Occupational Bloodborne Pathogen Exposures Research Articles

Implementation of a hotline (“S-T-I-C-K”) to expedite management of occupational bloodborne pathogen exposures at an academic medical center: A Process Improvement Initiative

Previously, blood and body fluid exposures were managed by a visit to the University Employee Health Clinic during normal business hours and the Emergency Department after hours. We implemented the "S-T-I-C-K" program where health care personnel were evaluated immediately after exposure by a nurse-driven 24/7 hotline. Increasing accessibility to care and a simplified process for exposure management led to a significant decrease in Emergency Department utilization and time between the exposure and receipt of post-exposure prophylaxis.

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.

Evaluating occupational exposures of dental nurses: A retrospective study.

The objective of this study was to investigate occupational blood-borne pathogen exposure among dental nurses and their attitudes toward infected patients, as well as the effectiveness of the training course, to provide a scientific basis for improving the quality of safety management in the dental hospital. The study was conducted using questionnaires administered from November 2019 to December 2019 in three hospitals in Sichuan Province, China. Frequencies for answers were calculated and presented as percentages. In total, 257 valid questionnaires were returned. Most (61.9%) nurses stated that they were involved in occupational exposure. Among them, 154 had experienced sharp injuries, and the syringe needle was the most common instrument for injuries (45.8%). Twenty-two individuals had mucosal exposure, and the proportion of eye exposure was the highest (90.9%). Only associations between training and mucosal membrane exposure were found; however, the relevance was weak (r = 0.141). Of the participants, 86.4% felt morally responsible for taking care of patients with infectious diseases, and most (92.6%) said they would continue with this career. Occupational exposure, particularly to sharp injuries, was common in medical care among dental nurses; however, vocational training had little effect on their incidence. As dental nurses still have positive attitudes toward patients with infectious diseases, more effective training should be conducted.

Analysis of Blood Borne Pathogen Exposure Monitoring Protocol Adherence in an Academic Medical Center: a seven year analysis and literature review

Health care workers (HCW) are at risk for occupational blood borne pathogen exposures (BBPE). Effective prevention and management of BBPEs relies upon reporting and post-exposure follow-up protocol adherence. As post-exposure monitoring completion is largely unexplored, seven years of a university healthcare system’s BBPE exposure data was explored and compared to documented rates.

Comparative Usability of Three Platforms for Collecting Standard Precautions Surveillance Data

Background: Although standard precautions are considered a building block in the prevention of healthcare-associated infections (HAIs) and bloodborne pathogen (BBP) exposures, little is known about the rate of adherence to standard precautions among healthcare workers in US acute-care hospitals and the processes used for measurement and surveillance. Methods: We evaluated the development and usability of electronic platforms to collect standard precautions surveillance data in support of the Simulation to Improve Infection Prevention and Patient Safety (SIPPS) Trial. SIPPS is a 5-year group-randomized group-interventional study to develop and test a simulation intervention to improve provider performance of standard precautions and prevent HAIs and occupational BBP exposures. In the pilot study, standard precautions adherence data were collected and validated using the Standard Precautions Observational Tool (SPOT) in a paper format. Adherence was measured using 10 indicators across the categories of hand hygiene, personal protective equipment, linen handling, and sharps disposal. The SPOT allows users to observe healthcare workers providing routine care and to record when an SP action is indicated and whether it was completed or missed. The data did not contain personally identifiable information or protected health information. The aim of this project was to design an electronic version of the SPOT that is simple and affordable to create, allows for rapid and structured data collection, and can be disseminated for broad standardization of standard precautions surveillance. Results: Three electronic platforms, including 2 survey-based platforms (Qualtrics and REDCap) and 1 website-based platform (Google), were evaluated for the following characteristics: (1) design interface, (2) customizability, (3) data entry speed, (4) accessibility, and (5) total cost. Both survey platforms performed well in design interface, allowing for a no- or low-code design and offered mobile-friendly formats. Rigid survey formats created obstacles in customization and rapid data collection, involving large amounts of scrolling or screen advancement. Survey-based platforms also required a subscription or access fee. Conversely, the website-based platform had a more challenging design interface but was easily customizable with low-level knowledge of hypertext mark-up language (HTML) and application programming interface deployment. The website platform allowed for a single screen view, mobile-phone–friendly design, and rapid data collection. It was developed using freely available resources. Conclusions: A website-based HTML form allows for faster data collection and a higher level of customization than survey-based platforms and can be designed and implemented free of cost using minimal web-development skills. This surveillance methodology will be field tested for fidelity of implementation and for broad use in surveillance.Funding: The Agency for Healthcare Research and Quality provided Funding: for this study (grant no. 1R18HS026418).Disclosures: Amanda Hessels reports that she is the primary investigator for the studies titled “Impact of Patient Safety Climate on Infection Prevention Practices and Healthcare Worker and Patient Outcomes” (grant no. DHHS/CDC/NIOSH 1K01OH011186 to Columbia University) and “Simulation to Improve Infection Prevention and Patient Safety: The SIPPS Trial (AHRQ grant no. R18: 1R18HS026418 to Columbia University)

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.

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.

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.

Standardizing the Care of Occupational Blood-Borne Pathogen Exposures to Reduce Unnecessary Use of the Emergency Department

Care of health care workers with a blood-borne pathogen (BBP) exposure who seek treatment in emergency departments needs to be standardized. A standardized system may lead to better care for exposed individuals. An interprofessional process was developed to standardize care of occupational BBP exposures in nonemployees. A health planning program design was conducted to compare outcomes before and after the standardized process was enacted. Standardizing treatment of occupational exposures provided more efficient care for exposed nonemployee workers and allowed an improved use of ED resources. Programs developed to improve utilization of the emergency department have a greater chance of success when developed using an interprofessional, collaborative approach.

Assessment of Management Policies and Practices for Occupational Exposure to Bloodborne Pathogens in Dialysis Facilities

Occupational exposure management is an important element in preventing the transmission of bloodborne pathogens in health care settings. In 2008, the US Centers for Disease Control and Prevention conducted a survey to assess procedures for managing occupational bloodborne pathogen exposures in outpatient dialysis facilities in the United States. A cross-sectional survey of randomly selected outpatient dialysis facilities. 339 outpatient dialysis facilities drawn from the 2006 US end-stage renal disease database. Hospital affiliation (free-standing vs hospital-based facilities), profit status (for-profit vs not-for-profit facilities), and number of health care personnel (≥100 vs <100 health care personnel). Exposures to hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV); provision of HBV and HIV postexposure prophylaxis. We calculated the proportion of facilities reporting occupational bloodborne pathogen exposures and offering occupational exposure management services. We analyzed bloodborne pathogen exposures and provision of postexposure prophylaxis by facility type. Nearly all respondents (99.7%) had written policies and 95% provided occupational exposure management services to health care personnel during the daytime on weekdays, but services were provided infrequently during other periods of the week. Approximately 10%-15% of facilities reported having HIV, HBV, or HCV exposures in health care personnel in the 12 months prior to the survey, but inconsistencies were noted in procedures for managing such exposures. Despite 86% of facilities providing HIV prophylaxis for exposed health care personnel, only 37% designated a primary HIV postexposure prophylaxis regimen. For-profit and free-standing facilities reported fewer exposures, but did not as reliably offer HBV prophylaxis or have a primary HIV postexposure prophylaxis regimen relative to not-for-profit and hospital-based facilities. The survey response rate was low (37%) and familiarity of individuals completing the survey with facility policies or national guidelines could not be ascertained. Significant improvements are required in the implementation of guidelines for managing occupational exposures to bloodborne pathogens in outpatient dialysis facilities.

Outcomes of a consultation service to emergency medicine clinicians for postexposure management of occupational bloodborne pathogen exposures

Potential bloodborne pathogen exposures, many of which occur after hours and are evaluated by emergency medicine physicians, are an important occupational hazard. Emergency medicine physicians might not be as conversant with the latest US Public Health Service guidelines as occupational medicine physicians. This research presents an efficient model in which a single expert occupational medicine physician provides guidance to many emergency medicine clinicians. Outcomes evaluation indicates that the service was widely utilized and highly rated.

Occupational exposure to blood and body fluids among health care workers in a general hospital, China

To understand current status of occupational exposure to blood and body fluids (BBF), and awareness of knowledge about occupational bloodborne pathogen exposures and universal precaution among hospital-based health care workers (HCWs). A cross-sectional study was conducted during April to May 2004 to study incidence of occupational exposure to BBF among 1,144 hospital-based HCWs. The total incidence and the average number of episodes exposure to BBF was 66.3/100 HCWs per year and 7.5 per person per year in the past year, respectively. The incidence (per 100/HCWs per year) and the average number of episodes (per HCW per year) of percutaneous injury (PCI), mucous-membrane exposure (MME), and exposure to BBF by damaged skin was 50.3 and 1.8; 34.4 and 1.7; and 37.9 and 4.0, respectively. The leading incidence and the average number of episodes of PCI occurred in delivery room (82.6 and 1.8). The highest percentage of PCI's that occurred during the previous 2 weeks occurred during a surgical operation (22.8%). Of all sharp instruments, the suture needle contributed the highest percentage of PCI's (24.7%) among HCWs in the last 2 weeks. Over two-thirds (68.3%) of respondents were immunized with Hepatitis B vaccine; less than one-half (47%) of HCWs wore gloves while doing procedures on patients. The respondents demonstrated a lack of knowledge regarding transmission of bloodborne diseases and universal precautions. Risk for potential exposure to BBF appears high in HCWs, and almost all of episodes are not reported. It is urgent to establish the Guideline for Prevention and Control of Occupational Exposure to Bloodborne Pathogens among HCWs. Am. J. Ind. Med. 52:89-98, 2009. (c) 2008 Wiley-Liss, Inc.

Occupationally acquired infectious diseases among health care workers in Brazil: Use of Internet tools to improve management, prevention, and surveillance

Education is a major component of prevention strategies to reduce the risk of occupational transmission of bloodborne pathogens to health care personnel. This study describes the results of an Internet-based project, "Projeto Riscobiologico.org", for which the main objectives are to disseminate information in the Portuguese language about occupational exposures to bloodborne pathogens through a mailing list and Web site as well as to increase case reports of these events in Brazil. The mailing list expanded quickly with a total of 2078 participants (from 337 different cities and all Brazilian states), and 5613 messages were exchanged over a 5-year period. Mean length of participation was almost 2 years (697 days). Most of the participants (74%) reported that they frequently manage occupational exposures. Nevertheless, results showed an important lack of basic knowledge regarding this issue. In contrast with the high participation in the mailing list, a small number of institutions started to participate in the voluntary surveillance system. The Internet can be used as a tool to increase knowledge and improve practices in the prevention of occupational bloodborne pathogen exposures. In addition, it may represent a unique opportunity to implement a national surveillance system.

Occupational blood-borne pathogen exposures among community workers

Occupational blood-borne pathogen exposures among community workers

Toll-Free Hot Line for Treating Occupational Bloodborne Pathogen Exposures

Toll-Free Hot Line for Treating Occupational Bloodborne Pathogen Exposures

Home visiting for improving health care utilization and parenting skills in urban minority populations

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.