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Occupational exposure and antiretroviral prophylaxis

 

Clinical bottom line

Nurses and clinical technicians had most needlestick injuries. The occupation and sex of the exposed healthcare worker was a major determinant of uptake of post exposure prophylaxis.


Reference

M Russi et al. Antiretroviral prophylaxis of health care workers at two urban medical centres. Journal of Occupational and Environmental Medicine 2000 42: 1092-1100.

Study

To respond to guidance about bloodborne HIV infection, a protocol was drafted with input from all stakeholders for provision of a 24-hour immediate evaluation of blood borne pathogen exposure. Instruction sheets were developed, education sessions held, and a special laboratory requests implemented to ensure confidentiality of results and to streamline follow ups. Initial prescriptions were made available for a 96-hour supply of antiretroviral medication while results from laboratories were awaited.

Extensive efforts were made to track each potential blood borne pathogen exposure, and to collect data. Job titles were classified into 12 occupational categories.

Results

Injuries

Over 18 months there were 639 potential exposures. Of these 284 (44%) occurred in nurses, 138 (22%) in doctors, 148 (22%) in clinical technicians and the remainder in housekeeping,and other staff.

Most of the exposures (62%) involved hollow bore needles.

The HIV status was known to be positive in 7%, negative in 63% and was unknown in 30%. HIV positive tests were found in 0.15% of exposed workers.

Hepatitis C was positive in 4.8% of source patients, and 1% among exposed workers.

Prophylaxis

Post-exposure prophylaxis for HIV was taken by 82 individuals (13%). Two thirds of these took the medications for less than 96 hours. Ten completed the full four week course. Reasons for discontinuation included confirmation that the source patient tested negative for HIV (65%), gastrointestinal adverse effects (13%), headache (4%) and personal decision after counselling in 18%.

Prophylaxis was accepted more in men than women, and doctors than nurses or clinical technicians, and when the source patient was known to have tested positive for HIV. Twenty nine workers did not accept prophylaxis even when the source patients tested positive for HIV.

Post-exposure prophylaxis by main worker category is shown in Figure 1. Prophylaxis was much more accepted by doctors and other grades than by nurses and clinical technicians.

Figure 1: Acceptance of post exposure prophylaxis by job category


For exposure involving hepatitis C positive source patients, 26% accepted post exposure prophylaxis.

Comment

The occupation and sex of the exposed healthcare worker was a major determinant of uptake of post exposure prophylaxis. It may be that education is an issue for nurses, especially as they are the single largest group experiencing needlestick injuries.