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Abstract

Introduction. Health care workers (HCW) have a high risk of infectious substance exposure. Hepatitis B, hepatitis C, or human immunodeficiency virus (HIV) are some diseases transmitted by body fluid or body tissue. Cipto Mangunkusumo Hospital Jakarta has been implementing post-exposure prophylaxis (PEP)s towards HIV, hepatitis B, and hepatitis C. This study aimed to identify the implementation of post-exposure prophylaxis of HIV, Hepatitis B, and Hepatitis C among HCW in Cipto Mangunkusumo Hospital Jakarta. Methods. A cross-sectional study was conducted to exposed workers in Cipto Mangunkusumo Hospital Jakarta between 2014-2016 who had been recorded by report. Demographic data were collected through medical record and interview was conducted to gather additional data. Statistical analysis was conducted with SPSS 20. Results. Among 196 reports, most HCW were female (69.9%), worked as nurse (38.3%), medical doctor (49.5%), and exposed percutaneously (93.4%). There were 183 risky exposures, with 19 (10.4%) reactive anti-HIV, 11 (6.0%) positive HBsAg, and 12 (6.6%) reactive anti-HCV in source of exposure. Almost all of the HCW has no HIV, hepatitis B, nor hepatitis C at the moment of exposure. Recommendation for antiretroviral (ARV) was given to 81 HCW, but only 49.4% completed the course. Anti-HIV follow up was done only by 21.3% workers. Recommendation of PEP for hepatitis B was given to 37 HCW. But, only 13.5% and 13.3% receive hepatitis B vaccination and hepatitis B immunoglobulin, respectively. Follow-up of HBsAg and anti-HBs on 3rd and 6th months were done by 41 (31.1%), 38 (28.8%), and 2 (1.5%) workers who were recommended to receive prophylaxis. In 182 workers recommended to do the follow-up of anti-HCV, 39 (21.4%), and 37 (20.3%) workers did the follow-up on 3rd and 6th month. Majority of exposed workers were not re-evaluated for HBsAg (64.9%) and anti-HCV (69.9%). Conclusions. The implementation of post-exposure prophylaxis for HIV, Hepatitis B, and Hepatitis C was still low especially in re-evaluation serologic marker. Comprehensive management is recommended including improving knowledge of health care workers, re-evaluation of operational procedure standard, and effective communication.

References

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Bahasa Abstract

Pendahuluan. Petugas kesehatan memiliki risiko pajanan infeksi yang cukup tinggi. Hepatitis B, hepatitis C, dan human immunodeficiency virus (HIV) adalah beberapa penyakit yang dapat menular melalui pajanan cairan atau jaringan tubuh. Rumah Sakit Umum Cipto Mangunkusumo (RSCM) telah mencanangkan profilaksis pasca pajanan terhadap HIV, hepatitis B, dan hepatitis C. Penelitian ini dilakukan untuk menilai pelaksanaan profilaksis pasca pajanan terhadap HIV, hepatitis B, dan hepatitis C pada petugas kesehatan di RSCM Jakarta. Metode. Studi potong lintang dilakukan pada petugas terpajan yang terdata melalui laporan di RSCM Jakarta pada tahun 2014-2016. Data demografis dikumpulkan melalui rekam medis dan dilanjutkan dengan wawancara untuk data tambahan. Data diolah secara statistik menggunakan SPSS versi 20. Hasil. Dari 196 subjek yang melaporkan pajanan, sebagian besar merupakan perempuan (69,9%), bekerja sebagai perawat (38,3%), dan dokter (49,5%), serta mayoritas terpajan secara per kutan (93,4%). Dari seluruh laporan tersebut didapatkan 183 pajanan berisiko, dengan anti-HIV reaktif pada 19 (10,4%), HBsAg positif pada 11 (6,0%), dan anti-HCV reaktif pada 12 (6,6%) sumber pajanan. Mayoritas petugas terpajan diketahui tidak memiliki HIV, hepatitis B, dan hepatitis C. Hanya 27,5% petugas terpajan memiliki kadar anti-HBs protektif. Dari 183 pajanan berisiko, sebanyak 44,3% mendapatkan rekomendasi antiretroviral (ARV), namun hanya 49,4% petugas yang minum ARV secara lengkap (28 hari). Capaian evaluasi anti-HIV pada bulan ke-3 dan ke-6 hanya dilakukan oleh 21,3% petugas. Rekomendasi profilaksis pasca pajanan hanya diberikan kepada 20,3% laporan, dengan capaian hanya 13,5% dan 13,3% untuk vaksinasi hepatitis B dan immunoglobulin (HBIG). Evaluasi ulangan HBsAg 3 dan 6 bulan secara lengkap hanya dilakukan oleh 13,5% petugas kesehatan, mayoritas petugas (64,9%) tidak melakukan evaluasi ulang HBsAg. Dari seluruh pajanan berisiko hepatitis C, mayoritas tidak melakukan evaluasi ulang terhadap anti-HCV (69,9%). Simpulan. Pelaksanaan profilaksis pasca pajanan terhadap HIV, hepatitis B, dan hepatitis C masih rendah, terutama pada evaluasi status serologis lanjutan. Oleh karena itu, penanganan profilaksis secara komprehensif penting dilakukan termasuk peningkatan pengetahuan dan kesadaran petugas kesehatan, peninjauan kembali standar operasional prosedur, dan komunikasi yang efektif.

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