Magnitude of BBFs exposure
In Ethiopia, data about BBFs exposure among HCWs are lacking. Hence the present study tried to provide the magnitude of splash exposure among HCWs and some possible risk factors observed in this group of people. In this study, there was high magnitude of the BBFs splash to mouth, eyes or ears. More than one fifth (21.2%) of HCWs experienced BBFs exposure 1 year prior to the study and more than a quarter (28.43%) of HCWs experienced at least one splash exposure during their entire carrier.
Splash exposure was significantly associated with working in Delivery and operation theatre, having multiple responsibilities (work overload) and manual washing of soiled linen.
Comparison with similar studies
Higher and lower prevalence rates were also detected as compared to similar study populations in different parts of the world. Prevalence of splash exposure, in this study, was higher compared to other studies conducted in United Arab emirate, Tanzania, and Iowa [18, 25, 26]. This higher prevalence is probably due to small sample size of this study, variation in the study areas and inclusion of non professional health care workers like cleaners, porters, sample transporters and laundry workers in this study. Non professional health care workers are less knowledgeable on risk of splash exposure and have greater chance to follow malpractice.
One hundred forty one (28.43%) HCWs reported BBFs splash to their mouth, eyes or ears throughout their entire carrier, which is lower than a study reports in United States of America emergency medical hospital (56.1%) , Kenya rift valley provincial hospital (51%) , Serbia (59%) , Palestine (51.7%) , University of Gondar (70.2%)  and Debre Berhan (56.6%) , Amhara region, north Ethiopia and Jimma Zone (68.5%) , Oromia region, south west Ethiopia. This lower exposure was probably due to better intervention strategies designed and implemented at national level since 2010 . For instance, Ethiopian hospital reform implementation Guideline was finalized in 2010 and widely implemented then after.
One year self reported splash exposure was 21.2%, which is almost similar to report from eastern Ethiopia (20.2%) , but three times lower than study conducted in University of Gondar, Northwest Ethiopia (62.3%) , This discrepancy might be due to the fact that graduate batch medical students (interns) who have direct and frequent contact with patients, were included in Gondar study. Sample size, sampling techniques and variation in study area may also contribute for the differences.
Four hundred thirteen (83.3%) HCWs reported dissatisfaction by the provision of infection prevention and control materials. HCWs in sub Saharan Africa are dissatisfied with their job, overworked and underpaid and less protected [20, 32]. Lack of infection prevention materials seriously affect prevention efforts and put patients, visitors and HCWs at greater risk of infection and contributes to the dissatisfaction of HCWs with their work environment.
Three factors increased risk of splash exposure. First, risk of splash exposure had increased in delivery/operation theatre than in outpatient departments. This is consistent with report from six Hospitals in Tigray  in which working in delivery and gynecological departments were increased risk of splash exposure. The using practice of personal protective equipment may aggravate the problem. In this study, Health care workers who did not always use personal protective equipments were more in delivery/operation room (13.3%) than in outpatient departments (8.6%).
Second, there was a twofold increased risk of splash exposure among HCWs who had additional responsibilities in the institution compared to those who had no such additional responsibilities. Even though there is limitation of study findings specific to splash exposure on additional responsibilities, working long hours was also a significant predictor of the risk of blood and body fluid exposure . This is most probably due to shortage of time to strictly follow recommended procedures of exposure reduction strategies. Working excessive hours can result in stress and emotional and physical exhaustion, which are likely to increase the chance of human error and contribute to a tendency towards risky behaviors such as poor compliance with the standard precautions in general. One study revealed that excess work load contributed for more than half (64.6%) of splash exposure .
Third, HCWs who washed soiled linen in the institute had faced significantly increased risk of splash exposure compared to HCWs who never washed soiled linen in the institute. According to world health organization (WHO) as well as Ethiopian Hospitals Reform Implementation Guide Line Standards, laundry is the recommended place to wash soiled linen and laundry machine need to carry out such activities . So, existence of manual linen washing practice in study areas contributed for splash exposure of staff.
About 18% of exposed HCWs started Post exposure prophylaxis (PEP). This result was almost similar to study conducted in Iran  and Tanzania , but about four times less than study conducted in Gondar, north west of Ethiopia .
We recognized some limitations in our study. Information on exposure was sought for the preceding 12 and more months and therefore there was a possibility of recall bias among HCWs. There was also a probability of information bias as those who had got splash exposure might have been more eager to participate in the study.
Validity of the study
We had not recognized any selection bias as all HCWs were involved in the study. So, we think that our results are likely to reflect quite well what was happening among HCWs. The questionnaire was answered anonymously, so that the participants could answer with no fear of being linked to their response, and this may promoted the accuracy of the response. We were able to collect information on several potential risk factors and assess their relative contribution to the risk while adjusting for the other factors.