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Barré‐Sinoussi F, Abdool Karim SS, Albert J, Bekker L, Beyrer C, Cahn P, Calmy A, Grinsztejn B, Grulich A, Kamarulzaman A, Kumarasamy N, Loutfy MR, El Filali KM, Mboup S, Montaner JSG, Munderi P, Pokrovsky V, Vandamme A, Young B, Godfrey‐Faussett P. Expert consensus statement on the science of HIV in the context of criminal law. J Int AIDS Soc 2018; 21:e25161. [PMID: 30044059 PMCID: PMC6058263 DOI: 10.1002/jia2.25161] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Globally, prosecutions for non-disclosure, exposure or transmission of HIV frequently relate to sexual activity, biting, or spitting. This includes instances in which no harm was intended, HIV transmission did not occur, and HIV transmission was extremely unlikely or not possible. This suggests prosecutions are not always guided by the best available scientific and medical evidence. DISCUSSION Twenty scientists from regions across the world developed this Expert Consensus Statement to address the use of HIV science by the criminal justice system. A detailed analysis of the best available scientific and medical research data on HIV transmission, treatment effectiveness and forensic phylogenetic evidence was performed and described so it may be better understood in criminal law contexts. Description of the possibility of HIV transmission was limited to acts most often at issue in criminal cases. The possibility of HIV transmission during a single, specific act was positioned along a continuum of risk, noting that the possibility of HIV transmission varies according to a range of intersecting factors including viral load, condom use, and other risk reduction practices. Current evidence suggests the possibility of HIV transmission during a single episode of sex, biting or spitting ranges from no possibility to low possibility. Further research considered the positive health impact of modern antiretroviral therapies that have improved the life expectancy of most people living with HIV to a point similar to their HIV-negative counterparts, transforming HIV infection into a chronic, manageable health condition. Lastly, consideration of the use of scientific evidence in court found that phylogenetic analysis alone cannot prove beyond reasonable doubt that one person infected another although it can be used to exonerate a defendant. CONCLUSIONS The application of up-to-date scientific evidence in criminal cases has the potential to limit unjust prosecutions and convictions. The authors recommend that caution be exercised when considering prosecution, and encourage governments and those working in legal and judicial systems to pay close attention to the significant advances in HIV science that have occurred over the last three decades to ensure current scientific knowledge informs application of the law in cases related to HIV.
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Affiliation(s)
| | - Salim S Abdool Karim
- Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
- Centre for the AIDS Program of Research in South AfricaUniversity of KwaZulu‐NatalDurbanSouth Africa
- Weill Medical CollegeCornell UniversityNew YorkNYUSA
| | - Jan Albert
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstitutetStockholmSweden
| | - Linda‐Gail Bekker
- Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Chris Beyrer
- Department of EpidemiologyCenter for AIDS Research and Center for Public Health and Human RightsJohn Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Pedro Cahn
- Infectious Diseases UnitJuan A. Fernandez Hospital Buenos AiresCABAArgentina
- Buenos Aires University Medical SchoolBuenos AiresArgentina
- Fundación HuéspedBuenos AiresArgentina
| | - Alexandra Calmy
- Infectious DiseasesGeneva University HospitalGenevaSwitzerland
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas‐FiocruzFiocruz, Rio de JaneiroBrazil
| | - Andrew Grulich
- Kirby InstituteUniversity of New South WalesSydneyNSWAustralia
| | | | | | - Mona R Loutfy
- Women's College Research InstituteTorontoCanada
- Women's College HospitalTorontoCanada
- Department of MedicineUniversity of TorontoTorontoCanada
| | - Kamal M El Filali
- Infectious Diseases UnitIbn Rochd Universtiy HospitalCasablancaMorocco
| | - Souleymane Mboup
- Institut de Recherche en Santéde Surveillance Epidemiologique et de FormationsDakarSenegal
| | - Julio SG Montaner
- Faculty of MedicineUniversity of British ColumbiaVancouverCanada
- BC Centre for Excellence in HIV/AIDSVancouverCanada
| | - Paula Munderi
- International Association of Providers of AIDS CareKampalaUganda
| | - Vadim Pokrovsky
- Russian Peoples’ Friendship University (RUDN‐ University)MoscowRussian Federation
- Central Research Institute of EpidemiologyFederal Service on Customers’ Rights Protection and Human Well‐being SurveillanceMoscowRussian Federation
| | - Anne‐Mieke Vandamme
- KU LeuvenDepartment of Microbiology and ImmunologyRega Institute for Medical Research, Clinical and Epidemiological VirologyLeuvenBelgium
- Center for Global Health and Tropical MedicineUnidade de MicrobiologiaInstituto de Higiene e Medicina TropicalUniversidade Nova de LisboaLisbonPortugal
| | - Benjamin Young
- International Association of Providers of AIDS CareWashingtonDCUSA
| | - Peter Godfrey‐Faussett
- UNAIDSGenevaSwitzerland
- Department of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonEngland
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Rasouli A, Hosseini SM, Bahadori M, Ravangard R. Characteristics of Occupational Injuries in a Pharmaceutical Company in Iran. Bull Emerg Trauma 2018; 6:155-161. [PMID: 29719847 DOI: 10.29252/beat-060210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective To prioritize occupational hazards in a Pharmaceutical Company in Iran using the analytical hierarchy process (AHP). Methods This was a cross-sectional study conducted in a Pharmaceutical Company in Iran in 2017. All employees working in the administrative, production, installations and facilities, and laboratory units were studied using the consensus method (N=n=130 employees). A data collection form was designed for identifying the hazards using the Nominal Group Technique (NGT) method, as well as a pair-wise questionnaire was used for collecting required data in the quantitative phase. The collected data were analyzed using Expert Choice 10.0 and SPSS 23.0. Results The results showed that among hazards detected in the studied units, the highest and lowest weights and priorities were, respectively, related to "inhalation of toxic gases" (W=0.253) and "being exposed to radiation" (W=0.022) in the laboratory unit, "skin injuries" (W=0.205) and "bending and straightening for a long time" (W= 0.032) in the production unit, "falling down" (W=0.271) and "standing and sitting for a long time " (W=0.037) in the installations and facilities unit, and "hand joint failure" (W=0.295) and "working in a low-light environment" (W=0.092) in the administrative unit. Conclusion The results of the present study showed that there were hazards in all of the studied units. These results indicated a high level of hazards in the pharmaceutical company's units. Due to the increased medication diversification and increased workload for these companies, paying attention to the preventive and corrective measures in order to reduce the risk of emerging hazards is essential.
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Affiliation(s)
- Abbas Rasouli
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Seyed Mojtaba Hosseini
- Department of Health Services Management, North Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ramin Ravangard
- Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Seroconversion rate among health care workers exposed to HIV-contaminated body fluids: The University of Pittsburgh 13-year experience. Am J Infect Control 2017; 45:896-900. [PMID: 28449921 DOI: 10.1016/j.ajic.2017.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND The studies enumerating the risk of HIV transmission to health care workers (HCWs) as 0.3% after percutaneous exposure to HIV-positive blood, and 0.09% after a mucous membrane exposure, are weakened by dated literature. Our study aims to demonstrate the seroconversion rate after exposure to HIV-contaminated body fluids in a major academic center in the United States. METHODS A prospectively maintained database of reported occupational injuries occurring between 2002 and 2015 at an academic medical center was analyzed. Data collected included the type of injury, injured body part, type of fluid, contamination of sharps, involvement of resident physicians, use of postexposure prophylaxis, and patients' HIV, hepatitis B virus, and hepatitis C virus status. RESULTS A total of 266 cases were included in the study. Most exposures were caused by percutaneous injuries (52.6%), followed by 43.2% mucocutaneous injuries. Of the injuries, 52.6% were to the hand and 33.5% to the face and neck. Blood exposure accounted for 64.3% of all cases. Of the patients, 21.1% received postexposure prophylaxis. None of the HCWs exposed to HIV-contaminated body fluids seroconverted (seroconversion rate, 0%). CONCLUSIONS HIV does not seem to be as easily transmitted by needlestick, laceration, or splash injuries as previously surmised. Further large-scale and multicenter studies are needed for a more accurate estimation of the risk of transmission of HIV in U.S. health care workers.
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Wild C, Dellinger J. HIV-Testung an der Allgemeinbevölkerung. Wien Med Wochenschr 2013; 163:519-27. [DOI: 10.1007/s10354-013-0196-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 03/18/2013] [Indexed: 10/26/2022]
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Risk factors for transmission of HIV in a hospital environment of Yaoundé, Cameroon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:2085-100. [PMID: 20623013 PMCID: PMC2898038 DOI: 10.3390/ijerph7052085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 03/10/2010] [Accepted: 04/04/2010] [Indexed: 11/24/2022]
Abstract
Risk factors for HIV transmission within a hospital setting were assessed using pre-structured questionnaires and observations. Of 409 respondents, 66.3% corresponded to the nursing staff, 14.4% doctors and 8.3% laboratory staff. The irregular use of gloves and other protective clothing for risky tasks, and recapping of needles after use were some of the risk factors identified, especially amongst nurses. Preventive measures were not always implemented by health personnel. More emphasis should be placed not only on diffusing universal precautions and recommendations for hospital staff safety, but accompanying measures for monitoring and evaluation of implementation of these standards are also indispensable.
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Khan AM, Rahman AKSM, Pietroni M, Salam MA. Experience of needle-stick injury among healthcare providers at an urban diarrhoeal-disease hospital in Bangladesh. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2009; 103:365-8. [DOI: 10.1179/136485909x435076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Prüss-Ustün A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Am J Ind Med 2005; 48:482-90. [PMID: 16299710 DOI: 10.1002/ajim.20230] [Citation(s) in RCA: 383] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The global burden of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) infection due to percutaneous injuries among health care workers (HCWs) is estimated. METHODS The incidence of infections attributable to percutaneous injuries in 14 geographical regions on the basis of the probability of injury, the prevalence of infection, the susceptibility of the worker, and the percutaneous transmission potential are modeled. The model also provides the attributable fractions of infection in HCWs. RESULTS Overall, 16,000 HCV, 66,000 HBV, and 1,000 HIV infections may have occurred in the year 2000 worldwide among HCWs due to their occupational exposure to percutaneous injuries. The fraction of infections with HCV, HBV, and HIV in HCWs attributable to occupational exposure to percutaneous injuries fraction reaches 39%, 37%, and 4.4% respectively. CONCLUSIONS Occupational exposures to percutaneous injuries are substantial source of infections with bloodborne pathogens among health-care workers (HCWs). These infections are highly preventable and should be eliminated.
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Affiliation(s)
- Annette Prüss-Ustün
- Protection of the Human Environment, World Health Organization, Geneva, Switzerland.
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The Curse of HIV: How Well Prepared is our Paramedical Force? Med J Armed Forces India 2005; 61:230-3. [DOI: 10.1016/s0377-1237(05)80160-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2003] [Accepted: 02/29/2004] [Indexed: 11/22/2022] Open
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Diaz LF, Savage GM, Eggerth LL. Alternatives for the treatment and disposal of healthcare wastes in developing countries. WASTE MANAGEMENT (NEW YORK, N.Y.) 2005; 25:626-37. [PMID: 15993347 DOI: 10.1016/j.wasman.2005.01.005] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2004] [Revised: 01/11/2005] [Accepted: 01/11/2005] [Indexed: 05/03/2023]
Abstract
Waste production in healthcare facilities in developing countries has brought about a variety of concerns due to the use of inappropriate methods of managing the wastes. Inappropriate treatment and final disposal of the wastes can lead to adverse impacts to public health, to occupational health and safety, and to the environment. Unfortunately, most economically developing countries suffer a variety of constraints to adequately managing these wastes. Generally in developing countries, few individuals in the staff of the healthcare facility are familiar with the procedures required for a proper waste management program. Furthermore, the management of wastes usually is delegated to poorly educated laborers who perform most activities without proper guidance and insufficient protection. This paper presents some of the most common treatment and disposal methods utilized in the management of infectious healthcare wastes in developing countries. The methods discussed include: autoclave; microwave; chemical disinfection; combustion (low-, medium-, and high-technology); and disposal on the ground (dump site, controlled landfill, pits, and sanitary landfill). Each alternative for treatment and disposal is explained, including a description of the types of wastes that can and cannot be treated. Background information on the technologies also is included in order to provide information to those who may not be familiar with the details of each alternative. In addition, a brief presentation of some of the emissions from each of the treatment and disposal alternatives is presented.
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Affiliation(s)
- L F Diaz
- CalRecovery Inc., 2454 Stanwell Drive, Concord, CA 94520, USA.
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Denis MA, Ecochard R, Bernadet A, Forissier MF, Porst JM, Robert O, Volckmann C, Bergeret A. Risk of occupational blood exposure in a cohort of 24,000 hospital healthcare workers: position and environment analysis over three years. J Occup Environ Med 2003; 45:283-8. [PMID: 12661185 DOI: 10.1097/01.jom.0000052961.59271.9d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Early and efficient prevention of occupational blood exposure at hospital requires knowledge of exposures and risks according to staff characteristics. Calculation of annual exposure rates and relative rates from personal and occupational data. The overall annual incidence was 3.5 per 100 workers per year; maximum for nurses and midwives (6.5); minimum for cleaners and paramedics (0.6). Exposures affected mainly nurses (57.81% of accidents, 12.12% of cohort) and occurred mostly in the surgical and the medical departments (26.34 and 25.20% of accidents). Men/women and students/physicians rate differences were not significant. Emergency and intensive care staffs had the highest relative rates (4.27 and 3.05) compared with maintenance staff. Nurses and laboratory staff were more exposed than physicians (3.76 and 2.30 times) were. Our results prompt prevention and training to be precisely focused and efficiently devised.
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Affiliation(s)
- Marie-Agnes Denis
- Occupational Health Department, Edouard Herriot Hospital, Lyon, France.
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Blázquez RM, Moreno S, Menasalvas A, Guerrero C, Novoa A, Segovia M. [Occupational exposures to blood-borne pathogens in health care workers]. Enferm Infecc Microbiol Clin 2001; 19:156-60. [PMID: 11428345 DOI: 10.1016/s0213-005x(01)72595-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine the rate of occupational exposures to blood-borne pathogens in different occupations of health care workers. To analyze the characteristics and outcome of the occupational exposure. MATERIAL AND METHODS We have evaluate occupational exposures to blood-borne pathogens reported by health care workers during 1996-1999. The following data were collected: characteristics of the workers, type of occupational exposure, immunity status of the exposed worker, infectivity of the source patient and follow up serologic testing of the worker. RESULTS A total of 407 occupational exposures were reported. The highest rate of occupational exposure was found among nurses (61.6%). Needlestick accident was the most often occupational exposure reported (84.5%). Mucosal exposures with accidental splashes were reported in 15.2% of cases. In 14.5% of these accidents workers were at risk for occupational transmission of blood-borne pathogens. Among the different occupations of health care workers, the rate of exposures with a source infected patient was higher in medical staffs (28.3%) than nurses (13.9%) The rate of exposures with a source infected patient was higher in accidental splashes than in percutaneous exposures (33.8% vs 13.3%), besides in none of the accidental splashes, employees had used appropriate barrier precautions. There were no cases of transmission of occupational blood-borne infections. CONCLUSIONS Although nurses are the health care workers with highest rates of occupational exposures, medical staffs are the most often occupationally exposed to a source infected patient. Universal barrier precautions are no appropriately used in most of the occupational accidents, specially in those involving mucosal exposures.
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Affiliation(s)
- R M Blázquez
- Servicio de Microbiología, Hospital J.M. Morales Meseguer, Murcia.
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Sotir M, Switzer W, Schable C, Schmitt J, Vitek C, Khabbaz RF. Risk of occupational exposure to potentially infectious nonhuman primate materials and to simian immunodeficiency virus. J Med Primatol 1997; 26:233-40. [PMID: 9437261 DOI: 10.1111/j.1600-0684.1997.tb00217.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Five hundred fifty persons who worked with nonhuman primates (NHP) or with NHP material in 13 North American research institutions were surveyed for potential occupational exposures and tested for antibodies to simian immunodeficiency virus (SIV). Needlesticks and mucocutaneous exposures were reported more frequently among persons who handled SIV-negative or SIV-status-unknown (SIV-N/U) animals (36% and 35%) or who worked with SIV-N/U material in the laboratory (18% and 17%) than among persons who handled SIV-positive NHP (SIV-P) (9% and 4%) or worked with SIV-P material (6% and 8%). The risk for needlesticks when working with both SIV-N/U and SIV-P animals and the risk for mucocutaneous exposures from SIV-N/U animals increased with the number of years working with NHP. Persons who performed invasive tasks (e.g., obtaining blood samples, performing surgery/autopsies) were more likely than others to sustain needlesticks (adjusted OR = 3.55, 95%CI = 1.40-9.02). Two (0.4%) of 550 persons had antibodies to SIV. One appears to be infected with SIV, as previously reported. These data suggest that persons who work with NHP or with NHP material are at risk for occupational exposure to potentially infectious materials including SIV. Prevention strategies are needed to reduce the risk for needlesticks and mucocutaneous exposures around all NHP, and safety guidelines should emphasize prevention options for invasive tasks performed with animals.
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Affiliation(s)
- M Sotir
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Lymer UB, Schütz AA, Isaksson B. A descriptive study of blood exposure incidents among healthcare workers in a university hospital in Sweden. J Hosp Infect 1997; 35:223-35. [PMID: 9093921 DOI: 10.1016/s0195-6701(97)90210-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In an attempt to document blood exposure incidents and compliance with recommended serological investigations, universal precautions and incident reporting routines, data was collected from occupational injury reports during a two-year period. In addition, a sample of healthcare workers (HCWs) answered a questionnaire about blood tests and work routines. In a third part of the study some HCWs were asked about the type and actual frequency of incidents, together with the number of reported incidents during the two-year study period. Of a total of 473 reported occupational blood exposures, the majority came from nurses and the minority from physicians. Most reported incidents occurred on hospital wards. The most common incidents were needlestick injuries, and 35% occurred when the needle was recapped. Medical laboratory technicians (MLT) reported significantly more mucocutaneous incidents than other professionals (P < 0.01). In 10% of the incidents, the patient had a known blood-borne infection. Serological investigations post-exposure varied among professional groups, and 35% were not tested. No seroconversion was shown in the HCWs tested. In the third part of the study, respondents recalled 1180 incidents, although only 9% of these had been reported. The majority occurred in operating theatres, and in connection with anaesthesia. There was a significant difference (P < 0.001) between the different professional groups with regard to the frequency of incident reporting. Physicians reported only 3% and MLTs 36% of the incidents. Eighty-one percent believed that the accident could have been avoided. Despite knowledge of universal precautions, professionals continue to behave in a risky manner, which can result in blood exposure incidents.
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Affiliation(s)
- U B Lymer
- Department of Clinical Microbiology, Faculty of Health Sciences, Linkoping, Sweden
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