Needlestick injuries and hepatitis risk among health care workers

Abstract

The risk of occupationally acquired infection with Hepatitis B (UB) and Hepatitis C (HC) among health care workers is a result of the frequency of needlestick injuries with patient blood contact (NI), the prevalence of patient virus carriers (C), the probability of transmission (T) and the immune status of the personnel, in the case of HB mainly the vaccination rate (Y). The purpose of the present representative study was to quantitatively register these determinants and thereby calculate the rate of nosocomial hepatitis infections to be expected among hospital workers in Germany. Method: We inquired all blood-exposed personnel (n= 528) at a general hospital as to NI over the last three months. Injuries with used needles, canules, scalpels and other surgical instruments, blood spashed into the eye or mouth as well as contact with blood on open wounds were taken into consideration. The prevalence of C was determined on a group of 769 consecutive patients according to HBsAg, HBeAg, anti-HCY and HCY RNA. T was accepted to be 30% for HB and 2% for HC according to literature sources. The estimation of V was based on an inquiry of 360 hospital occupational physicians. Results : 22% of the personnel recalled at least one NI over the three month period. Silent cases calculated according to official accident reports during the inquiry period made up 91%. The average injury rate was extrapolated to 2.2 occurences per person per year. Physicians and surgical staff showed the highest injury rate. For C, we found 1.0% of patients with HBsAg, 0.3% with HBeAg 1.0% with anti-HCY and 0.5% with HCV RNA. Of the total of 855,000 bloodexposed hospital workers in Germany, 82% are vaccinated against HB and 5% are naturally immune according to the occupational physicians. Conclusions: The prevalence of C among hospitalized patients does not differ from the general Western European population (UB 0.4-1.1%, HC 0.20.8%). According to our figures, 730 occupationally acquired HB-infections and 380 HC-infections can be expected yearly in German hospitals. The resulting occupationally related hepatitis mortality for HC is expected to be 5 times that for HB.