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Risk of exposure by job and work area

 

Clinical bottom line

Bloodborne exposure to HIV infection, mainly from needlestick injury, affected 8 in 100 nurses, 2 in 100 doctors and 1 in 100 housekeeping staff in infectious disease areas over five years.


Reference

V Puro et al. Risk of exposure to bloodborne infection for Italian healthcare workers, by job category and work area. Infection Control and Hospital Epidemiology 2001 22: 206-210.

Study

This was part of a multicentre prospective study on the occupational risk of infection. In each centre an employee health team has to be present to interview exposed workers regarding the details of exposure, and offer prophylaxis, with appropriate follow up. This study involved 18 acute care hospitals over five years from 1994 to 1998. All were urban and with moderate to high prevalence of HIV infection in their population.

Results

The hospitals have 16,500 beds, with 35,000 healthcare workers. Over the five-year period they notified over 6,000 AIDs cases.

Over the five years there were 14,349 exposures to blood and body fluids. There were 368 percutaneous and 462 mucocutaneous exposures to known HIV infected sources (6%).

Of these 10,988 were percutaneous, with 65% of them (7,100) were caused by hollow bore needlestick injuries. Disposable needles and syringes accounted for 48% of all needlesticks (3,400), followed by winged steel needles at 28% (2,000) and infusion catheters at 10% (710). Activities involving needlesticks were manipulation of vascular access devices (33%), parenteral injections (26%) or drawing blood (22%).

There were 3,361 mucocutaneous exposures, about 40% of which were conjunctival.

The total exposure rates by clinical area and job category are shown in in Table 1. The highest rates of exposure to HIV infection was in infectious disease for all categories. Exposure to HIV infection affected 8 out of 100 nurses and 2 out of 100 doctors in this time. Rates for midwives were 11.8% and 0.5% for total and HIV exposures, for laboratory technicians were 4.6 and 0.5 and for pathologists 4.2 and 0.2 respectively.

Table 1: Exposure by job and clinical area (rate per 100 full time equivalents over five years)

 

Doctor

Nurse

Housekeeper

Clinical area

Total

HIV

Total

HIV

Total

HIV

General medicine

2.1

0.06

12.6

0.4

4.8

0.05

Infectious disease

3.3

1.9

11.3

7.8

2.2

0.8

Other medical

2.4

0.08

9.5

0.2

3.5

0.0

General surgery

11.8

0.9

14.1

0.3

7.2

0.06

Specialist surgery

10.4

0.5

10.0

0.3

4.8

0.08

Intensive care

6.4

0.3

10.8

0.5

4.2

0.1

Dialysis

5.9

0

12.5

0.3

5.1

0.0

Laboratory

1.3

0.1

3.7

0.1

5.1

0.0

Comment

There was also an analysis of higher risk exposures involving needlestick injuries that were either deep, or a needle placed in a source patients's artery or vein, or both. Higher risk injuries were 44% of the total, and again were higher in nurses than in doctors.

The study demonstrates that different jobs and clinical areas are predictably associated with higher risk of injury and exposure. This should help the targeting of preventive measures.