J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 6, Number 3, June 2014, pages 197-204

Knowledge Levels Regarding Crimean-Congo Hemorrhagic Fever Among Emergency Healthcare Workers in an Endemic Region

**Table 1.** Questions Asked to Participants
Q1	Have you ever heard of CCHF?/td>
Q2	Do you think that your CCHF knowledge level is sufficient?/td>
Q3	Where did you obtain your CCHF knowledge?a. During my education /b. media/ c. seminars-occupational education/ d. patients whom I followed up.
Q4	Have you ever worked in a clinic where CCHF patients received follow-up care?/td>
Q5	Do you always use gloves during interventions for patients with hemorrhage in the emergency room setting?/td>
Q6	Do you always use protective equipment (masks, gloves, and so on) during interventions for patients who are admitted to the emergency room with nausea, vomiting and enteritis?/td>
Q7	Do you always use protective equipment (masks, gloves, and so on) during interventions for patients who are admitted to the emergency room with active hemorrhage?/td>
Q8	Do you always use gloves during invasive procedures in the emergency room?/td>
Q9	Do you dispose of used sharp equipment and needles in the medical waste box after invasive procedures in the emergency room?/td>
Q10	What is your approach to a suspicious CCHF patient? a. The patient should be hospitalized immediately/ b. Contact isolation precautions should be implemented/ c. Gloves should be used/ d. Facemasks should be used/ e. Sharp equipment and used needles should be disposed of in a medical waste box/ f. Usage of 1/10 diluted bleach is sufficient to disinfect environments that are contaminated with patients’ blood and secretions.
Q11	Is CCHF a hemorrhagic viral infection?/td>
Q12	Does CCHF occur due to infection of the human body by the CCHF virus?/td>
Q13	Can the CCHF virus be transmitted to humans by ticks?/td>
Q14	Can all ticks carry and transmit CCHF?/td>
Q15	Can the CCHF virus be transmitted from human to human?/td>
Q16	Is CCHF especially common in the summer?/td>
Q17	Can CCHF be an asymptomatic disease?/td>
Q18	Should adhered ticks on the human body be removed by pouring a substance that kills ticks on the bitten area?/td>
Q19	Should people wear protective clothing and apply insect repellent when in rural and woody areas?/td>
Q20	What are the symptoms and signs of CCHF?(yes/no): Fever, dysuria, headache, hemorrhage, nausea/vomiting, constipation, diarrhea, weakness, diffuse muscle pain, anorexia, cough, rhinorrhea, low white blood cell (WBC) high WBC, anemia, vitamin B12 deficiency, high CK, low platelets, high AST/ALT, positive blood cultures, positive urine cultures.
Q21	What are the transmission methods of CCHF?a. Bite of infected tick/ b. Contact with blood, tissue or secretions of infected animals/ c. Contact with sick people’s blood or secretions/ d. Inhalation/ e. Eating the meat of animals that have been bitten by infected ticks.
Q22	Who is at risk for CCHF?a. People living in rural areas and their families/ b. Crop farmers and their families/ c. Livestock farmers and their families/ d. Soldiers/ e. Campers/ f. Scouts/ g. Wood workers/ h. People who visit rural and woody areas/ i. Butchers/ j. Abattoir workers/ k. Veterinarians.
Q23	Can CCHF be transmitted nosocomially?/td>
Q24	Should health care workers undergo daily check-ups (of temperature and other symptoms) for 14 days after contact with infected blood and secretions?/td>
Q25	Do you know of an effective and safe vaccine for humans against CCHF?/td>
Q26	Has treating a CCHF patient created risk for you at your job?/td>
Q27	Are you afraid of CCHF, although you are well informed about how it is transmitted?/td>
Q28	Would you prefer not to work with CCFH patients if you could?/td>

Table 1. Questions Asked to Participants

Have you ever heard of CCHF?/td>

Do you think that your CCHF knowledge level is sufficient?/td>

Where did you obtain your CCHF knowledge?a. During my education /b. media/ c. seminars-occupational education/ d. patients whom I followed up.

Have you ever worked in a clinic where CCHF patients received follow-up care?/td>

Do you always use gloves during interventions for patients with hemorrhage in the emergency room setting?/td>

Do you always use protective equipment (masks, gloves, and so on) during interventions for patients who are admitted to the emergency room with nausea, vomiting and enteritis?/td>

Do you always use protective equipment (masks, gloves, and so on) during interventions for patients who are admitted to the emergency room with active hemorrhage?/td>

Do you always use gloves during invasive procedures in the emergency room?/td>

Do you dispose of used sharp equipment and needles in the medical waste box after invasive procedures in the emergency room?/td>

Q10

What is your approach to a suspicious CCHF patient? a. The patient should be hospitalized immediately/ b. Contact isolation precautions should be implemented/ c. Gloves should be used/ d. Facemasks should be used/ e. Sharp equipment and used needles should be disposed of in a medical waste box/ f. Usage of 1/10 diluted bleach is sufficient to disinfect environments that are contaminated with patients’ blood and secretions.

Q11

Is CCHF a hemorrhagic viral infection?/td>

Q12

Does CCHF occur due to infection of the human body by the CCHF virus?/td>

Q13

Can the CCHF virus be transmitted to humans by ticks?/td>

Q14

Can all ticks carry and transmit CCHF?/td>

Q15

Can the CCHF virus be transmitted from human to human?/td>

Q16

Is CCHF especially common in the summer?/td>

Q17

Can CCHF be an asymptomatic disease?/td>

Q18

Should adhered ticks on the human body be removed by pouring a substance that kills ticks on the bitten area?/td>

Q19

Should people wear protective clothing and apply insect repellent when in rural and woody areas?/td>

Q20

What are the symptoms and signs of CCHF?(yes/no): Fever, dysuria, headache, hemorrhage, nausea/vomiting, constipation, diarrhea, weakness, diffuse muscle pain, anorexia, cough, rhinorrhea, low white blood cell (WBC) high WBC, anemia, vitamin B12 deficiency, high CK, low platelets, high AST/ALT, positive blood cultures, positive urine cultures.

Q21

What are the transmission methods of CCHF?a. Bite of infected tick/ b. Contact with blood, tissue or secretions of infected animals/ c. Contact with sick people’s blood or secretions/ d. Inhalation/ e. Eating the meat of animals that have been bitten by infected ticks.

Q22

Who is at risk for CCHF?a. People living in rural areas and their families/ b. Crop farmers and their families/ c. Livestock farmers and their families/ d. Soldiers/ e. Campers/ f. Scouts/ g. Wood workers/ h. People who visit rural and woody areas/ i. Butchers/ j. Abattoir workers/ k. Veterinarians.

Q23

Can CCHF be transmitted nosocomially?/td>

Q24

Should health care workers undergo daily check-ups (of temperature and other symptoms) for 14 days after contact with infected blood and secretions?/td>

Q25

Do you know of an effective and safe vaccine for humans against CCHF?/td>

Q26

Has treating a CCHF patient created risk for you at your job?/td>

Q27

Are you afraid of CCHF, although you are well informed about how it is transmitted?/td>

Q28

Would you prefer not to work with CCFH patients if you could?/td>

**Table 2.** General Knowledge Distribution of HCWs About CCHF
Question	Answer	Doctors	Nurses	Paramedics	P	Total
Q1	Yes	54	100	39	100	16	100	-	109	100
Q2	Yes	44	81.5	28	71.8	14	87.5	0.361	86	78.9
Q3	Yes	24	44.4	22	56.4	2	12.5	0.009	48	44
Q4	a	30	55.6	14	35.9	7	43.8	0.167	51	46.8
	b	0	0	14	35.9	0	0	< 0.001	14	35.9
	c	10	18.5	19	48.7	10	62.5	0.001	39	35.8
	d	10	18.5	18	46.2	6	37.5	0.015	34	31.2

Table 2. General Knowledge Distribution of HCWs About CCHF

Question

Answer

Doctors

Nurses

Paramedics

Total

Yes

100

109

100

Yes

81.5

71.8

87.5

0.361

78.9

Yes

44.4

56.4

12.5

0.009

55.6

35.9

43.8

0.167

46.8

35.9

< 0.001

35.9

18.5

48.7

62.5

0.001

35.8

18.5

46.2

37.5

0.015

31.2

**Table 3.** Distribution of Participants Who Answered “Yes” to Questions About Prevention of Transmission and Approach to Patients
Question	Doctors	Nurses	Paramedics	P	Total
Q5	49	90.7	39	100	16	100	0.069	104	95.4
Q6	33	61.1	35	89.7	16	100	< 0.001	84	77.1
Q7	33	61.1	30	76.9	16	100	0.003	79	72.5
Q8	49	90.7	39	100	16	100	0.069	104	95.4
Q9	47	87	29	74.4	11	68.8	0.158	87	79.8
Q10a	35	64.8	37	94.9	11	68.8	0.001	83	76.2
Q10b	52	96.3	39	100	16	100	0.642	107	98.2
Q10c	54	100	39	100	16	100	-	109	100
Q10d	54	100	39	100	16	100	-	109	100
Q10e	34	63	33	84.6	9	56.3	0.036	76	69.7
Q10f	19	35.2	30	76.9	11	68.8	< 0.001	60	55.1
Q11	54	100	37	94.9	16	100	0.252	107	98.2
Q12	50	92.6	39	100	16	100	0.200	105	96.3
Q13	54	100	37	94.9	16	100	0.252	107	98.2
Q14	11	20.4	11	28.2	5	31.3	0.558	27	24.8
Q15	54	100	37	94.9	16	100	0.252	107	98.2
Q16	54	100	37	94.9	16	100	0.252	107	98.2
Q17	32	59.3	17	43.6	5	31.3	0.094	54	49.5
Q18	5	9.3	7	18	5	31.3	0.091	17	15.6
Q19	54	100	39	100	16	100	-	109	100

Table 3. Distribution of Participants Who Answered “Yes” to Questions About Prevention of Transmission and Approach to Patients

Question

Doctors

Nurses

Paramedics

Total

90.7

100

0.069

104

95.4

61.1

89.7

100

< 0.001

77.1

61.1

76.9

100

0.003

72.5

90.7

100

0.069

104

95.4

74.4

68.8

0.158

79.8

Q10a

64.8

94.9

68.8

0.001

76.2

Q10b

96.3

100

0.642

107

98.2

Q10c

100

109

100

Q10d

100

109

100

Q10e

84.6

56.3

0.036

69.7

Q10f

35.2

76.9

68.8

< 0.001

55.1

Q11

100

94.9

100

0.252

107

98.2

Q12

92.6

100

0.200

105

96.3

Q13

100

94.9

100

0.252

107

98.2

Q14

20.4

28.2

31.3

0.558

24.8

Q15

100

94.9

100

0.252

107

98.2

Q16

100

94.9

100

0.252

107

98.2

Q17

59.3

43.6

31.3

0.094

49.5

Q18

9.3

31.3

0.091

15.6

Q19

100

109

100

**Table 4.** Distribution of Participants Who Answered “Yes” to Questions About Symptoms and Laboratory Findings of CCHF (Q20)
Question	Doctors	Nurses	Paramedics	P	Total
High fever	54	100	39	100	16	100	-	109	100
Dysuria	10	18.5	10	25.6	2	12.5	0.516	22	20.2
Headache	52	96.3	30	76.9	9	56.3	< 0.001	91	83.5
Hemorrhage	54	100	33	84.6	16	100	0.004	103	94.5
Nausea/vomiting	51	94.4	37	94.9	16	100	1.000	104	95.4
Constipation	0	0	8	20.5	0	0	< 0.001	8	7.3
Diarrhea	37	68.5	32	82.1	16	100	0.013	85	78
Weakness	54	100	39	100	16	100	-	109	100
Diffuse muscle pain	51	94.4	33	84.6	16	100	0.136	100	91.7
Anerexia	48	88.9	37	94.8	11	68.8	0.034	96	88.1
Cough	22	40.7	7	18	5	31.3	0.065	34	31.2
Rinorrhea	24	44.4	16	41	12	75	0.058	52	47.7
Low WBC	32	59.3	27	69.2	2	12.5	< 0.001	61	56
High WBC	27	50	19	48.7	9	56.3	0.875	55	50.5
Vit B12 deficiency	2	3.7	17	43.6	5	31.3	< 0.001	24	22
High CK level	40	74.1	27	69.2	11	68.8	0.846	78	71.6
High LDH	39	72.2	27	69.2	9	56.3	0.479	75	68.8
Low thrombocytes	51	94.4	25	64.1	6	37.5	< 0.001	82	75.2
High AST/ALT	54	100	36	92.3	14	87.5	0.026	104	95.4
Positive blood cultures	34	63	25	64.1	11	68.8	0.914	70	64.2
Positive urine cultures	18	33.3	21	53.9	7	43.8	0.141	46	42.2

Table 4. Distribution of Participants Who Answered “Yes” to Questions About Symptoms and Laboratory Findings of CCHF (Q20)

Question

Doctors

Nurses

Paramedics

Total

High fever

100

109

100

Dysuria

18.5

25.6

12.5

0.516

20.2

Headache

96.3

76.9

56.3

< 0.001

83.5

Hemorrhage

100

84.6

100

0.004

103

94.5

Nausea/vomiting

94.4

94.9

100

1.000

104

95.4

Constipation

20.5

< 0.001

7.3

Diarrhea

68.5

82.1

100

0.013

Weakness

100

109

100

Diffuse muscle pain

94.4

84.6

100

0.136

100

91.7

Anerexia

88.9

94.8

68.8

0.034

88.1

Cough

40.7

31.3

0.065

31.2

Rinorrhea

44.4

0.058

47.7

Low WBC

59.3

69.2

12.5

< 0.001

High WBC

48.7

56.3

0.875

50.5

Vit B12 deficiency

3.7

43.6

31.3

< 0.001

High CK level

74.1

69.2

68.8

0.846

71.6

High LDH

72.2

69.2

56.3

0.479

68.8

Low thrombocytes

94.4

64.1

37.5

< 0.001

75.2

High AST/ALT

100

92.3

87.5

0.026

104

95.4

Positive blood cultures

64.1

68.8

0.914

64.2

Positive urine cultures

33.3

53.9

43.8

0.141

42.2

**Table 5.** Knowledge Level Distribution of HCWs Regarding Transmission Methods and At-Risk Populations for CCHF
Question	Answer	Doctors	Nurses	Paramedics	P	Total
Q21	a	54	100	39	100	16	100	-	109	100
	b	46	85.2	30	76.9	14	87.5	0.577	90	82.6
	c	49	90.7	37	94.9	16	0	0.655	102	93.6
	d	25	46.3	11	28.2	14	87.5	< 0.001	50	45.9
	e	7	13	9	23.1	7	43.8	0.028	23	21.1
Q22	a	54	100	39	100	16	100	-	109	100
	b	47	87	39	100	16	100	0.033	102	93.6
	c	54	100	39	100	16	100	-	109	100
	d	28	51.9	21	53.9	11	68.8	0.482	60	55.1
	e	54	100	37	94.9	16	100	0.252	107	98.2
	f	49	90.7	34	87.2	16	100	0.438	99	90.8
	g	52	96.3	37	94.9	16	100	1.000	105	96.3
	h	51	94.4	36	92.3	16	100	0.739	103	94.5
	i	34	63	25	64	7	43.8	0.354	66	60.6
	j	47	87	29	74.4	11	68.8	0.158	87	79.8
	k	50	92.6	34	87.2	16	100	0.347	100	91.7

Table 5. Knowledge Level Distribution of HCWs Regarding Transmission Methods and At-Risk Populations for CCHF

Question

Answer

Doctors

Nurses

Paramedics

Total

Q21

100

109

100

85.2

76.9

87.5

0.577

82.6

90.7

94.9

0.655

102

93.6

46.3

28.2

87.5

< 0.001

45.9

23.1

43.8

0.028

21.1

Q22

100

109

100

0.033

102

93.6

100

109

100

51.9

53.9

68.8

0.482

55.1

100

94.9

100

0.252

107

98.2

90.7

87.2

100

0.438

90.8

96.3

94.9

100

1.000

105

96.3

94.4

92.3

100

0.739

103

94.5

43.8

0.354

60.6

74.4

68.8

0.158

79.8

92.6

87.2

100

0.347

100

91.7

**Table 6.** Distribution of Participants Who Answered “Yes” to Questions About the Approach to CCHF as a Hospital Worker
Question	Doctors	Nurses	Paramedics	P	Total
Q23	51	94.4	32	82	16	100	0.057	99	90.8
Q24	51	94.4	36	92.3	16	100	0.739	103	94.5
Q25	52	96.3	39	100	16	100	0.642	107	98.2
Q26	47	87	37	94.9	16	100	0.305	100	91.7
Q27	46	85.2	32	85	16	100	0.204	94	86.2
Q28	36	66.7	15	38.5	11	68.8	0.015	62	56.9

Table 6. Distribution of Participants Who Answered “Yes” to Questions About the Approach to CCHF as a Hospital Worker

Question

Doctors

Nurses

Paramedics

Total

Q23

94.4

100

0.057

90.8

Q24

94.4

92.3

100

0.739

103

94.5

Q25

96.3

100

0.642

107

98.2

Q26

94.9

100

0.305

100

91.7

Q27

85.2

100

0.204

86.2

Q28

66.7

38.5

68.8

0.015

56.9