title: Accidental exposure to biological material in healthcare workers at a university hospital: Evaluation and follow-up of 404 cases.
abstract: 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.
authors.affiliation: Division of Infectious Diseases of the Hospital das Clínicas School of Medicine, University of São Paulo, Brazil. elianabg@zerbini.org.br
authors.forename: Eliana Battaggia
authors.initials: EB
authors.lastname: Gutierrez
authors.forename: Marta Heloísa
authors.initials: MH
authors.lastname: Lopes
authors.forename: Maria Aparecida Shikanai
authors.initials: MA
authors.lastname: Yasuda
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents; D000998:Antiviral Agents; D017325:Hepatitis B Vaccines; D007136:Immunoglobulins