Increasing the risk of nosocomial transmission of HIV: pitfalls and practices at a busy secondary level hospital with a high burden of HIV

Abstract

Healthcare professionals working in high HIV prevalence settings are at continuous risk of nosocomial acquisition of HIV. Risk factors for percutaneous injuries include recapping or manipulation of needles following venesection and improper disposal of sharps. Prompt risk assessment and access to antiretroviral post-exposure prophylaxis (PEP) is essential to reduce the risk of HIV seroconversion. This study audits the practice of doctors involved in high risk procedures for acquisition of blood-borne viruses. Forty-two doctors working at GF Jooste Hospital, Cape Town, were polled by anonymous questionnaire as to their venesection practice, sharps disposal, history of at-risk exposures and access to PEP. An observational study of sharps bin use was undertaken concurrently. Thirty-six doctors responded, 92% of whom were misusing blood-taking equipment. Five times the number of sharps bins were available in medical wards compared to surgical. Twenty-four doctors sustained a total of 67 blood risk exposures since qualification. Less than half of exposures were reported and only 35% of those who reported their incident received post-exposure counselling and appropriate management. Twenty-five exposures led to a course of PEP. Median delay to PEP was two hours and median duration of PEP was 21 days. Incorrect venesection practice, improper sharps disposal and inadequate post-exposure management are directly increasing the risk of nosocomial transmission of HIV. We believe that these practices are widespread within the South African health service and need to be addressed to adequately protect our doctors and nurses.