Occupational exposure to sharps injury among healthcare providers in Ethiopia regional hospitals

Magnitude of occupational exposure to sharp injuries among nurses working in South Gondar zone public hospitals, Northcentral Ethiopia: institution-based cross-sectional study

OBJECTIVE

This study aimed to determine the magnitude of occupational exposure to sharp injuries and identify its associated factors among nurses.

DESIGN

Institution-based cross-sectional study design was conducted from 1 to 30 November 2022.

ANALYSIS

The collected data were entered into EpiData V.4.2; then, exported to Stata V.14 for analysis. Variables with a p value of <0.05 at 95% CI were considered significantly associated with occupational exposure to sharp injuries.

SETTING

The study was conducted in South Gondar zone public hospitals.

PARTICIPANTS

Nurses working in South Gondar zone public hospitals.

RESULTS

Of the total respondents, 213 (56.65%) were between the ages of 25 and 34 with the mean±SD of age 30.22±6.63 years. Similarly, 202 (53.72%) of the respondents were women. This study finding showed that the magnitude of occupational exposure to sharp injuries among nurses was 52.39% (95% CI: 47.92% to 56.37%). Moreover, this study finding showed that year of service >10 years (adjusted OR (AOR)=2.35, 95% CI: 1.21 to 4.57), lack of infection prevention training (AOR=1.85, 95% CI: 1.09 to 3.45), job-related stress (AOR=2.24, 95% CI: 1.27 to 3.89) and presence of contaminated sharps at the workplace (AOR=2.76, 95% CI: 1.67 to 4.72) were significantly associated with occupational exposure to sharp injuries among nurses.

CONCLUSIONS

Generally, this study finding reported that the magnitude of occupational exposure to sharp injuries among nurses was high. This study finding also showed that years of service >10 years, lack of infection prevention training, job-related stress and the presence of contaminated sharps at the workplace were independent predictors of occupational exposure to sharp injuries among nurses. Hence, all the concerned bodies should strengthen regular provision of infection prevention training to nurses at all levels. Nurses should practice proper use of safety box more than ever in order to avoid the presence of contaminated needles and other sharp materials at the workplace.

Occupational-Related Injuries and Associated Risk Factors Among Healthcare Workers Working in Developing Countries: A Systematic Review

Background

Occupational-related diseases or illnesses account for an estimated 2.4 million deaths worldwide every year. Currently, occupational hazards threaten healthcare workers' (HCWs) lives, safety, and well-being. Therefore, providing the prevalence and major causes of occupational-related diseases may enable injury reduction and the creation of safer working environments, which are important for providing higher quality services. The current study aimed to determine the prevalence of occupational-related injuries and associated risk factors among HCWs, particularly in developing countries.

Methods

The articles published in English were retrieved using a combination of Boolean logic operators (AND, OR, and NOT), Medical Subject Headings (MeSH), and keywords in electronic databases (SCOPUS/Science Direct, Web of Science, DOAJ, PubMed/MEDLINE, CINAHL, and Google Scholars). Using Joanna Briggs Institute critical appraisal tools, a quality assessment was conducted to determine the articles' relevance. In addition, the relevant articles were identified through a series of assessment and evaluation stages.

Results

About 721 studies were searched using electronic databases, of which 36 articles included 139,578 HCWs. The average prevalence of occupational-related injuries among HCWs in the career and previous last year accounted for 60.17%, ranged from 32% to 87.8% and 39.16%, ranged from 1.14% to 87%, respectively. The current study found that sex and hours worked, stress at work, occupation, age, training in infection prevention, use of universal precautions, recapping needles, ward work experience, staffing and resource adequacy, awareness, outdated guidelines, and previous exposure to sharp injury were statistically associated with occupational-related injuries.

Conclusions

This study revealed that 39% and 60% of HCWs experienced occupational-related injuries in the last year and during their career, respectively. Therefore, the appropriate measures must be taken to reduce the burden of occupational-related injuries by following standard precautions or occupational health and safety measures.

The Cross-Sectional Study of attitudes towards risk factors of viral infections transmitted by blood-borne pathogens

OBJECTIVE

The objective of this paper was threefold: To assess risk factors of blood-borne pathogen exposure and viral infection for employees at their workplace, to spot the differences between groups of respondents without exposure and those exposed to blood-borne infections, and to identify main risk predictors.

METHOD

The Cross-Sectional Study was conducted, surveying 203 employees, at the Institute for Emergency Medical Services in Serbia, which were eligible to enter the study and surveyed by Previously Developed Questionnaire.

RESULTS

A total of 97.60% of respondents have perceived risk at their workplace, but there were low numbers of HIV, HbcAg, and Anti-HCV testing and poor percent of vaccination for hepatitis B. There were no statistically significant differences between spotted groups of respondents in their attitudes. Three variables were predictors: accidental usedneedle stick injuries (OR = 90.34; 95% CI, 8.79-928.03), contact with the blood of patientsthrough the skin (OR = 176.94; 95% CI, 24.95-1254.61), and the years of service (OR = 0.92; 95% CI, 0.86-1.00).

CONCLUSION

The significance of this study is that it points to a double risk, because not only health workers are endangered, but also citizens who receive first aid.

The effect of simulation-based education before a cadaver dissection course

Although the methods for medical education continue to evolve due to the development of medicines, the cadaver dissection course still plays a fundamental role. The cadaver dissection course allows students to learn to handle instruments correctly while actively exploring three-dimensional anatomy. However, dissection comes with the risk of accidental injury. In recent years, the number of classes offered for the cadaver dissection course has decreased while the amount of knowledge required in clinical medicine has increased. Simulation-based education (SBE) has been proven to be an effective educational method that enhances the development of practical skills by integrating learners' knowledge and skills. This study aimed to investigate the effect of SBE as a preparatory education course when taken prior to a medical student's enrollment in the cadaver dissection course. In the present study, an SBE assuming practical cadaver dissection course was performed in the Clinical Simulation Center. The frequency of injury rates per 1000 h of cadaver dissection course was significantly less in 2017 and 2018 compared to that in 2016. Two years after the implementation of the SBE, average student self-efficacy scores and written examination scores significantly increased, whereas self-contentment scores were relatively unchanged. The results showed that the implementation of SBE decreased the incidence of injuries and improved students' overall self-efficacy scores and increased acquisition of knowledge evident on written examination score. Therefore, SBE as a preparatory education course may effectively promote the combined development of dissection skills and anatomical knowledge in the subsequent fundamental cadaver dissection course.

Prevalence and associated factors of needle stick and sharps injuries among healthcare workers in northwestern Ethiopia

Background

Needle stick and sharp injuries (NSSIs) are a common problem among healthcare workers (HCWs). Although the factors related to NSSIs for HCWs are well documented by several studies in Ethiopia, no evidence has been reported about the magnitude of and factors related to NSSIs in hospitals in northwestern Ethiopia.

Methods

An institution-based cross-sectional study was carried out from January to March 2019 among 318 HCWs in three randomly-selected hospitals of the eight hospitals found in South Gondar Zone. Sample sizes were proportionally allocated to professional categories. Study participants were selected by systematic random sampling methods using the monthly salary payroll for each profession as the sampling frame. Data were collected using a self-administered questionnaire. The outcome of this study was the presence (injured) or absence of NSSIs during the 12 months prior to data collection. A binary logistic regression model with 95% confidence interval (CI) was used for data analysis. Variables from the bi-variable analysis with a p-value ≤ 0.25 were retained into the multivariable analysis. From the multivariable analysis, variables with a p-value less than 0.05 was declared as factors significantly associated with NSSIs.

Main findings

The prevalence of NSSIs was 29.5% (95% CI: 24.2–35.5%) during the 12 months prior to the survey. Of these, 46.0% reported that their injuries were moderate, superficial (33.3%) or severe (20.7%). About 41.4% of the injuries were caused by a suture needle. Factors significantly associated with NSSIs were occupation as a nurse (adjusted odds ratio [AOR] = 2.65, 95% CI: 1.18–4.26), disposal of sharp materials in places other than in safety boxes (AOR = 3.93, 95% CI: 2.10–5.35), recapping of needles (AOR = 2.27, 95% CI: 1.13–4.56), and feeling sleepy at work (AOR = 2.24, 95% CI: 1.14–4.41).

Conclusion

This study showed that almost one-third of HCWs had sustained NSSIs, a proportion that is high. Factors significantly associated with NSSIs were occupation as a nurse, habit of needle recapping, disposal of sharp materials in places other than in safety boxes and feeling sleepy at work. Observing proper and regular universal precautions for nurses during daily clinical activities and providing safety boxes for the disposal of sharp materials, practicing mechanical needle recapping and preventing sleepiness by reducing work overload among HCWs may reduce the incidence of NSSIs.

Occupational exposure to blood/body fluid splash and its predictors among midwives working in public health institutions at Addis Ababa city Ethiopia, 2020. Institution-based cross-sectional study

BACKGROUND

Blood/body fluid splash are hazards to health care professionals in their working area. Around twenty bloodborne pathogens are known to be transmitted through these occupational injuries. This problem alters the health status of health care professionals in different ways, including physically, mentally, and psychologically. Even though health professionals especially midwives who are working in delivery rooms are highly affected, little is known about the exposure. So, this study was aimed to assess the prevalence of exposure to blood/body fluid splash and its predictors among midwives working in public health institutions of Addis Ababa city.

METHODS

Institution based cross-sectional study was conducted among 438 study participants in public health institutions in Addis Ababa. Data was collected from March 1-20, 2020 by a self-administered questionnaire. The data were entered into Epi data version 3.1 and then exported to SPSS version 24 for analysis. All variables with P<0.25 in the bivariate analysis were included in a final model and statistical significance was declared at P< 0.05.

RESULTS

In this study, a total of 424 respondents respond yielding a response rate of 97%. The prevalence of blood and body fluid splashes (BBFs) was 198 (46.7%). Not training on infection prevention, working in two shifts (> 12 hours), not regularly apply universal precautions, job-related stress, an average monthly salary of 5001-8000 were independent predictors of blood and body fluid splashes.

CONCLUSION

The study revealed that nearly half of midwives were exposed to BBFS. This highlights the need for key stakeholders such as policymakers and service providers to design appropriate policies to avert this magnitude and making the environment enabling to comply with standard precautions. We recommend that this study may be done by including rural setting institutions and by including other health professionals that are susceptible to BBFS at work. Formal training on infection prevention and safety practice to apply universal precautions will be needed from the concerned bodies to prevent exposures to blood/body fluid splash.

Investigation and Analysis of Sharp Injuries among Health Care Workers from 36 Hospitals in Shandong Province, China

Background

This study investigated and analyzed the current situation of sharp injuries among health care workers (HCWs) in China's Shandong Province.

Methods

By means of questionnaire survey, the incidence of sharp injuries among HCWs from 36 hospitals in China's Shandong Province in October 2019 was investigated, and the results of this survey were compared with those of October 2012.

Results

A total of 48165 HCWs were investigated. 549 cases of sharp injuries occurred. The incidence of sharp injuries was 1.14%, which was significantly lower than that in October 2012 (9.71%). In the occupational distribution of sharp injuries among HCWs, the proportion of nurses was 58.65%, doctors 23.32%, and interns 12.02%. Among the distribution of sharp injury departments, general wards, operating rooms, intensive care units, disinfection supply centers, and outpatient clinics were the high-incidence sites of occupational exposure among HCWs. The main instruments causing sharp injuries in HCWs were syringes, scalp steel needles, surgical suture needles, vacuum blood collection needles, and glass slides. Drug administration, double-handed loop needle cap, blood extraction, surgical suture needle, and arteriovenous needle extraction were high-risk operations causing sharp instrument injuries in HCWs.

Conclusion

The incidence of sharp injuries among HCWs from 36 hospitals in Shandong Province in October 2019 was significantly lower than that in October 2012. Sharp injuries were a common type of occupational exposure for HCWs. The occurrence of sharp injuries should be effectively reduced by changing wrong habitual behavior and implementing standard protective measures.

Knowledge and awareness regarding occupational needle stick and sharp injuries among dental personnel in Malaysia

BACKGROUND

Accidental occupational injuries increase the risk of communicable diseases like hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) among dental personnel. Such occupational injuries affect healthcare quality by enhancing dissatisfaction and lack of motivation to work among dental personnel.

OBJECTIVE

The present study aims to assess knowledge and awareness regarding needle stick and sharp injury among dental personnel and compared the knowledge and awareness level about needle stick injuries between dental professionals and dental supporting staff working at the School of Dental Sciences, Universiti Sains Malaysia.

METHODS

This cross-sectional study was conducted from March 2016 to March 2017. The total sample included 112 registered dental personnel including dental professionals (lecturers, dental officers, and postgraduate students) and dental supportive staff (including staff nurses and dental surgery assistant) who were selected from the School of Dental Sciences, Universiti Sains Malaysia at Kelantan District of Malaysia. Data were collected by a structured questionnaire.

RESULTS

In our study 60.7% respondents answered correctly for all the statements regarding knowledge and 51.8% of the respondents answered correctly for the statements regarding awareness on needle stick and sharp injury. No significant difference of knowledge level has been observed between the dental professionals and dental supportive staff (p < 0.819), whereas the awareness level was significantly different between these two groups (p < 0.016).

CONCLUSIONS

There is a difference regarding awareness level on needle stick and sharp injury between dental professionals and dental supportive staff in our study but no differences were found in knowledge level between two groups.

Magnitude and Determinants of Needlestick and Sharp Injuries among Nurses Working in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background

Needlestick and sharp injuries are a big risk to the health of nurses. Every day, nurses face the likelihood that they will injure themselves. Although many injuries will have no adverse effect, the possibility of acquiring infections like hepatitis C virus, hepatitis B virus, and human immunodeficiency virus can cause untold psychological harm. Nurses are in danger of injuries caused by needlestick and sharp instruments in hospitals.

Objective

The objective of this study was to assess the magnitude and determinants of needlestick and/or sharp injuries among nurses working at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2018.

Methods

An institution-based cross-sectional study was conducted among 268 nurses working at Tikur Anbessa Specialized Hospital from February to March 2018. A stratified random sampling technique was used to select the study participants. Data were collected using a self-administered questionnaire. A bivariate and multivariate logistic regression model was fitted to spot factors associated with needlestick and/or sharp injury. An adjusted odds ratio with a 95% confidence interval was computed to determine the level of significance.

Result

The prevalence of needlestick and/or sharp injuries among nurses was 36.2% (95% CI 30.2%, 42.3%). Presence of contaminated needles and/or sharp materials in the working area (AOR = 2.052 (95% CI 1.110, 3.791)), needle recapping after use (AOR = 1.780 (95% CI 1.025, 3.091)), working in the pediatric ward (AOR = 0.323 (95% CI 0.112, 0.930)), and being female (AOR = 0.461 (95% CI 0.252, 0.845)) were significantly associated with needlestick and/or sharp injury at p value of ≤0.05. Conclusion and Recommendation. The proportion of needlestick and/or sharp injury was high among nurses. The safety of nurses depends directly on the degree to which nurses can identify and control the numerous occupational hazards specific to jobs. Thus, working unit specific safety precautions, a safe working environment, and appropriate needle and sharp disposal improve nurses' safety practices and thereby decrease the injuries.

The Prevalence of Needlesticks and Sharp Injuries, and the Associated Factors Among Midwives and Nurses in North Wollo Zone Public Hospitals, North East Ethiopia: An Institution-based Cross-sectional Study

Background

Health professionals are at high risk of exposure for needlestick or sharp injury due to repeated exposure in clinical areas. This exposure leads to the acquiring of different infectious diseases like human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and other infectious diseases. Nurses and midwives having repeated exposure due to long working time, not wearing personal protective equipment, less work experience, and who are unable to apply infection prevention utilization guidelines are at high risk of needlestick and sharp injuries.

Methods

An institutional-based, cross-sectional study design was conducted in North Wollo Zone public hospitals. A simple random sampling technique was applied to select study subjects. The method of data collection was self-administered questionnaires that are structured and pretested from February to March 2019. The data were analyzed using both descriptive and analytical statistics. Binary logistic regressions were used to test the association between variables. Then, P-value <0.05 was considered as statistically significant in this study.

Results

Of the 147 respondents who participated in the study, 50.3% were female and 49.7% were male. The prevalence of needlestick and the sharp injuries was 75.5%. Recap practice of needle (AOR: 3.880; 95%CI: 1.666–9.036), working room (maternal care room) (AOR: 2.968; 95%CI: 1.012–8.703), and contagious room like emergency room (AOR: 3.587; 95%CI: 1.383–9.301) are significantly associated with needlestick and sharp injuries.

Conclusion

This study showed that three-quarters of the study subjects were exposed to needlestick injury at least once in the past year. Needle recapping practice and working room were associated with needlestick and sharp injuries. Then, health personnel should avoid the practice of recapping a needle and tale care themself to avoid needle and sharp injuries in the workplace.

Occupational Exposure to Blood and Body Fluids among Health Care Workers in Gondar Town, Northwest Ethiopia: A Result from Cross-Sectional Study

Background

Health care workers are at the greatest risk of developing blood-borne diseases through occupational exposure to blood and other contaminated body fluids. Occupational exposure to blood and body fluids (BBFs) continues to be the major public health problems and serious concern for the health care force in Ethiopia. Therefore, this study was aimed to determine the prevalence of exposure to blood and other body fluids and its associated risk factors among health care workers.

Methods

The institution-based cross-sectional study design was employed from January 20 to February 30, 2018. A stratified random sampling followed by a simple random sampling technique was used to select 286 study participants. Data were collected using a pretested and structured questionnaire. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with occupational exposure to BBFs. The significance level was obtained at a 95% confidence interval (CI) and p value ≤ 0.05.

Results

The prevalence of occupational exposure to blood and body fluids among health care workers in the last 12 months was 65.3% (95% CI: 59.4, 70.9). Lack of readily available personal protective equipment (adjusted odds ratio (AOR)) = 3.01, 95% CI: 1.56, 5.84), lack of training (AOR = 3.36, 95% CI: 1.1, 11.2), Khat chewing (AOR = 2.74, 95% CI: 1.3, 5.8), and being a medical doctor (AOR = 5.1, 95% CI: 1.68, 15.21) were significantly associated risk factors with occupational exposure to blood and other body fluids.

Conclusions

In this study, occupational exposure to blood and other body fluids among health care workers remains a major health problem. Hence, ensuring the availability of personal protective equipment, developing strategies on banning, and strict monitoring of Khat chewing and training on infection prevention should be emphasized to minimize the problem.

Sharps Injuries during Dissection: A Five-Year Retrospective Study in the Context of Safety

The supplementation of lecture-based anatomy teaching with laboratory sessions, involving dissection or anatomical specimens, is commonly used. Hands-on dissection allows students to handle instruments correctly while actively exploring three-dimensional anatomy. However, dissection carries a potential risk of sharps and splash injuries. The aim of this study was to quantify the frequency rate of such cases per 1,000 student-hours of dissection and identify potential factors than might influence safety in anatomy laboratories. Data were retrospectively collected from September 2013 to June 2018 at the University of St Andrews, Scotland, UK. Overall, 35 sharps injuries were recorded in undergraduate medical students, with a frequency rate of 0.384 and no splash cases. A statistically significant, moderate negative association between year of study and frequency rate (rho₍₂₅₎ = -0.663; P < 0.001) was noted. A statistically significant difference in the frequency rate between different semester modules (χ² ₍₄₎ = 13.577, P = 0.009) was observed with the difference being between Year 1 Semester 2 and Year 3 Semester 1 (P = 0.004). The decreasing trend with advancing year of study might be linked to increasing dissecting experience or the surface area of the region dissected. The following factors might have contributed to increased safety influencing frequency rates: single-handed blade removal systems; mandatory personal protective equipment; and having only one student dissecting at a given time. The authors propose that safety familiarization alongside standardized training and safety measures, as part of an evidence-based culture shift, will instill safety conscious behaviors and reduce injuries in anatomy laboratories.

Epidemiology of viral hepatitis B and C in Punjab, Pakistan: a multicenter cross-sectional study, 2017-18

Background: Globally, approximately 240 million people are chronically infected with hepatitis B virus (HBV) and hepatitis C virus (HCV), which are responsible for 96% of all hepatitis-related mortality. Pakistan has the second highest prevalence of HCV in the world. Methods: We conducted this study to ascertain the prevalence and potential risk factors associated with HBV and HCV infections in Punjab. A multi-center cross-sectional study was conducted, involving 24 Hepatitis Prevention and Treatment Clinics of the Pakistan Kidney and Liver Institute and Research Center clinics, Lahore. A total of 141,705 individuals who visited the clinics during 2017-18 were included for seroprevalence analysis of hepatitis B (HBsAg) and C (Anti-HCV). In addition, 12,427 individuals from the main group underwent detailed face-to-face interviews based on a predesigned questionnaire for risk factor assessment. Results: The overall prevalence for HBV and HCV was 8.4% and 42.7%, respectively. Of those with HCV infection, 4.2% had a co-infection. The transgender population had a higher seroprevalence of HBV (11.8%) and HCV (58.8%). Higher HBV seroprevalence was found in a younger age group (16-30 years), while the older age group (>61 years) had a higher HCV seroprevalence. Geographically, Muzaffargarh district had the highest HBV seroprevalence at 26%, followed by Rajanpur district (20.3%). HCV seroprevalence was significantly (P value <0.05) higher in Shujabad district (66.4%), followed by Muzaffargarh (65.2%). Using multivariable logistic regression analysis, age, gender, intravenous injections, hijama therapy, dental procedure, circumcision by barbers, barber shaving, hospitalization and having had surgical procedures were all found to be significant risk factors (OR >1; p<0.05) for HBV and HCV. Conclusions: There is an urgent need for proper implementation of preventive and control strategies, as well as formal evaluation and monitoring mechanisms. Sustainable and adequate funding of public-sector hepatitis programs is also an extremely important area that should not be neglected.

Injury and infection in dental clinics: Risk factors and prevention

Needlestick and sharp instrument injuries are common in dental practice and present the risk of direct exposure to blood-borne pathogens, including hepatitis B virus. This cross-sectional study was carried out to determine the risk factors of injury and infection in three types of dental clinic in Riyadh, Saudi Arabia. A total of 274 male and 241 female dentists completed a structured questionnaire on demographic factors, compliance with infection control practices, and past exposure to injury and infection hazards. Dentists with more years of professional experience were significantly less likely to report having had an injury in the past (unadjusted odds ratios (ORs) and 95% confidence intervals (CIs) were 0.48, 0.27–0.87 and 0.38, 0.16–0.89 for dentists with 10–20 years and for those with over 20 years of experience, respectively). Greater compliance with infection control procedures was associated with significantly fewer reports of previous infection (OR 0.31, 95% CI 0.12–0.84). Experience of occupational safety training was not associated with a lower rate of injury or infection. Greater occupational safety knowledge and compliance with infection control management practices contribute to a reduced risk of injury and infection among dentists. More focused and specialized training on infection control and occupational safety is needed for all practicing dentists and dental students.

Health-care workers' occupational exposures to body fluids in 21 countries in Africa: systematic review and meta-analysis

OBJECTIVE

To estimate the lifetime and 12-month prevalence of occupational exposure to body fluids among health-care workers in Africa.

METHODS

Embase®, PubMed® and CINAHL databases were systematically searched for studies published between January 2000 and August 2017 that reported the prevalence of occupational exposure to blood or other body fluids among health-care workers in Africa. The continent-wide prevalence of exposure was estimated using random-effects meta-analysis.

FINDINGS

Of the 904 articles identified, 65 studies from 21 African countries were included. The estimated pooled lifetime and 12-month prevalence of occupational exposure to body fluids were 65.7% (95% confidence interval, CI: 59.7-71.6) and 48.0% (95% CI: 40.7-55.3), respectively. Exposure was largely due to percutaneous injury, which had an estimated 12-month prevalence of 36.0% (95% CI: 31.2-40.8). The pooled 12-month prevalence of occupational exposure among medical doctors (excluding surgeons), nurses (including midwives and nursing assistants) and laboratory staff (including laboratory technicians) was 46.6% (95% CI: 33.5-59.7), 44.6% (95% CI: 34.1-55.0) and 34.3% (95% CI: 21.8-46.7), respectively. The risk of exposure was higher among health-care workers with no training on infection prevention and those who worked more than 40 hours per week.

CONCLUSION

The evidence available suggests that almost one half of health-care workers in Africa were occupationally exposed to body fluids annually. However, a lack of data from some countries was a major limitation. National governments and health-care institutions across Africa should prioritize efforts to minimize occupational exposure among health-care workers.