4.1% (34 out of 824) of HCWs had antibodies against HCV, of which 21 (61.8%) were male and 13 (38.2%) were female while 25 (73.5%) were married and 9 (26.4%) were unmarried. 32 (94.1%) positive HCWs belonged to the undergraduate category while only 2 (5.9%) from the graduate category (Table ​(Table2).2). Of these positive cases, 18 (52.9%) had history of dental treatment, 4 (11.8%) had been transfused, 4(11.6%) had surgery in the past, 4 (11.8%) had a history of hospitalization, 3 (8.82.5) had jaundice and one of them were intravenous drug users (Table ​(Table3).3). HCV RNA was detected in 23 (2.79%) HCWs. The most predominant HCV genotype was 3a (73.91), followed by 3b (13.04%), 1a (4.34%), mixed infection (4.34%) and unidentified genotyping (4.34%). With respect to the professional categories, 44.1% (15 out of 240) of nurses, 32.3% (11 out of 240) of technicians, 14.7% (5 out of 114) of assistant and general staff, 8.8% (3 out of 200) of doctors and none of administrative staff were infected with HCV. In this study occupational accidents most frequently occurred in HCWs by work pressure (38.4%), followed by non-cooperation of patients (30.9%), inappropriate handling of instruments (11.7%), lack of attention (6.9%), hurry (4.4%), inexperience (4%) and others (3.7%).

A total of 729 occupational exposures were recorded in 572 HCWs during the previous one year period of their service. Of the 572 HCWs who acquired injures, 273 (82.5%) were female and 299 (60.6%) male. The mean age of these HCWs was 30 ± 7.89 years, with a minimum age of 20 years and maximum of 54 years. When the number of occupation exposure among the HCWs of different occupational group participated were compared, a high percentage of nurses sustained injuries (47.3%), followed by technicians (31.3%), doctors (13.1%) and assistant staff (8.2%).

In this study 4.1% anti-HCV positivity was recorded. This figure was lower to that reported from Rawalpindi (5.6% out of 250) [13], from Karachi (6% out of 217) [14] and from Abbottabad (5.6% out of 125) [10]. The difference in low prevalence rate in this study and high prevalence in previously published literatures from diverse regions of Pakistan reflects the variation in the distribution of HCV between and within different Pakistani geographical areas, actual difference in risk at different hospitals, and the compulsion of mandatory screening of serological status of patients in these hospitals before undergoing invasive procedures (surgery/dental), which alerts the HCWs to facilitate appropriate planning during treating the infected patients. On the other hand attempts of viral screening of blood donors have markedly reduced the transfusion-related infections rate in patient population [5]. In contrast, current figure was higher than mentioned (1.6% out of 383) from Islamabad [8] which could be due to reason that 41% of HCWs had service length between 1-5 years. However, methodological differences of sampling strategies and published data of relatively small-scale surveys also contribute to these differences in seroprevalence.

Genotype-3a was the most prevalent genotype in this studied population followed by genotypes 3b, 1a and mixed infection. It is reported that 75%-90% of HCV Pakistani patients [9] were harboring genotype 3a, also confirmed [5-7,15,16].

As for demographic data, neither age group nor marital status was responsible for any statistically significant differences between both groups for HCV while significant association was found between duration of employment in a clinical environment, age of HCWs and education of HCWs [8,17-19].

Rampal et al., [20] documented that each year an estimated figure of more than three million HCWs experience an injury with a biological contaminated sharp instrument and these exposures result in about 16,000 infections of HCV. In this study prevalence of injuries is not uniform in different working departments, among the professional groups, the nurses had the increased vulnerability of injury as they spent greater amount of time in administrative therapies and everything concerning direct assistance to patients. Mass of same evidence was shown by various workers [1,21-24]

While laboratory technicians, who manipulate microorganisms in laboratory, which might involves incidences like transferring blood from the syringe to the vial and missing the target, and anesthesia technicians posed a great threat of acquisition of hepatitis, also confirmed by different authors from worldwide [20-24]. Frequency among doctors was relatively low, probably due to benefit sufficiently from preventative measures and preoperative screening of patients for HCV in studied hospitals before undergoing surgery. Same conclusion also holds true by others [17,25]. None of the administrative staff was found with positive result for HCV, which might be due to their not in direct contact with the patients, but still that factor not eliminate the risk of infection due to small sample size studied. HCWs were at high risk of encountering occupational injuries to blood and other infectious body fluid and therefore have more chances to acquire HCV in their work places. All the HCV positive HCWs at PIMS hospital, Islamabad, had a definite history of needle stick injury except one had history of surgery [8].

This study results showed that although all HCWs were aware about the importance of screening for hepatitis as it made aware of self-care, start therapy and also apply appropriate preventive measure during their provision of services, however there were gaps in their knowledge and practice. The figures in this study were lower than those reported (93.7%) [8]. In spite of considering important, this approach is flawed for a number factors including ethical, legal, economic, moral, and cultural come into play here. The absence of a prophylactic vaccine from HCV infection, the logic of this approach would dictate that repeat and continual screening for HCV is recommended [19]. Another malaise in our health system is the reuse of contaminated needles and equipment in health related procedure. In this study history of dental treatment, history of surgery and blood transfusion has been demonstrated to be responsible as a route of transmission of HCV. This finding verified results of the earlier studies [6,25,26]. Current study was in agreement with previous study [5,6,9,26] that the major contributing factors towards increased HCV prevalence include unchecked blood transfusions and reuse of injection syringes in Pakistani population, as several small groups involved in recycling and repacking of used un-sterilized syringes, which were easily available in market at low cost. Screening in the long term, reduce the pool of hepatitis-infected HCWs performing exposure prone procedure, consequently reduce the frequency of HCW to patient transmission events [10,21].