Emergency department blood or body fluid exposure evaluations and HIV postexposure prophylaxis usage.
OBJECTIVE
To determine the frequency and type of patient visits for blood or body fluid exposures to a large, urban emergency department (ED); to ascertain the frequency that human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP) was prescribed for these exposures; and to compare HIV PEP usage by patient group, occupation, and exposure type.


METHODS
Retrospective medical record review of ED patient visits (January 1, 1995, through June 30, 2001) extracted from two separate billing record computerized databases using 14 ICD-9 codes that defined blood or body fluid exposures.


RESULTS
Of the 1,436 visits, 22% were by health care workers (HCWs) and 78% by non-HCW adults, adolescents, or children. Sixty percent of the HCWs sustained needlestick or sharp injuries, 73% of non-HCW adults had human bites, and 81% of adolescents and children had sexual exposures. Nurses were the largest group of HCWs, whereas police, correction officers, and security guards were the largest group of non-HCWs exposed at work. HCWs and non-HCW adults who sustained nonsexual exposures were much more likely to present for an evaluation within 24 hours than adolescents or children who suffered sexual assault (p<0.001). HIV PEP was prescribed 143 times: 92 to HCWs and 51 to all other patients. HIV PEP was most often prescribed to HCWs sustaining needlestick injuries.


CONCLUSIONS
The majority of patients were not HCWs, which attests to the need for national, nonoccupational blood or body fluid management guidelines. There may be particular groups who would benefit from educational campaigns informing them of the need for early-intervention, postexposure measures to prevent an HIV infection.
Merchant
Roland C
RC
Section of Emergency Medicine, Brown Medical School, Rhode Island Hospital, Providence 02903, USA. merchant@lifespan.org
Becker
Bruce M
BM
Mayer
Kenneth H
KH
Fuerch
Janene
J
Schreck
Barbara
B
D000293:Adolescent; D000328:Adult; D000488:Allied Health Personnel; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D001826:Body Fluids; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004781:Environmental Exposure / Q000517:prevention & control; D006678:HIV; D006801:Humans; D038801:International Classification of Diseases; D016273:Occupational Exposure / Q000517:prevention & control; D012189:Retrospective Studies; D012723:Sex; D012742:Sex Offenses