Blood and body fluid exposures among US medical students in Botswana.
BACKGROUND
Medical students from resource-rich countries who rotate in resource-limited settings have little pre-departure experience performing procedures, and lack familiarity with local equipment. The risk of blood and body fluid exposures during such rotations is significant.


OBJECTIVE
1) Determine whether a simulation-based intervention reduced exposures among US medical students on a rotation in Botswana; 2) determine whether exposures were underreported; 3) describe exposures and provision of human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP).


METHODS
University of Pennsylvania medical students who traveled to Botswana for a clinical rotation from July 2007 to February 2010 were eligible to participate.


METHODS
Twenty-two students participated in the simulation-based intervention.


RESULTS
To evaluate the intervention, we used a pre/post quasi-experimental design and administered a retrospective survey. The response rate was 81.7% (67/82). Needlesticks were eliminated [8/48 (16.7%) to 0/19 (0.0%), p = 0.07]. Splashes were unchanged (6/48 [12.5%) to 3/19 (15.8%), p=>0.99]. Three students did not report their exposure. Fifteen exposures were reported to an attending, who counseled the student regarding HIV PEP. Three students did not take PEP because the exposure was low-risk.


CONCLUSIONS
Our intervention was associated with a decrease in needlestick exposures. Medical schools should consider training to reduce exposures abroad.
Hospital of the University of Pennsylvania, Division of Infectious Diseases, Philadelphia, PA 19104-6073, USA. jessicasarahmerlin@gmail.com
Jessica S
JS
Merlin
Gail
G
Morrison
Stephen
S
Gluckman
Gregg
G
Lipschik
Darren R
DR
Linkin
Sarah
S
Lyon
Elizabeth
E
O'Grady
Heather
H
Calvert
Harvey
H
Friedman
D001826:Body Fluids / Q000382:microbiology / Q000821:virology; D001902:Botswana; D003625:Data Collection / Q000379:methods; D006801:Humans; D016602:Needlestick Injuries / Q000382:microbiology / Q000517:prevention & control* / Q000821:virology; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control*; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D012189:Retrospective Studies; D013337:Students, Medical / Q000523:psychology; D014481:United States