Wednesday, July 18, 2012

Occupational Exposures of Blood and Body Fluids by Healthcare Workers- Are They Reported?

Here is an important article in the Journal of Hospital infection on HCW reporting of blood and body fluid exposures. The major concern is exposure to potentially infectious body fluids with HIV and Hepatitis B and C viruses. The article highlights that only 58% of respondents (N=120) from a UK Dental Institute reported their needlestick injuries. Respondents felt that an electronic reporting system would facilitate reporting of injuries.

Surgeons in training are at particular risk for needlestick injuries and these frequently go unreported, as documented here (full -text) in the New England Journal of Medicine. The overall response rate was 95% (N=699) from 17 medical centers.  By the final year of training, 99% of residents had experienced a needlestick injury, for 53%, the injury involved a high risk patient. As many as 51% of all needlesticks were not reported to employee health. Most respondents cited "It takes too much time" as a reason for not reporting a needlestick injury. If the needlestick injury was witnessed by another person, such as a supervising surgeon, then the event was more likely reported. 

Safety in healthcare is not limited to patients. Systems must be in place to most best safety practices in the OR. This include systems based strategies, as recommended by the American College of Surgeons, that function to minimize percutaneous injury risk, such as the use of double gloves, blunt tip suture needles and hands free zones for the passing of sharp instruments.

Needlestick injuries can be a real threat. Despite excellent antiretrovirals to prevent infection with HIV, a failure of HIV postexposure prophylaxis was recently reportedInfection with HIV, Hepatitis B or Hepatitis C can be a career ending event, particularly for a surgeon, as infected healthcare workers with detectable serum viral loads are not allowed to perform invasive procedures. 

This needs to be taken seriously. Reporting of needlestick injuries must be vigorously encouraged and be made nearly effortless so that prompt post-exposure management is initiated. 

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