Participation in a blood and body fluid exposure programme in a multinational healthcare facility in an emerging country

Background: Blood and body fluid exposures (BBFE) are an important occupational hazard to which healthcare providers are exposed, with more than 5,000 daily exposures worldwide. While the majority of programmes for the management of BBFE were written for developed countries, most BBFE transmissible infections in healthcare providers occur in the developing countries, where reporting of exposures is low. It is therefore a high priority to establish effective BBFE programmes in developing countries, and to identify and reduce barriers to participation in these programmes. Aim: To examine participation in a newly established BBFE programme, responsive to the needs of a multinational workforce, in a hospital in United Arab Emirates (UAE). Methodology: Mixed methods. Methods: Three systematic reviews and one structured review of the literature were performed on topics central to management of BBFE. Two quantitative and two qualitative studies were conducted to assess the participation in and impact of implementing a new BBFE programme. The first quantitative study assessed the knowledge, attitudes, and practices of the healthcare providers prior to implementation of the programme. The second quantitative study constituted pre- and post-intervention clinical audits to assess the impact of the programme on healthcare providers’ behaviour. The first qualitative study examined the lived experience of healthcare providers after occupational exposure to HIV-infected body fluid. The second qualitative study involved a cross-cultural comparison of healthcare providers’ beliefs and attitudes toward BBFE in UAE and New Zealand. Results: Healthcare providers in the hospital were found to have detailed knowledge of potential treatment options. The results reflected a preference for personal discretion in decisions on reporting and risk assessment before post-exposure management. The second quantitative study demonstrated that the programme successfully improved the reporting rates of occupational exposures from 19.5/100 beds annually in 2006-7 to 27.7/100 beds annually in 2008-9. The study identified several features which the programme used to improve reporting and post-exposure management: corporate policy, development of a BBFE protocol, introduction of immunisation campaigns, use of safe devices, and post-exposure counselling. The qualitative studies explored post-exposure stress and the effect of non-organisational factors. These studies demonstrated that healthcare providers were more concerned about the social implications (particularly stigma, and legal or financial penalties) rather than the biological consequences of the disease. It was evident from the case studies that concern regarding stigma played a significant role in post-exposure stress, with healthcare providers in UAE having far more concerns in this regard compared to New Zealand-based healthcare providers. The findings suggested that in UAE occupational reporting is not just an organisational issue; it needs to be addressed at a societal level as well. Conclusions: This thesis characterised the organisational and non-organisational factors which influenced participation of healthcare providers in a BBFE programme. The hospital’s programme was successful in addressing organisational factors, but interventions to address non-organisational factors are also required. All hospitals in the Middle East should develop BBFE programmes that optimise their effectiveness in the cultural context in which they operate