Blood-borne Occupational Exposure Research Articles

A survey of bloodborne occupational exposure protection behavior among qualified Chinese midwives: A cross-sectional study

BackgroundBloodborne occupational exposure is a major public health concern of the China Health Commission, especially among midwives who are at high risk among healthcare workers. Knowledge of occupational exposure and appropriate protective behaviors play important roles in reducing occupational exposure. The purpose of this study was to understand the knowledge and level of protection against bloodborne occupational exposure among midwives in China. MethodsThis was a multi-center, cross-sectional study. Midwives from hospitals that are members of Infectious Disease Nursing Committee of Chinese Nursing Association were selected as survey participants from February 2019 to February 2022 using a judged sampling method. Data were collected by using a self-developed questionnaire for Chinese midwives to report their current knowledge and behavior related to bloodborne occupational exposure protection. ResultsA total of 2850 questionnaires were distributed and 2742 valid questionnaires were obtained, resulting in an effective rate of 96.21 %. Midwives scored 2742 (6.495 ± 1.529) points for their knowledge about bloodborne occupational exposure protection, with the level and type of hospital being independent factors affecting the midwives' knowledge of bloodborne occupational exposure protection (χ2 = 27.284, P = 0.038; χ2 = 28.374, P = 0.000). Of the midwives, 1460 were qualified for bloodborne occupational exposure protection behavior, with a qualified rate of 53.25 %. Working years (χ2 = 9.372, P = 0.002) and working hours (χ2 = 13.933, P = 0.000) were also the independent factors for bloodborne occupational exposure protective behavior in midwives. ConclusionChinese midwives possess relatively good knowledge of bloodborne exposure protection against bloodborne infectious diseases, but their behavioral level is not optimistic. Improvements to both knowledge and behavioral level of bloodborne occupational exposure protection are necessary.

Management of Occupational Bloodborne Pathogen Exposure among Medical Personnel: a 4-Year Prospective Study.

This study examined the management of occupational bloodborne pathogen exposure at a tertiary hospital in China. This prospective study was conducted at the Zhejiang Hospital of Traditional Chinese Medicine between January 2016 and December 2019. Data on bloodborne occupational exposure management were collected. In total, 460 exposures were reported. The majority of exposures (40.2 %) were from hepatitis B virus (HBV)-positive index patients. Of the 460 cases, 453 (98.5%) exposures were reported timeously, and 371 (80.7%) cases received emergency treatment response and management. Sixty-eight personnel (93.2%) received timely prophylaxis treatment. Only 82/113 (72.6%) personnel completed the recommended follow-up period. Outsourced personnel(P = 0.002) and interns (P = 0.011) were independent follow-up factors. Although adequate compliance was achieved with timely reporting and prophylactic medication, there is room for improvement in terms of emergency treatment response and follow-up compliance. Furthermore, HBV vaccination and improved follow-up with outsourced personnel are recommended.

Current status and high-risk factors of blood-borne occupational exposure among midwives in China: A cross-sectional survey

To identify the problems and high-risk factors of blood-borne occupational exposure among midwives in China. Midwives from the obstetrics department and delivery room of hospitals in institutions. The self-compiled questionnaire on the current status of blood-borne occupational exposure of Chinese midwives was used for data collection. The incidence rate of blood-borne occupational exposure was 46.77%. The independent risk factors were working years ≤5 years (P=.001), unable to take standard prevention at work (P=.000), unaware of human immunodeficiency virus treatment procedures (P=.000), and average daily working hours of 8 hours (P=.002), the high risk of blood-borne occupational exposure at work (P=.000), and contact with patient fluids, blood without gloves (P=.000). Midwives are at high risk of blood-borne occupational exposure, and midwives with ≤5 years of service are the focus group. Failure to achieve standard prevention, the length of working hours and the ignorance of the treatment process of acquired immunodeficiency syndrome have a certain impact on the occurrence of blood-borne occupational exposure. It is necessary to focus on cultivating high-level midwifery talents to overcome the shortage of midwives and rationally use midwifery resources, as well as to strengthen standard prevention and improve the occupational protection and guarantee system for midwives.

Risk factors analysis and intervention of blood-borne occupational exposure in medical staff

Objective: To analyze the risk factors of blood-borne occupational exposure among medical staff and explore the relevant intervention measures. Methods: In June 2020, the data of blood-borne occupational exposure and related factors reported by medical staff in a grade Ⅲ, Grade A general hospital from 2011 to 2019 were analyzed by retrospective investigation. Results: Among 431 cases of blood-borne occupational exposure, 69.37% were nurses. It mainly occurred in medical staff with 0-4 years of service, accounting for 63.57%; The main place of occupational exposure was in the ward 47.56%; Sharp instrument injury was the main occupational exposure route 91.65%. Occupational exposure department was mainly surgery department 17.87%; The main source of exposure was hepatitis B virus (HBV) 37.12%, followed by treponema pallidum 20.19%. Statistical analysis results show that: Exposure sites (χ(2)=43.585, P<0.01) , exposure sources (χ(2)=22.693, P<0.01) , treatment methods after exposure (χ(2)=18.866, P<0.01) , Flushing (χ(2)=31.963, P<0.01) and disinfection (χ(2)=14.216, P<0.01) were significantly different. Conclusion: The effective measures to reduce blood-borne occupational exposure are to strengthen occupational protection training of medical staff, standardize operation procedures, strengthen supervision of key groups and departments, improve reporting, monitoring and follow-up systems to realize informatization, and do a good job in risk control.

Application of failure mode and effect analysis in reducing the risk of nosocomial infection

Objective: To explore the effect of failure mode and effect analysis (FMEA) in the management of nosocomial infection, and provide reference for the effective prevention and control of nosocomial infection. Methods: Using FMEA to identify, analyze, evaluate and screen out the high-risk events of nosocomial infection in January 2020, from which two hospital level priority improvement projects of hand hygiene compliance and blood-borne occupational exposure were determined. After risk control and intervention measures, the effects before and after improvement were compared. Results: Except for the lack of incentive mechanism and insufficient communication between medical and nursing teams, the differences in hand hygiene compliance and blood-borne occupational exposure risk priority coefficients before and after the implementation of FMEA were statistically significant (P<0.05) . After the implementation of FMEA, the hand hygiene compliance was 74.92% (79375/105953) , which was significantly higher than 68.40% (58361/85328) before the implementation of FMEA, and the difference was statistically significant (χ(2)=996.55, P<0.01) . The incidence of blood-borne occupational exposure after the implementation of FMEA was 3.85% (80/2080) , which was lower than the 6.16% (123/1998) before the implementation of FMEA, and the difference was statistically significant (χ(2)=11.49, P<0.01) . Conclusion: FMEA has a good effect in nosocomial infection management. It can identify and evaluate the risk of nosocomial infection prospectively, so as to control the risk effectively.

Blood-borne occupation exposures in dental practice of medical staff: status and protection

Objective: To understand the status of blood-borne occupational exposure and protection among health care workers (HCWs) in dental practice, and provide evidence for making effective prevention. Methods: From April 1 to 15, 2019, a stratified random sampling method was conducted to investigate the data of blood-borne occupational exposure among 221 dental HCWs in 2018, and Chi-squared Test was used to evaluate the differences of status on occupational exposure and protection among different professionals, such as nurses, doctors and trainees, and among different-grade hospitals. Results: A total of 166 HCWs were exposed to occupational exposure 269 times, with the annual incidence of 75.11% (166/221) , and 37.55% (101/269) of exposures were reported. However, all source patients of exposures had failed to be traced. 89.59% (241/269) of exposures were sharp injuries. The top three instruments caused injuries were syringe/bilan needles, suture needles and vehicle needles, accounting for 35.68% (86/241) 、16.60% (40/241) and 16.18% (39/241) , respectively; and the top three exposure operations were removal/disposal of needles or instruments, suture/assisting suture and injection of anesthetic, accounting for 37.17% (100/269) 、22.30% (60/269) and 17.84% (48/269) , respectively. There were statistically significant differences among different professionals in occupational exposure frequency, reporting rate, the types of instruments caused injuries, exposure operations and hepatitis B vaccinated time (P<0.01) . The compliance rate of standard precautions, safe operation, post-exposure reporting and prevention, and training on occupational protection were generally poor among HCWs, with significant differences in different-grade hospitals (P<0.01) . Conclusion: There is a high incidence, low reporting rate and poor self-protection of blood-borne occupational exposure among dental HCWs. Strongly suggesting that standard precautions, safe use and disposal of oral instruments, active post-exposure report and prevention must be improved for everyone.

Study on the influence of health belief model on the compliance of medical staff with sharp injury protection behavior

Objective: To explore the effects of the intervention based on the theoretical framework of Health Belief Model on improving sharp injury protection behavior compliance of medical staffs, in order to provide some references for energetically developing blood-borne occupational exposure protection intervention in the region. Methods: According to the inclusion criteria, 178 medical staffs were selected, implemented intervention of the theory of health belief model. Methods included diversity training, experiencing operation, filed observation and supervision and so on, strengthened intervention after 1 month, evaluated the intervention effect after 3 months, used questionnaires and field observation to evaluate the effect before and after the intervention. Results: the scores of security behavior compliance were higher before intervention and there was significant difference (P<0.05) . Observed that, after the intervention the incidence of unsafe behavior in medical personnel dropped from 29.1% to 13.2%, the difference was statistically significant (P<0.05) . Conclusion: The intervenion of the theory of health belief model can strengthen sharp injury protection belief of medical personnels, improve behavior compliance, reduces the occurrence of sharp injury.

Mental health sataus and influencing factors of medical staff after blood-borne occupational exposure

Objective: To explore the mental health status and influencing factors of medical staff after blood-borne occupational exposure, and to provide scientific basis for effective psychological intervention. Methods: From January 2017 to December 2018, 178 medical staff with blood-borne occupational exposure in three hospitals of Shandong Province were collected as the contact group, and 100 routine medical staff as the control group during the same period. Questionnaires were conducted among medical staff in the two groups, including general information questionnaire, symptom checklist 90 (SCL-90) , post-traumatic stress disorder self-rating scale (PCL-C) , coping style scale (CPS) , social support scale (SSRS) . The basic situation and mental health level of medical staff in the two groups, as well as the coping and social support status of medical staff exposed to hematogenous occupational exposure were analyzed. Relevant influencing factors. Results: The total score of SCL-90 was 1.66+0.33, 45 (38.14%) were positive, and 21 (21.00%) were positive in the control group. The difference was statistically significant (χ(2)=7.529, P<0.05) . Compared with the control group, the scores of SCL-90 somatization, obsessive-compulsive symptoms, depression, anxiety, hostility, paranoia and total scores of medical staff in the exposure group increased significantly (P<0.05) . The total PCL-C score of exposure group was 36.84+9.50, PTSD positive 47 (39.83%) and control group 13 (13.00%) . The difference was statistically significant (χ(2)=19.534, P<0.05) . Compared with the control group, PCL-C re-experience, avoidance, vigilance factor scores and total scores of medical staff in the contact group increased significantly (P<0.05) . The problem solving, help seeking and subjective support of the medical staff in the positive mental health group with blood-borne occupational exposure were significantly lower than those in the negative group, while self-blame, fantasy and withdrawal were significantly higher than those in the negative group (P<0.05) . The mental health level of medical staff with occupational exposure was negatively correlated with problem solving, help seeking and subjective support, and positively correlated with self-blame, fantasy and withdrawal (P<0.05) . Problem solving, help seeking and subjective support were protective factors of mental health (OR=2.121, 1.616, 1.371) , and self-blame and withdrawal were risk factors of mental health (OR=0.160, 0.484) . Conclusion: Medical personnel exposed to blood-borne occupational exposure are prone to psychological problems and PTSD. Solving problems, seeking help and subjective support are protective factors for mental health, while self-blame and withdrawal are risk factors for mental health.

Investigation and analysis of the status of blood-borne occupational exposure of medical staff in a top three hospital and intervention measures

Objective: To understand the current situation of blood-borne occupational exposure among health care workers and evaluate the intervention effect of PDCA. Methods: Retrospective survey was adopted to investigate and analyze the blood-borne occupational exposure incidents in a hospital from January 2015 to December 2018, and to compare the intervention effects after PDCA management. Results: A total of 82 cases of occupational exposure occurred from 2015 to 2017, and only 9 cases happened after the implementation of PDCA intervention. The exposed population was mainly consisted of nurses (59 cases, 64.83%) , and mainly with low-working age (1-5 years) (56 cases, 61.54%) , and the main source of exposure was hepatitis B (34 cases, 37.36%) . In addition, after the implementation of PDCA, the vaccination rate of personnel was 77.78%, the standardized field treatment rate was 100%, the preventive drug use rate was 88.89%; The qualified rate of occupational protection assessment was higher than that before intervention, which all shows the difference was statistically significant (P<0.05) . Conclusion: With the guide of PDCA management, Strengthen the training of new employees or ones with low working years as well as their awareness of protection, and standardize the relevant operational procedures, which can significantly improve the prevention of blood-borne occupational exposure and stress management of medical staff.

Occupational exposure to blood-borne diseases in specialized hospitals for infectious diseases and its legal and policy status

Objective To explore occupational exposure in general hospitals specializing in infectious diseases, to discuss occupational exposure protection against infectious diseases and the status quo of relevant policy and legal protection after exposure, and to propose suggestions accordingly. Methods Totally the data of occupational exposure to blood-borne diseases from Beijing Ditan Hospital, Capital Medical University between January and December 2017 were retrospectively investigated, including patients' name, age, gender, occupation, exposure time, type of exposure sources, methods of exposure, parts of exposure, medication after exposure, follow-up after exposure and compensation after exposure. SPSS 19.0 was used for statistical analysis. Results There were 424 cases of exposure to blood-borne diseases, and most of them were nurses (n=233, 54.95%) , followed by doctors (n=115, 27.12%) ; the source of exposure was mainly hepatitis B virus (HBV, n=197, 46.46%) , followed by human immunodeficiency virus (HIV, n=74, 17.45%) ; the method of exposure was mainly prinking wound (n=307, 72.41%) , followed by mucosal splash (n=78, 18.40%) ; the parts of exposure were mainly the hand (n=331, 78.07%) , followed by the eye and the oral cavity (n=78, 18.40%) ; there was no infection after occupational exposure; and there were no policies related to the compensation after exposure, nor relevant data or records. Conclusions Occupational exposure protection against infectious diseases and the management following exposure are problematic. There is a lack of relevant policies or laws, which should be further improved. Key words: Infectious diseases; Medical staff; Blood-borne occupational exposure; Legal protection

A preliminary study on the cognition of blood borne occupational exposure protection system and safety culture construction in medical institutions

Objective By investigating the current situation of medical staff, this paper preliminarily analyzed the problems existing in the construction of blood-borne occupational exposure protection system and safety culture, and provided theoretical basis for the establishment of an efficient and feasible protection system in medical institutions in China in the future. Methods This study was designed for cross-sectional study. A total of 514 staff from different levels of medical institutions and different occupations were selected by convenience sampling from March 2017 to February 2018. A self-made cognitive questionnaire on blood-borne occupational exposure system and safety culture in medical institutions was used to conduct a questionnaire survey, and the results were analyzed. Results 80%-90% of the respondents have a certain grasp of blood-borne occupational exposure. Respondents who did not achieve standard prevention eventually had occupational exposure of 90.35% (103/114) , while those who could achieve standard prevention at work only had 57.50% (230/400) . The difference was statistically significant (P<0.05) . There were significant differences in standard prevention awareness rate, occupational exposure and post-treatment methods of sharp instrument injuries among staff with different professional titles (P<0.05) . There were significant differences in occupational exposure and post-treatment of sharp instrument injuries among staff with different working years (P<0.05) . Conclusions Different levels of medical institutions have made progress in process establishment, protective equipment allocation and related knowledge training, but also reflected the different levels of occupational exposure problems. More ideas and enlightenments were put forward for how to further reduce the incidence of blood-borne occupational exposure of medical institutions staff and improve their coping ability in the future. Key words: Cross-sectional study; Occupational exposure; Hematogenous; Occupational protection; Protection system; Safety culture

Analysis of blood-borne occupational exposure in surgical related medical staff

Analysis of blood-borne occupational exposure in surgical related medical staff

Blood-borne occupational exposure and protection in medical staff of a traditional Chinese medicine hospital

Objective: To investigate blood-borne occupational exposure and related protection in the medical staff of a traditional Chinese medicine hospital, and to provide a reference for reducing the risk of blood-borne occupational exposure. Methods: Forty-eight medical workers with blood-borne occupational exposure in 2015 were selected to analyze the incidence of blood-borne occupational exposure, influencing factors, operations that caused blood-borne occupational exposure, pathogens, and occupational protection. Results: The incidence rate of blood-borne occupational exposure in the medical staff of the traditional Chinese medicine hospital in 2015 was 3.30% (48/1 455) , and the frequency was 0.04 time/person/year. The workers with blood-borne occupational exposure were mostly nurses, females, workers aged <30 years, workers with <5 working years, and workers with a junior professional title. There was a significant difference in the incidence rate of blood-borne occupational exposure between workers with different ages and working years. The main way of blood-borne occupational exposure was sharp injury (96.08%) . The main operations that caused blood-borne occupational exposure were covering or separating the syringe needle after injection and disposing used sharp instruments. The main exposure site was the hand (96.08%) , with the thumb and index finger for the left hand and the middle finger and index finger for the right hand; there was no significant difference in the exposure site distribution between the two hands (P<0.05) . The main pathogen that caused blood-borne occupational exposure was hepatitis B virus (68.96%) . The rate of correct local treatment for blood-borne occupational exposure was 88.24%. The rate of prophylactic medication was 74.51%, and hepatitis B immunoglobulin (HBIG) plus hepatitis B vaccine was the main way, followed by HBIG. In all workers with blood-borne occupational exposure, 62.74% did not wear gloves. Conclusion: The medical workers with few working years have a high risk of blood-borne occupational exposure, so the training on protection against blood-borne occupational exposure should be strengthened to reduce the risk of blood-borne occupational exposure and infection.

Analysis on influence factors of medical staff blood-borne occupational exposure based on structural equation modeling

Objective To analyze the influence factors of medical staff blood-borne occupational exposure by structural equation modeling, in order to improve medical staff of blood-borne occupational exposure protection performance of the system to provide the theory basis for operation. Methods The influence factors of medical staff blood-borne occupational exposure and their correlation were analyzed by exploratory factor analysis and structural equation modeling fitting. Results Model fitting was ideal, hospital decision -makers and department management directly affected the behavior intention of medical staff, department management greatly influenced by the behavioral intention to the medical personnel, path coefficient was 0.27. Hospital decision-makers of behavioral intention to the medical personnel directly affect smaller, path coefficient was 0.03, but its indirect impact on behavioral intention by department management. Behavioral intention of occupational exposure protection action, the path coefficient was 0.80, behavioral intention determined the basic medical personnel blood-borne occupational exposure protection behavior. Conclusions Hospital should improve the system of standards and to establish effective communication channels, at the same time enhance the care ability. Enforcement departments should improve the standard system, equipped with adequate safety equipment, for the medical staff to provide the best working environment, so as to improve the medical staff of blood-borne occupational exposure protection behavior compliance. Key words: Medical staff; Occupational exposure; Protection act; Structural equation modeling

The impact of blood-borne occupational exposure to the medical personnel on individual cognitive

Objective To discuss the influence of individual cognitive on medical personnel blood-borne occupational exposure protection action from the angle of behavior operation. Methods Medical staff of 14 hospitals in zunyi were investigated by questionnaire designed based on the theory of health belief model, and analyzed the data by structural equation model. Results Sample data and the assumption model was ideal, the blood-borne occupational exposure protective behavior of medical staff could be explained variance of 87% by susceptibility, severity, behavioral benefit and barrier cognition. The order of influencing factors from high to low were behavioral benefit, severity, behavioral barrier and susceptibility to cognition, and path coefficients were 0.39, 0.27, -0.21, 0.03. Conclusions Susceptibility, severity and behavioral benefit cognition have positive effection on protective behavior, the behavioral benefit cognition have more influence on blood-borne occupational exposure protective behavior of medical staff, and behavioral barrier cognition have negative effection, the results of health belief model can explain blood-borne occupational exposure protective behavior of medical staff better. Key words: Medical staff; Occupational exposure; Protection act; Individual cognitive

Knowledge, attitudes, and practices regarding blood-borne occupational exposure among reproductive health staff in Tianjin

To investigate the knowledge, attitudes, and practices regarding blood-borne occupational exposure among reproductive health staff in Tianjin, China. By random, stratified, and clustered sampling, 507 reproductive health-related medical workers in Tianjin were selected. A Self-Administered KAP Questionnaire on blood-borne occupational exposure was employed to gauge the general characteristics, awareness of knowledge, attitudes to occupational exposure, implementation of pre-exposure protection, incidence of occupational exposure, and demands for continuing education. Among all respondents, 63.15% (305/483) were aware of the reporting procedures and related departments after the incidence of occupational exposure. The awareness rate of classification of HIV occupational exposure was 48.45% (234/483). About preventive medication time after HIV and hepatitis B virus exposure, the awareness rates were 37.89% (183/483) and 31.47% (152/483), respectively. The average score of occupational exposure knowledge among respondents was 74.45±14.00. The multivariate analysis indicated that medical staff of obstetrics and gynecology, females, doctors and high-level medical institutions showed significantly higher awareness than urology professionals, males, nurses, and medical staff of primary health care institutions, respectively (t = 12.140, t = 5.428, t = 2.582, F = 4.218, P<0.05). Of the respondents, 93.17% (450/483) and 94.41% (456/483) thought that washing hands properly and wearing protective glasses were effective methods for the prevention of occupational exposure, but only 15.94% (89/483) and 3.93% (19/483) adhered to proper hand washing and wearing protective glasses within nearly one year in practical work. Of the respondents, 60.46% (292/483) had experienced the occupational exposure during their vocation, and 95.65% (462/483) needed respective trainings. The awareness of occupational exposure among reproductive health-related medical staff is lacking, especially in preventative medication and reporting procedures after the incidence of occupational exposure. The implementation of protective measures is inadequate and incidence of occupational exposure is higher. Therefore, continuing education is necessary to improve the knowledge and attitudes towards occupational exposure in medical staff. At the same time, strict and effective supervision and management system should be established.

Medical graduates’ knowledge of bloodborne viruses and occupational exposures

A survey of medical graduates commencing employment as junior doctors was performed to investigate knowledge of bloodborne viruses and occupational exposure management, coupled with their experience of occupational exposures. There was a mismatch between general knowledge (excellent) and knowledge of postexposure management (poor), and graduates had commonly experienced an occupational exposure and not reported it. The knowledge deficit regarding postexposure management and history of poor practice (ie, nonreporting) following an exposure implies that the transition period from student to junior doctor may be associated with increased occupational health and safety risk.