Perceptions Regarding Hepatitis B and C Diseases, and Their Risk Factors among Ward Boys Working in Tertiary Care Hospitals of Islamabad

TABLECREATED

Table 1: Summary of themes.

Lack of Infection Control Process in Hospital

In the public hospital of Islamabad, the infection control process was not standardized because of the poor infrastructure of local bodies and lack of interest of government officials. The participants were not aware of the infection control process. Hospital did not organize any session for wardboys about infection control process. There was a big gap of knowledge among wardboys about infection control. They had a lot of experience working in a high-risk environment but they still did not have knowledge about infection control process.

The Spread of Infection

The ward boys were working in tertiary care hospitals of Islamabad did not have in-depth knowledge about the spread of infection. The ward boys were working in these hospitals having Matriculation Certificate. While collecting data from ward boys, they were telling, they did not have knowledge about this disease and its spread in hospital and community, even during the hiring process they did not get any departmental training nor from human resource department one ward boy verbalize during his concern during an interview about spreading the infection control. Ward boys from both hospitals told about their perceptions regarding the spread of infection. When they told their perceptions it was concluded that they do not have enough awareness about the spread of infection. Ward boys informed that they had never taught about the spread of infection ever. They knew a little bit about spreads of infection but still, there was a need to know more about spreads of infection.

Awareness about the Spread of Disease

Both Public and private hospital wardboys have different knowledge and perceptions regarding disease spread. There was a vast gap in knowledge among them. They did not have sufficient knowledge about the diseases process and its spread. They were not aware of the disease as it is a communicable disease. They answered like; they are unaware of this disease. They heard about it from unit and patients. It is a liver disease in which our liver does not work properly. Patients suffered from anorexia and paleness of the body. They knew a little bit about the spread of disease but that was not enough. Wardboys working in hospitals were on high risk of being infected. They were telling about this, I concluded they did not have enough knowledge about it.

Lack of in-Service Refresher Training in Hospital

Both hospitals public as well as private were not giving the opportunity to their wardboys to learn and advance their knowledge. There was no facilitation for wardboys to enhance their knowledge and skills according to modern technology medical field are so vast and both hospitals have a great opportunity to advance their workers with skill and knowledge. Knowledge and skill deficiency have been found among wardboys as they answered questions. Wardboys from both hospital said that there were no educational activities and inservice refresher trainings occur up till now. They did not know about disease process and its spreading process. Furthermore, hospital administration was not taking imitative to take any action to teach the wardboys. Ward boys from hospital verbalize that, they did not take any lecture or trainings session related to any disease pattern in hospital. They were not trained at any point at all.

Public Hospital v/s Private Hospital Perceptions

Wardboys from both hospitals said that they were on high risk to get this disease. Wardboys told that they knew they are working in a hospital where patients came with different diseases so we can get this disease from them. Wardboys from both hospitals identified they are on high to get this disease. Risk perception of wardboys from the private hospital was almost the same as a public hospital. As both hospitals wardboys told same thing, they are on high risk of getting this disease, and can be a career of spreading disease among patients.

Hospital Perceptions

As far as hospital perceptions is concern, the management was least bother to educate their most important line of staffs. The management of both hospitals were had the same thinking process to words the education of staff members. Analysis of the interview yielded interconnected themes. These were that hepatitis disease is not very known to everyone. They do not have knowledge about disease its spread. They have knowledge about its precaution due to the enforcement of hospital policy.

Lack of Infection Control Process in the Hospital

A35 year’s old male ward boy from the public hospital told, “Main yahan 10 saal say Kam kr Raha humhy infection k mutaliq Kuch Nai btaya jata bus itna btaya jata ha k gloves pehna krain mareez ka kam krty waqat. humhy kisi kisam ki koi class nai dijati infection control walay atay hn kabhi kabhi aur bus hmy kuch nai kehty hum apna kam krty rehty hn”.

Health system is worthy if it has control over the infection. It will never improve if there is no control over the spread of infection in the hospital setting as well as the community. In Pakistan public and private sector, the hospital’s infection rate is high. The infection control process is very important in every hospital because if it is in control then it has a great effect all over the disease burden and if it is not in control then it increases morbidity and mortality rate of a hospital as well as the country. In the public hospital of Islamabad, the infection control process was not standardized. The participants were not aware of the infection control process. Hospital did not organize any session for wardboys about infection control process. There was a big gap of knowledge among wardboys about infection control. They had a lot of experience working in a high-risk environment but they still did not have knowledge about infection control process.

A 33 years old ward boy from public hospital identified, “There is a team for the infection control process that is working to control the infection. They never told me how we control the spread of infection. I am working here for more than 7 years. I did not learn about it. I use gloves while handling the patients and changing their bedsheet. I wear gloves mostly but not all the time while caring for the patients”.

Ward boys from public hospital realized that there is a lack of infection control process in their hospital. They were not trained in the hospital regarding infection control. They have been working here from many years but the organization of the hospital did not take any interest to teach them. They did not know about the infection control process. They come to perform their duties and then going back without even knowing. They did learn from other staff that spread of infection occurs from patients. Mostly they use gloves but sometimes they do not use gloves while handling the patients. They were doing malpractice in the hospital.

A 25 years old wardboy from private hospital informed. “Hammy koi pta nai k infection control kaisay hota ha na he kisi ny hmy koi class di ha bus supervisor aur infection walay atay hn aur yeah keh kr chalay jatay hn k gloves pehn liya kro unit main gloves pary howay hoty hum aksar pehn lyty hn bus itna he hota ha kabhi hmy btaya nai k infection kaisay lgta ha isko hum kaisay control kr skty hn”.

The participant from the private hospital informed about the infection control process. They told that there is an infection control department in our hospital that is working to control the spread the infection in the hospital. Routinely rounds, check and balance are maintained in every department. There is a proper team for the infection control program. It has a separate department name as infection control department which is working in the hospital. When asked they knew about infection control process. They said they did not know about it. They also identified that there is no session from this team for us about infection control process.

A 23 years old ward boy from the private hospital said “ I do not exactly know about infection control process and I did not take any class about it I think there is lacking in infection control process in my hospital because they came in our department and go back without giving any information. They never focus on us. I am working here for more than 3 years I did not know anything about it”.

In private hospitals, wardboys realized they don’t have sufficient knowledge regarding infection control process. They were told that there is a lack of infection control process in our hospital. They did not know anything regarding infection control. They identified infection control come and did nothing. In both hospitals, wardboys identified that they did not know about the infection control process although both hospitals have infection control department separately. Infection control process in both hospitals was not good according to the ward boy’s point of view. Wardboys told that they wear gloves while care of the patients, not all the time but sometimes they wear gloves. Hospitals infection control management never takes any action to organize infection control session for them. That’s why they did not know about the infection control process. They did not have any idea about infection control except wearing gloves. They have a knowledge deficit about the infection control process. The infection control process is very important to know among wardboys working in tertiary care hospitals because in tertiary care hospitals multiple patients having different diseases came, wardboys have direct contact with patients if they do not know about infection control process they are on high risk to get the infection in the hospital. As the wardboys explained that they do not know about it. In both hospitals, there was no learning environment for wardboys. All the wardboys did not about the infection control process they have deficit knowledge which leads to malpractice. According to wardboys, both hospitals have infection control department but they were focusing to control the spread the infection and unable to teach the ward boys till now how it spread what precautionary measure are necessary for communicable diseases. Both hospitals have the same issues about the gap in knowledge and practices. As wardboys told there was infection control team in both hospitals which are working to control the spread of infection but many lacking are still present in both hospitals. Wardboys working in both hospitals do not know in-depth knowledge about infection control. All participants from the public sector and private sector said they are using gloves while handling the patients. They did not use always gloves but mostly use gloves. And there were no specific precautions for hepatitis patients in their point of view.

Awareness about the Spread of Infection

Effective use of infection preventions and control strategies is very important for the provision of quality health care to the clients as well as for maintenance of a safe working environment. Wardboys educational background was not sufficient to work with patients. Infections are an important cause to increase or decrease the morbidity rate and mortality rate of any country. If we control the spread of infections of communicable diseases, then we will be able to control the spread of the diseases.

A 31 years old wardboy from public hospital informed “Infection syringe say phelta ha mareez k sath khana khanay say phelta ha us k hath milanay say phelta ha usko touch krny say phelta ha mareez ki bedsheet sy phelta ha aur us k khoon sy phelta ha agar hmy lg jaiy to hum ny apna checkup kabhi bi nai krwaya hmhy zarorat nai prhti the main alhamdulilah theak hn aur na kabhi hospital walo ny hmy bola ha checkup ka”.

The wardboys were working in tertiary care hospitals of Islamabad did not have in-depth knowledge about the spread of infection. The wardboys were working in these hospitals having Matriculation Certificate. While collecting data from wardboys, they were telling, they did not have knowledge about this disease and its spread in hospital and community. Wardboys from the public hospital told about their perceptions regarding the spread of infection. When they told their perceptions it was concluded that they do not have enough awareness about the spread of infection.

“A 28 years old wardboy from public hospital Islamabad was telling, “It spreads through needle prick injuries, used razor blade, direct contact with patients and they are coughing”.

Wardboys from the public hospital told that they do not know about how exactly spreads of infection occur. They gave their different perceptions when asked if they were ever taught about the spread of infection. All the wardboys of the study informed that they had never taught about the spread of infection ever. They knew a little bit about spreads of infection but still, there was a need to know more about spreads of infection.

A 23 years old wardboy working in private hospital Islamabad told, “infection syringe ki needle sy lgta ha bus itna he pta ha k syringe ki needle sy lgta aur kuch bi nai pta”.

Wardboys working in private hospital gave a little information about spreads of infection. Their knowledge was limited related to awareness of the spread of infection. They were told that they did not have any idea about how it spreads.

A 28 years old ward boy working in private hospital Islamabad expressed himself “It spreads through sharing razors blade, used syringes, dirty bed sheets. It also spread through sharing patient’s meal with others and if we do not wear gloves while working in hospital infection will spread”.

From private hospitals, participants were not fully aware of the spread of infection. They informed according to their understanding. Participants were focusing on that infection will spread many ways like sharing meals. Most of the participants realized they do not have enough knowledge about the spread of infection. It seemed wardboys had little idea about the mechanism of spread of infection in the hospital. In both hospitals, the public and private hospital interviews were taken from wardboys. Wardboys said they do not know how the infection spread in the hospital. They realized that they do not have enough knowledge to describe exactly how it spread. As yet, in Pakistan, there is no institute which has started any certificate or diploma course in infection control. Awareness about the spread of infection is very important especially in developing countries because the infection rate is high in developing countries like Pakistan. They were telling according to their thoughts. They were telling about their qualification which does not contain such information. While working in hospitals they never conduct any class related to infection control. Participants said they are telling according to their point of view. Some of the ward boys kept a little information on how the infection spreads. They identified one or two things in which infection will spread; as wardboys mentioned it spreads through needle stick injuries and razor blades.

Awareness about the Spread of Disease

Awareness about disease pattern is very important because if one knows about the disease process one will deal with the patients well and take precautions to prevent infections. The deficiency in knowledge seems like a high-risk attitude. It is most prominent in wardboys of these hospitals. Education of wardboys about risks and modes of transmission of hepatitis disease is important.

A 26 years old wardboy from public hospital. “Kala yarqan (Hepatitis B and C) phelta ha jb hamri body main khoon kam hojata ha khas tor pe hamry mehday (stomach) main khoon kam hojata ha hum sai sy khana na khatay jigar main garmi barh jaiy tbi bi kala yarqan hojata ha.is ke elawa jb hum kisi mareez sy milty hn salam dua krty hn to us k ganday kapro sy aur mareez k khansi krnay sy bi yeah bemari lgti ha.”

The wardboys working in a public hospital did not know about the disease process and its spread in hospitals. They told about the spread of disease was totally irrelevant, unrealistic and also very limited. Mostly signs and symptoms were not present. It was concluded there was a big gap of knowledge among wardboys. Wardboys from the public hospital did not study the disease process and its spread in their academic studies as they mentioned. Wardboys had little knowledge about the disease process. Wardboys informed they did not take any class related to the disease process as they were working for many years in the hospital. They learned things from their own. A35 years old wardboys from public hospital was telling about the spread of disease “I do not know anything about Hepatitis disease except it has two types these are Yellow(Hepatitis A) and Black Hepatitis(Hepatitis B, C) It spreads if we don’t take care of its precautions like sharing meal with hepatitis patients. It also spreads utensils sharing and food sharing with patients. Its signs and symptoms are abdominal distension, bleeding from mouth and jaundice”. Mostly wardboys from the public hospital gave the same answers about the spread of disease. They responded like common men who do not know about hepatitis disease exactly. They were focusing on the disease will spread if we will share meals with hepatitis patients. In fact, there was a big gap between knowledge and practice. They identified there was not a single session organized from management for them, Where they learned about the disease process. They were working in the hospital for many years; wardboys identified there was no learning facility for them.

A 25 years old wardboy from private hospital Islamabad said “kala yarqan mareez k sath khana khanay unko milnay sy un k sath zyda batain krny sy aur thandi cheezain khanay sy jaisay bazar sy juice banda peeta ha jo dabay wala hota ha us phelta ha yeah aisi beemari ha jo kisi ko bi lg skti ha zarori nai aisa ho kisi aur trah bi lg skti ha”.

Wardboys from private hospitals described disease process according to their knowledge. Their educational background was not covering clinical education. They did not study any disease in their studies. Although they were working in the hospital still they did not exactly know how the disease process and its spread was. They do not know anything about the disease process most of them said they do not have any idea about the disease process and its spread. They were trying to answer the questions according to their knowledge as they listen from others. They were telling, they were never asked about the spread of disease that’s why they do not know about it. A 24 years old wardboy working in private hospital Islamabad, “Hepatitis is a disease of the liver in which level of blood volume in the human body will decrease and water in blood also decreases. In this disease the blood volume will decrease in our body due to malfunctioning of liver and blood colour will become black. It has two types Hepatitis A and Hepatitis B, C. if a person having this disease he became weak. Hepatitis B is very dangerous no treatment for it”. Wardboys told about hepatitis disease is basically liver disease. They heard about it from unit and patients. It is a liver disease in which our liver does not work properly. Patients suffering from anorexia and paleness of the body. They knew a little bit about the spread of disease but that was not enough. Wardboys working in hospitals were on high risk of being infected. They had to know about it spreads. They were telling about this, I concluded they did not have enough knowledge about it.

Both Public and private hospital wardboys have different knowledge and perceptions regarding disease spread. There was a vast gap in knowledge among them. They did not have sufficient knowledge about the diseases process and its spread. They were not aware of the disease as it is a communicable disease. They answered like; they are unaware of this disease.

Lack of in-Service Refresher Training in Hospital

In every organization, refresher training is important especially in the hospital setting as they play an important role. Health care workers need to know what is happening around the world. In service, training basically enhances the knowledge and competency of a person. In-service refresher training is very important for tertiary care hospital because this type of hospital has an advanced level of care and dealing with multiple specialities at a time. The workers deal with different types of patients having different diseases-service refresher training play an important role to overcome causes of mortality and effectiveness in patient’s care.

A 38 years old ward boy from public hospital Islamabad was telling. “Meray hospital main hamaray liay koi aisi class ya training nai howi na he hmy kis ny btaya ha kabhi kisi ny kuch aisa hmy kabhi kisi ny kisi bemari k mutaliq koi training nai mili main kai salo (years) sy kam kr raha aisa kuch nai howa”.

Wardboys from public hospitals informed that was no in services refresher training in their hospital for them. Wardboys were not aware of in-service refresher training. Wardboys informed they are working for many in hospitals but did not attend any training related to their fields. As concluded they were not aware of it.

A 33 years old wardboy from the public hospital said.” There is no in-service refresher training in hospital for wardboys since I am working 10 years. We did not take any training in hospital related to patient care and about a disease or clinical related”.

Wardboys were working in the hospital they had many years’ experience as a wardboys still hospital was not focusing on their clinical knowledge and training. There were no educational and inservice refresher training to be arranged for this group.

A 25 years old ward boy from private hospital informed,” Main is hospital main 5 saal (years) sy kam kr raha hn hum ward boys k liay kabhi koi infection control ya hmaray department ki trf sy koi training nai howi jis main hmy kisi bemari ya ehtiyat k baray main btaya gia ho”.

As the wardboys from private hospital realized that there is a good infection control department in our hospital but they are not facilitating us. There was not a single training session arranged from higher management or infection control department for them. They did not attend any service related training during their service in their hospital.

A 27 years old wardboy from private hospital explained. “There is no training session or short courses for wardboys in this hospital. We did not know about disease process because our hospital organized many sessions for other workers but there is not a single training or session for us related to clinical and about patient handling for us. They came and told us to wear gloves while handling the patient only”.

Wardboys private hospital said that there were no educational activities and in-service refresher trainings occur up till now. They did not know about disease process and its spread. Hospital was not taking any action to teach the wardboys. Wardboys from hospital told, they did not take any lecture or trainings session related to any disease pattern in hospital. They were not trained at any point at all. Both hospitals public as well as private were not giving the opportunity to their wardboys to learn and advance their knowledge. There was no facilitation for wardboys to enhance their knowledge and skills according to modern technology medical field are so vast and both hospitals have a great opportunity to advance their workers with skill and knowledge. Knowledge and skill deficiency have been found among wardboys as they answered questions.

Public Hospital v/s. Private Hospital Perceptions

The wardboys in these hospitals have different knowledge and having different risk perceptions about disease. While collecting the data according to their knowledge and they have different perceptions about the disease and its risk.

A 24 years wardboy from public hospital expressed his views“Yeah aik aisi beemari ha jo kisi ko bi lg skti ha.jb hum bura sochty hn tb bi yeah bemmari lg skti ha.q k bemari ki koi khas wajah nai hoti bus hojati ha.aur main hospital main kam krta hn main smjta hn k mjy khatra ha k mjy yeah bemari lg jaiy”.

Wardboys from the public hospital had different perceptions about the risk of the disease. According to their knowledge, they have different perceptions. They were told that we were on high risk of getting this disease.

A wardboy from private hospital answered. “yeah aik aisi bemari ha jo khoon (blood) sy aur needle sy phelti ha hum hospital main kam krty hn yeah cheezain hoti hn hmry pas mareez (patients) atay hum unka khayal rakhty hn unka kam krty hain un k pass jatay hn aur yeah bemari aisay he phelti ha mjy lgta ha k yeah bemari mjy bi lg skti ha q k bemari koi bi ho wo Khuda ki traf sy ati ha main khatra mehsoos krta hn is k honay ka”.

According to them, the disease spread with blood and needle prick injuries. They deal with multiple patients in a day. They thought this disease came from God. Everyone was on high risk to get this disease and they were on high risk to get this disease. Some wardboys from private hospitals had different perceptions regarding the spread of this disease they thought this disease spread from the community. One wardboys expressed his feeling he infected from hepatitis when he was not working in the hospital. Peoples mostly got this infection from the community, not in the hospital so according to his views, we cannot get hepatitis disease from the hospital. Wardboys from both hospitals said that they were on high risk to get this disease. Wardboys told that they knew they are working in a hospital where patients came with different diseases so we can get this disease from them. Wardboys from both hospitals identified they are on high to get this disease. Risk perception of wardboys from the private hospital was almost the same as a public hospital. As both hospitals told same that, they are on high risk of getting this disease.

Data Availability Statement

The Qualitative (Raw) data used to support the findings of this study are available from the corresponding author upon request.

Discussion

This study was conducted to know the perceptions of wardboys about the risk factors of hepatitis disease in tertiary care hospital of Islamabad. The wardboys working in a public hospital did not know the basic knowledge of the disease and spread of infection. The private sector gives great focus on preventions of infectious disease in their hospital. But in this study, the wardboys are not well aware of the disease process. They did not use personal protective equipment’s while handling the patients. They were taught by their senior’s staff to wear gloves. There was none availability of other personal protective equipment’s like gowns, mask and face shield according to wardboys. There was a bit of knowledge and were not trained as they were working in a hospital. A tertiary level hospital having limited resources to control the spread the infection for the general population. It had been observed in this study that participants were not aware of the risk factors and high-risk population of these diseases. The private hospital should focus on its wardboys and arrange the programs and training courses for them. A study in Northern India, there has not been ample research regarding the assessment of obstacles faced by health care workers due to knowledge deficit regarding the implementation of infection prevention practices [21]. Wardboys were working in a high-risk environment. The infection control process decreases the nosocomial infection, morbidity and mortality but wardboys did not have basic knowledge of it. In the Public sector hospital, the burden of the patient’s burden was high. So this leads to the spread of infectious disease among patients and health care provider. Healthcare-Associated Infections (HAIs) guidelines of prevention of infection remain the same regardless of the infection [22]. As in public hospital, they have organized structure and proper developed infection control department which play a significant in prevention and control of infection. Effective infection prevention and control is central to providing high-quality health care for patients and a safe working environment for those that work in healthcare settings. Risk management is an important part of this step when implemented effectively patients can be provided quality of care through infection prevention. Therefore it will not wrong to highlight the fact that Infection Control is a fundamental part of the clinical care of an individual. A survey suggested that a simple practice as poor hand hygiene can be responsible for causing as much as 40% of infection transmitted in a hospital setting [23]. In both public and private hospital, wardboys said that they do not know how the infection spread in the hospital. Awareness about the spread of infection is essential especially in developing countries like Pakistan where hepatitis is more prevalent. Some of the ward boys on kept a little information about how the infection spreads. They identified one or two things in which infection will spread; as wardboys mentioned it spreads through needle stick injuries and razor blades [24]. Relating to this a study suggested that one-third of healthcareassociated infections are preventable [25]. One tertiary Public sector study showed that basic hand washing facilities are still not available at 25% of public sector hospitals of Pakistan [26]. It is the utmost need of the developing countries to formulate required policies for implementation of standards that achieve infection prevention [27]. Both Public and private hospital wardboys were knowledge deficit. They were not aware of the disease process and its causes. Most participants in the study showed misperceptions about the disease. They were not familiar with the disease process or its management due to deficiency of teaching sessions and in compliance with the up gradation on knowledge. A study shows a lack of knowledge about hepatitis was reported among healthcare workers [28]. The burden of healthcare-associated infections is shared by both developed and developing countries. According to a WHO survey conducted in 55 hospitals in 14 countries in 4 regions, the total percentage of patients who had nosocomial infection 8.7%. Thus, relating to poor practices among healthcare workers [29]. In this regards, Wardboys considered themselves to be at high risk of acquiring this disease still they were not following standard practices of disease prevention and it could result fatal for them as any wrong practice can prove life-threatening to them. Whereas the study showed that Health care workers all around the world are at risk of attaining infectious diseases like hepatitis B and C because of the nature of their profession [30]. It was observed in this study that participants did not know about the spread of Hep B and C infection, making them more susceptible to transmission of infection both to self and others. The only route of transmission that the majority of participants were familiar with was the needle stick injury. It was found that perceptions of the majority of participants about the disease and its risk factors were similar in both settings. Most of the participants thought that they were at high risk of acquiring this disease. In their view, it would be due to bad luck that they or any of their colleagues shall acquire this disease. Majority of studies couldn’t find the difference between public and private health sector when it comes to the quality of one or both results are mixed as to whose better. In this study, failing to achieve the self-ideals and having the emotions of futility regarding the treatment turned into frustration over the course of time [31]. Wardboys believed this disease came from God. They thought everyone is on high risk to get this disease. In Iran, diseases were regarded as the punishment of sins by God Almighty. Evidence shows that these struggles lead to degradation in health and well-being [32-34]. Research Funding. The research was purely based on education purpose, hence it was conducted from self finance.

Conclusion

From this study, it is concluded that ward boys in private and public tertiary care hospitals are at high risk of acquiring Hep B and C infection. They lacked knowledge about the infective disease as well as ways to prevent its spread. Certifications should be made mandatory for such personnel before they are allowed to work in this environment. Hospitals do not have a proper system for infection control measure and lack of infection control training, especially for wardboys. Only a few of them have knowledge about personal protective equipment’s PPE, and the majority of them are working at high risk of infection. The wardboys are not aware of the infection control process related to hepatitis B and C. The infection control team does not organize awareness seminars and courses for them. The wardboys who are working in private hospital know that there was infection control department to control the spread the infection in the hospital. Even though, this department does not organize proper awareness session for wardboys. In both healthcare sectors, they have the same issues about the gap in knowledge and practices among wardboys. Wardboys working in both hospitals do not know in-depth knowledge about the spread of disease and infection control. All wardboys use gloves while handling the patients, but they don’t follow specific precautions for hepatitis patients in their point of view.

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