Preventing transmission of blood-borne pathogens: a compelling argument for effective device-selection strategies.
Disease transmission from percutaneous injury occurs in 2% to 40% of health care workers (HCWs) after exposure to the hepatitis B virus (HBV), in 3% to 10% after exposure to the hepatitis C (HCV) virus, and in 0.2% to 0.5% after exposure to the HIV virus. According to a recently published case-control study from the Centers for Disease Control and Prevention, the following factors increase the risk of HIV seroconversion in HCWs after percutaneous exposure to HIV-infected blood: deep injury, visible blood on the device, procedures involving needle placement directly into a vein or artery, and terminal AIDS in the source patient. Postexposure use of zidovudine by HCWs appears to reduce the risk of HIV transmission by 79%. Institutions seeking to reduce the risk of HCW seroconversion should conduct analyses of specific tasks associated with these high-risk factors, and safety interventions should be installed when tasks and devices increase the risk of seroconversion. Although this type of outcome-based strategy may not significantly reduce the total number of needlestick injuries, reducing high-risk exposures minimizes disease transmission and maximizes the cost-effectiveness of the intervention.
Culver
J
J
Employee Occupational Health Services, Emory University Hospital, Atlanta, GA 30322, USA.
D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control / Q000635:transmission; D017848:Blood-Borne Pathogens; D004866:Equipment Contamination; D004869:Equipment Safety / Q000379:methods*; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000379:methods; D007239:Infections / Q000635:transmission*; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D009339:Needles; D016602:Needlestick Injuries / Q000517:prevention & control*; D016273:Occupational Exposure / Q000517:prevention & control; D018570:Risk Assessment