Bloodborne Pathogen Exposure Research Articles

Survey identifies need for subspecialized pediatric hematology/oncology nursing education in nine Еurasian countries

Background. In 2018, Eurasian Alliance in Pediatric Oncology (EurADO) members identified pediatric hematology/oncology nursing education as a regional priority. In most participating Eurasian countries, pediatric hematology/oncology nursing is not recognized as a subspecialty; thus, subspecialized education offerings may be limited. A working group of nurse leaders was formed to set nursing priorities to advance pediatric cancer nursing and subspecialized education in the region. As an initial project, members determined a need to develop a train-the-trainer course for regional implementation to improve nurses’ subspecialty knowledge.Purpose/Objective. A needs assessment was conducted to evaluate Eurasian nurses’ pediatric hematology/oncology education needs to inform the development of a pediatric hematology/oncology nursing train-the-trainer course in Eurasia.Design/Methods. From August to September 2019, a paper-based needs assessment was disseminated in English and Russian to working group members for dissemination to pediatric cancer nurses in their hospitals. Items included multiple choice, yes/no, Likert-type scale and open-ended questions. Questions assessed participant demographics, subspecialty education topics of interest and perceived high-risk issues for nurses and patients.Results. Responses were received from 233 nurses representing 13 hospitals in 9 countries. Priority topics of interest included overview of pediatric cancers and treatment, chemotherapy administration and side effects, oncologic emergencies and vascular access. Nurses reported that patients in their settings were at high-risk for infection, depression/psychological issues, treatment-related side effects and complications. Perceived high-risk areas for nurses included stress/burnout, high workloads/short-staffing, hazardous drug and blood borne pathogen exposure and limited equipment.Conclusion. Survey findings reveal a lack of subspecialty pediatric hematology/oncology education opportunities for nurses practicing in Eurasian hospitals. The Eurasia Pediatric Hematology/Oncology Nursing Course was developed based on survey results and is currently being implemented across centers in the region.

Thinking Outside the Box: Development of an Audit Tool to Track Reusable Instruments Outside of SPD

<h3>Background</h3> Infection Control (IC) standard IC.02.02.01 is the most common finding by The Joint Commission (TJC). The primary focus for proper implementation of this standard has historically been the Sterile Processing Department (SPD) and endoscopy lab. This study, however, focuses on bedside staff's implementation of IC.02.02.01 by deploying an internally developed audit tool to quantify knowledge and compliance with safe instrument transport. <h3>Methods</h3> Meetings with SPD were held to ascertain the list of departments utilizing instrumentation undergoing HLD or sterilization. Infection Prevention (IP) developed a nine-question audit tool to measure elements of guidelines from the Association for the Advancement of Medical Instrumentation (AAMI), the Association of periOperative Registered Nurses (AORN), and the Occupational Safety and Health Administration (OSHA). A rating for each question of ‘Yes,' ‘No,' or ‘Not Applicable' and one open-ended question of ‘Other findings' was included. An IP and a member of SPD leadership visited each department. The standardized monitoring tool was completed, and recommendations on practice changes were communicated. <h3>Results</h3> Twenty-three patient care areas were identified as receiving reusable instrumentation from SPD. Each area was evaluated using the audit tool, and no area was found to be 100% compliant. The most often cited non-compliant measures were: (1) staff not wearing appropriate personal protective equipment and (2) compliance with moistening and removing gross soil at the point of use. <h3>Conclusions</h3> Decentralized hospital departments working with reusable instrumentation are sometimes forgotten when educating on the importance of standard IC.02.02.01. After auditing the end user in this study, IP determined that more education on bloodborne pathogen exposure and the importance of precleaning at point of use are needed. Routine compliance monitoring with a standardized tool is helpful to quickly find staff knowledge gaps and address issues.

Systematic Review of Blood-Borne Pathogen Exposure Rates Among Medical Students

BackgroundBlood-borne pathogen exposures (BBPEs) pose a risk to health care workers (HCWs). Needlestick injuries (NSIs) have declined overall, but not for surgical HCWs. There are limited data regarding BBPEs among medical students (MSs) in their clinical years. We aimed to quantify this risk for third- and fourth-year MSs. MethodsA literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PUBMED database was searched to identify studies of third- and fourth-year MSs using the terms BBPE, NSI, and MS. Studies of other HCWs were excluded if MS data were not extractable. Additional studies were identified from references. Descriptive analysis was performed. ResultsSeven of 171 articles published from 2002 to 2018 met study criteria. All used self-reported data from surveys/questionnaires. One-third of MSs reported BBPEs (n = 194/600, 32.3%) with a mean of 1 in 3.09 and a median of 1 in 3.53 (range: 1 in 1.9-8.3 students). Most events were NSIs (144/194, 74%) with a mean of 1 NSI per 4.05 MSs and median of 1 in 4.625 (range: 1 in 2.47-10.71). The remaining BBPEs reported included blood and bodily fluid splashes (n = 37, 19%), other mucocutaneous exposures (n = 7, 3.6%), and uncategorized injuries (n = 2, 1%). ConclusionsOne-third of senior MSs reported BBPEs during clinical rotations. Most BBPEs were NSIs. Quantifying this risk allows for anticipatory education and protocol development to protect students and other new HCWs. Educational efforts focused on NSI prevention before and during clinical rotations may help reduce BBPEs.

Nursing Faculty Experiences With Students' Needlestick Injuries.

Nursing students are at increased risk of needlestick injury (NSI) due to limited clinical experience and underdeveloped skills. The purpose of this study was to describe faculty experiences with nursing students who sustain an NSI. A retrospective cross-sectional survey design was used to examine nursing faculty experience with student NSIs occurring during clinical practicum experiences. Thirty-four percent (n = 904) of nursing faculty respondents reported having supervised at least 1 nursing student who experienced an NSI while providing care to a patient. Only 47% (n = 1112) of faculty indicated that a student could access effective exposure management. Structured simulation activities in which faculty manage a student NSI would provide faculty with essential NSI exposure management experience. Integrating blood-borne pathogen exposure management simulation into faculty development activities would bring a level of realism to the training that a lecture or written policy cannot provide.

A management program for preventing occupational blood-borne infectious exposure among operating room nurses: an application of the PRECEDE-PROCEED model.

ObjectivesThe study aim was to determine the effect of an occupational blood-borne pathogen exposure (OBE) management program based on the PRECEDE-PROCEED model on knowledge, attitude and behaviour regarding OBE prevention among operating room nurses.MethodsThis was a one-group pre-test post-test experimental study. The PRECEDE-PROCEED model was used to design and evaluate the effect of an OBE management program on 87 operating room nurses from February to July 2018. The study included pre-intervention assessment; risk factor analysis; interventions targeted to predisposing, reinforcing and enabling factors and focusing on areas of low scoring; and a post-intervention assessment. Attitudes, knowledge and behaviour compliance regarding OBE were measured before and after the 6-month program using a self-developed questionnaire. Descriptive epidemiological analysis and t-tests were used for data analysis.ResultsLow-scoring items for OBE knowledge, attitudes and behaviour were identified in the baseline assessment. Six months post-intervention, there were significant improvements in attitudes toward OBE prevention, in knowledge about OBE safety precautions and in behaviour compliance with standard precautions.ConclusionsThe findings indicate the effectiveness of an OBE management program based on the PRECEDE-PROCEED model for improving knowledge, attitudes and behaviour adherence to OBE prevention among operating room nurses.

Safety and Communication in the Operating Room: A Safety Questionnaire After the Implementation of a Blood-Borne Pathogen Exposure Checkpoint in the Surgical Safety Checklist Preprocedure Time-Out

The Surgical Safety Checklist (SSC) decreases patient morbidity and mortality and improves operating room (OR) communication. However, the SSC does not currently include any discussion on employee safety. One institution has implemented a blood-borne pathogen exposure (BBPE) checkpoint in the SSC in order to improve employee safety and to further improve communication. The aim of this study was to determine if the implementation of a BBPE checkpoint improved caregiver safety and communication in the OR. This was a multidisciplinary prospective survey study in which an anonymous questionnaire was distributed to all OR personnel who handle sharps. Survey responses were analyzed for demographics and BBPE safety attitudes. The frequency of reported BBPE incidents collected from quality improvement data 12 months before and after the implementation of the BBPE checkpoint were reviewed. Caregivers feel safer in the OR with the BBPE checkpoint (p < 0.001). Communication was improved. Compliance in trauma surgeries was less than elective. Reported BBPE incidents were significantly decreased based on quality improvement data (p = 0.045). The BBPE checkpoint was implemented in the SSC at one institution in order to emphasize employee safety and improve communication. The results shed light on the attitudes of OR personnel by suggesting an improvement in safety and communication. In addition, there has been decrease of reported BBPE incidents among OR personnel. Universal implementation of a BBPE checkpoint could improve provider safety and communication in all ORs.

Occupational Hazards among Healthcare Workers in Africa: A Systematic Review.

Background:While all healthcare workers are exposed to occupational hazards, workers in sub-Saharan Africa have higher rates of occupational exposure to infectious diseases than workers in developed countries. Identifying prevalence and context of exposure to blood and bloodborne pathogens may help guide policies for prevention.Objective:This systematic review examined occupational exposure rates to blood and bloodborne pathogen among healthcare workers in sub-Saharan Africa.Methods:In November 2017, a comprehensive literature search was conducted to identify studies reporting exposure of health workers in African coutnries to blood and bodily fluids. Title, abstract and full text screening were used to narrow our search. Studies more than 10 years old, or published in non-English languages were excluded.Findings:Fifteen studies reported a variety of exposures. The lifetime prevalence of needlestick injury ranged from 22–95%, and one-year prevalence ranged from 39–91%. Studies included a range of descriptive statistics of knowledge, attitudes, practice and access factors related to exposures. Two studies reported 21–32% of respondents linked poor knowledge or training with prevention of needlestick injuries. Rates of recapping needles ranged from 12–57% in four studies. Attitudes were generally positive toward occupational safety procedures while access was poor.Conclusions:The high burden of blood and bloodborne pathogen exposures demonstrated here indicates a high risk for contracting bloodborne illnesses. Although the data are sparse, implementation of preventative policies based on current knowledge remains critical to minimize risk and reduce exposure. There remains a pressing need for high quality data on occupational hazards to identify the burden of exposures and inform preventive policies in Sub-Saharan Africa. Additional studies are needed to determine whether differential exposures exist between professions and the associations with knowledge, attitudes, practices, and access factors to create targeted strategies to diminish occupational hazards.

Underreporting of Bloodborne Pathogen Exposures in Nursing Students.

Although nursing students perform many of the same procedures as licensed nurses, students are less skillful when handling sharps and are at higher risk of injury. Low rates of bloodborne pathogen (BBP) exposure reporting are described among students in all health care disciplines. This study describes reporting behaviors of undergraduate nursing students who experienced a needlestick injury during a clinical practicum experience. This study implemented a retrospective survey design to query the BBP exposure experience of nursing students in prelicensure nursing programs. Of the 4140 survey responses, 6.6% (n = 274) of respondents sustained a percutaneous BBP exposure during a clinical practicum experience, and 52% (n = 127) of these exposures were not reported. Reasons for nonreporting included fear the student would "get in trouble," that the incident would affect the student's clinical grade, and concern about being perceived as lacking clinical skill. Bridging communication gaps between students and faculty is essential to ensure that students report BBP exposures to permit access to timely triage and exposure management.

Bloodborne Pathogens Standard Enforcement at the Occupational Safety and Health Administration: The First Twenty-Five Years.

Bloodborne pathogen exposures continue to be an occupational health concern of high importance. It is uncertain whether national regulations and enforcement have an impact on employer action for reducing risk. The goal of this research was to determine whether citations issued under the Occupational Safety and Health Administration’s Bloodborne Pathogens Standard changed over time given these changing risks and controls. Researchers analyzed 31,066 inspections. There were 77,142 citations issued between 1991 and 2015. The highest frequency is the time period just after revisions of the 2001 standard. There were striking levels of noncompliance, most evident in Exposure Control Plan and Recordkeeping violations. No other pattern or change was evident. In the time periods after 2005, numbers of citations remained steady or declined. As new bloodborne pathogens emerge annually, it is essential to continue to focus on enforcing the standard to keep employers in compliance and workers protected.

Don’t Get Stuck: A Quality Improvement Project to Reduce Perioperative Blood-Borne Pathogen Exposure

Blood-borne pathogen exposure (BBPE) represents a significant safety and resource burden, with more than 380,000 events reported annually across hospitals in the United States. The perioperative environment is a high-risk area for BBPE, and efforts to reduce exposures are not well defined. A multidisciplinary group of nurses, surgical technologists, surgeons, and employee health specialists created a BBPE prevention bundle to reduce Occupational Safety and Health Administration (OSHA) recordable cases. Mandatory double gloving, a safety zone, engineered-sharps injury prevention devices, and clear communication when passing sharps were implemented in an evidence-based fashion at one institution. Days between exposures and total number of exposures were monitored. Analysis by specialty, role, location, type of injury, and timing was performed. During fiscal year (FY) 2015, 45 cases were reported. During the first year of implementation, cases decreased to 38 (a 15.6% decrease; p < 0.65). In the postimplementation period (FY 2017), only 21 cases were reported (an additional 44.7% decrease; p < 0.12), for a total decrease of 53.3% (p < 0.01). The mean number of days between injuries significantly increased (2.5 to 16.3) over the study period. For FY 2017, the main cause of BBPE was needlestick while suturing (47.6%); fellows and attendings combined had the most injuries (52.4%); among divisions, pediatric surgery (19.0%), operating room staff (19.0%), and orthopedics (19.0%) had the most events. A comprehensive and multidisciplinary approach to employee safety, focused on reduction of BBPE resulted in a significant progressive annual decrease of injuries among perioperative staff.

Needlestick injury prevention training among health care workers in the Caribbean.

ABSTRACTThe rate of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections among health care workers that is caused by sharps injuries is higher in the Caribbean and Latin America than in other regions of the world. To respond to and reduce occupational exposures to bloodborne pathogens while also strengthening capacities in the Caribbean, needlestick injury prevention training programs for health care workers were implemented, beginning in 2011. The programs included lectures, workshops, policy reviews, evaluations of safety devices, and workplace assessment. During the training, baseline data from health care workers on their personal history of needlestick injuries and bloodborne pathogen exposure was collected. That baseline data showed that 40% of the participants had sustained sharps injuries during their professional career. In this capacity-building effort, 210 health care workers from five countries have been trained, six health care centers in the Caribbean have been evaluated. and occupational safety and health committees have been established in various countries to monitor and improve safety policies and practices.

Self-stool banking as a source for fecal microbiota transplantation: A pilot study

Background: Fecal microbiota transplantation is a promising therapeutic alternative for refractory Clostridium difficile infection. Self-stool donation can overcome challenges with donor screening and eliminate risks of blood borne pathogen exposure. We assessed the feasibility of a fecal banking protocol. A secondary objective was to identify perceptions around fecal banking. Methods: Admitted medicine patients were screened over 15 months. Patients with gastrointestinal comorbidities or factors affecting intestinal microbiota were excluded. Participants completed a survey and could opt to bank a sample. Processing occurred during defined lab hours. Feasibility was assessed on process and resource indicators. Success was defined as 50% consent rate. Results: A total of 4,675 patients were screened; 60% were excluded, primarily because of antibiotic exposure (1,343, 48%). A total of 537 patients were surveyed, of whom 73% consented to fecal banking. The primary reason for declining was that fecal banking was considered ‘too gross’ (34%). Of 72 samples provided, 27 were successfully banked. Lack of a bowel movement was the primary reason for not banking (54%), and inadequate quantity was the top reason for rejecting a collected sample (63%). Average processing time was 58 minutes (range 22–640 min). The majority of participants reported a preference for using their own stool (82%), and 87.5% (n=64) were willing to bank again. Conclusion: A self-donor fecal banking protocol is feasible. Scalability of this process is addressed through dedicated resources for collecting and processing samples from larger cohorts. Formal evaluation of the efficacy and microbiome integrity of samples is required.

Study on intervention of bloodborne pathogen exposure in a general hospital

Objective: To improve the awareness of bloodborne pathogen exposure protection knowledge, reduce the contact incidence (including sharp injuries, contacting with the broken skin and mucous mem-brane contact) , and increase the self-report incidence of bloodborne pathogen exposure in the healthcare work-ers of the investigated hospital after the intervention. To summarize effective prevention and intervention mea-sures of occupational exposure to bloodborne pathogen. Methods: The project was on the basis of previous inves-tigations in a general hospital, after comparing the personnel structure and departments distribution of 727 HC-Ws before the intervention and 614 HCWs after the intervention, we selected several departments in which the healthcare workers with a higher risk of occupational exposure to bloodborne pathogens. We promoted the hospi-tal to set up occupational health prevention and control system, improved related files, supplemented by knowl-edge training, discussion and field guidance, such a comprehensive intervention in the hospital. After the inter-vention, we conducted an cross-sectional investigation, and compared the rate of protection knowledge aware-ness, self-reporting rate after exposure, occupational exposure to bloodborne pathogens (including sharp inju-ries, contacting with the broken skin and mucous membrane contact) incidence before and after the intervention. Results: Before and after the intervention, the total score of the investigated population of 14 knowledge points that we focused on in training showed a significant difference (P<0.05) , total contact incidence of bloodborne pathogen exposure reduced from 81.57 persons/100 persons per year to 43.81 persons/100 persons per year, the RR of bloodborne pathogen exposure in the former investigation was 1.86 times of that in the latter investigation, the self-reported incidence increased form 2.06 persons/100persons per year to 9.45 persons/100 persons per year, self-reporting rate after exposure increased form 0.47% to 9.65%. Conclusion: The interventions signifi-cantly improved the awareness of bloodborne pathogen exposure protection knowledge, effectively reduced the contact incidence of bloodborne pathogen exposure, and increased the self-reported incidence in the healthcare workers of the investigated hospital.

Bloodborne pathogen exposures: Difference in reporting rates and individual predictors among health care personnel.

Employees in health care settings are at varying risk for bloodborne pathogen (BBP) exposures. We compared differences in reporting rates of BBP exposures among health care personnel during 2 different time periods, assessing job category, years of experience, and sex as potential predictors for exposure. A retrospective review of the employee health department BBP database at 2 time periods (September 1, 2012-April 30, 2013, and September 1, 2013-April 30, 2014) in which 2 different reporting protocols (call center vs pager) was used. A survey was administered to assess reported and unreported exposures within a 12-month period. BBP exposures were highest among residents and lowest among students. Physicians' reporting rate doubled when the call center was no longer used (relative risk, 2.40; 95% confidence interval [CI], 1.04-5.52). Percutaneous injuries were the most common (78.3%), and most occurred in the operating room or postanesthesia unit (30.8%) and patient rooms (28.9%). Of 1,105 survey respondents, 103 (9.3%) recalled some type of exposure, but only 80 (77.7%) reported these exposures. When accounting for years of experience and sex, job category was significantly associated with injury or exposure within the previous 12 months (P < .001). Risk of exposure among residents was 3 times higher (odds ratio, 3.10; 95 CI, 1.60-6.00) than nurses. Risk and reporting behaviors of BBP exposures vary widely across different providers. Training and education to prevent BBP exposures may need to be tailored toward different provider types.

Health care worker follow-up compliance after occupational bloodborne pathogens exposure: A brief report.

A retrospective cohort study was conducted examining health care worker (HCW) compliance with Centers for Disease Control and Prevention recommendations following occupational bloodborne pathogen (BBP) exposure. HCWs with a BBP exposure from a known HIV- or hepatitis C virus-seropositive individual were less likely to complete recommended follow-up compared with HCWs with seronegative source patient exposures (adjusted odds ratio, 0.02 and 0.09, respectively). Continued targeted education and extra vigilance in performing postexposure surveillance are warranted in this higher-risk population.

Relationship between patient safety climate and adherence to standard precautions.

Standard precautions (SPs) are designed to limit bloodborne pathogen exposures among health care workers (HCWs) and health care-associated infections. SP adherence is globally suboptimal; however, reasons are underexplored. This study aim was to explore the relationships among safety climate factors and SP adherence by HCWs in hospitals using newly developed survey and observational tools. Cross-sectional data from 11 units in 5 hospitals were collected between March and September 2015. A patient safety and standard precaution survey was administered to nurses and pooled with data from observations of HCW-patient interactions using defined SP indications. Descriptive statistics of distributions, frequencies, and Pearson correlation coefficients were calculated to determine the unit-level relationships among dimensions of the patient safety climate and unit percentages of SP adherence (P < .05). There were 540 HCW-patient encounters with 1,713 SP indications and 140 surveys collected. Although most nurses (94%) reported always or often adhering to SPs and generally reported positive scores on unit safety climate, observed SP adherence was 62% (unit range, 31%-80%). Only 30% of nurses rated staffing positively, and this was inversely related to observed SP adherence. Adherence to the full complement of observed SP behaviors by HCWs of all types was suboptimal. The relationship between safety climate, particularly staffing, and adherence to SPs warrants further testing.

Reporting and case management of occupational exposures to blood-borne pathogens among healthcare workers in three healthcare facilities in Tanzania.

In sub-Saharan Africa, blood-borne pathogens exposure (BPE) is a serious risk to healthcare workers (HCW). We conducted a cross-sectional study assessing BPE among HCW at three public hospitals in Tanzania. From August to November 2012, HCW were surveyed using Audio-Computer Assisted Self-Interview. All HCW at risk for BPE were invited to participate. Factors associated with reporting BPE were identified using logistic regression. Of the 1102 eligible HCW, 973 (88%) completed the survey. Of these, 690 (71%) were women and 499 (52%) were nurses and nurse assistants. Of the 357 HCW who had a BPE (32%) in the previous 6 months, 120 (34%) reported it. Among these 120 reported exposures, 93 (78%) HCWs reported within 2 h of exposure, 98 (82%) received pre- and post-HIV test counselling, and 70 (58%) were offered post-exposure prophylaxis (PEP). Independent factors associated with reporting BPE were being female (adjusted odds ratio [AOR], 2.0; 95% confidence interval [CI], 1.2-3.5), having ever-received BPE training (AOR, 2.0; 95% CI, 1.2-3.5), knowledge that HCW receive PEP at another facility (AOR, 2.6; 95% CI, 1.5-4.4), low/no perceived risk related to BPE (AOR, 4.2; 95% CI, 1.9-9.4) and HIV testing within the past year (AOR, 2.3; 95% CI, 1.2-4.4). These results highlight the importance of appropriate training on the prevention and reporting of occupational exposure to increase acceptance of HIV testing and improve access to PEP after BPE.

Occupational exposure to bloodborne pathogens among health care workers in Botswana: Reporting and utilization of postexposure prophylaxis

This study assessed reporting behavior and satisfaction with postexposure prophylaxis (PEP) systems among health care workers (HCWs) at risk for occupational bloodborne pathogen exposure (BPE) in 3 public hospitals in Botswana. A cross-sectional survey among HCWs provided information on perceptions, attitudes, and experiences with occupational exposures, reporting, and postexposure care. HCWs potentially in contact with blood or body fluids were surveyed using audio computer-assisted self-interview. Between August 2012 and April 2013, 1,624 HCWs completed the survey; most were women (72%), and almost half (48%) were nurses. Sixty-seven percent of them had ever received training related to BPE management; 62% perceived themselves to be at high risk for BPE. Among the 426 HCWs who were exposed to sharps injuries or splashes in the last 6 months, 160 (37%) reported the exposure. Of these, 111 of the 160 (69%) received PEP, and 79 of the 111 (71%) completed their medication. Whereas >92% of the total HCWs had ever been tested for HIV, only 557 (37%) were tested in their own health facility. Most HCWs (87%, n = 1,406) reported they would be interested in testing themselves. Of HCWs who reported an exposure, less than half (49%, n = 78) were satisfied with existing reporting systems. Underreporting of occupational exposures and dissatisfaction with PEP management is common among HCWs. Improved PEP management strategies and regular monitoring are needed.

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.

Knowledge, attitudes and practices surrounding occupational blood-borne pathogen exposure amongst students in two Chinese dental schools.

To investigate the knowledge, attitudes and practices surrounding occupational blood-borne pathogen exposure amongst dental students at two Chinese dental schools, as well as important factors that are associated with their career choice and attitudes towards infected patients. The study was conducted using a student self-administered questionnaire from March to June 2013 at two Chinese dental schools. Chi-square tests and multivariable logistic regression were used to compare the categorical variables and identify the variables related to attitudes. One hundred and seventy-one students answered the questionnaire (response rate 83%). Most participants had incomplete knowledge about occupational exposure and participants' compliance with the infection control programme during routine clinical work was low. Fifty-six participants (34%) experienced at least one occupational exposure, but only one reported the incident. Percutaneous injuries and mucous membrane exposures were the main causes for exposure. Protection of the eyes and post-exposure management were inadequate. According to most participants, they had received insufficient education. Their concerns about the risk of infectious professional exposure would influence their career choice and approach to patients. Only 14% and 26% of the participants were willing to treat human immunodeficiency virus- and hepatitis B virus-infected patients, respectively. More effective education on prevention and management is required for dental students to reduce the harm caused by occupational exposure. It is important to ensure dental students' knowledge and understanding before allowing them to enter clinical training.