Personalized education improves hepatitis B vaccination rate among physicians in Saudi Arabia.

To the Editor: Hepatitis B virus (HBV) and other bloodborne pathogens are occupational hazards for healthcare workers (HCWs) who are exposed to blood and body fluids in occupational settings.1,2 The Centers for Disease Control and Prevention had estimated that 6,800 HCWs whose jobs entail exposure to blood become infected with HBV each year.3 The hazards can be reduced by use of Universal Precautions and HBV immunization. Saudi Arabia is an endemic area for HBV; previous studies have shown an average prevalence of hepatitis B surface antigen of approximately 10%, with males usually having higher rates than females.4,5 This suggests that HCWs in Saudi Arabia who regularly come in contact with blood and body fluids are at substantial risk of HBV infection. This study was designed to estimate the proportion of nursing staff and physicians at the Security Forces Hospital in Riyadh who were immune to HBV and also to assess what impact a personalized, educational awareness campaign may have on improving the rate of hepatitis B vaccination among HCWs. We conducted a two-round survey. In the first round, an anonymous self-administered questionnaire was sent to all HCWs who worked in hospital departments known to involve risk of exposure to blood and body fluids. The questionnaire covered the current hepatitis B immunization status of the workers; if the worker claimed to have been immunized, whether post-immunization antibody was evaluated; whether and when booster doses were given; and whether there had been earlier hepatitis B infection and treatment. For 6 months following the initial survey, an intensive educational awareness campaign was conducted (directed especially at physicians, who scored low on hepatitis B immunity prevalence during the first survey). Each physician was sent a personalized letter, emphasizing the need to be vaccinated or to complete the vaccination series. At the end of the educational campaign, a similar questionnaire again was distributed to the physicians. The immunity rate among the physicians was estimated and compared with the rate at the first survey. The difference in the rates was tested for significance using a chi-square statistic. Questionnaires were distributed to 665 nursing staff and 276 physicians during the first round; 469 nurses (70.5%) and 235 physicians (85.5%) responded. Of the 469 nurses, 422 (90%) were found to be immune. Only 141 (60%) of the physicians were immune. A total of 256 physicians received the questionnaire in the second-round survey; of these, 226 (88.3%) responded. Of the 226 respondents, 157 (69.5%) were immune. A chi-square analysis (Table) indicated that the increase in the immunity rate was statistically significant (P=.03). We found a relatively low prevalence rate of HBV immunity among physicians at the Security Forces Hospital. Although the initial survey found 90% immunity among the nursing staff, only 60% of the physicians were immune. However, a 6-month personalized, educational awareness campaign produced a significant increase of approximately 10% in the immunity rate among the physicians. In a United States survey, only 56% of physicians had received at least one HBV vaccination, and of these only 45% were immune.3 There is the need, therefore, to devise strategies to minimize the risk of HBV among HCWs. Personalized, educational awareness campaigns, could be an important strategy to achieve this objective. In our facility, HCWs not only were given necessary information on the risk of exposure to bloodborne pathogens but hepatitis B vaccine is made available to HCWs free, and compliance to the recommended strategies is monitored. We now check the HBV immune status of all new employees working in patientcare areas before initial assignment, and hepatitis B vaccine is given as appropriate, depending on antibody status. In conclusion, hepatitis B remains a preventable occupational risk to HCWs, and implementation of strategies to reduce risk, including immunization, should be encouraged. Personalized education can improve awareness and increase vaccination rates among HCWs.