Accidental exposure to biological material in healthcare workers at a university hospital: Evaluation and follow-up of 404 cases.
The care and follow-up provided to healthcare workers (HCWs) from a large teaching hospital who were exposed to biological material between 1 August 1998 and 31 January 2002 is described here. After exposure, the HCW is evaluated by a nurse and doctor in an emergency consultation and receives follow-up counselling. The collection of 10 ml of blood sample from each HCW and its source patient, when known, is made for immunoenzymatic testing for HIV, HBV and HCV. Evaluation and follow-up of 404 cases revealed that the exposures were concentrated in only a few areas of the hospital; 83% of the HCWs exposed were seen by a doctor responsible for the prophylaxis up to 3 h after exposure. Blood was involved in 76.7% (309) of the exposures. The patient source of the biological material was known in 80.7% (326) of the exposed individuals studied; 80 (24.5%) sources had serological evidence of infection with 1 or more agents: 16.2% were anti-HCV positive, 3.8% were HAgBs positive and 10.9% were anti-HIV positive. 67% (273) of the study population completed the proposed follow-up. No confirmed seroconversion occurred. In conclusion, the observed adherence to the follow-up was quite low, and measures to improve it must be taken. Surprisingly, no difference in adherence to the follow-up was observed among those exposed HCW at risk, i.e. those with an infected or unknown source patient. Analysis of post-exposure management revealed excess prescription of antiretroviral drugs, vaccine and immunoglobulin. Infection by HCV is the most important risk of concern, in our hospital, in accidents with biological material.
Gutierrez
Eliana Battaggia
EB
Division of Infectious Diseases of the Hospital das Clínicas School of Medicine, University of São Paulo, Brazil. elianabg@zerbini.org.br
Lopes
Marta Heloísa
MH
Yasuda
Maria Aparecida Shikanai
MA
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D017848:Blood-Borne Pathogens; D001938:Brazil; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control*; D006509:Hepatitis B / Q000517:prevention & control*; D017325:Hepatitis B Vaccines; D006526:Hepatitis C / Q000517:prevention & control*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D017758:Infectious Disease Transmission, Patient-to-Professional; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D010564:Personnel, Hospital
D019380:Anti-HIV Agents; D000998:Antiviral Agents; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins