Geleneksel ve Tamamlayıcı Tıp (GETAT) Uygulamalarında Enfeksiyon Kontrol Önlemleri, Hijyen ve Çalışan/Hasta Güvenliği

Amaç: Geleneksel ve tamamlayıcı Tıp (GETAT) uygulamaları, ilgili alanda sertifikası bulunan hekim ve/veya diş hekimi sorumluluğunda ve Sağlık bakanlığınca yetkilendirilmiş merkezlerde yapılması gerekmektedir. Eğitimler esnasında standart enfeksiyon kontrol önlemleri/hijyen ve enfeksiyonlarla alakalı temas bilgisi verilmekte birlikte yetersiz olabileceği düşünülmektedir. Bu çalışmada GETAT uygulayan hekimlere klinikte enfeksiyon kontrol önlemleri/hijyen kurallarının önemini hatırlatma ve vurgulama amacıyla onların bilgi, tutum ve davranışlarının belirlenmesi amaçlanmıştır. 

Infection Control Measures, Hygiene and Employee / Patient Safety in Traditional and Complementary Medicine (T&CM) Applications

Aim: Traditional and complementary medicine (T&CM) applications should be performed under the responsibility of the physician and / or dentist who is certified in the relevant field and in the centers authorized by the Ministry of Health. During the trainings, standard infection control measures / hygiene and contact information related to infections are given and thought to be inadequate. In this study, it was aimed to determine the knowledge, attitudes and behaviors of  T&CM physicians in order to remind and emphasize the importance of infection control measures / hygiene rules in the clinic.Method: The study was conducted with a digital questionnaire questioning hygiene practices in T&CM clinic which was prepared with the support of demographic information and literature, and their attitudes and behaviors related to the subject were determined. The data obtained were analyzed statistically.Results: A total of 103 participants were 54.4% male, 46.6% general practitioner, 9.7% family physician and 38.8% had a professional experience of 20 years or more. 95.0% of physicians have at least one T&CM  certificate and the most obtained certificate was determined as 64.3% hijama (cupping therapy), 45.9% acupuncture, 34.7% ozone treatment and 33.7% leech treatment. 92.8% of the participants had hepatitis B vaccine, 49.5% had tetanus vaccine and 22.7% had flu vaccines. AntiHBs titers against Hepatitis B of 54.5% were over 10 IU. 65.7% of physicians accumulate or render cutter drill tools in special waste bags and 11.8% in red medical waste bags. 57.0% of the participants put “non-penetrating tools” in red medical waste bags and 28.0% in the same bag with all wastes. While 51.5% of the physicians strongly recommend T&CM applications to others, 72.5% found that the level of knowledge on infection control measures / hygiene in T&CM applications was sufficient. 86.2% of physicians think that if adequate hygiene rules are not applied in T&CM , It may cause hepatitis and HIV transmission. While 65.6% of the patients were asked about their Hepatitis B, C and HIV test status before T&CM administration, 71.6% of them stated that their approach to T&CM application could be changed to a Hepatitis B, C or HIV (+) patient. While 73% stated that all materials in contact with the patient were disposable and 37,6% used continuous protective equipment against infectious diseases; 61,3% reported that they did not work in the clinic without gloves. 21% of physicians stated that T&CM may have infective complications. While 50.5% of the physicians said that we have an infection control procedure to be used in stab wounds, 35.6% reported that they had been exposed to Sharp penetrating stab injuries 1-3 times in the last 5 years. More than half of the participants (54.5%) stated that they needed additional hygiene training on T&CM practices.Conclusion: It was determined that additional training would be meaningful in the prevention of hygiene, medical waste and bloodborne infections. 

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  • 1. https://www.who.int/traditional-complementary-integrative-medicine/about/en/ Erişim tarihi: 16 Eylül 2019
  • 2.https://getatportal.saglik.gov.tr/TR,24683/geleneksel-ve-tamamlayici-tip-nedir.html Erişim tarihi: 16 Eylül 2019
  • 3. Ray SC, Thomas DL. Hepatitis C. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Churchill Livingstone Elsevier, 2015: 1904-27.
  • 4. El-Ghitany EM, Wahab MA, Wahab EWA, Hassouna S, Farghaly AG. A comprehensive hepatitis C virus risk factors meta-analysis (1989-2013); Do they differ in Egypt? Liver Int; 2014. Article in Press.
  • 5. Madani TA. Hepatitis C virus infections reported in Saudi Arabia over 11 years of surveillance. Ann Saudi Med 2007;27:191-4.
  • 6. Narendranathan M. Leeches and hepatitis B. Lancet 1992;339:1362.
  • 7. Nehili M, Ilk C, Mehlhorn H, Ruhnau K, Dick W, Njayou M. Experiments on the possible role of leeches as vectors of animal and human pathogens: A light and electron microscopy study. Parasitol Res 1994;80:277-90.
  • 8. Karmochkine, M., Carrat, F., Dos Santos, O., Cacoub, P., & Raguin, G. (2006). A case-control study of risk factors for hepatitis C infection in patients with unexplained routes of infection. J Viral Hepat, Vol.13, No.11, pp. 775-782, ISSN 1352-0504
  • 9. Karaca, C., Cakaloğlu, Y., Demir, K., Ozdil, S., Kaymakoğlu, S., Badur, S., & Okten, A. (2006). Risk factors for the transmission of hepatitis C virus infection in the Turkish population. Dig Dis Sci, Vol.51, No.2, pp. 365-369, ISSN 0163-2116
  • 10. Walsh, B., Maguire, H., & Carrington, D. (1999). Outbreak of hepatitis B in an acupuncture clinic. Commun Dis Public Health, Vol.2, No.2, pp. 137-140, ISSN 1462-1843
  • 11. Wiwanitkit, V., HIV infection after Chinese traditional acupuncture treatment. Complement Ther Med, 2003;11(4): 272, ISSN 0965-2299
  • 12. Woo, P.C., Lin, A.W., Lau, S.K. and Yuen, K.Y. Acupuncture transmitted infections. British Medical Journal, 2010;340, 1147-1152.
  • 13. CDC. Guidance for Evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR 2013;62:10.
  • 14. U.S. Public Health Service. Updated U.S. Public Health Service Guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2001;50(RR-11):1-52.
  • 15. Güneş A. E., Akupunktur tedavisi sırasında doktorun aldığı mikrobiyolojik risklerin analizi: tek merkezli çalışma. Uluslararası geleneksel ve tamamlayıcı tıp kongresi 19 - 22 Nisan 2018 / İstanbul
  • 16. Piro S, Sammud M, Badi A et al. (2001). Hospital – acquired malaria transmitted by contamined gloves. Journal of Hospital Infection 47(2):156-158.