, Gambhir R, Kapoor V, Jindal G, Garg S, Setia S. Attitudes and Awareness Regarding Hepatitis B and Hepatitis C Amongst Health-care Workers of a Tertiary Hospital in India. Ann Med Health Sci Res 2013; 3(4): 551-8.
[http://dx.doi.org/10.4103/2141-9248.122105] [PMID: 24380007]
]. Setia et al. investigated awareness toward HBV and HCV amongst HCWs of a tertiary level hospital in India, indicated nursing students’ knowledge was considerably lower than the dental and medical students [24Setia S, Gambhir R, Kapoor V, Jindal G, Garg S, Setia S. Attitudes and Awareness Regarding Hepatitis B and Hepatitis C Amongst Health-care Workers of a Tertiary Hospital in India. Ann Med Health Sci Res 2013; 3(4): 551-8.
[http://dx.doi.org/10.4103/2141-9248.122105] [PMID: 24380007]
] As well as, a study in Turkey indicated that mean knowledge score was significantly higher in fourth-year students than third-year students [25Gökengin D, Yamazhan T, Özkaya D, et al. Sexual knowledge, attitudes, and risk behaviors of students in Turkey. J Sch Health 2003; 73(7): 258-63.
[http://dx.doi.org/10.1111/j.1746-1561.2003.tb06575.x] [PMID: 14513628]
].

Several studies tried to show the effect of HCWs training on knowledge to viral hepatitis, reported participants who received more education showed considerable improvement in their knowledge levels [6DSouza RF, Glynn MJ, Alstead E, Osonayo C, Foster GR. Knowledge of chronic hepatitis C among East London primary care physicians following the Department of Healths educational campaign. QJM 2004; 97(6): 331-6.
[http://dx.doi.org/10.1093/qjmed/hch060] [PMID: 15152106]
, 26Fischer LR, Conboy KS, Tope DH, Shewmake DK. Educating health professionals: a hepatitis C educational program in a health maintenance organization. Am J Manag Care 2000; 6(9): 1029-36.
[PMID: 11184064]
, 27Zdanuk S, Gimpel J, Uhanova J, Kaita KD, Minuk GY. The impact of medical informatics on the confidence of rural physicians caring for patients with chronic hepatitis C viral infections. Fam Pract 2001; 18(6): 602-4.
[http://dx.doi.org/10.1093/fampra/18.6.602] [PMID: 11739345]
].Therefore, providing more education course can help health staff to remember the preventative measure.

In the current study, almost half of the HCWs had history of NSI whereas 93% of them pass educational course about NSI. Perhaps the reason for the such high rate of NSI in spite of passing education was carelessness because of high workload. Similarly, Joukar et al. in a survey showed 54% of health care professionals had a history of NSI [7Joukar F, Mansour-Ghanaei F, Soati F, Meskinkhoda P. Knowledge levels and attitudes of health care professionals toward patients with hepatitis C infection. World J Gastroenterol 2012; 18(18): 2238-44.
[http://dx.doi.org/10.3748/wjg.v18.i18.2238] [PMID: 22611318]
]. In another study, nurses who had NSI history showed considerably higher knowledge scores toward HBV, while knowledge score concerning having NSI history in our study was not different.

We reported similarity in total knowledge score toward HBV concerning work experience, but more experienced worker mentioned better score in questions related vaccine availability and treatment strategy. Joukar et al. in their study declared the mean score between the work experience groups was similar [7Joukar F, Mansour-Ghanaei F, Soati F, Meskinkhoda P. Knowledge levels and attitudes of health care professionals toward patients with hepatitis C infection. World J Gastroenterol 2012; 18(18): 2238-44.
[http://dx.doi.org/10.3748/wjg.v18.i18.2238] [PMID: 22611318]
]. This finding indicate the result of repeated educational course during work years. Abozead et al. reported the high frequency of NSIs among HCWs while, more than 60% of nurses did not pass any educational program about viral hepatitis immunity and control [28Abozead SE, Abuhasheesh M, Nawafleh H, Kawafha MM, Al-Tarawneh O. Knowledge and Practices of Jordanian Nurses on Needlestick Injuries: An Evaluative Study. Infect Dis Clin Pract 2015; 23(1): 21-5.
[http://dx.doi.org/10.1097/IPC.0000000000000159]
]. In the same way, Askarian et al. in a cross-sectional study revealed 71.1% of the students had NSIs, unfortunately 82% of them did not reported and worked up [29Askarian M, Malekmakan L. The prevalence of needle stick injuries in medical, dental, nursing and midwifery students at the university teaching hospitals of Shiraz, Iran. Indian J Med Sci 2006; 60(6): 227-32.
[http://dx.doi.org/10.4103/0019-5359.25904] [PMID: 16790948]
]. Our study participants who had history of immunization were more knowledgeable about HBV, especially in relation to mode of transmission, vaccine availability and treatment strategy. Responders with history of education about NSI showed the higher score about nature of HCV.

Our study revealed a similarity in knowledge score at the eight university teaching hospitals, and also, the mean score of the all eight hospital were less than mean total score. This finding may be due to insufficiency of educational program in the hospital setting especially after graduation. Awareness levels derived from previous survey were unsatisfactory in all HCWs even medical students. Despite, the majority of HCWs passed the educational program, they showed unsatisfactory knowledge on causative agents, mode of transmission, symptoms and prevention strategy. As well as, a high frequency of NSIs reported in health staff. Hence, extensive and effective continuing health educational course should be provided to health staff. Health staff should be sensitive and responsible for own health and wellbeing creating a culture of self-care among HCW, vaccine availability and accessibility may increase healthcare [7Joukar F, Mansour-Ghanaei F, Soati F, Meskinkhoda P. Knowledge levels and attitudes of health care professionals toward patients with hepatitis C infection. World J Gastroenterol 2012; 18(18): 2238-44.
[http://dx.doi.org/10.3748/wjg.v18.i18.2238] [PMID: 22611318]
, 16Mansour-Ghanaei R, Joukar F, Souti F, Atrkar-Roushan Z. Knowledge and attitude of medical science students toward hepatitis B and C infections. Int J Clin Exp Med 2013; 6(3): 197-205.
[PMID: 23573351]
, 17Mesfin YM, Kibret KT. Assessment of knowledge and practice towards hepatitis B among medical and health science students in Haramaya University, Ethiopia. PLoS One 2013; 8(11): e79642.
[http://dx.doi.org/10.1371/journal.pone.0079642] [PMID: 24278151]
, 20Samuel S, Aderibigbe S, Salami T, Babatunde O. Health workers’ knowledge, attitude and behaviour towards hepatitis B infection in Southern Nigeria. Int J Med Med Sci 2009; 1(10): 418-24., 22Yamazhan T, Durusoy R, Tasbakan MI, et al. Nursing students immunisation status and knowledge about viral hepatitis in Turkey: a multi-centre cross-sectional study. Int Nurs Rev 2011; 58(2): 181-5.
[http://dx.doi.org/10.1111/j.1466-7657.2010.00869.x] [PMID: 21554290]
, 24Setia S, Gambhir R, Kapoor V, Jindal G, Garg S, Setia S. Attitudes and Awareness Regarding Hepatitis B and Hepatitis C Amongst Health-care Workers of a Tertiary Hospital in India. Ann Med Health Sci Res 2013; 3(4): 551-8.
[http://dx.doi.org/10.4103/2141-9248.122105] [PMID: 24380007]
, 30Adekanle O, Ndububa DA, Olowookere SA, Ijarotimi O, Ijadunola KT. Knowledge of hepatitis B virus infection, immunization with hepatitis B vaccine, risk perception, and challenges to control hepatitis among hospital workers in a Nigerian Tertiary Hospital 2015.
[http://dx.doi.org/10.1155/2015/439867]
-41Wahsheh M, Hassan Z, Hassan Al-Wahsh F. Hepatitis Knowledge and Attitudes among Jordanian Nursing Students. Int J Health Promot Educ 2011; 49(1): 9-15.
[http://dx.doi.org/10.1080/14635240.2011.10708201]
]. Juon et al. [42Juon H-S, Park BJ. Effectiveness of a culturally integrated liver cancer education in improving HBV knowledge among Asian Americans. Prev Med 2013; 56(1): 53-8.
[http://dx.doi.org/10.1016/j.ypmed.2012.11.003] [PMID: 23159302]
] in a randomized control trial evaluated the effectiveness of a community based education program in improving HBV knowledge among 877 Asian Americans. They found even a 30-minute educational program can increase the level of knowledge after 6-month follow-up. All previous study recommended extended health educational program and increase the quality of training, but there is a question whether such program can warranty the safety of health care workers.

In the present study, we had large sample sizes, which increase the statistical power. While majority of previous studies conducted in small sample size [7Joukar F, Mansour-Ghanaei F, Soati F, Meskinkhoda P. Knowledge levels and attitudes of health care professionals toward patients with hepatitis C infection. World J Gastroenterol 2012; 18(18): 2238-44.
[http://dx.doi.org/10.3748/wjg.v18.i18.2238] [PMID: 22611318]
, 19Sacchetto MS, Barros SS, Araripe TdeA, Silva AM, Faustino SK, da Silva JM. Hepatitis B: knowledge, vaccine situation and seroconversion of dentistry students of a public university. Hepat Mon 2013; 13(10): e13670.
[http://dx.doi.org/10.5812/hepatmon.13670] [PMID: 24348639]
, 34Dahlström E, Funegård Viberg E. Knowledge about hepatitis B virus infection and attitudes towards hepatitis B virus vaccination among Vietnamese university students in Ho Chi Minh City: –A quantitative study. 2013., 40ul Haq N, Hassali MA, Shafie AA, Saleem F, Farooqui M, Aljadhey H. A cross sectional assessment of knowledge, attitude and practice towards Hepatitis B among healthy population of Quetta, Pakistan. BMC Public Health 2012; 12(1): 692.
[http://dx.doi.org/10.1186/1471-2458-12-692] [PMID: 22917489]
] an important aspect of the current study refers to comparing knowledge in a multicenter survey between tertiary level hospitals of our University. As well as, we tried to review the results of the pervious study about knowledge of hospital staff. Our study, while having much strength, involved some limitations that should be considered [2Organization WHO. Prevention and control of viral hepatitis infection, 2012.]. Only individuals who agreed to complete survey were eligible for participation in the study. In fact we did not try to encourage non responder to participate. However, there was no significant difference in demographic characteristics between responders and non responders [1Longstreth GF. Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1995; 90(2): 206-10.
[PMID: 7847286]
]. We did not coordinate a specific time and place for filling questionnaire, which might decrease the none response rate. Because the most reason for none responding was lack of time.

CONCLUSION

The results of this study indicate a low level of knowledge among HCWs about the hepatitis B and hepatitis C, especially in nature of disease, prevention and treatment strategy. More educated worker reported better knowledge toward viral hepatitis. In spite of the majority of HCWs had NSI education, more than 50% of them reported history of NSI. In service training about universal and standard precaution and also improvement in work condition can decrease the probable risk for health professional.

CONFLICT OF INTEREST

The authors confirm that this article content has no conflict of interest.

AUTHORS’ CONTRIBUTION

Farahnaz Joukar and Fariborz Mansour-Ghanaei designed the study; Mohammad Reza Naghipour contributed data analysis. Farahnaz Joukar supervised the procedure. Farahnaz Joukar and Tolou Hasandokht drafted the manuscript.

FUNDING/SUPPORT

The study was supported by the Gastrointestinal and Liver Diseases Research Center of Guilan University of Medical Science.

FINANCIAL DISCLOSURE

There was no relevant financial relationship.

ACKNOWLEDGEMENTS

The study is a part of Phd by research thesis. We would like to thank all members of Gastrointestinal & Liver Diseases Research Center (GLDRC). We would also like to thank all the hospitals staves that assisted us in this study.

REFERENCES

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[PMID: 7847286]
[2] Organization WHO. Prevention and control of viral hepatitis infection, 2012.
[3] Mansour-Ghanaei F, Sadeghi A, Mashhour MY, et al. Prevalence of hepatitis B and C infection in hemodialysis patients of Rasht (Center of Guilan Province, Northern Part of Iran). Hepat Mon 2009; 9(1): 45-9.
[4] Waheed Y, Shafi T, Safi SZ, Qadri I. Hepatitis C virus in Pakistan: a systematic review of prevalence, genotypes and risk factors. World J Gastroenterol 2009; 15(45): 5647-53.
[http://dx.doi.org/10.3748/wjg.15.5647] [PMID: 19960560]
[5] Organization WHO. Department of communicable disease surveillance and response. 2002.
[6] DSouza RF, Glynn MJ, Alstead E, Osonayo C, Foster GR. Knowledge of chronic hepatitis C among East London primary care physicians following the Department of Healths educational campaign. QJM 2004; 97(6): 331-6.
[http://dx.doi.org/10.1093/qjmed/hch060] [PMID: 15152106]
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[http://dx.doi.org/10.3748/wjg.v18.i18.2238] [PMID: 22611318]
[8] Zaidi MA, Beshyah SA, Griffiths RF. Needle stick injuries: An overview of the size of the problem, prevention and management. Ibnosina J Med Biomed Sci 2009; 2(2): 53-61.
[9] Askarian M, Ghavanini AA. Survey on adoption of measures to prevent nosocomial infection by anaesthesia personnel. East Mediterr Health J 2002; 8(2-3): 416-21.
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(Indiana University School of Nursing, USA)

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