Occupational HIV Exposure Research Articles

Risk Control Countermeasures in HIV Occupational Exposure for Healthcare Workers and Police Officers

In recent years, due to changes in the social governance environment, there have been a number of causative factors that should not be overlooked in relation to HIV occupational exposure among health care workers and front-line workers who handle HIV-infected crime cases in China. Beijing Normal University project team deploys the satisfaction with the effectiveness for occupational exposure prevention and control on the special police brigade, in search of more feasible risk control countermeasures. In contrast to the “lack of protection knowledge and skills” and the “fluke mentality about the risk of exposure”, it is more important to pay attention to the social discrimination and other factors that cause some people with HIV to “deliberately conceal their exposure” and even “commit the crime of malicious transmission”. In the prevention and risk control of HIV occupational exposure, we should aim for “zero infection”, fully implement the concept of “universal protection”, refine the rules of safe disposal of sharp instruments, clarify the principles of timely treatment, comprehensive reporting, confidentiality and informed consent after exposure, strengthen life education, anti-discrimination and de-stigmatization education, and improve the special support fund and insurance provisions for occupational exposure.

Managing sharps injuries: awareness, assessment, reduction

British Journal of Healthcare ManagementVol. 24, No. 12 Risk ManagementManaging sharps injuries: awareness, assessment, reductionJ Ian BlenkharnJ Ian BlenkharnEmail:E-mail Address: [email protected]Blenkharn Environmental, LondonSearch for more papers by this authorJ Ian BlenkharnPublished Online:7 Dec 2018https://doi.org/10.12968/bjhc.2018.24.12.578AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Blenkharn JI. Blood splashes around sharps bins: hygiene failures in the clinical environment? International Journal of Hospital Environment and Hygiene Management. 2012;1:1–9 Google ScholarBlenkharn JI, Odd C. Sharps injuries in healthcare waste handlers. Annals of Occupational Hygiene. 2008;52(4):281–286. https://doi.org/10.1093/annhyg/men010 Crossref, Google ScholarDunleavy K, Taylor A, Gow J et al.. Management of blood and body fluid exposures in police service staff. Occupational Medicine (London). 2010;60(7):540–545. https://doi.org/10.1093/occmed/kqq111 Crossref, Google ScholarGrimmond T. Use and activation of safety engineered sharps devices in a sample of 5 Florida healthcare facilities. J Assoc Occ Hlth Prof. 2014;34:13–15. Google ScholarHealth and Safety (Sharp Instruments in Healthcare) Regulations 2013, HSE Information Sheet and Guidance for employers and employees. http://www.hse.gov.uk/pubns/hsis7.pdf (accessed 6 November) Google ScholarLeigh JPO, Wiatrowski WJ, Gillen M et al.. Characteristics of persons and jobs with needlestick injuries in a national data set. Am J Infect Control. 2008;36:414–420. https://doi.org/10.1016/j.ajic.2007.07.020 Crossref, Google ScholarSchuurmans J, Lutgens SP, Groen L et al.. Do safety engineered devices reduce needlestick injuries? J Hosp Infect. 2018;100:99–104. https://doi.org/10.1016/j.jhin.2018.04.026 Crossref, Google ScholarThe Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. 2013. No. 645. http://www.legislation.gov.uk/uksi/2013/645/pdfs/uksi_20130645_en.pdf (accessed 6 November) Google ScholarSohn JW, Kim BG, Kim SH et al.. Mental health of healthcare workers who experience needlestick and sharps injuries. J Occup Health. 2006;48:474–9 Crossref, Google ScholarWorthington MG, Ross JJ, Bergeron EK. Posttraumatic stress disorder after occupational HIV exposure: two cases and a literature review. Infect Control Hosp Epidemiol. 2006;27:215–7. https://doi.org/10.1086/501155 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 December 2018Volume 24Issue 12ISSN (print): 1358-0574ISSN (online): 1759-7382 Metrics History Published online 7 December 2018 Published in print 2 December 2018 Information© MA Healthcare LimitedPDF download

Bibliometric analysis on research hotspots on HIV post-exposure prophylaxis related articles in the world, 2000-2017

Objective: To analyze and reveal the distribution, research hotspots and study trend of worldwide published articles correlated with HIV/AIDS post-exposure prophylaxis (PEP), and provide information for related studies in China. Methods: CiteSpace software 5.1 was used to visualize all related papers in the web of science database published during 2000-2017. Results: The average growth rate of international PEP-related papers was 10.78%,and number of published papers in 2016 was highest (n=34), relevant research hotspots have shifted from the prevention of occupational HIV exposure to the prevention of non-occupational HIV exposure in group at high risk, such as MSM, in recent years. Clustering analysis classified research hotspots into three categories, including risk reduction through enhanced intervention, current status of global HIV PEP and German-Austrian Recommendation. Conclusions: Non-occupational HIV PEP in groups at high-risk, especially MSM, has received increasing attention in recent years, the research of PEP mainly focus on improving the awareness and use of PEP in MSM and compliance in the course of medication. In the context of severe HIV epidemic in MSM without effective control in China, PEP should be strengthened to assess and explore the risk of HIV infection in MSM to provide reference for medical personnel and related departments to implement HIV non-occupation exposure blockade and formulate PEP medication.

Prophylaxis for Occupational HIV Exposure in Healthcare Workers

Prophylaxis for Occupational HIV Exposure in Healthcare Workers

HIV/AIDS occupational exposure and integrative care; knowledge, attitude, and skills of healthcare workers in Gansu Province, China

Background: For HIV infected patients, distinct infectious disease hospitals currently exist in China, therefore, attitudes promoting separation within health care settings persist both in healthcare workers and community. The misinformation and fear of infection negatively affect Health Care Workers, (HCWs) attitudes towards caring for patients with HIV. However, the level of knowledge, attitudes, and skills (KAS) towards occupational exposure to HIV and post-exposure standards of care are unknown in Gansu, China. Methods: We conducted a cross-sectional study to evaluate the knowledge, attitudes, and skills of health care workers regarding HIV occupational exposure and treatment. We analyzed findings in a total of 324 HCWs through a self-reported questionnaire. Results: HCWs with a higher than average KAS composite score compared to HCWs with a lower KAS score were more likely to be working clinically (p=0.0023), and had completed a university degree or above (p=0.0370). The univariate analysis model also showed additional factors that HCWs having a higher KAS composite score were significantly associated with being a physician (OR 9.22; p=0.045) and receiving formal infection control training (OR 4.20; p<0.0001). Conclusions: Our study provides considerable information on occupational exposure regarding HIV/AIDS in Gansu Province of China. A continuous education is necessary to increase the level of knowledge, attitude and skills of HCWs about the risk of infection at the workplace. With the adoption of standardized occupational exposure protocols and infection control programs, we should be able to reduce barriers of HIV care into general hospital facilities which in turn can modify their attitudes.

Factors associated with loss to follow-up after occupational HIV exposure in Cape Town, South Africa: a retrospective cohort study

BackgroundThere is limited data on factors associated with loss to follow-up (LTFU) of health care workers (HCWs) following occupational exposure to HIV, and most studies were conducted in an era when poorly tolerated antiretrovirals like zidovudine were used.MethodsA retrospective cohort study was conducted of HCWs attending a referral hospital’s Occupational Health Clinic in Cape Town, South Africa for post-exposure prophylaxis (PEP) during a period when tenofovir was available. Our primary outcome was LTFU at the 3-month visit. We selected seven variables a priori for our logistic regression model and ensured there were at least 10 outcome events per variable to minimize bias.ResultsTwo hundred and ninety-three folders were evaluated for descriptive analysis. LTFU worsened with successive visits: 36% at 6 weeks, 60% at 3 months, and 72% at 6 months. In multivariate analysis at the 3-month visit LTFU was associated with age (adjusted odds ratio (aOR), 0.6 per 10-year increase [95% CI, 0.5–0.9]), HCW category of doctor (aOR 2.7 [95% CI, 1.3–5.5]), and time from exposure to receiving PEP of more than 24 h (aOR 5.9 [95% CI, 1.3–26.9]).ConclusionWe identified factors associated with LTFU of HCWs after occupational HIV exposure, which could be used to target interventions to improve follow-up.

Knowledge, Attitude, and Practices Regarding Occupational HIV Exposure and Protection among Health Care Workers in China: Census Survey in a Rural Area.

Health care workers (HCWs) seek, treat, and care for patients living with HIV/AIDS on a daily basis and thus face a significant risk to work-related infections. To assess the knowledge, attitude, and practices regarding occupational HIV exposure and protection among HCWs in low HIV prevalence areas of rural China. A cross-sectional questionnaire survey was carried out among all medical units in Pucheng County, Shaanxi, China. Response rate of this study was 94%. The average overall knowledge score of HCWs was 10.9 of 21.0. Deficiencies in general, transmission, exposure, and protection knowledge were identified among HCWs at all levels. A high rate of occupational exposure (85%) and lack of universal precautions practice behavior were recorded. Significant predictors of universal precautions practice behavior were female sex, prior training, and greater knowledge about HIV/AIDS. Health care workers at various levels have inadequate knowledge on HIV/AIDS and do not practice universal precautions. Nurses and medical technicians at the county level faced more occupation risk than other HCWs. The key of AIDS training for different levels of HCWs should be distinguished.

Effects of nurses' risk perceptions of human immunodeficiency virus occupational exposure on their attitudes and behavior of self-protection

Objective To explore the effects of nurses' risk perceptions of occupational HIV exposure and the self-efficacy on their attitudes and behavior of self-protection in nursing care. Methods An anonymous survey was conducted in eligible nurses with self-designed questionnaire in three conveniently selected comprehensive hospitals in Wuhan. Structural equation modeling was applied in the data analysis. Results Risk perceptions exerted positive effects on the attitudes of self-protection. The standardized path coefficient was 0.45 (P=0.009). The attitudes of self-protection and the risk perceptions exerted no impact on the behavior of self-protection (P > 0.05).The impacts of the self-efficacy on the attitudes and the behavior of self-protection was positive. The standardized path coefficient was 0.15 (P= 0.02)and 0.53 (P < 0.01), respectively. Conclusions Risk perceptions exerted positive effects on the attitudes of self-protection. But the attitudes of self-protection and the risk perceptions exerted no impact on the behavior of self-protection. Self-efficacy can improve the attitudes of self-protection and enhance the behavior of self-protection. Key words: Occupational exposure; Human immunodeficiency virus; Risk perception; Self-protection; Structural equation model

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.

Best practice for needlestick injuries.

Needlestick injuries (NSIs) are a significant health hazard. Occupational transmission of bloodborne pathogens among healthcare workers (HCWs) is rare but has been repeatedly reported in the literature. In October 2010, new regulations were introduced for medical aftercare of HCWs following NSIs at the University Hospital Frankfurt. In June 2013, a university hospital-wide early intervention program was introduced that gives HCWs immediate 24/7/365 access to an HIV postexposure prophylaxis kit after confirmed or probable occupational HIV exposure. Interdisciplinary collaboration between the attending surgeon and occupational health as well as infectious disease specialists facilitates optimal postexposure medical treatment of HCWs who suffer NSIs. Complete reporting of NSIs is a prerequisite for achieving optimal treatment of the affected HCWs. An NSI is an emergency and needs to be evaluated immediately and, if necessary, treated as soon as possible. A standardized algorithm for initial diagnostic and treatment has proven to be helpful.

A Novel Explanation for PEP Failure

The use of postexposure prophylaxis (PEP) after occupational HIV exposure reduces the risk for HIV acquisition by >80%. PEP failure, when it occurs, is usually attributed to delayed initiation, transmitted drug resistance, or suboptimal medication adherence. What could be the explanation in situations when none of these factors appears to be the main cause of failure? To answer this question, researchers examined the case of a healthcare worker …

Revised guidelines for occupational HIV exposure include simpler regimens

Updated federal guidelines for the management of occupational exposure to HIV in health care workers recommend immediate prophylaxis using at least three antiretroviral drugs, with an emphasis on counseling and follow-up to ensure that the 28-day regimen is followed.1 Although this presents clinical opportunities for pharmacists, the first duty for the profession may be more basic, said Betty Dong, professor of clinical pharmacy and family and community medicine at the University of California at San Francisco (UCSF) schools of pharmacy and medicine. “Somebody in the pharmacy should be cognizant of these guidelines so that if an exposure happens in a hospital, they have their initial starter pack ready for the patient” for immediate use, Dong said. “These are drugs that are not in most hospitals,” she explained. According to the updated guidelines, which were previously revised in 2005, the preferred regimen for postexposure prophylaxis (PEP) is 400 mg of...

LAMIVUDINE-ARTESUNATE CO ADMINISTRATION ALTERS PIROXICAM MEDIATED ANALGESIA IN MICE

Lamivudine-Artesunate co-administration is common in HIV-malaria settings, as well as in prophylaxis from occupational HIV exposure and presumptive malaria treatment. Pain is a symptom often associated with malaria and HIV which is usually treated with piroxicam due to availability, affordability, and low addiction potential. This study evaluated possible analgesic effects of lamivudine and artesunate, and also the effect of lamivudine-artesunate co-administration on piroxicam mediated analgesia in mice using acetic acid-induced writhing method. Animals received 21 day intraperitoneal treatments with vehicle, lamivudine, artesunate or lamivudine/artesunate co-administration. The result showed that artesunate possessed analgesic properties, and also showed that piroxicam mediated analgesia was significantly reduced (p 0.05) in the presence of concomitant lamivudine-artesunate treatment. This data suggests the need for caution and possible alternate analgesics while on lamivudine-artesunate therapy in order to effectively alleviate pain, when this is desired in lamivudine-artesunate co administration.

Regimes de profilaxia após exposição ocupacional ao HIV: revisão da literatura

&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;&lt;p&gt;Os acidentes ocupacionais com materiais biológicos contaminados com HIV geram grande&lt;/p&gt;&lt;/span&gt;&lt;/span&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;impacto no trabalhador que se acidenta, apesar de serem responsáveis por um número pequeno de soroconversões. Desde o início da epidemia da AIDS, uma grande preocupação tem sido demonstrada na prevensão dessa infecção relacionada ao trabalho. Este estudo teve como objetivo rever a literatura &lt;/span&gt;&lt;/span&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;sobre os regimes de profilaxia após exposição ocupacional ao vírus HIV, bem como comparar as recomendações existentes nos diferentes países e auxiliar os médicos frente à situação de um acidente ocupacional com material biológico potencialmente contaminado com HIV. Observou-se que, inicialmente, dava-se grande importância à prevenção dos acidentes com as precauções padrão. A partir do momento &lt;/span&gt;&lt;/span&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;em que começaram a surgir os anti-retrovirais, estes tiveram destaque e iniciou-se seu uso em acidentes considerados de alto risco, mesmo sem estudos que provassem a sua efetividade e segurança quando &lt;/span&gt;&lt;/span&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;utilizados como quimioprofilaxia. Atualmente, o desafio vem sendo o aumento da resistência viral diante &lt;/span&gt;&lt;/span&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;dos anti-retrovirais disponíveis e, quando ocorre acidente ocupacional com paciente-fonte HIV positivo e com cepas resistentes do vírus, cria-se uma certa dificuldade em conduzir o caso de forma segura. &lt;/span&gt;&lt;/span&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;Apesar de existirem muitos consensos a respeito desse tema, várias considerações como: toxicidade &lt;/span&gt;&lt;/span&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;&lt;span style="font-family: Helvetica; font-size: xx-small;"&gt;das drogas, resistência viral, indicação do uso de ARVs e adesão do profissional ao tratamento devem ser feitas no momento em que é prescrito, ou não, um esquema profilático a um profissional que se acidenta com material contaminado, ou potencialmente contaminado, com vírus do HIV.&lt;/span&gt;&lt;/span&gt;

Service outcome of antiretroviral Post-Exposure Prophylaxis (PEP) for occupational HIV exposure among health care personnel

Discussion Those tested for HIV were all Non – Reactive; shows the effectiveness of PEP services. We are finding obstacles on follow up tracking like “I am much aware about the risk, stigma of HIV Positivity, negligence for follow up and confidentiality issues at the workplace etc.” that prevent the HCP for PEP and increase the risk of transmission. Practice and regular sensitization with UPW has increased the awareness among HCP for reducing HIV infection risk and transmission and prevention through PEP. Published: 11 May 2010

Investigation of nurses' knowledge and behavior of HIV occupational exposure and prevention

Objective To learn nurses' knowledge and behavior of AIDS precaution and HIV occupational exposure, aiming at existing problems, putting forward corresponding measures. Methods 520 nurses from 21 hospitals in AIDS severest districts of Xinjiang were investigated using self-designed questionnaire from October to December in 2007. Results Nurses lacked comprehensive knowledge of AIDS precaution and occupational exposure. The score of HIV medium's sterilization, the monitoring and preventing knowledge of HIV occupational post-exposure infection was low. Nurses' knowledge of AIDS precaution and occupational exposure showed significant statistical differences among different nations, education degrees, working sections, etc. And nurses' behaviors related AIDS prevention should be standardized and strengthened. Conclusions The training of nurses' knowledge of HIV occupational exposure and prevention should be attached importance to. Also, enhancing preventive awareness, implementing universal prevention, and improving hospital environment will play the vital parts in perfecting the management of nurses' HIV occupational exposure and prevention. Key words: Nurses; Acquired Immunodeficiency Syndrome; Occupational Exposure; Questionnaires

Notice to Readers: Updated Information Regarding Antiretroviral Agents Used as HIV Postexposure Prophylaxis for Occupational HIV Exposures

Notice to Readers: Updated Information Regarding Antiretroviral Agents Used as HIV Postexposure Prophylaxis for Occupational HIV Exposures

Occupational HIV exposure among Thai healthcare workers: an analysis of 558 exposures during 1998–2007

Methods Thai Red Cross Society (TRCS) has adopted a policy of reporting and following all occupational HIV exposure of its employees. All incident reports, actions taken and follow-up anti-HIV results were compiled. Here we analyzed the incidental reports from 1998–2007 in order to see whether there were any changes in the exposure patterns or PEP regimens prescribed from that reported during 1991–1997 (Southeast Asian J Trop Med Public Health 1999; 30: 496–503).

Occupational HIV Exposure During Primary Infection

CDC guidelines for postexposure prophylaxis (PEP) rely on HIV antibody testing of source patients. However, HIV-antibody tests are often negative

Preventing AIDS: The British Experience

The UK is described by the Department of Health in London as “a relatively low prevalence country for HIV infection.” The word “relatively” is the key. By comparison with the huge numbers of cases seen in much of sub-Saharan Africa, for example, HIV/AIDS is a minor problem in the UK. However, that is no grounds for complacency, as shown by the need for an official target for further reduction, which is a 25% decrease in new diagnoses of HIV infection by the end of 2007. To see how achievable this might be, we need to look at the ways in which new cases are currently arising. Last year saw 7,750 new diagnoses of HIV infection in the UK, but the more detailed breakdown is available up to the end of 2004.1 As of Dec 31, 2004, there were an estimated 58,300 people over the age of 15 years living with HIV in the UK, and this number is rising not only because of new diagnoses but also because of successful anti-HIV drug regimens. Male-to-male transmission remains an issue, at a plateau of around 1,800 new diagnoses annually. Heterosexual intercourse accounts for 4,000 new diagnoses each year, but most of those are acquired outside the UK. Injecting drug use accounts for just 150 new cases; mother-to-child transmissions number only 130 or so (the introduction of antenatal testing as a routine will have helped here); HIV infection due to blood transfusions or blood products is now very rare, most cases being acquired overseas; occupational HIV exposure is also very uncommon. Clearly the 2007 target (i.e., 25% decrease in new diagnoses) can be met only by making a significant impact on the two main sources, which are HIV transmission via same sex or heterosexual intercourse. The early willingness of British health officials and politicians to recognise the potential danger of HIV and do something about it when the world found out about this virus more than 20 years ago explains much of the early success. Still, as elsewhere in the world, pendulums swing back and prevention messages need repeating, especially now that anti-retroviral drugs mean that HIV infection is no longer seen as a death sentence, at least in countries such as the UK where such treatment is affordable. However, public health guidance and policy needs sensitive handling because so many British cases of HIV infection are either acquired outside the country or arise in ethnic minority groups, and more generally, it is difficult to see how prevention can be further enhanced in the UK other than by reinforcement of existing advice. The budget statement in April 2006 did contain a tax concession on condoms, by which the value added tax (a sort of sales tax) would be only 5% instead of the typical 17.5%. Though generally welcomed, this looks like a cosmetic gesture. The non-use of condoms is hardly likely to be based on price. More controversial is post-exposure prophylaxis (PEP). When exposure has been occupational (eg, a needlestick accident involving a healthcare worker) the British PEP guideline is clear, but the same document1 appears more tentative when it comes to exposure via sexual intercourse. This guidance, from February 2004, is currently being revised, but the British Association for Sexual Health and HIV has lately issued its own advice. That guideline2 recommends, provided the source individual is known to be HIV positive, PEP where the exposure has been due to receptive or insertive anal or vaginal sex. As with the U.S. guidelines,3 a further proviso is that the exposure is not more than 72 hours old. The indications for PEP are still being debated, and there is the potential to make some impact on prevention. However, any impression on national HIV statistics will be lessened by the simple fact that so many people who are HIV positive are not aware of their status.