lood and body fluid (BBF) exposure to health care workers and the infectious complications associated with it, is a global issue (1,2,3).Each day thousands of healthcare workers (HCWs), around the world, suffer accidental occupational exposures during the course of their role of caring for patients. These injuries can result in a variety of serious and distressing consequences ranging from extreme anxiety to chronic illness and premature death for the individual involved (4,5).

HCWs in developing countries are at serious risk of infection from blood-borne pathogens particularly hepatitis B virus (HBV), hepatitis C virus (HCV) and Human Immunodeficiency Virus ( HIV ) because of the high prevalence of such pathogens in many poorer regions of the world, especially they are endemic in sub-Saharan Africa (3,6).

In May 2007, the World Health Assembly endorsed the Global Plan of Action on Workers Health (GPA) for the period 2008-2017 with the aim to move from strategy to action and to provide new impetus for action by Member States. It calls on all countries to develop national plans and strategies for its implementation. There have been made countless interventions by employers and workers to attempt to make workplaces healthier, in many countries and many diverse settings (7,8).

Ethiopia's Federal ministry of health (FMOH) has been leading reform in Hospitals throughout the country using EHRIG and IP is one of thematic area for the reform with aim of stopping the transmission of infectious agents is the only way to reduce the occurrence of Health care acquires infections (HCAIs) to ensure the safety of employees, patients and visitors (9).

Occupational hazards faced by healthcare personnel in University of Gondar hospital have received increasing attention but existing surveillance systems and HCWs responsiveness for Safety Precautions are inadequate to describe the scope and magnitude of occupational exposures to infectious agents that HCWs experience, the outcomes of these exposures and injuries, and the impact of preventive measures (10).

The study was conducted in University of Gondar Hospital; Gondar was one of the metropolitan cities of Ethiopia, founded in 1636 by Emperor Fasilades, 748 kms northwest from Addis Ababa.

Sampled health professionals, janitors and medical students Health Care Workers that are assigned for clinical services, academic staffs that had regular program for patient care and graduate bacth interns were included in the study.

Health Care Workers who were on leave (maternity, annual, sick, fieldwork) during the study period as well as HCWs who had not worked at least six months within the last one year , were excluded in this study.

Sample size was calculated using a single population proportion. Considering 20.2% of one-year prevalence of at least one BBFs exposure in previous study in Ethiopia (13), a sample size of 285 was required with sampling error 5%, at a 5% c confidence level.

A stratified sampling technique was used to select the participants using lists of monthly payroll as a sampling framework and the number of participants selected from each stratum was determined by proportional to size.

Dependent:-Exposures of HCWs and medical students to blood and body fluids.

Independent:-Age, gender, marital status, religion, occupation, work experience in the area, uses of Personal Protective equipments, Infection Prevention trainings, educational status and working shift.

The data collection was done via selfadministered questionnaire and interview using structured questionnaire. Self-administered questionnaire was used for Health professionals and interns, and data from janitors was collected by interview using the structured questionnaire.

Quality of data was assured through intensive training for data collectors and supervisors, pre-testing the questionnaire on similar setting that was not included in the study, close supervision and assistance of data collectors, checking filled questionnaires on daily basis for completeness, clarity and accuracy of data. In addition data cleaning was also made before commencement of the analysis.

Data was coded and entered into the SPSS version 20. Descriptive statistics was made using frequencies, tables, and figures and narrative explanations. Associations were examined using binary and multiple logistic regressions. P-value less than0.05 was taken as a cut-off point to say significant at 95% confidence level.

Ethical approval was obtained from the Research and Ethics Review Committee at Bahir Dar University. Written consent was also obtained from Amhara-regional health Bureau and University of Gondar hospital to conduct the study. All the study participants were informed about the purpose of the study and finally verbal consent was obtained before data collection. The respondents had the right to refuse participation or terminate their involvement at any point during the study. Information provided by each respondent was kept confidential. Furthermore, report writing did not refer a specific respondent with identifiers.

Out of the 285 selected HCWs and graduate batch interns, 252 responded giving response rate of 88.4%. Twelve incomplete questionnaires were discarded. Among the respondents, 127 (50.4%) were males. From the total participants 158 (62.7%) were health professionals, (24.6%) were housekeeping staffs, and 32 (12.7%) were graduated interns. Respondents age range from 19 to 54 years with a mean age of 29 years. Among participants in this study 113(44.5%) had less than two years of work experiences. HCWs who hand experiences two to four years were 62(24.6%) and only 45(17.7%) were five years and more experienced in their current position. Other demographic information is presented in Table 1.

The overall prevalence of lifetime and one-year prevalence of one occupational exposure to BBF at least once during the study period were 177(70.2%) and1587 (62.3%) respectively (Table 2). The exposure rate of BBFs in the last-one year was highest among interns 29(90.6%), followed by HP 100(63.3%) and least among housekeeping staffs 28(45.2%). Among exposed for NSI in the last twelve months, 50(61.0%) of them encountered once and 32 (39.0%) of faced two and more times.

Of those NSI exposed, 25 (30.5%) of respondents reported that the needle or sharp objects that cause the recent injury were visibly contaminated with blood prior to causing the injury, where as 38(46.3%) and 19(23.2%) were not contaminated and not sure respectively. Majority of the recent NSI, 58(70.7%) of were moderately penetrated skin while superficial skin scratch and deep punctures or wounds were 18 ( Overall, performing procedure for patients 78(52.2%) was the most hazardous procedure particularly among interns and staff health professionals. Disassembling, processing and cleaning used equipments 30(19.1%), phlebotomy, collecting and transporting blood sample 21 (13.4%) and assisting delivery 16(10.2%) were other hazardous procedures exposing the HCWs to potential infectious material in order of frequency. Major causes for occurrences BBFs exposure are presented in Figure 1.

Exposure to blood and potentially infectious body fluids has been recognized as a potential health hazard in HCWs (1,4). In this study, 62.3% of the respondents were exposed to blood and contaminated body fluids at least once in the preceding year through NSI and splash .This was similar with studies in South Africa (62%) (11). There was a 32.5% of one year prevalence of needle sticks and sharps injuries identified in this study ,which was the same with previous study in Hawassa City(30.9%), but different from Harari Regional State and Dire Dawa Administrative Council (17.5%) and Addis Ababa (19%) (12)(13)(14). Although needle stick injuries are most common means of exposure for health care workers, blood borne pathogens can also be transmitted through contact with eyes, nose, and mouth or through broken skin (15,16). The prevalence of one year splash exposure of BBFs was 53.2%, which was also different from Harari Regional State and Dire Dawa Administrative Council (20.2%) (12). This high prevalence of NSI and splash exposure in this study might be due to inclusion of medical students and housekeeping staffs which were not targeted in previous studies and might also be due to high work load on few professionals in the study area.

It has been reported that medical students experience the majority of needle-stick injuries in the world (3,5). The results of this study showed that highest prevalence of percutaneous (68.8%) and mucosal (75%) exposure among medical students, which was almost comparable with other studies in South Africa (62%) and Uganda that reveal interns suffered more NSI than any occupational groups (17,18).

Eighty two percents of respondents had work experiences of less than five years. There was significant correlation between work experiences and the rate occupational exposure to BBFs. HCWs whose experience was two-four years were more exposed than HCWs who had experiences above four years (AOR=3.2,95% CI=1.4-7.5). Studies done in Iran showed that about 54% of the personnel with less than five years of working experience were exposed at least once during the previous year; however, this was 30.6% among the personnel with more than ten years of experience (19). Study in India identified that as experience was increasing, incidence of injury was decreasing (21). Moreover, HCWs in University of Gondar hospital have to deal with a high load of patients, this fact combined with urgency of some interventions and unavailability of PPEs might contributed to this high prevalence of BBFs among studied groups.

Healthcare workers have increased chance of acquiring blood borne pathogens through occupational exposure in developing countries due to a combination of increased risk and fewer safety precautions (3,22). Most exposures are caused by a departure from standard precautions (23). One of the factors for occurrences of BBFs exposure in this finding was lacks of use of PPEs (39.5%), non-consistent use of PPEs was found to be associated with chance of sustaining NSI previous studies in Ethiopia (12,13,14,24). Wearing gloves may reduce (>50%) the volume of blood introduced through an injury (23). A major reason for not using all PPEs was inadequate supply (59.7%). Previous study of Ethiopia showed that Seventy-nine percent of HCWs reported that they did not wear any of the PPEs because of unavailability (24). Exacerbating the risk to health care workers in developing countries is a lack of gloves, gowns, masks, and goggles to protect them from contact with blood(3).

Needle-stick injuries to providers are usually attributable to the abrupt movement of patients during the procedure (25). Unexpected movement of patients during care was second major factor for BBFs exposures (23%); this was similar with report from West Africa (23%) (27). In previous studies in Ethiopia and abroad, needle recapping was major causes of NSI Regarding the overall situation in which the recent exposures occurred, 49(31.2%) were occurred in the morning shift, while 40(25.5%) and 31 (19.7) occurred in the afternoon and in the night shifts respectively; but 37(23.6%) of them did not remember the shift that the exposure was happened. (5,(12)(13)(14)19), promisingly, it was of interest that needle recapping was not listed as a cause for accidental exposure in this study, suggesting adherence to the hospital's protocol and guidelines (9).

The risk of acquiring blood borne infections (BBI) from occupational exposures is dependent on the concentration of infectious virus in the implicated body fluid, the volume of infected material transferred, frequency of percutaneous, per mucosal exposure to blood or body fluid, device visibly contaminated with the source patient's blood, depth of injury, procedures involving a needle placed directly in the patient's vein or artery and type of needle involved (hollow needles contain more blood therefore there will be a higher risk of transmission) (3,26). In this survey, Hollow needles contributed to 55% of the needle-stick injuries which was the same with prior studies in Ethiopia and overseas (5, 6, 12-14, 19, 20, 24). Suture needles contributed to 28% of the percutaneous exposures, which was the same as South Africa (17).

Of the mucosal exposures within the last 12 months, blood and bloody products were involved in 64% of exposure. NaSH showed that blood and blood product involved in almost 79% of all reported splash exposures and it was 86% study in Iran (19,20).

Study in India explored that exposure was inversely related to training, a sizeable number of those trained were subsequently exposed (21). In this study satisfactory training, but not training by itself, was highly associated with preventions of BBFs exposures. HCWs who was satisfied with trainings given was less likely exposed for BBFs than none trained and unsatisfied one (AOR=0.501, 95% CI=0.23-0.91).

Including both health professionals and non health professionals like janitors/cleaners to asses occupational exposure to BBF could be taken as the strength of the study but not screening of viral infections like HIV and hepatitis for exposed HCWs and since the study was based on self report about previous one year and life time occupational exposure to BBF the result might be affected by recall bias.

Injuries from sharp objects and BBFs splash exposure among HCWs were a widespread occupational hazard in University of Gondar hospital and higher previous studies in Ethiopia. Occupation, work experience and satisfactory training were factors for occurrences occupational exposure. This study showed that medical students were more exposed to BBFs than health professionals and housekeeping staffs.

This loss of a wage-earning health care worker can be devastating to the financial security of the worker's family. The loss of HCWs can also have a disproportionate effect on the fragile health care infrastructure of Ethiopia, where trained health professionals are scarce in relation to the overall populations they serve. VI.

1. Initial effort is supposed to be focused on altering the behavior of HCWs to follow standard operating procedures during patient care and consistent availability of PPEs.

2. The ways of infection prevention training supposed to be revised and participant centered because the results of this study showed that satisfactory training, but not training by itself, has impacts on prevention of blood and body fluid exposures to healthcare workers.

3. Attending physicians and senior HCP must be made responsible for ensuring that students are capable of performing procedures safely before expecting them to do so without supervision. It is responsibility of medical educators to provide a safe learning environment for students before they face the risks of direct patient care.

We sincerely thank the study participants for their participation in the study.