الفهرس 
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Abstract
Infections with the hepatitis B virus (HBV) and the hepatitis C virus (HCV) are serious public health hazards; both induce acute and chronic hepatitis, cirrhosis, and liver cancer. Most morbidity and mortality result from the chronic form of viral hepatitis caused by HBV and HCV infections.
Nursing professionals are prone to different exposures and they have to follow certain precautions to control and prevent infectious hazards which varies during their career, but it is often the highest during their professional training. Nurses had a three to four times higher risk of HBV and HCV infection than the general population. Nursing students’ knowledge about HBV and HCV should have to be assessed in order to determine to what extent they will provide the health care service to patients without spreading the infection either to themselves or between patients depending on their own knowledge about HBV and HCV.
The aim of this work was to study the knowledge and attitude of nursing students at different grades of Faculty of Nursing in Alexandria University about viral hepatitis B and C. The sample was selected randomly from all grades, using the equal allocation technique. The total sample size was 400, one hundred students were selected randomly from both sexes from each grade who are accepted to participate in the study.
Study design: A cross-sectional study design was used to conduct the current study.
Study setting: The Faculty of Nursing in Alexandria University.
Study population: Nursing students at different grades from both sexes of Faculty of Nursing in Alexandria University.
Data collection: The following information was gathered using a pre-designed self-administered structured questionnaire: Age, Socio-demographic characteristics such as: age, gender, grade, marital status, residence…etc.
1- Family history regarding occurrence of HBV and HCV infections among any family member.
2- Students’ knowledge about various aspects of HBV and HCV infections such as: etiology, signs and symptoms, high risk persons, mode of transmission, methods of diagnosis and early detection, safety measures, availability of vaccine, treatment, their practices to prevent infection … etc.
3- Sources of knowledge: courses, family or friends, internet, mass media (radio and TV), healthcare providers, newspapers…etc.
Using a two-point Likert scale, students’ attitudes regarding hepatitis B and C were assessed (Almualm et al., 2018).
In the light of data analysis, the main results of this study could be summarized as follows:
1- Three quarters (75.0%) of studied sample were above 19 years, with a mean age of (21.22±2.221). Nearly two thirds (61.5%) of them were females. The highest percentages (97.0% and 90.0%) were single and from urban areas respectively.
2- Only 4 (1.0%) and 2 (0.5%) students had previously infected with HBV and HCV, respectively. More than three quarters (77.5%) of studied sample had investigated about Hepatitis C in “100 Million Healthy Lives” initiative.
3- The knowledge and attitude of the nursing students about some aspects of HBV and HCV are adequate in some aspects and inadequate in another. As regards collective knowledge score, nearly half of the studied sample (46.8%) had good level of knowledge, while 40.7% had fair level of knowledge.
4- More than half of the studied sample (58.8%) had never vaccinated against Hepatitis B, and only 28.0% of them had taken their complete doses of hepatitis B vaccine.
5- More than three quarters (79.0%) of studied sample had no previous history of infection with hepatitis among their family members, while only 3.5% and 17.5% of them had previous infection with HBV and HCV, respectively.
6- Nearly one third (32.7%) of studied sample had worked in private hospitals beside faculty education, and more than one quarter (29.0%) of them had reported NSI contaminated with blood. Concerning precautions had taken after NSI, 13.1% of them did nothing, 44.7% milked the site of puncture, while 5.3% did the correct action.
7- The great proportion of the studied sample (86.8% and 92.0%) had reported the correct answer regarding the causative agent of HBV and HCV, respectively. and a high proportion of them (92.0% & 90.8%) also had reported correct answers regarding their knowledge about modes of transmission either through needle stick injury and infected blood transfusion. the highest percentage (92.0% & 90.8%) of students gave correct answer regarding needle stick injury, 90.8% for infected blood transfusion and. Also the majority of students (91.8%) had stated the correct answer regarding the diagnosis of HBV and HCV.
8- Nearly 90.0% of studied sample gave correct answers for injecting drug users, followed by 82.5% for hemodialysis patients, then 78.8% for HIV patients as risk factors.
9- Knowledge about students’ practices to prevent transmission of disease and infection, 91.5%, 91.0% and 87.5% of the studied sample gave correct answers for discarding needles and sharp instruments in safety box, avoiding exposure to contaminated needle stick injuries and sharp instruments and wearing the protective barriers during faculty training, respectively.
10- The main source of knowledge as stated by 54.0%, the studied sample was faculty lectures, media and internet represented 3.5%. On the other hand, the least sources were medical team representing 1.8% and books /journals representing 0.5%.
11- Most of the studied sample (73.2%) had positive attitude, while the rest of them (26.8%) had a negative attitude.
12- Almost all (98.3% and 97.7%) of the studied sample accepted to get screened for hepatitis B and C and to get the treatment if they were positive for hepatitis B or C, respectively.
13- More than 80% of the studied sample agreed the possibility of infection by toothbrush (88.0%), marring a person with hepatitis B or C patient without using condoms (64.8%).
14- Regarding the relation between knowledge and their reported attitude, highest percentages of positive attitude (76.7% and 73.3%) reveals to fair and good knowledge score of the studied sample respectively, while the highest percentage of negative attitude (38.0%) goes to poor knowledge score. The association between students’ total attitude score by mean and total knowledge scores were found to be statistically insignificant (p=0. 122).
15- As regards the studied sample knowledge about some aspects of HBV and HCV some significant predictor variables were found to affect their knowledge. These include: Age, gender and academic year of the studied sample were proved to be significant predictor variables affect their knowledge, while no any factor influencing their attitude of the studied sample about some elements of HBV and HCV.
16- Regarding their reported attitude about some aspects of HBV and HCV, the present study revealed that there were no any factor influencing attitude of the studied sample about some aspects of HBV and HCV.
Based on the findings of the present study, the following proposed recommendations are suggested:
1- Strengthening the role of faculties in disseminating and addressing knowledge and updating information related to HBV & HCV infections in terms of modes of transmission, self-protection, and the role of vaccination in prevention of the disease to all students in different grades.
2- Integrating the program of prevention of HBV & HCV on the curriculum of students of all collages particularly nursing faculties.
3- Continuous in-service training programs for infection control for all infectious diseases for all nursing students during their practices.
4- Strengthening the health education role of Mass Media and internet powered by Ministry of Health and populations. Disseminated knowledge has to be prepared in a manner that can establish and support positive attitude towards B and C viral hepatitis.
5- Further research should be conducted on undergraduate nursing students to investigate the HB vaccination status and related knowledge.
6.2. Conclusion
On the light of the study results, it can be concluded that hepatitis B virus (HBV) and HCV infections are major health problems; both are responsible for acute and chronic hepatitis, cirrhosis, hepatocellular carcinoma (HCC) and/or fibrosis. It was found that nurses are highly exposed to HBV and HCV infections from about three to four times greater than the general population. Nursing professionals form a fundamental element in the health care system. Nurses are responsible to provide clients/patients with a high-quality care. During the course of acquiring their undergraduate degree at some phase of their learning, they are taught about the occupational hazards. One of the most important steps for viral hepatitis elimination is increasing general knowledge. Insufficient knowledge of nursing students regarding some issues of HBV and HCV will lead to increase the risk of infection for both themselves and also other population.
from the results of the current study, it could be generally concluded the following:
The results of the present study revealed that the knowledge and attitude of the nursing students about some aspects of HBV and HCV are adequate in some aspects and inadequate in another aspect. As regards knowledge, nearly half of the studied sample (46.8%) had good level of knowledge, while 40.7% had fair level of knowledge.
As regards attitude, most of the studied sample (73.2%) had positive attitude, while the rest of them (26.8%) had negative attitude.
Regarding the relation between knowledge and their reported attitude, the highest percentages of positive attitude (76.7% and 73.3%) was revealed to be fair and good knowledge score of the studied sample respectively, while the highest percentage of negative attitude (38.0%) goes to poor knowledge score. The association between students’ total attitude score by mean and total knowledge scores were found to be statistically insignificant (p=0. 122).
As regards the studied sample knowledge about some features of HBV and HCV, some significant predictor variables were found to affect their knowledge. These include: age, gender and academic year.
Regarding their reported attitude about some aspects of HBV and HCV, the present study revealed that there were no any factor influencing attitude of the study participants about some aspects of HBV and HCV.
6.3. Recommendations:
In view of previous conclusions, the following recommendations are suggested:
1- A carefully designed strategy with multiple educational approaches directed to all sections of population has to be devised. Students are one of the best groups to be addressed for health education regarding Hepatitis who could then act as resource of information to their families.
2- Infection control rules and regulations should be an integrated in nursing curriculum of all disciplines including medical, dental, nursing as well as for any institute providing training to paramedics.
3- All students should be screened for HBV and HCV, trained better in the control and prevention of HBV and HCV infection.
4- Reporting of sharp injuries should be considered as an essential part of infection control activity.
5- Post exposure prophylaxis and follow up facility should be provided by the hospital management for all students should be compulsory for them and for free.
6- Every student should have HBV mandatory personal vaccination record that documents vaccinations given and should be given to health authorities.
7- Using the evidence of completing the vaccination as a requirement for job practicing requirements.
8- Further studies are highly needed to evaluate knowledge and practice of the undergraduate nursing students regarding HBV & HCV in other Governorates in Egypt.