Accidental exposures to blood and other body fluids in a large academic medical center

Prevalence and determinants of occupational exposures to blood and body fluids among health workers in two tertiary hospitals in Nigeria

BACKGROUND

Healthcare associated infections among health workers commonly follow occupational exposures to pathogens infecting blood or body fluids of patients. We evaluated the prevalence and determinants of occupational exposures to blood/body fluids among health workers in two tertiary hospitals in Nigeria.

METHODS

In a cross section study undertaken in two tertiary hospitals in North-central and South-south Nigeria in 2011, a structured self-administered questionnaire was used to obtain demographic data and occupational exposures to blood/body fluids in the previous year from doctors, nurses and laboratory scientists. Independent predictors of occupational exposures were determined in an unconditional logistic regression model.

RESULTS

Out of 290 health workers studied, 75.8%, 44.7%, 32.9%, 33.9% and 84.4% had skin contact with patient's blood, needle stick injuries, cut by sharps, blood/body fluid splashes to mucous membranes and one or more type of exposures respectively. Ninety one percent, 86%, 71.1%, 87.6%, 81.3%, and 84.4% of house officers, resident doctors, consultant doctors, staff nurses, principal/chief nursing officers and laboratory scientists, respectively had one or more type of exposures in the previous year (P>0.05). Professional group was found to be the only independent predictor of cut by sharps. House officers and nurses had higher and more frequent occupational exposures than other professional groups.

CONCLUSION

Our results suggest high rates of occupational exposures to blood/body fluid among health workers in Nigeria, especially among newly qualified medical doctors and nurses. Health facilities in Nigeria ought to strengthen infection prevention and control practices while targeting high risk health workers such as house officers and nurses.

Factors Promoting Consistent Adherence to Safe Needle Precautions Among Hospital Workers

Objective:

To examine organizational factors and occupational characteristics associated with adherence to occupational safety guidelines recommending never recapping needles.

Design:

Mail surveys were conducted with healthcare workers (HCWs) and infection control professionals (ICPs).

Setting:

The surveys were conducted at all non-federal general hospitals in Iowa, except one tertiary-care hospital. Survey data were linked to annual survey data of the American Hospital Association (AHA).

Participants:

HCWs were sampled from statewide rosters of physicians, nurses, and laboratory workers in Iowa. Eligible HCWs worked in a setting and position in which they were likely to routinely handle needles. ICPs at all hospitals in the state were surveyed.

Results:

Ninety-nine ICPs responded (79% response rate). AHA data were available for all variables from 84 (85%) of the hospitals. Analyses were based on 1,454 HCWs who identified one of these hospitals as their primary hospital (70% response rate). Analyses were conducted using multiple logistic regression. Positive predictors of consistent adherence included infection control personnel hours per full-time–equivalent employee (odds ratio [OR], 1.03), frequency of standard precautions education (OR, 1.11), facilities providing personal protective equipment (OR, 1.82), facilities using needleless intravenous systems (OR, 1.42), and management support for safety (OR, 1.05). Negative predictors were use of “blood and body fluid precautions” isolation category (OR, 0.74) and increased job demands (OR, 0.90).

Conclusion:

Healthcare organizations can improve staff safety by investing wisely in educational programs regarding approaches to minimize these risks, providing protective equipment, and eliminating the use of blood and body fluid precautions as an isolation policy.

Healthcare workers' compliance with universal precautions in Turkey

Blood-borne pathogens (BBP) represent remarkable occupational risks for healthcare workers (HCWs). Avoiding occupational blood exposure is a basis of prevention of the blood-borne pathogens (BBP). The effectiveness of the prevention strategies depends on the compliance and adherence to the program by healthcare-facility personnel. The aim of this study was to evaluate Turkish HCWs' compliance with Universal Precautions (UP). An analytic, cross-sectional, countrywide survey study was performed in hospital settings, (n = 5145) in 30 hospitals in 19 cities. In total, 1726 of the 5143 (33.6%) participants' behaviors were accepted as satisfactory for compliance with UP. The hepatitis knowledge levels of 2,650 (51.5%) participants were found to be satisfactory. In the multivariate analysis, working at a surgical site (P = 0.004), living in a rich region (P = .007) and the existence of a health office for HCWs (p = .000) were found to be contributor factors for HCWs' compliance with UP. Conversely, being a nurse (P = .000) and HBV/HCV carrier status (P = .039) were significant preventing predictors for HCWs' compliance with UP. Along with the other well-known predictive factors, regional economic status and a health office for HCWs are contributors for compliance with UP.

Predictive factors for occupational bloodborne exposure in Turkish hospitals

BACKGROUND

This study was conducted to evaluate the epidemiology of percutaneous injury and/or mucosa exposure (PME) with blood or other body fluids that poses serious risks for health care workers (HCWs).

METHODS

An analytic, cross-sectional, countrywide survey study was conducted to describe the extent of and predictive factors for PME among HCWs in hospital settings in Turkey, with total of 5258 HCW participants from 30 hospitals in 19 cities throughout the country.

RESULTS

The respondent group included 41.3% nurses, 29.0% doctors, 9.3% laboratory workers, and 20.3% paramedics. The survey found that 50.1% of the participants reported at least 1 occupational PME in the previous year. Doctors (2.57/person/year) and nurses (2.56/person/year) had the highest PME incidents. In the multivariate analysis, working at a surgical site (P = .000), being a doctor (P = .000), being a nurse (P=.000), young age (P = .025), and living in a poor region (P = .005) were significant factors for high occupational exposure. The presence of a health office for HCWs at the hospital (P = .000) and working at a university hospital (P = .003) were significant predictors of less occupational exposure. Overall, the mean number of PME incidents was 2.16/person/year.

CONCLUSION

Along with the other well-known predictive factors, regional economic status and a health office for HCWs are preventive factors for PME exposure of HCWs.

Working with risk: occupational safety issues among healthcare workers in Kenya

The objective of this study was to explore knowledge of, attitudes towards and practice of post-exposure prophylaxis (PEP) among healthcare workers (HCWs) in the Thika district, Kenya. We used site and population-based surveys, qualitative interviews and operational research with 650 staff at risk of needlestick injuries (NSIs). Research was conducted over a 5-year period in five phases: (1) a bio-safety assessment; (2) a staff survey: serum drawn for anonymous HIV testing; (3) interventions: biosafety measures, antiretrovirals for PEP and hepatitis B vaccine; (4) a repeat survey to assess uptake and acceptability of interventions; in-depth group and individual interviews were conducted; and (5) health system monitoring outside a research setting. The main outcome measures were bio-safety standards in clinical areas, knowledge, attitudes and practice as regards to PEP, HIV-sero-prevalence in healthcare workers, uptake of interventions, reasons for poor uptake elucidated and sustainability indicators. Results showed that HCWs had the same HIV sero-prevalence as the general population but were at risk from poor bio-safety. The incidence of NSIs was 0.97 per healthcare worker per year. Twenty-one percent had had an HIV test in the last year. After one year there was a significant drop in the number of NSIs (OR: 0.4; CI: 0.3-0.6; p<0.001) and a significant increase in the number of HCWs accessing HIV testing (OR: 1.55; CI: 1.2-2.1; p=0.003). In comparison to uptake of hepatitis B vaccination (88% of those requiring vaccine) the uptake of PEP was low (4% of those who had NSIs). In-depth interviews revealed this was due to HCWs fear of HIV testing and their perception of NSIs as low risk. We concluded that Bio-safety remains the most significant intervention through reducing the number of NSIs. Post-exposure prophylaxis can be made readily available in a Kenyan district. However, where HIV testing remains stigmatised uptake will be limited - particularly in the initial phases of a programme.

Occupational health needs of universities: a review with an emphasis on the United Kingdom

This study describes the needs of universities in relation to planning the provision of occupational health services, by detailing their occupational hazards and risks and other relevant factors. The paper presents the results of (1) an enquiry into publicly available data relevant to occupational health in the university sector in the United Kingdom, (2) a literature review on occupational health provision in universities, and (3) selected results from a survey of university occupational health services in the UK. Although the enquiry and survey, but not the literature review, were restricted to the UK, the authors consider that the results are relevant to other countries because of the broad similarities of the university sector between countries. These three approaches showed that the university sector is large, with a notably wide range of occupational hazards, and other significant factors which must be considered in planning occupational health provision for individual universities or for the sector as a whole.

Planning and execution of a successful hepatitis B immunization program

Today's college students occupy a "window" between older adults, whose need for hepatitis B vaccination is minimal, and younger people who receive the vaccine as part of their childhood immunization series. However, because of the high-risk activities that are often part of student behavior, college students are among the individuals who are at the highest risk for this disease; 75% of all reported hepatitis B cases occur in persons between the ages of 15 and 39 years. It is therefore imperative that college health professionals take seriously their responsibility to educate students about issues related to hepatitis B and make available programs that enable the students to receive immunizations. This article briefly describes a successful hepatitis B education and immunization program at an institution that has no mandatory prematriculation immunization requirements.

Health professional students' occupational exposures to blood-borne pathogens: primary and secondary prevention strategies

Health science students, along with the health professionals they hope to become, are at increased risk for certain occupational injuries and illnesses. One of these risks is occupational exposure to blood-borne pathogens, such as human immunodeficiency virus (HIV) and hepatitis, which may result in severe illnesses or even death. Two case studies demonstrate postexposure care of exposed individuals at the University of Texas Medical Branch Student Health Services before and after policy changes and prevention strategies were strengthened in response to exposure incidents.

Contagious diseases in competitive sport: what are the risks?

Great concern is often expressed over the possibility of contagion among athletes in competitive sports, particularly sports with much person-to-person contact. Human immunodeficiency virus (HIV) is only the most notorious of infectious agents; potentially, other viruses, bacteria, and even fungi may be involved. Because of the concern, however, special attention is paid to HIV and hepatitis B infections. For most of the infections considered, the athlete is more at risk during activities off the playing field than while competing. Inclusion of immunizations against measles and hepatitis B among prematriculation immunization requirements (PIRs) for colleges and universities would eliminate these two diseases from the list of dangers to college athletes and all students. Education, rather than regulations, should remain the cornerstone in considering the risks to athletes from contagious diseases.