Healthcare workers are at risk of exposure, possible transmission and infection of hepatitis B because the majority of them are in constant contact with patients or infective material from patients. Knowledge, Attitude and Practice of employees at the workplace towards these infections are key to preventing one from getting nosocomial diseases.² Most of the earlier KAP studies conducted in India were observational studies. In our present study, we implemented an intervention in the form of educational video demonstration to all the participants and measured its impact on knowledge and attitude scores.⁸ Our study includes 156 total healthcare workers, out of which 87(55.76%) were Nursing staff, 35(22.43%) were lab technicians and 34(21.79%) were ward attendants. Among them, female candidates were 119(76.30%) and the male candidates were only 37(23.70%). Similarly in the study of Gurubacharya DL⁹ female candidates 59(84%) were more than the male candidates 11(1%). Most of the candidates were aged between 31-50 years 82(52.56%) followed by below 30 years of age 58(37.17%) and more than 50 years of age 16(10.25%). Among total (n=156) candidates, 62(39.7%) had experience of 6-10 years and only 7(4.4%) had an experience of more than 20 years (Table 1). Likewise in the study of Shah PD they showed 29(38.6%) candidates had experience of 3-10 years and 19 (25.3%) had experience of more than 20 years.

The findings of the present study discovered some interesting facts regarding KAP of HCWs concerning some important aspects of hepatitis B infection and its vaccination. Results showed that among all HCW, nursing staff and lab technician had good knowledge as compared to ward attendants, whereas ward attendants showed unfavorable attitudes and unsatisfactory practices towards hepatitis B infection and its vaccination which is quite a matter of concern. Level of knowledge about hepatitis B infection and its vaccination is diverse among the different categories of healthcare personnel which might be due to differences in their level and type of education.

Out of 156 HCWs, almost 109(69.87%) candidates knew about the incubation period of Hepatitis B infection, whereas only 63(84%) of participants were having knowledge about incubation period in the study of Shah et al.,⁸ 52(33.33%) and 88(56.41%) HCWs were aware about the mode of transmission and the transmission through the drop of blood respectively similarly in the study of Aniaku, et al.,⁷ 79.6% students knew about the transmission of Hepatitis B infection. Approximately 82(52.56%) and 72(46.15%) HCWs were knew about the fact that the liver is the most affected organ by Hepatitis B virus and lead to cancer but after educational training it was increased up to 127(81.41%) and 117(75%) respectively. Bharti et al.,¹⁰ and Shrestha et al.,¹¹ showed 96.7% and 43.6% knowledge regarding the same. About the investigation of the Hepatitis B, nearly 119(76.28%) candidates knew, whereas in the study of Abdela et al.,¹² showed relatively lower proportion of the students (52.4 %).knew that HBV has treatments.

When asked about prevention, 116(74.35%) and 127(81.41%) candidates were aware about the schedule of vaccination doses and the route of administration. Similarly, Bhattarai et al.² and Shrestha et al.¹¹ observed 316 (77.4%) and 145 (80.1%) participants knew about the recommended complete doses schedule. Knowledge about the minimum protective titer of HBs antibody must be > 10 IU/ml and the protection of the vaccine could last for at least 20 years was observed in 108(69.23%) and 46(29.48%) HCWs but in the study of Bhattarai S. et al.² showed only 122 (29.9%) and 160 (39.2%) candidates knew about the same. Overall ward attendants showed poor knowledge about Hepatitis B infection and its vaccination but all participants were provided adequate knowledge on hepatitis B and its vaccination through educational video and the results shows that training is necessary in all levels of health care workers.

Among all the categories of HCWs, nursing staff had the highest favorable attitude towards hepatitis B infection and its vaccination i.e 407(51.97%) which was increased up to 565(72.15%) after the educational training. Majority of the candidates 113 (72.43%) had no fear about getting Hepatitis B infection because they are aware about such infections, whereas the results in the study of Abdela et al.¹² are in concordance with our result where 223 (90.7%) candidates are not scared of Hepatitis B infection. The study done by Shah et al.,⁸ 89.3% consulted a doctor after exposure to infected blood which is higher than our study where 94(60.25%) believed that they should take the vaccine after exposure to the blood and body fluids. In the study of Shrestha et al.,¹¹ 50.8% (n = 92) agreed that hepatitis B vaccination is safe and effective, while in our study 112 (71.79%) would go for the full vaccination if there is any interruption in the vaccination doses. Most of the candidates believed 142(91.02%) that it is necessary to check anti-HBsAg antibodies titer after getting vaccine which is higher than the study done by Gurubacharya et al.,⁹ where only 6 workers (14%) had been tested for Anti-HBs. The Centre for Disease Control (CDC) recommendation is to test for antibodies after completion of three injections of HBV vaccine, and if negative, give a second three-dose vaccine and test again for anti-HBsAg antibodies. If there is no antibody response, no further vaccination is recommended.⁹ Shockingly 22 (14.10%) candidates feared that the Anti-HBs titer would not rise to the desired level whereas 89 (57.05%) had no effect. Regarding immediate information to be given after exposure to NSI, Alsabaani et al.,³ showed 59.4% or 30.9% agreed that all sharp injuries at work should be reported immediately whereas in our study 133(85.23%) candidates agreed about the same.

Practices concerning prevention of Hepatitis B infection were satisfactory in which nursing staff showed highest safe practices that is 670 (70%). When asked HCWs about response towards Hepatitis B infected patients, 92 (58.97%) candidates were treating them with universal precautions however, 39 (25%) would like to refer the patient Shrestha et al.¹¹ showed that 6.6% (n = 12) strongly agreed on feeling uncomfortable while sitting with a Hepatitis B positive person and 18.8% (n = 34) strongly disagreed. In our study, 44(28.20%) HCWs were fully vaccinated (three doses) while 42(26.92%) HCWs were partially vaccinated. Around 67(42.94%) HCWs checked anti-HBsAg titre. However in the study of Rathi, et al.,¹³ observed only 13 (8%) had received a completed course of hepatitis B vaccination while 30 (18.7%) had history of inability to complete the three doses of hepatitis B vaccination The reasons for not getting vaccinated might be lack of interest, fear of injection or adverse reaction or planning to get immunized later.

Health care workers should be aware about exposure to the blood and the body fluids as they are highly prone to getting infections. In our study 56(35.89%) HCWs had exposed to NSI and mostly 23(14.74%) had exposed once in a year and after exposing to the NSI 103(66.02%) believed that it is necessary to report the incident to the Infection control officer but Gurubacharya et al.,⁹ showed higher results than our study where 52 subjects (74%) out of 70 had a history of needle-stick injury and out of those, 27(52%) had 1 -2 pricks per year. This somehow reflects their lack of responsibility towards themselves. Most of the needle stick injuries might be caused while recapping of needle 24(15.38%). Sharma et al¹⁴ also showed 33.5% had NSI but 26.3% had reported the incident and they were caused while doing IM/IV procedures (36.1%) and recapping of needles (32.8%). Reason behind NSI could be due to rush and uncooperative behavior of the patients. Shockingly 38(24.35%) HCWs were washing their fingers after exposure to the NSI. 123(78.84%) candidates were disposing needles into the white puncture proof container which is in concordant with the study of Sharma et al.¹⁴ where 84.8% candidates disposing needles correctly. Approximately 114(73.07%) HCWs were practicing correct method of preparation of 1% sodium hypochlorite from the 5% strength for the blood spillage management likewise in the study of Mehta et al.,¹⁵ where 40.6% (n=28) nurses and 42.46% (n=31) doctors were doing correct Blood spillage management. Most of our HCWs 128(82.05%) were not sharing a blade/razor with the family members while in study of Shrestha et al.,¹¹ the majority 129(71.3%) ask for a new blade while cutting or shaving hair. Nearly 98(62.82%) participated previously in the health campaign or training. Results are quite high compared to the study done by Shah PD et al.,⁸ where only 49.3% candidates participated previously in training, so it is very evident that training programmes should be conducted at regular intervals in healthcare settings.

This type of HCW assessment and training has not been conducted in our healthcare setting; therefore this study and training were helpful for all HCWs as there was an improvement found in KAP with reference to hepatitis B infection and its vaccination.

This study emphasizes the lack of understanding regarding HBV infection and its vaccination. Therefore, it is strongly advised that healthcare facilities should change their training programmes to give HCWs, the knowledge and skills they need. In order to attain universal coverage, healthcare facilities should develop measures to provide HBV testing and immunization to all medical personnel.