Blood And Body Fluid Exposures Research Articles

Blood and body fluids exposure (BBFE): knowledge, attitudes, and practices of healthcare workers involved in plastic and reconstructive surgery in Togo

Introduction: Infectious risk among healthcare workers (HCW) is a major public health issue, especially in developing countries. This study aimed to assess the awareness and frequency of blood and body fluids exposure (BBFE) among HCW involved in plastic surgery care activities at the Sylvanus Olympio Teaching Hospital (SOTH). Methods: A cross-sectional study was conducted among HCW involved in plastic and reconstructive activity in the SOTH from July 1st to September 30th, 2021. The study assessed knowledge, attitude, and practices of HCW in face of BBFE using an anonymous selfadministered questionnaire. Results: A total of 101 participants were included (participation rate 91.8%). There was a male predominance; Male/Female ratio was 3.04. The mean age was 35.5 ± 9.4 years [18-65 years]. More than half of the responders (68.32%) had less than 5 years’ professional experience. Nearly half (48.5%) of the participants already had at least one BBFE. Sting (84.2%), blood splashes (61.4%), or skin cuts (54.5%) were the main mechanisms of occurrence. HIV was the most known hazard mentioned by 99/101 (98%) of the participants followed by hepatitis B (91/101, 90%), hepatitis C (71/101, 70%). No participant mentioned the risk of syphilis, Human Papilloma Virus (HPV), or COVID-19 infection. The approach towards the relative measures to be taken including accident declaration were unsatisfactory. Conclusion: The results of this study highlighted the seriousness of BBFE among HCW involved in plastic and reconstructive activities in the SOTH. There is a need for training and information to increase the awareness and knowledge among this specific staff and by extension among all the technical staff in the SOTH. Introduction : Les risques d’infection chez les professionnels de santé constituent un problème de santé publique particulièrement dans les pays en voie de développement. Cette étude a eu pour but d’évaluer les connaissances, attitudes et pratiques par rapport aux accidents avec exposition au sang ou aux produits sanguins (AES) du personnel impliqué dans les activités de chirurgie plastique et reconstructive au Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO). Méthode : Une étude transversale a été menée auprès du personnel impliqué dans les activités de chirurgie plastique et reconstructrice du CHU SO dans la période du 1er Juillet au 30 septembre 2021. Les connaissances, attitudes, et pratiques du personnel face aux AES a été évaluées par un questionnaire rempli de façon anonyme. Résultats : Un nombre de 101/110 participants (91,8%) ont répondu au questionnaire et ont été inclus dans l’étude. Il y avait une prédominance masculine avec une sex-ration de 3/1. L’âge moyen des participants était de 35,5 ± 9,4 ans avec des extrêmes de 18 et 65 ans. Plus de la moitié des participants (68,32%) avait une expérience professionnelle de moins de 5 ans. Presque la moitié des participants (48,5%) ont déjà été victime au moins une fois d’accident avec exposition au sang ou aux liquides biologiques. Les piqûres (84,2%), les éclaboussements de sang (61,4%), les lacérations cutanées (54,5%) étaient les mécanismes les plus fréquents. L’infection à HIV était le risque le plus connu mentionné par 99/101 (98%) des participants suivis de l’infection à hépatite B (91/101, 90%), et hépatite C (71/101, 70%). Aucun des participants n’a mentionné le risque de contamination par la syphilis, le Human Papilloma Virus (HPV), ou la COVID-19. Les connaissances des premières mesures à prendre ainsi que la déclaration de l’accident étaient insuffisantes chez la majorité des participants. Conclusion : Les résultats de cette étude montrent un déficit de connaissance d’attitudes et de pratiques du personnel impliqué dans les activités de chirurgie plastique et reconstructrice au CHU SO. Il en sort la nécessité de former ce personnel et par extension tout le personnel du CHU SO sur les AES.

Occupational blood and body fluid exposure among emergency medical service providers in the eThekwini metropole of South Africa.

Emergency Medical Service (EMS) providers in South Africa are among health care workers (HCW) most at risk of contracting infectious diseases due to occupational exposure to blood and body fluids (BBF). While the austere, dynamic, and challenging nature of the prehospital environment appears to be one of the primary drivers to this risk, the growing prevalence of bloodborne infections within the country; particularly Hepatitis B, C and Human Immunodeficiency Virus (HIV), has inevitably compounded the problem. The aim of this study was to investigate the knowledge, practices, and prevalence of BBF exposure among EMS providers in the eThekwini metropole of KwaZulu-Natal, South Africa. This cross-sectional questionnaire-based study was completed by 96 randomly selected EMS providers who worked for the state-run ambulance service and were stationed within the eThekwini metropole. A total of 41 (42.7%) of the 96 respondents indicated memorable exposure to BBF at some point in their operational career. Exposure appeared to be mostly as a result of needlestick injuries (NSI) (63.4%), followed by BBF exposure into the eyes (19.5%). At the time of exposure, a total of 40 participants (97.6%) were wearing gloves, 22% (n=9) were wearing facemasks, and 9.8% (n=4) were wearing eye protection. Less than half of the respondents (46, 47.9%) were aware of existing EMS espoused BBF exposure policies, and 55 (57.3%) knew about post-exposure prophylaxis for HIV. Majority of the respondents (n=74; 77.1%) indicated that they always recapped needles, and 46.9% (n=45) dispose of sharps containers when completely full. The findings suggest that BBF related knowledge and practices among EMS providers working in the eThekwini metropole may be inadequate, and may increase the risk of blood exposure. In order to improve knowledge, immediate provision of EMS-specific BBF exposure training is required.

Experience with Bloodborne Pathogen Exposures Among Operation Room Nurses in Korea: A Qualitative Study

Background: Operation room (OR) nurses are at a high risk for bloodborne pathogen (BBP) exposures because they are constantly in contact with blood and body fluid (BBF) through surgical sites, and they frequently use sharp surgical instruments and sutures during surgeries. We explored occupational experiences with BBP exposures among OR nurses in South Korea. Methods: With an institutional review board’s approval, this qualitative research was performed with 12 OR nurses who had worked for >3 months and had experienced BBP exposures. Based on the main research question “How is the experience of BBP exposure among OR nurses?” the semistructured questions for in-depth interview were prepared. Narrative data were collected through 1-hour individual interviews from June to September 2020 and were analyzed using a thematical analysis method. Results: The average age of the participants was 34.4 years with an average 9.75 years of clinical experience. The main theme extracted was “The nurses are alerted to their safety after experiencing the aftereffects and emotional trauma from BBP exposures,” with 4 subthemes and 14 concepts. The first subtheme, “OR nurses risking exposure to BBF,” included (1) hurried doctors and hasty nurses; (2) sharp surgical instruments everywhere; (3) deprioritized self-protection due to ongoing surgery; (4) inattentive to BBF risk; and (5) uncomfortable, foggy goggles and receded safety devices. The second subtheme, “BBP exposures occurred in a flash,” included (1) sharp injury occurred in a split second; (2) temporarily treat sharp wounds while hiding frightened feelings; and (3) OR nurses concentrated on surgery by suppressing anxiety and sharp wounds. The third subtheme, “Burdened time that could be overwhelmed alone,” included (1) BBP exposures moments that I wish to reverse; (2) anger over dangerous environments and the turmoil of anxiety; (3) exhausted body and facial discoloration due to taking postexposure prophylaxis; and (4) exposure to BBP that I want to hide from family and friends. The fourth subtheme, “Voice for everyone’s safety,” included (1) establishing a safety culture, which requires everyone’s efforts, and (2) necessity of practical resources for decreasing BBP exposures. Conclusions: The participating OR nurses felt that they were working with a high risk to BBF exposures and called for institutional interventions to reduce the risks, including surgeons’ attentive collaboration. Korean hospitals should make greater efforts to establish safety culture in ORs and to provide repeated, tailored education to prevent BBF exposures. They should also supply high-quality protective equipment and safety-engineered devices for OR nurses.Funding: NoDisclosures: None

Occupational exposure to blood and body fluids among primary healthcare workers in Johannesburg health district: High rate of underreporting.

BackgroundHealthcare workers (HCWs) are at risk of bloodborne infections from sharp instrument injuries and skin and mucous membrane exposures to contaminated blood and body fluids (BBF). While these have clinical and occupational health implications, little is known about BBF exposure and its reporting pattern in South African primary healthcare (PHC). The aim of this study was to determine the rate of BBF exposure, the extent of reporting and the reasons for not reporting among HCWs in PHC facilities in Johannesburg, South Africa.MethodsIn a cross-sectional study involving 444 participants, an 18-item, self-administered questionnaire was used to collect information on socio-demographic characteristics, HCWs’ exposures to BBF in the last year, whether the exposure was reported and the reasons for not reporting. Analysis included descriptive statistics and chi-square test.ResultsMost participants were nurses (87.4%) and female (88.1%). About a quarter of participants (112) reported having at least one BBF exposure in the last year. Overall, there were 355 exposures, resulting in 0.8 BBF exposure per HCW per year. Of these exposures, 291 (82.0%) were not reported. Common reasons for not reporting include lack of time (42.72%), perception that the source patient was at low risk for human immunodeficiency virus (24.7%) and concerns about confidentiality (22.5%). Blood and body fluids exposures involving nurses (p < 0.001), sharp instrument (p < 0.001) and HCWs aged < 50 years (p = 0.02) were significantly more likely to be reported.ConclusionThis study found a high rate of underreporting of BBF exposures among HCWs in PHC facilities in Johannesburg, suggesting an urgent need for interventions to improve reporting.

PIN70 COST OF BLOOD AND BODY FLUID OCCUPATIONAL EXPOSURE MANAGEMENT IN CHINA

To determine the cost of management of occupational exposure to blood and body fluids (BBF) in healthcare facilities in China. A survey was conducted from August to October 2018, seeking general information concerning the management of occupational exposures to BBF and cost of the management process according to the protocol of each individual healthcare facility. In total, 211 healthcare facilities were surveyed using a stratified sampling method. The survey was conducted using a web-based form and protocol uploading system. The information collected includes direct cost such as laboratory testing fee, drug cost and medical service fee, and indirect cost such as wage, lost working time, injury compensation, psychological counseling time, etc. The cost of BBF post-exposure management varies greatly in infection status of the exposure source patients, the immune status of exposed employees, and the location and level of healthcare facilities. The mean values of the management cost are ¥5,936 ($897), ¥5,738 ($867), ¥4,508 ($681), ¥12,709 ($1,920) and ¥7,441 ($1,124) for HBV positive source, HCV positive source, TP positive source, HIV positive source and Unknown source, respectively. These numbers are higher than previously reported, and the variations among healthcare facilities are wide. The cost of managing BBF exposure is an economic burden in China. Some healthcare facilities, particularly those in rural areas, have insufficient post-exposure management. More effective prevention methods should be put in place to minimize exposure and cost.

Education and devices to prevent blood and body fluid exposures.

Healthcare workers are at risk of blood and body fluid exposures (BBFE) while delivering care to patients. Despite recent technological advances such as safety-engineered devices (SEDs), these injuries continue to occur in healthcare facilities worldwide. To assess the impact of an education and SEDs workplace programme on rates of reported exposures. A retrospective cohort study, utilizing interrupted time series analysis to examine reported exposures between 2005 and 2015 at a 600-bed hospital in Perth, Western Australia. The hospital wards were divided into four cohorts. A total of 2223 records were available for analysis. The intervention was most effective for the first cohort, with significant improvements both short-term (reduction of 12 (95% CI 7-17) incidents per 1000 full-time equivalent (FTE) hospital staff) and long-term (reduction of 2 (CI 0.6-4) incidents per 1000 FTE per year). Less significant or consistent impacts were observed for the other three cohorts. Overall, the intervention decreased BBFE exposure rates at the hospital level from 19 (CI 18-20) incidents per 1000 FTE pre-intervention to 11 (CI 10-12) incidents per 1000 FTE post-intervention, a 41% reduction. No exposures resulted in a blood-borne virus infection. The intervention was most effective in reducing exposures at a time when incidence rates were increasing. The overall effect was short-term and did not further reduce an already stabilized trend, which was likely due to improved safety awareness and practice, induced by the first cohort intervention.

Hepatitis-C Virus Infection and Exposure to Blood and Body Fluids among Nurses and Paramedical Personnel at the Alexandria University Hospitals, Egypt

BackgroundWorldwide, prevalence of anti-HCV positivity in health care workers (HCWs) ranges from 0% to 9.7%. The current study was conducted to calculate prevalence of HCV infection, frequency and characteristics of blood and body fluid (BBF) exposure among HCW at the Alexandria University Hospitals. MethodsHospital-based cross-sectional approach was adopted. At the Hospitals, 62.2% of available nurses and paramedical personnel voluntarily participated (n=499), and were interviewed, screened for HCV antibodies. Quantitative estimation of HCV-RNA was done to seropositive cases. ResultsPrevalence of anti-HCV antibodies and HCV infection was 8.6%, and 4.4% respectively. The frequency of BBF exposures was 66.7%. Blood/blood products were mainly involved (92.1%). More than half of exposed HCWs reported not wearing personal protective devices. Anatomical site of exposure was mainly right hand palm (36.2%). Regarding needle-stick injuries, two thirds of injured HCWs were the original user of sharp item which was contaminated in 79.7% of injuries. In 70.2% of injuries, disposable syringes were involved and occurred during item disposal. About 61% of injuries were superficial. ConclusionPrevalence of HCV infection among HCWs is similar to that among general population in the country. Nurses and housekeepers are frequently exposed to BBF. Adherence to infection control measures according to the National Guidelines is crucial to reduce HCV transmission.

Impact of Safety-Engineered Devices on the Incidence of Occupational Blood and Body Fluid Exposures Among Healthcare Personnel in an Academic Facility, 2000-2014.

Legislative actions and advanced technologies, particularly dissemination of safety-engineered devices, have aided in protecting healthcare personnel from occupational blood and body fluid exposures (BBFE). To investigate the trends in BBFE among healthcare personnel over 15 years and the impact of safety-engineered devices on the incidence of percutaneous injuries as well as features of injuries associated with these devices. Retrospective cohort study at University of North Carolina Hospitals, a tertiary care academic facility. Data on BBFE in healthcare personnel were extracted from Occupational Health Service records (2000-2014). Exposures associated with safety-engineered and conventional devices were compared. Generalized linear models were applied to measure the annual incidence rate difference by exposure type over time. A total of 4,300 BBFE, including 3,318 percutaneous injuries (77%), were reported. The incidence rate for overall BBFE was significantly reduced during 2000-2014 (incidence rate difference, 1.72; P=.0003). The incidence rate for percutaneous injuries was also dramatically reduced during 2001-2006 (incidence rate difference, 1.37; P=.0079) but was less changed during 2006-2014. Percutaneous injuries associated with safety-engineered devices accounted for 27% of all BBFE. BBFE was most commonly due to injecting through skin, placing intravenous catheters, and blood drawing. Our study revealed significant overall reduction in BBFE and percutaneous injuries likely due in part to the impact of safety-engineered devices but also identified that a considerable proportion of percutaneous injuries is now associated with these devices. Additional prevention strategies are needed to further reduce percutaneous injuries and improve design of safety-engineered devices.

Surgical Team Stability and Risk of Sharps-Related Blood and Body Fluid Exposures During Surgical Procedures.

To explore whether surgical teams with greater stability among their members (ie, members have worked together more in the past) experience lower rates of sharps-related percutaneous blood and body fluid exposures (BBFE) during surgical procedures. A 10-year retrospective cohort study. A single large academic teaching hospital. Surgical teams participating in surgical procedures (n=333,073) performed during 2001-2010 and 2,113 reported percutaneous BBFE were analyzed. A social network measure (referred to as the team stability index) was used to quantify the extent to which surgical team members worked together in the previous 6 months. Poisson regression was used to examine the effect of team stability on the risk of BBFE while controlling for procedure characteristics and accounting for procedure duration. Separate regression models were generated for percutaneous BBFE involving suture needles and those involving other surgical devices. RESULTS The team stability index was associated with the risk of percutaneous BBFE (adjusted rate ratio, 0.93 [95% CI, 0.88-0.97]). However, the association was stronger for percutaneous BBFE involving devices other than suture needles (adjusted rate ratio, 0.92 [95% CI, 0.85-0.99]) than for exposures involving suture needles (0.96 [0.88-1.04]). Greater team stability may reduce the risk of percutaneous BBFE during surgical procedures, particularly for exposures involving devices other than suture needles. Additional research should be conducted on the basis of primary data gathered specifically to measure qualities of relationships among surgical team personnel.

The status of occupational blood and infectious body fluids exposures in five blood centres in China: a 5-year review.

Little information about the occupational exposures to blood and body fluid (BBF) among blood service workers (BSWs) in blood stations in China is available currently. To assess current status of occupational exposure to BBF and assess the knowledge about occupational blood-borne pathogen exposures and universal precaution among BSWs in blood donations in China. To understand the incidence of occupational exposure in five blood centres in China. A cross-sectional study was conducted from January 2008 to December 2013. There were a total of 99 BBF exposures reported during the study period. The total incidence of BBF exposures was 4.4 per 100 person-years. Higher rates were observed for persons employed less than five years and persons less than 45 years old. Nurses have the highest percentage (49.5%) of BBF exposures. BBF exposures occurred most commonly during the afternoon (62.7%). Percutaneous injuries were the most common BBF exposures. Most incidents occurred during sharps use (73.4%). The major cause of occupational exposure was that there was no continuous training (48.4%) and improper use of equipment (23.2%). Only 56.6% of BBF exposures had appropriate first aid measures. During this research work, one staff member was reported to have seroconverted to syphilis after BBF exposure. To reduce BBF exposures, it is urgent to take several effective actions in China, including improved occupational health systems, adequate education, administrative support, increased use of standard precautions, better safety devices/products and work practices.

Influence of multiple factors on the incidence of occupational blood and body fluid exposures in health care workers in Guizhou, China: A structural equation modeling approach

We investigated the influence of multiple factors on the incidence of occupational blood and body fluid exposures (BBFEs) in health care workers (HCWs) in Guizhou, China, using structural equation modeling (SEM). SEM tested in general hospitals was evaluated using survey data from a sample of 1,774 HCWs from 25 hospitals in Guizhou, China, between January and April2014. The incidence of occupational BBFEs in HCWs was affected by HCWs' knowledge of safe work practices, HCWs' belief in their ability to use safe work practices, HCWs' use of safe work practices, the workplace safety environment, sufficiency of the controls implemented at health care facilities, and workloads. Knowledge of safe work practices had the most influence on the incidence of occupational BBFE in doctors and laboratory technicians. Ability to use safe work practices had the most influence on the incidence of occupational BBFEs in nurses. The workplace safety environment, sufficiency of controls implemented at health care facilities, HCWs' knowledge of safe work practices, HCWs' belief in their ability to use safe work practices, HCWs' use of safe work practices, and workload influence the incidence of occupational BBFEs in HCWs.

Surgical Procedure Characteristics and Risk of Sharps-Related Blood and Body Fluid Exposure.

OBJECTIVE To use a unique multicomponent administrative data set assembled at a large academic teaching hospital to examine the risk of percutaneous blood and body fluid (BBF) exposures occurring in operating rooms. DESIGN A 10-year retrospective cohort design. SETTING A single large academic teaching hospital. PARTICIPANTS All surgical procedures (n=333,073) performed in 2001-2010 as well as 2,113 reported BBF exposures were analyzed. METHODS Crude exposure rates were calculated; Poisson regression was used to analyze risk factors and account for procedure duration. BBF exposures involving suture needles were examined separately from those involving other device types to examine possible differences in risk factors. RESULTS The overall rate of reported BBF exposures was 6.3 per 1,000 surgical procedures (2.9 per 1,000 surgical hours). BBF exposure rates increased with estimated patient blood loss (17.7 exposures per 1,000 procedures with 501-1,000 cc blood loss and 26.4 exposures per 1,000 procedures with >1,000 cc blood loss), number of personnel working in the surgical field during the procedure (34.4 exposures per 1,000 procedures having ≥15 personnel ever in the field), and procedure duration (14.3 exposures per 1,000 procedures lasting 4 to <6 hours, 27.1 exposures per 1,000 procedures lasting ≥6 hours). Regression results showed associations were generally stronger for suture needle-related exposures. CONCLUSIONS Results largely support other studies found in the literature. However, additional research should investigate differences in risk factors for BBF exposures associated with suture needles and those associated with all other device types. Infect. Control Hosp. Epidemiol. 2015;37(1):80-87.

Occupational Safety Precautions among Nurses at Four Hospitals, Nablus District, Palestine

Occupational hazards, exposure to blood and body fluids (BBF) accidents and safety precautions constitute an important public health issue. We assessed the prevalence and determinants of exposure to occupational hazards among nurses, and their knowledge of occupational safety precautions. In a cross-sectional study, we surveyed 332 nurses working in 4 hospitals, Nablus, West Bank, Palestine, by a questionnaire. Bivariate analysis tested the associations between ever exposure and the high likelihood of BBF exposure and the independent socio-demographic and occupational variables. Binary logistic regression analysis was used to assess the associations between the same two exposures and selected independent variables (those significant in the bivariate analysis). Prevalence of ever exposure to BBF was 51.7%, and was associated with working in private and charitable hospitals (OR 2.62, 2.68, respectively), having 4–6 family members (OR 0.52) and "nursing" being as one's top career choice at university (OR 0.48). The prevalence of high likelihood of BBF exposure was 62.2%, and was associated with working in charitable and private hospitals (OR 7.81, 2.43, respectively) and "nursing" being as one's top career choice (OR 0.57). Regarding knowledge, most respondents believed it is necessary to enact laws and regulations regarding occupational safety precautions, reported the use of sharps containers, immediate disinfection after an accident, reporting an accident, and using personal protective equipment. Nurses had adequate knowledge of the risks of their hospital work. Nevertheless, they exhibited high prevalence of exposure to BBF accidents. Future studies are needed to re-evaluate existing occupational safety guidelines in hospitals, establish monitoring and evaluation protocols for health care workers' adherence to the guidelines, and institute well-defined policies for reporting occupational injury incidents so these can be handled appropriately.

Prevalence and risk factors of needlestick injuries, sharps injuries, and blood and body fluid exposures among operating room nurses in Thailand

Operating room nurses are at high risk for occupational exposure to bloodborne pathogens. This study examined the prevalence of and risk factors for needlestick injuries (NSIs), sharps injuries (SIs), and blood and body fluid exposures (BBFEs) among operating room nurses in Thai hospitals. A cross-sectional study was performed in 247 Thai hospitals. Questionnaires eliciting demographic data and information on injury occurrence and risk factors were distributed to 2500 operating room nurses, and 2031 usable questionnaires were returned, for a response rate of 81.2%. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multiple logistic regression analysis. The prevalence of NSIs, SIs, and BBFEs was 23.7%, 9.8%, and 40.0%, respectively. Risk factors for NSIs were training without practice (OR, 1.67; 95% CI, 1.29-2.17), haste (OR, 4.81; 95% CI, 3.41-6.79), lack of awareness (OR, 1.36; 95% CI, 1.04-1.77), inadequate staffing (OR, 1.60; 95% CI, 1.21-2.11), and outdated guidelines (OR, 1.69; 95% CI, 1.04-2.74). One risk factor was identified for SIs: haste (OR, 2.43; 95% CI, 1.57-3.76). Risk factors for BBFEs were long working hours per week (OR, 2.07; 95% CI, 1.06-4.04), training without practice (OR, 1.55; 95% CI, 1.25-1.91), haste (OR, 1.66; 95% CI, 1.30-2.13), lack of awareness (OR, 1.54; 95% CI, 1.22-1.95), not wearing protective equipment (OR, 1.61; 95% CI, 1.26-2.06), and inadequate staffing (OR, 1.63; 95% CI, 1.26-2.11). This study highlights the high prevalence of NSIs, SIs, and BBFEs among Thai operating room nurses. Preventable risk factors were identified. Appropriate guidelines, adequate staffing, proper training, and self-awareness may reduce these occurrences.

Evaluation of High Risk Blood and Body Fluid Exposures at a Large Urban Teaching Hospital

Evaluation of High Risk Blood and Body Fluid Exposures at a Large Urban Teaching Hospital

Sharp Decrease of Reported Occupational Blood and Body Fluid Exposures in French Hospitals, 2003-2012: Results of the French National Network Survey, AES-RAISIN.

To assess the temporal trend of reported occupational blood and body fluid exposures (BBFE) in French healthcare facilities. Retrospective follow-up of reported BBFE in French healthcare facilities on a voluntary basis from 2003 to 2012 with a focus on those enrolled every year from 2008 to 2012 (stable cohort 2008-12). Reported BBFE incidence rate per 100 beds decreased from 7.5% in 2003 to 6.3% in 2012 (minus 16%). Percutaneous injuries were the most frequent reported BBFE (84.0% in 2003 and 79.1% in 2012). Compliance with glove use (59.1% in 2003 to 67.0% in 2012) and sharps-disposal container accessibility (68.1% in 2003 to 73.4% in 2012) have both increased. A significant drop in preventable BBFE was observed (48.3% in 2003 to 30.9% in 2012). Finally, the use of safety-engineered devices increased from 2008 to 2012. Of the 415,209 hospital beds in France, 26,158 BBFE could have occurred in France in 2012, compared with 35,364 BBFE in 2003. Healthcare personnel safety has been sharply improved during the past 10 years in France.

Blood and body fluid exposures: consent for source patient testing

Exposure to blood and body fluids (BBF) remains a major occupational hazard in health care. Routine testing of source patients for blood borne viruses where exposure has occurred is recommended in the UK. Whilst in practice source patient identification may be challenging the reasons why identified individuals are not tested, including issues relating to consent and procedure compliance, are not fully understood. To identify the frequency of serological testing in identified source patients and the reasons for not testing, including refusal and absence of consent. A review of all BBF exposure incidents reported to the Sheffield Occupational Health Service between 1 January 2009 and 31 December 2009. Of 490 reported BBF exposure incidents source patients were identified in 87% of cases and tested in 56% of the incidents. Rates of source patient testing were higher following incidents affecting medical (76%) and nursing staff (69%) than those involving non-clinical (36%) and dental staff (17%). Reasons for not testing source serology among identifiable patients (151) were not recorded in 66% of incidents, in 20% there was incapacity to give consent and in 5% testing was refused. This study found that despite guidance, routine source testing is not universal. Incapacity to consent is a contributory factor for some source serology not being tested and clarification of the ethical and legal position would be helpful. Larger studies should explore other reasons why identified source patients are not tested in practice and explore the policy implications of those findings.

Occupational hepatitis C seroconversions in a Brazilian hospital

There are six known cases of occupational human immunodeficiency virus (HIV) seroconversion in Brazil. However, there are neither published cases of occupational hepatitis C virus (HCV) seroconversion nor systematic studies of blood and body fluid exposures (BBFE) that could estimate the risk of HCV or HIV occupational seroconversion in Brazil. To describe the outcomes of BBFEs in a Brazilian hospital over 12 years and 2 months. Statistical analysis of a computerized database of exposure events recorded on printed forms. Incidence rates (IR) were calculated as the number of BBFE per 100 full-time equivalent worker-years. There were 1457 BBFE, 87% being percutaneous and 561 (38%) recurring in health care workers (HCWs) who reported having previous exposures. The highest IRs occurred in laboratory technicians (9.7), medical students (9.5), cleaning staff (9.5) and nursing aids (9.2). The IR in temporary employees was 13.0. Two HCWs, a nursing aid and a surgeon, seroconverted to hepatitis C after HCV exposures involving 13 G catheter needles. The risk of acquiring a HCV infection was 2 in 38 percutaneous HCV exposures, i.e. 5% (95% CI: 0.89-16.3). There were no seroconversions to HIV despite 80 percutaneous HIV exposures. HCV has a higher potential for occupational transmission than HIV. Measures to reduce the risks of BBFE and occupational transmission of blood-borne viral infections should be improved in Brazil.

Impact of stigma, culture and law on healthcare providers after occupational exposure to HIV and hepatitis C

Worldwide, approximately three million needlestick or sharps injuries occur annually during healthcare procedures, with an estimated 18–35 healthcare professionals (HCPs) acquiring HIV each year as a result. This qualitative study examined the lived experience of occupational exposure to HIV or hepatitis C reported by four HCPs working in a tertiary care hospital in United Arab Emirates (UAE). Findings were based on interviews conducted as part of a larger two-year study investigating an intervention to improve the reporting and management of blood and body fluid exposures (BBFE) in the hospital. The data showed that due to cultural differences, individuals exposed to the same disease within the same legal system could have different concerns. Five themes arose from the data: (1) experiencing the unexpected, (2) inevitability and finality, (3) impact of stigma, (4) responsibility and risk and (5) legal and financial implications. The participants' most important concerns and causes of stress arising from occupational BBFE were related to the social implications (i.e., stigma; legal and financial costs) rather than the biological consequences of the disease. Social implications like these may negatively impact on reporting of occupational BBFE in UAE, but may need to be addressed at a societal rather than organisational level.

Blood and body fluid exposures in the French military

Occupational exposure to blood and body fluids (BBFs) is a hazard of many occupations, particularly hospital-based health care providers. However, non-hospital-based health care workers (HCWs) and other personnel not providing health care are also at risk. To present the results of surveillance of accidental exposure to BBFs among non-hospital-based French military personnel between 2007 and 2009, comparing different occupational categories. The study population included all French military personnel subjected to occupational BBF exposure in a non-hospital setting. BBF exposure was defined as any percutaneous (needlestick injury, scalpel cut, etc.) or mucocutaneous (splash to mucosa, eyes or non-intact skin) exposure to blood, a biological fluid contaminated with blood or a fluid known to transmit blood-borne pathogens. Between 1 January 2007 and 31 December 2009, 704 occupational BBF exposures were reported in non-hospital-based French military personnel. Annualized BBF exposure incidence rates were statistically different among health care workers in non-hospital settings, firefighters, 'gendarmes' and other military personnel, with respectively 38.7, 5.4, 0.8 and 0.1 exposures per 1000 persons per year. Among the 97 cases of HIV post-exposure prophylaxis (PEP) initiated, the source patient's HIV status was unknown in 78 cases (84%). These results suggest that the appropriateness of HIV PEP initiation in the French military should be reviewed. Adapting French guidelines for managing BBF exposure, for non-hospital-based environments should be considered.