The frequency of incidental injuries related infections in health care workers and other persons in celje region, their prevention and postexposure prophylaxis

Abstract

Background: Injuries with sharp, potentially infected objects represent a danger, particularly due to the possibility of viral transmission, such as hepatitis B, hepatitis C and human immunodeficiency virus, and consequentially, the possibility of infections with these viruses. The possibility of a tetanus infection should always be excluded as well. In percutaneous exposure of patient’s blood to hepatitis B the possibility of infection ranges between 5–30%, while in exposure to hepatitis C it is 3–10% and in exposure to human immunodeficiency virus this rate is 0.3% (in exposure of mucous membranes 0.09%). Methods: The prospective investigation carried out in the period from 1997 to July 2004 was aimed at establishing the frequency and type of incidents as well as the categories of the affected health care workers along with the procedures and types of sharp objects involved in those incidents. A protocol with 20 incident-related questions was prepared. Post-exposure prophylaxis (immunoprophylaxis) against hepatitis B (specific anti-hepatitis B immunoglobulin and/or anti-hepatitis B virus vaccine) and against human immunodeficiency virus infection (chemoprophylaxis) was carried out by infectologists according to state-of-the-art doctrine. Considering the possibility of infection with hepatitis B virus, hepatitis C virus and human immunodeficiency virus, the injured persons were subjected to a clinical, laboratory and serological follow up for at least 6 months or more following the incident. Exactly the same follow-up approach after injury was used also in the rest of the injured persons from Celje region. In co-operation with the Commission for Control of Nosocomial Infections, the infectologists prepared written guidelines regarding the post-exposure prophylaxis for health care workers in hospitals with the risk for hepatitis B virus, hepatitis C virus and human immunodeficiency virus transmission, and also participated in the implementation of immunoprophylaxis program against hepatitis B infection. Results: In the seven-year study period, there were 373 cases of percutaneous injuries with sharp objects and exposures of open wounds or eye mucosa to the blood or visibly hemorrhageous body fluids treated in 116 men and 257 women at a mean age of 36 years. The majority of incidents occurred in medical nurses and technicians (181), which were followed by orderlies and cleaning service staff (43), physicians (41) and other personnel (11). In 97 cases the incident occurred outside the hospital setting, to persons who were not employed in health care. In the majority of cases, i. e. in 255 instances (68.4%), the injury was caused by piercing with a hollow needle. The source of possible infectious substance was identified in 225 (60.3%) cases. The source of infection was found in hepatitis B virus carriers in 26 cases, in anti-hepatitis B virus antibody carriers in 4 and in human immunodeficiency virus carriers in 3 cases. At the time of incident, a sufficient quantity of protective antiHBs antibodies (≥ 10 ml U/ml) was established in 183 (49.1%) of the injured persons, mostly health care workers of the General Hospital Celje, due to previous immunoprophylaxis. Following the incident, the majority of the injured, i. e. 194 (52.0%) persons, received at least one revitalizing dose of vaccine against hepatitis B while 68 (18.2%) persons also received a passive prophylaxis with specific anti-hepatitis B immunoglobulin; a 4-week chemoprophylaxis against human immunodeficiency virus was required in 2 persons. In the course of 6-month follow up, none of the injured persons showed evidence of hepatitis B virus, hepatitis C virus or human immunodeficiency virus in the blood nor the presence of seroconversion; the 32 persons injured in 2004 are still being followed up. Conclusions: In health care institutions, the incidence of injuries with sharp objects can be reduced by ensuring a safe working environment, safe medical-technical equipment, organization of continuous education and training in the use of different techniques (workshops), as well as by appropriate use of sealed containers for sharp object collecting. The staff should be currently informed about the Commission for Control of Nosocomial Infections guidelines regarding the measures to be taken in the case of an incident, and, after having received a first aid intervention, should have the possibility of reporting as fast as possible (within 2–3 hours) to the infectological service for possible immuno- or chemoprophylaxis. In the future, it will be necessary to ensure an even wider vaccination of health care workers against hepatitis B, take care of an accurate registration of all incidents, and enable expert data analyses along with a permanent care for further improvement of the situation.