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Occupational exposure in Virginia

 

Clinical bottom line

This prospective study indicated that the annual risk of a needlestick by doctors in acute care wards was 0.57 per year, and for nurses was o.83 per year.


Reference

JL Stotka et al. An analysis of blood and body fluid exposures sustained by house officers, medical students, and nursing personnel on acute-care general medical wards: a prospective study. Infection Control and Hospital Epidemiology 1991 12: 583-590.

Study

This prospective study took place on general medical wards at two acute care hospitals in Virginia, with 800 to 900 beds each. The study population was physicians, medical students and nurses, with physicians in ward teams of one resident, two house officers and three medical students.

A one page questionnaire was used, where workers were asked to complete one questionnaire for each adverse exposure incurred during the previous 24 hours, to blood (needlestick and non-needlestick), wound drainage, cerebrospinal fluid, synovial fluid, urine or bloody sputum. The procedure that led to the exposure was also noted.

Physicians completed the forms daily during rounds, while nurses completed the forms at the end of each shift. The study continued for 8-9 months.

Results

Physicians

Over the period there were 102 physicians who worked on the wards, and 100 completed at least one questionnaire indicating an adverse exposure to blood. There were 644 exposures, 15% by residents, 46% by interns, and 39% by medical students. This gave a mean number of exposures during the interval of 6.5, 8.7 and 4.7 respectively.

Most were non-needlestick, and only 7% (43 incidents) were needlesticks. This means that 102 doctors had 43 needlesticks over nine months, or 0.57 needlesticks per doctor per year.

Most of the time (81%) doctors did not use barrier precautions, and 476 of 524 (91%) exposures were preventable by simple use of protective devices.

Nurses

Ninety nurses worked on the wards, and 54 completed at least one questionnaire. There were 235 exposures, a mean of 2.6 exposures per nurse during the interval. Only 31 (13%) were needlesticks, meaning that 90 nurses had 31 needlesticks over five months, or 0.83 needlesticks per nurse per year. There as a mixed pattern of the use of barrier methods between different nursing grades.

Comment

This is a detailed study that richly describes differences between different grades of staff and their experience of contact with blood. It is limited by time and place, but describes how a similar study could be performed to inform practice ant any other institution.