Viral hepatitis elimination should receive more attention from Iranian nurses

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Dear Editor,
We read an interesting article by Rezaei, Hajizadeh, Zandian, Fathi, and Nouri (2017) in your journal. In the systematic review, the period prevalence of needle stick injuries (NSIs) in Iranian nurses was 44%, but less than half of these injuries had been reported by the nurses. The rate of NSIs is high in Iranian health occupations, and most of them remain unreported.
Rezaei et al.'s study showed a wide range in prevalence of NSIs among included studies, so they may have under‐estimated the rate of NSIs among Iranian nurses. They included some low‐quality published data in the Persian language indicating a very low rate of such injuries. Some of these studies used convenience sampling, and their samples may not have been representative. In addition, good quality studies use a blind method for filling their questionnaires to minimize the rate of denial because of stigma. In a recent study in the US in which data were collected data by email, 91% of interventional radiologists had sustained NSIs, and only 66% of the injuries were reported (Deipolyi, Prabhakar, Naidu, & Oklu, 2017).
The common reasons for NSI occurrence for nurses seem to be rushing, fatigue, lack of skill, stuck by others, and carelessness/accidents (Hasak, Novak, Patterson, & Mackinnon, 2017). Common reasons for not reporting NSIs may be a belief in low utility of reporting, long reporting processes, belief that the needle was not contaminated, and associated stigma (Deipolyi et al., 2017). The rate of these injuries is higher in healthcare workers in training and medical sciences students, compared to other groups of healthcare workers (Prüss‐Üstün, Rapiti, & Hutin, 2005).
The World Health Organization has a goal to eliminate viral hepatitis by year 2030 after introducing new direct acting antiviral (DAA) drugs. Their programs are concentrated on eliminating hepatitis C virus (HCV) and controlling hepatitis B virus (HBV) infections in the first step and transmission. NSIs are a barrier to these goals (Hesamizadeh, Sharafi, Rezaee‐Zavareh, Behnava, & Alavian, 2016; Karimi‐Sari & Alavian, 2017).
Monitoring of NSIs is needed to control HBV and HCV transmission and facilitate their elimination. The risk of transmission after NSI by an infected needle is approximately 1.8% for HCV, and 6–30% for HBV (Beltrami, Williams, Shapiro, & Chamberland, 2000). Vaccination and monitoring of serum HBS‐Ab titers are needed to control and reduce the transmission rate of HBV. In our recent study, only 68.5% of Iranian medical sciences students had received all three doses of HBV vaccine, and 35% had had an HBs‐Ab titer (Karimi‐Sari, Bayatpoor, Khotbesara, et al., 2017).
Viral hepatitis cannot be eliminated without increasing awareness and concern among the general population (Karimi‐Sari, Tajik, Bayatpoor, & Alavian, 2017). This awareness can reduce person‐to‐person transmission, which should be a priority. Nurses should be more concerned about elimination of viral hepatitis. Awareness campaigns and other educational programs could be acceptable solutions (Karimi‐Sari, Bayatpoor, & Alavian, 2017).
Policies are needed to increase health care workers’ knowledge and awareness of viral hepatitis and decrease the rate of NSIs. Further research is needed to determine the main reasons of NSIs in each region, barriers for NSI reporting, and change in the rate of these injuries over time, which will inform policies. Changing the process of NSI reporting, shortening the reporting process, making it more accessible, and removing the stigma regarding such injuries are recommended.

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