High risk for occupational exposure to HIV and utilization of post-exposure prophylaxis in a teaching hospital in Pune, India

Amita Gupta,Anita Basavaraj,Jayagowri Sastry,Robert C Bollinger,Arjun L Kakrani,Nikhil Gupte,Shreepad M Bhat,Anandini Krisagar,Shuchi Anand

doi:10.1186/1471-2334-8-142

Abstract

BackgroundThe risk for occupational exposure to HIV has been well characterized in the developed world, but limited information is available about this transmission risk in resource-constrained settings facing the largest burden of HIV infection. In addition, the feasibility and utilization of post-exposure prophylaxis (PEP) programs in these settings are unclear. Therefore, we examined the rate and characteristics of occupational exposure to HIV and the utilization of PEP among health care workers (HCW) in a large, urban government teaching hospital in Pune, India.MethodsDemographic and clinical data on occupational exposures and their management were prospectively collected from January 2003–December 2005. US Centers for Diseases Control guidelines were utilized to define risk exposures, for which PEP was recommended. Incidence rates of reported exposures and trends in PEP utilization were examined using logistic regression.ResultsOf 1955 HCW, 557 exposures were reported by 484 HCW with an incidence of 9.5 exposures per 100 person-years (PY). Housestaff, particularly interns, reported the greatest number of exposures with an annual incidence of 47.0 per 100 PY. Personal protective equipment (PPE) was used in only 55.1% of these exposures. The incidence of high-risk exposures was 6.8/100 PY (n = 339); 49.1% occurred during a procedure or disposing of equipment and 265 (80.0%) received a stat dose of PEP. After excluding cases in which the source tested HIV negative, 48.4% of high-risk cases began an extended PEP regimen, of whom only 49.5% completed it. There were no HIV or Hepatitis B seroconversions identified. Extended PEP was continued unnecessarily in 7 (35%) of 20 cases who were confirmed to be HIV-negative. Over time, there was a significant reduction in proportion of percutaneous exposures and high-risk exposures (p < 0.01) and an increase in PEP utilization for high risk exposures (44% in 2003 to 100% in 2005, p = 0.002).ConclusionHousestaff are a vulnerable population at high risk for bloodborne exposures in teaching hospital settings in India. With implementation of a hospital-wide PEP program, there was an encouraging decrease of high-risk exposures over time and appropriate use of PEP. However, overall use of PPE was low, suggesting further measures are needed to prevent occupational exposures in India.

Highlights

The risk for occupational exposure to HIV has been well characterized in the developed world, but limited information is available about this transmission risk in resource-constrained settings facing the largest burden of HIV infection
As a consequence of these exposures, an estimated 66,000 hepatitis B, 16,000 hepatitis C, and up to 1000 HIV infections occur each year. These infections acquired through the occupational route are largely preventable through strict infection control, universal precautions, use of safe devices, proper waste disposal, immunization against hepatitis B virus, and prompt management of exposures including the use of post-exposure prophylaxis (PEP) for HIV [5]
To expand the understanding of this issue in resourceconstrained settings, like India, we evaluated the epidemiology of occupational exposures and the utilization of a newly established PEP program among health care workers (HCW) in a large, urban government teaching hospital in Pune, where HIV antenatal prevalence was approximately 3.5%

Summary

Introduction

The risk for occupational exposure to HIV has been well characterized in the developed world, but limited information is available about this transmission risk in resource-constrained settings facing the largest burden of HIV infection. As a consequence of these exposures, an estimated 66,000 hepatitis B, 16,000 hepatitis C, and up to 1000 HIV infections occur each year These infections acquired through the occupational route are largely preventable through strict infection control, universal precautions, use of safe devices, proper waste disposal, immunization against hepatitis B virus, and prompt management of exposures including the use of post-exposure prophylaxis (PEP) for HIV (estimated to reduce HIV seroconversion by 81%) [5]. The use of these strategies are the standard of care in most highincome nations and have reduced the risk of HIV and hepatitis transmission among HCW. A lack of personal protective equipment (PPE), availability of safe devices, proper disposal of sharps and waste, and a high demand for injections place HCW in these settings at high risk for occupational exposures and infection [2]

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