ObjectivesA high prevalence of viral hepatitis B and C was found among healthcare workers during a province-wide screening in Sindh Province, Pakistan. A follow-up study was undertaken to identify risk factors for this high prevalence in healthcare workers.DesignPopulation based case–control design.SettingPublic sector healthcare facilities in a rural district of Pakistan.ParticipantsHealthcare workers who were screened for hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) antibodies. 178 healthcare workers employed at the public sector clinics and hospitals of the district were approached, of which 14 refused to participate. Cases had detectable serum antibodies against HCV and the presence of HBsAg. Healthcare workers non-reactive to HCV antibodies and with no HBsAg were controls. These were matched in a ratio of 1:1.Outcome measureDetectable serum HBsAg and HCV antibody titer were taken as outcome. OR for various exposures was calculated; those with p<0.25 were entered in a multivariate logistic regression model to find out significant predictors.ResultsNeedle stick injury (OR=6; CI95 1.4 to 23), recapping the needle (OR=5.7; CI95 1.1 to 28), wound care at accident and emergency of a hospital (OR=5.5; CI95 1 to 28), female gender (OR=3.4; CI95 1 to 12) and more than 10 years of formal education (OR=0.25; CI95 0.07 to 0.8) were associated with hepatitis C. Hepatitis B was found to be associated with trying to bend or break a needle after use (OR=4.9; CI95 1 to 24).ConclusionsHealthcare workers in Pakistan are at additional risk of exposure to bloodborne pathogens. Bi-dimensional risk factors present at individual and broader health systems levels are responsible. Occupational safety, health trainings and redesigning of the curriculum for allied health professionals are required.

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Over the past 25 years, principles of damage control Laparotomy have saved many lives. Quick recognition of injuries and immediate transfer to operating room are essential. Patients with polytrauma have substantial haemorrhage and go into a vicious cycle of death (hypothermia, coaugulopathy and acidosis). Prior to surgery, adequate resuscitation helps to improve both intra and post-operative mortality. And the focus is on control of bowel contamination and haemorrhage. Once achieved, patient is resuscitated in ICU setup to optimize physiology. Adequate hydration, blood transfusion, re-warming of the patient and other supportive measures are taken to arrest the ongoing cycle of coagulation, hypothermia and metabolic acidosis. Later, patient is moved to theatre for definitive management of injuries. Improvement in patient outcome has been reported by an increased understanding of damage control and the anatomical and physiological steps taken to improve the outcomes.

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