Circumstances surrounding occupational blood exposure events in the National Study to Prevent Blood Exposure in Paramedics

Occupational blood and body fluid exposure among emergency medical service providers in the eThekwini metropole of South Africa

INTRODUCTION

Emergency Medical Service (EMS) providers in South Africa are among health care workers (HCW) most at risk of contracting infectious diseases due to occupational exposure to blood and body fluids (BBF). While the austere, dynamic, and challenging nature of the prehospital environment appears to be one of the primary drivers to this risk, the growing prevalence of bloodborne infections within the country; particularly Hepatitis B, C and Human Immunodeficiency Virus (HIV), has inevitably compounded the problem. The aim of this study was to investigate the knowledge, practices, and prevalence of BBF exposure among EMS providers in the eThekwini metropole of KwaZulu-Natal, South Africa.

METHODOLOGY

This cross-sectional questionnaire-based study was completed by 96 randomly selected EMS providers who worked for the state-run ambulance service and were stationed within the eThekwini metropole.

RESULTS

A total of 41 (42.7%) of the 96 respondents indicated memorable exposure to BBF at some point in their operational career. Exposure appeared to be mostly as a result of needlestick injuries (NSI) (63.4%), followed by BBF exposure into the eyes (19.5%). At the time of exposure, a total of 40 participants (97.6%) were wearing gloves, 22% (n = 9) were wearing facemasks, and 9.8% (n = 4) were wearing eye protection. Less than half of the respondents (46, 47.9%) were aware of existing EMS espoused BBF exposure policies, and 55 (57.3%) knew about post-exposure prophylaxis for HIV. Majority of the respondents (n = 74; 77.1%) indicated that they always recapped needles, and 46.9% (n = 45) dispose of sharps containers when completely full.

CONCLUSION

The findings suggest that BBF related knowledge and practices among EMS providers working in the eThekwini metropole may be inadequate, and may increase the risk of blood exposure. In order to improve knowledge, immediate provision of EMS-specific BBF exposure training is required.

A Cross-Sectional Survey on Occupational Blood and Body Fluid Exposure Risk in a Tertiary Hospital in East Malaysia

Background and Aim

Healthcare workers (HCWs) routinely experience occupational blood and body fluid exposure (OBBE), including percutaneous injury and splash exposure to non-intact skin. The objective of this study was to determine the prevalence of OBBE and identify associated risk factors.

Methods

A cross-sectional study was performed on 334 HCWs at 9 workstations. Data were collected with a self-administered questionnaire that consisted of four parts: sociodemographic variables, work-related information, knowledge about needle stick and sharps injury and splash exposure, and information regarding previous OBBE incidents. The data were analyzed by SPSS version 22.0 software.

Findings

The prevalence of OBBE was 25.1% (95% confidence interval: 20.6–30.2), mostly due to percutaneous injuries, which were not reported to authorities. The highest proportions were among nurses and those working in the medical ward. Needle recapping practices were associated with almost a four-times higher risk of OBBE compared to no-recapping practices. HCWs who did not have any infection prevention training had a three-times higher risk of OBBE.

Conclusion

Factors associated with OBBE are unsafe work practices, inadequate infection prevention training, and lack of knowledge regarding blood-borne infection. There is a need for more training and increased awareness about the risks of OBBE to reduce unsafe practices.

Frequency of Occupational Bloodborne Infections and Sharps Injuries among Polish Paramedics from Selected Ambulance Stations

To evaluate the prevalence of bloodborne infections (BBIs) and assess the incidence and selected risk factors for sharps injuries (SIs), a cross-sectional serosurvey was performed between December 2018 and October 2019 among 286 paramedics (76.5% males; mean age, 37 years) from 17 randomly selected ambulance stations in the West Pomeranian region of Poland. An ELISA system was used to detect anti-HBc, anti-HCV, and anti-HIV. HBV vaccination uptake was 95.6%; 7.3% (95% CI: 4.6–11.0%) paramedics were anti-HBc positive, and anti-HCV/anti-HIV seropositivity was not reported. Almost one-fourth of paramedics reported having had ≥1 SI during the preceding year (Me = 6.0, range 1–100). Most recent exposures primarily took place during an emergency procedure (76.7%), in an ambulance (45.2%), caused by hollow-bore needles (73.8%), and were not reported (50.0%). Additionally, 52.2% of paramedics reported needle recapping, and 52.6% did not use safety engineered devices (SEDs) at work. Mean knowledge score was low (2.6 ± 1.7); 3.4% had never participated in infection-control (IC) training, and those not trained were more likely to suffer a SI (odds ratio (OR) 4.64; p = 0.03). Due to frequent SIs, of which half are unreported, paramedics remain at risk of acquiring occupational BBIs. SI risk could be reduced by providing training on IC procedures, ensuring better compliance with safe work practices, and supplying more SEDs.

Needlestick Injuries Among Emergency Medical Services Providers in Urban and Rural Areas

Through this study, we assessed the knowledge of EMS providers regarding needle stick injuries (NSIs) and examined differences by demographics. This cross-sectional study used a random sample of certified EMS providers in West Virginia. The survey consists of three sections: socio-demographic characteristics, whether or not got NSIs in the past 12 months, whether or not received needle stick training before. A total of 248 out of 522 (47.31%) EMS providers completed the survey. The majority of EMS providers (81.99%, n = 202) reported no NSI ever and 18.21% (n = 45) had at least one NSI within past 12 months. Chi square test was used and there was a statistically significant association between NSI occurrence and age (P < 0.01); certification level (P = 0.0005); and years of experience (P < 0.0001). Stratification methods were used and there was high varying proportion in NSIs between urban areas (38.50%) and rural areas (14.70%) among females (OR 0.28, CI 0.075-1.02, P = 0.05). Our survey of NSIs among EMS providers found that older, more highly certified, and more experienced providers reported higher frequencies of NSIs. Female EMS providers are more prone to NSIs in urban areas compared to women in rural areas. The results indicate a need to further examine NSIs and provide information regarding the safety precautions among urban and rural EMS providers.

Awareness of the Risk of Exposure to Infectious Material and the Behaviors of Polish Paramedics with Respect to the Hazards from Blood-Borne Pathogens-A Nationwide Study

(1) Background: To determine paramedics' frequency of contact with blood and other body fluids, as well as the analysis of knowledge of paramedics about blood-borne infections, their attitudes to patients infected with blood-borne viruses, and the post-exposure procedures implemented by paramedics; (2) Methods: An anonymous questionnaire among 190 paramedics working in various health care facilities in Poland (adjusted response rate, 76.3%); (3) Results: 78% of paramedics had contact with potentially infectious material at least several times a week. Paramedics' knowledge on transferring infection was insufficient. Paramedics with longer employment time and better professional experience suffered fewer injuries with used needles/medical tools (p = 0.079). Most frequently reported factors that prevented the use of personal protective equipment were emergency situations (19.5%), skin irritations and contact allergies (19%) and, in the case of protective gloves, reduced manual dexterity (16%). In total, 82% of paramedics were concerned about the risk of being infected with HIV, HBV or HCV as a result of performing their job. In total, 97% of paramedics behaved more carefully while caring for infected patients. In total, 90% of the paramedics never refrained from performing the specific procedures necessary to help the patient whom they knew to be infected; (4) Conclusions: Despite the paramedics' insufficient theoretical knowledge about the risk of blood-borne infections, the emphasis in the training of future paramedics should be on classes perfecting practical skills, because growing experience significantly reduces the risk of injury.

Self-reported behaviors and perceptions of Australian paramedics in relation to hand hygiene and gloving practices in paramedic-led health care

BACKGROUND

Noncompliance with recommended hand hygiene and gloving practices by workers in the emergency medical services may contribute to the transmission of health care-associated infections and lead to poor patient outcomes. The aim of this study was to explore the self-reported behaviors and perceptions of Australian paramedics in relation to their hand hygiene and gloving practices in paramedic-led health care.

METHODS

A national online survey (n = 417; 17% response rate) and 2 semistructured focus groups (6 per group) were conducted with members of Paramedics Australasia.

RESULTS

Although most of the study participants perceived hand hygiene and gloving to be important, the findings suggest poor compliance with both practices, particularly during emergency cases. All participants reported wearing gloves throughout a clinical case, changing them either at the completion of patient care or when visibly soiled or broken. Hand hygiene was missed at defined moments during patient care, possibly from the misuse of gloves.

CONCLUSIONS

Paramedic hand hygiene and gloving practices require substantial improvement to lower potential transmission of pathogens and improve patient safety and clinical care. Further research is recommended to explore how to alleviate the barriers to performing in-field hand hygiene and the misuse of gloves during paramedic-led health care.

Using formative research to design an epidemiologic survey: the north Carolina study of home care and hospice nurses

OBJECTIVES

Formative research can serve as a means of obtaining important information for designing an epidemiologic study, but descriptions of this approach in the epidemiologic literature are lacking. The objective of this paper is to describe the use of three formative research techniques in designing a survey of home care and hospice nurses.

METHODS

We conducted two focus groups, seven key informant interviews, and approximately fifteen hours of direct observation among home care and hospice nurses recruited by word of mouth in North Carolina in 2006.

RESULTS

We used information obtained from the formative research to decide which survey design would likely be most successful with this population (mail survey, as opposed to Internet survey or in-person interviews), which measure to use for the denominator of the blood exposure incidence rates (number of visits, as opposed to patient-time), and which items and response options to include in the questionnaire, as well as to identify specific survey techniques that would likely increase the response rate (emphasizing the regional focus of the study; sending the questionnaire to the home address).

CONCLUSION

When particular information for planning a study is unavailable from the literature or the investigator's experience, formative research can be an effective means of obtaining that information.

Management practices and risk of occupational blood exposure in U.S. paramedics: Needlesticks

BACKGROUND

The purpose of this study was to present risk estimates for needlestick in U.S. paramedics and estimated risk ratios for selected management practices.

METHODS

A mail survey was conducted among a national sample of U.S. paramedics in 2002-2003.

RESULTS

The adjusted response rate was 55% (n = 2,664). The overall 12-month risk of needlestick was 6.7% (95% confidence interval, 5.4-7.9). Risk ratios for provision of safety-engineered medical devices and two supervisory behaviors that emphasized safe work practices ranged from 2.5 to 3.2. The protective effect of working in an environment that included both of the supervisory behaviors was greater than the protective effect of always being provided with safety devices. A sensitivity analysis indicated that the risk ratio estimates were unlikely to be inflated by nonresponse bias.

CONCLUSIONS

These results suggest that greater provision of safety devices and interventions aimed at management practices that promote worker safety could substantially reduce the risk of needlestick among U.S. paramedics.

Management practices and risk of occupational blood exposure in U.S. paramedics: non-intact skin exposure

PURPOSE

To estimate the risk of blood exposure to non-intact skin in U.S. paramedics; to estimate risk ratios for selected management practices.

METHODS

A mail survey was conducted among a national sample of licensed paramedics in the United States in 2002-2003.

RESULTS

The adjusted response rate was 55% (N = 2,664). The overall 12-month risk of non-intact skin blood exposure was 8.7% (95% confidence interval: 6.4-11). As the number of types of personal protective equipment (PPE) always provided by the employer increased, risk decreased. Risk ratios and 95% confidence intervals for selected factors were: not being provided with appropriate PPE, 2.4 (1.6-3.3); job evaluation doesn't include following safety procedures, 1.8 (1.0-2.7); supervisor wouldn't speak to paramedic about not following Universal Precautions, 2.1 (0.9-3.2); both of the above supervisory behaviors, 2.3 (1.3-3.6).

CONCLUSIONS

Providing appropriate personal protective equipment is an effective means of preventing non-intact skin blood exposure and possible consequent bloodborne infection in paramedics. Future research should aim to identify factors limiting the provision of this equipment and to evaluate the advisability of interventions to increase provision. Supervisory behaviors that emphasize safe work practices may also be effective in preventing non-intact skin exposure in paramedics. Future research should develop interventions that apply general knowledge of management behaviors that promote worker safety to the work environment of paramedics.