Worldwide annual proportion of HCWs exposed to HBV infection were about 5.9% [1,5]. In developing countries, 40-60% of HBV infection in HCWs was attributed to professional hazard while in developed countries the attributed fraction was less than 10% due to vaccination coverage [1]. Being the instruments of healthcare system, their interaction with patients is likely to pose unavoidable safety risks for the HCW's [5-7]. The chances of contracting HBV after an HBV-contaminated accidental needlestick average one in 20 while chance of contracting HCV after an accidental needlestick is 3.5 in 100 [4]. In addition to occupational hazards, evidences suggested that certain other unidentified community risk factors put HCWs at risk of acquiring HBV, as the general population. There is a complex multiplicity of risks factors and it is difficult to tease out the biggest contributors to infection in HCWs [8,9].

18 (2.18%) HCWs were found positive for HBV while HBV and HCV mixed infection was not detected in any HCW. Characteristics and distribution (%) of HBV positive and HBV negative are summarized in Table ​Table1.1. Frequency of HBV-infection in nurses was 44.4%, 33.4% in technicians, 22.3% in assistant staff while no doctor and administrative staff was found positive. Significant association (P = 0.328) between HBV prevalence and five occupational categories were present (Figure ​(Figure11).

As for personal data, neither gender (P = 1.000), nor marital status (P = 0.8575) were found responsible for any statistically significant differences in between HBV negative and HBV positive HCWs. However, a strong correlation was found with age (P = 0.0896), employment duration (P = 0.0001), dental treatment (P = 0.0155), hospitalization (P = 0.0013), surgery (P = 0.0004) and blood transfusion (P = 0.0001). All HCWs were aware of the importance of screening, but overall 24.5% HCWs were aware of their viral status and only four (22.3%) were aware of their seropositivity.

Overall, 572 HCWs were involved in a total of 729 occupational exposures during the past one year period service. Percentage breakdown was 47.3% in nurses, 31.3% in technicians, 13.1% in doctors and 8.2% in assistant staff. Regarding the activity involved in occupational exposure, drawing blood was the main contributor (i.e. 33.6%), followed by recapping of syringes (17%), disposal of used needles (13.3%), insertion of drip (12.6%), trash collection (9.7%), surgical procedure (4.3%), collision with sharp objects (4.1%), fluid splash (3.0%), cleaning instruments (1.8%) and others (0.5%) (Table ​(Table22).

In this study, 605 (73.42%) HCWs had completed their vaccination regimen. Of which 83(13.7%) had been vaccinated before entering the hospital, while 522 (86.3%) received their vaccination after starting their job at the hospital. Regarding the vaccination status, highest coverage was found among doctors, followed by administrative staff, general and assistant staff, technicians and nurses. A significant difference in vaccine coverage in vaccination coverage was found between the doctors and all other categories (P= 0.0001) (Table ​(Table33).

The most commonly cited reasons for no vaccination in HCWs found were unaffordability/ high costs (39.8%), work pressure (38.8%), negligence (20.9%) and unavailability (0.5%). Statistical analysis showed significant association between vaccinated verses non vaccinated coverage (P = 0.0005) and barriers to complete vaccination (P= 0.0001) (Figure ​(Figure22).

In this study age and employment duration strongly correlated with HBV prevalence. One reason may be because seasoned staff member dealt with patients in an inadequately equipped set-up, which predisposed them to these risks even more. In addition to that, there was lack of awareness of personal prophylaxis and probably no or little vaccination option available to them. This logic is also proposed in other literatures [3,7,13-15]. Most of the HBV-infected HCW's in the present study had undergraduate level education. This fact alone is enough to put a rigorous emphasis on their proper education which also is most likely to serve as an effective tool in controlling the professional injuries [15,16]. Nurses and technicians were at high risk of HBV infection as they interact first-hand with the patients [1,5,12,17,18]. Prevalence of HBV might associate with their low socioeconomic status as it is the disease of poverty [3]. Similar to Sarwar and colleagues [9] none of doctor was found positive, but not in accordance to the other studies that among HCWs, surgeons/doctors have the highest risk of HBV infection from their patients [11,19].

Current study showed that excessive risk of exposures among the HCW as a whole as well as among different occupations Nurses had the highest predisposition to occupational accidents, also reported by others [4,6,18,20,21]. Laboratory workers and anesthesia technicians comprised another major portion of occupational injuries, also analysed by the others [4,7,12]. In the current study the percentage of reported incidents in doctors was lower than other studies [4,15,22]. The absolute recording of professional injuries was frequent in nurses but percentage was actually greater in the physicians as this group was found more inclined to self assesses and not report such injuries [22]. The incidence of occupational exposure is common feature of studies across the world [22]. Factors associated with an increased risk of occupational exposure can differ from place to place depending on the standard of facilities [23-25]. Poor economic situation doesn't allow facility and personnel to achieve proper level of sophistication and therein lies the problem [26,27].

Assessment of HBV vaccination coverage in health care setting is needed to evaluate the proportion susceptible to HBV infection [1]. This study demonstrated that vaccination program was successful when compared with previous studies from diverse regions of Pakistan ranging from 37.2% to 66.3% [2,9,12,19,28-30] as well as from other countries and regions such as Africa [1], Nepal [30], Japan, India, North Sydney, South London, Sweden and Egypt [31] but not satisfactory when compared with Australia, New Zealand [1], Iran and UK [30]. In recent study high (81.8%) vaccination status was recorded from Karachi [32] but still universal coverage is not achieved despite the availability of vaccine since 2002 [4]. Most of the western countries recommend the need for immunization against HBV in the start of career in healthcare setting [1] but no such policy is employed in Pakistan, either in letter or in spirit.