Three-year prospective study to improve the management of blood-exposure incidents.
OBJECTIVE
Throughout 2003-2005, all blood-exposure incidents registered by an expert counseling center in The Netherlands accessible by telephone 24 hours a day, 7 days a week, were analyzed to assess quality improvement in the center's management of such incidents. The expert center was established to handle blood-exposure incidents that occur both inside and outside of a hospital. Infection control practitioners carried out risk assessment, made the practical arrangements associated with managing incidents, and carried out treatment and follow-up, all in accordance with standardized procedures.


METHODS
We analyzed the time it took for exposed individuals to report the incident, the time required to perform a human immunodeficiency virus (HIV) test for the source individual when needed, occurrence of injuries, hepatitis B (HBV) vaccination status of exposed individuals, and adherence to protocol at the expert center.


RESULTS
A mean of 465 incidents was registered during each year of the 3-year study period. Although 698 (50%) of 1,394 reported exposures took place in a hospital, 704 (50%) took place outside of a hospital, and 460 (33%) occurred at a time other than regular office hours. HIV tests for source individuals were performed increasingly quickly over the course of the 3-year study period because of earlier reporting and improvements in practical matters associated with performing and processing the tests. The percentage of healthcare workers employed outside a hospital who were vaccinated against HBV increased from 34% (52 of 152) to 70% (119 of 170) during the 3-year study period. Consequently, the administration of immunoglobulin and unnecessary laboratory testing were reduced. In assessing the quality of the expert center, flaws in the handling of incidents were identified in 148 (37%) of 396 incidents analyzed in 2003, compared with 38 (8%) of 461 incidents analyzed in 2005.


CONCLUSIONS
The practical matters associated with management of blood-exposure incidents, such as timely reporting and administration of prophylaxis, should be optimized for incidents that occur at times other than regular office hours and outside of hospitals. The establishment of a 24-hour centralized counseling facility that was open 7 days a week to manage blood exposures resulted in significant improvements in incident management and better care.
van Wijk
Paul Th L
PT
Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
Pelk-Jongen
Marianne
M
Wijkmans
Clementine
C
Voss
Andreas
A
Schneeberger
Peter M
PM
D000062:Accidents, Occupational / Q000706:statistics & numerical data; D000998:Antiviral Agents / Q000627:therapeutic use; D017848:Blood-Borne Pathogens; D018890:Chemoprevention; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control / Q000635:transmission; D003376:Counseling / Q000379:methods; D003428:Cross Infection / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control / Q000635:transmission; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000379:methods; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D016273:Occupational Exposure; D010564:Personnel, Hospital / Q000706:statistics & numerical data; D011446:Prospective Studies; D012308:Risk Management / Q000379:methods*; D014777:Virus Diseases / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control / Q000635:transmission
D000998:Antiviral Agents