Knowledge and Awareness of the Health Care Workers about the Hepatitis B Infection and their Vaccination Status in a Newly Started Medical College.

INTRODUCTION: Healthcare workers (HCWs) are at high risk of hepatitis B virus infection (HBI) and so the present study was carried out to assess the knowledge of HCWs in a tertiary care medical college about HBI and hepatitis B vaccine (HBV). METHOD: After obtaining approval from Institutional Ethics Committee and informed consent from the study participants, HCWs that included teaching faculty, resident doctors, medical students, nurses, laboratory technicians, administrative staff and support staff (ward boys, attendants and sweepers) were administered a validated questionnaire. Descriptive statistics was applied for the categorical variables and the Chi-square test of association was used to assess the statistical significance of variables. RESULTS: A total of 300 HCWs were recruited for the study. Although, the overall knowledge amongst all the HCWs was found to be 68%, only 35.3%HCWs knew the transmission risk by needle stick injury (NSI). Similarly, only 40% correctly knew the precautions to be taken for preventing an NSI and 17% for the steps to be taken to disinfect a blood splash. Almost 92.7% (278/300) HCWs were aware about the availability of a vaccine, of which only 41% (1123/300) knew that vaccine will not work in case the patient is already infected. When asked about the steps to be taken in case of an NSI in non-vaccinated HCWs, only 54.7% (164/300) replied about treatment with both immunoglobulin and vaccination. A total of 160 (53.3%) HCWs were found to be vaccinated. The most common reason for not taking vaccination included an improper understanding of HBV and the infection it causes. CONCLUSION: To conclude, the study highlights good knowledge about hepatitis B infection with requirement of more emphasis on the practical aspects of management in a case of NSI/blood splash and can guide to improve the vaccination status and knowledge of HBI amongst HCWs.

Fluconazole prophylaxis against fungal colonization and invasive fungal infection in very low birth weight infants.

BACKGROUND: Fungal infections are common cause of morbidity and mortality in very low birth weight Infants OBJECTIVES: To evaluate the efficacy of prophylactic Fluconazole in preventing fungal colonization and invasive fungal infection in VLBW infants. DESIGN: Prospective, randomized, double blind placebo controlled clinical trial. SETTING: Tertiary level Neonatal intensive care unit. SUBJECTS: 120 preterm infants with birth Weight < 1500 g. INTERVENTION: Infants were randomly assigned during first three days to receive either Fluconazole or placebo till 28 days or less if, discharged or died earlier. Weekly surveillance cultures from groin, oropharynx, rectum and blood were collected in all patients. Fungal isolates were typed based on standard microbiologic techniques. Liver enzymes were monitored. RESULTS: Baseline risk factors for fungal infection in Fluconazole and Placebo groups were similar. Fungal colonization was seen in 30 infants (50%) in the placebo group and 11 infants (19%) in the Fluconazole group (P <0.001). Fungal colonization at rectum, groin and oropharynx was less in fluconazole groups. Fluconazole group showed significantly lower colonizations with Candida albicans but not with C. glabrata. Invasive infection was seen in 15 (25%) infants in Placebo group and 16 (26.7%) infants in Fluconazole group (P = 0.835). Various non-albicans Candida were responsible for 96.8% cases of invasive fungal infection (Candida glabrata 71%, C. parapsilosis 14.7% and C. tropicalis 9.6%). No significant hepatotoxicity was noticed during Fluconazole therapy. CONCLUSION: Prophylactic fluconazole during the first four weeks of life is effective in reducing fungal colonization but not invasive infection in VLBW infants.