Blood or Body Fluid Exposures and HIV Postexposure Prophylaxis Utilization among First Responders

Abstract

Objectives. To estimate the incidence of first-responder visits to emergency departments (EDs) for blood or body fluid exposures, elucidate any temporal patterns of these visits, and quantify human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) utilization for these exposures. Methods. This was a retrospective study of first responders presenting to Rhode Island EDs for blood or body fluid exposures from 1995 to 2001. Incidence rates for exposures with 95% confidence intervals (CIs) were estimated. Temporal trends for visits were modeled. Factors associated with HIV PEP utilization were identified using logistic regression. Odds ratios (ORs) with 95% CIs were estimated. Results. The average incidence rate of ED visits for blood or body fluid exposures was 23.29 (20.07–26.52) ED visits per 100,000 ambulance runs. The incidence rose between 1995 and 1999 and then decreased. First-responder ED visits were lowest in October and highest in April and were lowest at 7 am and highest at 7 pm. First responders presenting with a percutaneous or blood-to-mucous membrane exposure had a 4.13 (1.82–8.89) greater odds and those exposed to a known HIV-infected source had a 9.03 (1.59–51.26) greater odds of being offered HIV PEP. First responders presenting to a teaching hospital had a 2.21 (1.02–4.77) greater odds of being offered prophylaxis and a 4.20 (1.08–16.32) greater odds of accepting prophylaxis when it was offered. Conclusions. First responders face a risk of blood or body fluid exposure that varies over the course of the day and the year. HIV PEP is more likely to be used if the exposures are percutaneous, or blood-to-mucous membrane, or if the source is known to be HIV-infected. Standardization of protocols across EDs for administering HIV prophylaxis appears to be needed.