Hepatitis B is a leading cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma [1-4]. Hepatitis B previously known as serum hepatitis is an inflammatory disease of the liver caused by Hepatitis B virus (HBV) and is a global public health problem.

Nearly two billion people in the world have been acutely infected by HBV and there are nearly 350 million people chronically infected. [1] In South East Asian Region, there are estimated 80 million HBV carriers (about 6% of the total population). [5, 6] HBV is a DNA virus belonging to the virus family Hepadnaviridae. HBV enters the liver via the bloodstream and replication occurs only in the liver tissue. The virus is 42-47 nm in diameter and circulates in the blood in concentrations as high as 108 virions per ml.

HBV is transmitted by percutaneous or mucosal exposure to infected blood or other body fluids through numerous routes: perinatal, mother to child, sexual, needle-sharing, and occupational/health-care-related. [4, 7, 8] India has the intermediate endemicity of Hepatitis B with Hepatitis B surface antigen (HBsAg) prevalence between 2% and 10% among the population studied. The number of carriers in India has been estimated to be over 40 millions [5, 6].

In India the carrier rate are higher among health care personnel (10.87%) as compared to the blood donors (6%) and general public (5%). Among healthcare workers seroprevalence is two to four times higher than that of the general population. [9] Hepatitis B infections may occur in the health care settings due to lapse in the sterilization technique of instruments or due to the improper hospital waste management because 10 to 20% of health care waste is hazardous which may create a variety of health risks [10].

The majority of the infections are subclinical, so approximately 80% of all HBV infections are undiagnosed. [4] Among the health care personnel, HBV is transmitted by skin prick with infected, contaminated needles and syringes or through accidental inoculation of minute quantities of blood during surgical, gynaecological and dental procedures.[6] Nurses are probably the most common health care staff exposed to needle prick injuries and contact with infectious fluids.

35–45 years age group and married. All the nurses included in study were graduated in nursing training. (Table 1)

Table 1: Showing distribution of Age and Marital Status

Knowledge

Table 2: Showing Comparison regarding knowledge about they being at high risk of hepatitis B infection^*

* x²= 5.54; df= 1; p value = 0.018; statistically significant

All the nurses of MYH and PH were knew about hepatitis B as it is a viral infection, lead to fatal outcome. 22 (73.3%) of nurses of MYH and 13 (43.3%) of PH, think that they are at high risk for hepatitis B infection. (Table 1) 16 (53.3%) nurses of MYH and 12 (40%) of PH knew about needle stick being a mode of transmission. 29 (96.6%) of MYH and 27 (90%) of PH nurses knew that blood transmission being a mode of transmission (Figure 1).

(Table 3) Out of vaccinated 9 (81.82%) of MYH nurses and 23 (82.15%) of PH nurses had complete course of vaccination. (Table 4) 8 (72.73%) of nurses of MYH were vaccinated before entering the profession as compared to 4 (14.28%) of PH. (Table 5)

Table-3: Showing comparison regarding vaccination status^*

* ᵡ²= 18.7; df= 1; p value 0.000; statistically significant

Table-4: Showing comparison regarding course of vaccination

x²= 0.001; df = 1; p= 0.981; considered statistically non significant

Table-5: Showing vaccinated before or after entering the profession^*

* ᵡ²= 10.6; df= 1; p value 0.000; statistically significant

Practice

10 (33.33%) of MYH nurses and 14 (46.6%) of PH nurses were exposed to needle stick injury. (Table 6) 1 (10%) of nurses of MYH and 12 (85.7%) of PH nurses were vaccinated out of those exposed to needle stick injury. (Table 7) 2 (6.66%) of MYH nurses and 20 (66.67%) of PH nurses wrongly press the point of prick after a needle stick injury. 29 (96%) of MYH nurses and 25 (83.3%) of PH nurses put antiseptic after a needle stick injury. (Table 8) 9 (30%) nurses of MYH and 6 (20%) of PH had knowledge of post exposure prophylaxis. 26 (86.6%) nurses of MYH and 28 (93.3%) nurses of PH follow universal precautions. 100% nurses of both hospitals follow colour coding for waste disposal.

33.33% nurses of MYH and 66.67% of PH considered Operation theatre as risky place while 43.33% and 23.33% nurses of MYH and PH respectively; consider all hospital places as risky. Nurses of government hospital were thought that they are at risk which was significantly (p = 0.018) different from knowledge of nurses of PH. It was comparable to Habib et al [15] (65%) and Patel et al [12] (90.2%).

Attitude:

In this study 36.67% MYH and 93.33% PH nurses were vaccinated, out of which more than 80% were completely vaccinated. This was comparable to study done by K. Djeriri et al [16] shows that in morocco health workers only 55% are fully vaccinated, Patil et al [12] 96.2% Auxiliary health care worker are vaccinated, Singhal et al [17] (58.3%) and Dannetun et al [18] in this 79% HCWs are vaccinated out of which 40% were fully vaccinated. 85.52% PH nurses and 27.27% MYH nurses were vaccinated after entering the hospital. Higher percentage in private institute was mainly due to Hospital policy. Reason of non vaccination at government hospital was unavailability (31.5%) and negligence (10.52%). Reason of non vaccination in private hospital was negligence (100%) (Figure 4)

Practice:

33.33% MYH nurses and 46.66% PH nurses were exposed to needle stick injury. Knowledge about course of action revealed that 96% MYH and 83.83% PH nurses put antiseptic while 10% MYH and 23.33% PH nurses do not do anything. In study by Patel et al [12] 40.5%

AHCWs knew the correct course of action after a needle stick injury. 70% MYH nurses and 80% PH nurses does not aware correct procedure of post exposure prophylaxis. All the nurse of Government and private Hospital follow standard method of bio waste management.

This study was carried out with 60 nurses who was not representative of all the nurses of various hospitals in Indore District, needs more sample size to be incorporated which unfortunately was not included due to time constraint.

The findings in the present study reiterate the need for refresher training at regular interval of nurses of both government and private hospital. There should be compulsory provision for hepatitis B vaccination before entering to hospitals.