Posted: 17-Nov-2006 << BACK
Eye of the needle: surveillance of significant occupational exposure to bloodborne viruses in healthcare workers
The latest report on surveillance of significant occupational exposures to bloodborne viruses in healthcare workers has been published by the Health Protection Agency Centre for Infections. Titled Eye of the Needle, the report details surveillance data on significant occupational exposures to bloodborne viruses in healthcare workers in England, Wales, and Northern Ireland [1]. Unless otherwise stated in the text, the data are based on a subset of 40 reporting centres which consistently reported to the surveillance scheme.
Occupational exposures to bloodborne viruses in the healthcare setting are an increasing public health concern. The report highlights that in 2005, there were two documented cases of hepatitis C seroconversion in healthcare workers. Eleven healthcare workers have now been reported as having contracted hepatitis C via this route, including the latest reported cases. Healthcare workers who initiated treatment within the eight months following the date of exposure have all achieved viral clearance.
Following reported occupational exposure to hepatitis C positive source patients, less than half (46%; 112/242) of healthcare workers reported follow-up at six months post-exposure. For the reports on exposures to hepatitis C positive source patients received in 2005, only 20% (49/242) of healthcare workers returned for all the appropriate follow-up tests at the correct time points after first being exposure. This finding is worrying since the majority of hepatitis C infected cases show no symptoms of their infection. Symptoms of infection can take up to 30 years before the infection manifests itself, when chronic damage to the liver has already occurred. It is therefore essential that healthcare workers are made aware of the need to attend follow-up appointments and ensure they know the outcome of their exposure.
The report found that in the majority of cases of HIV occupational exposures, national guidance on the use of HIV post-exposure prophylaxis guidelines was followed. In 2005, 65% (62/94) of healthcare workers who initiated HIV post-exposure prophylaxis (PEP) following exposure to an HIV positive source patient, were prescribed the current recommended starter pack regimen of AZT (Zidovudine), 3TC (Lamivudine), and Nelfinavir. Guidelines from the Expert Advisory Group on AIDS, recommend that HIV PEP should be started as soon as possible after the exposure, ideally within an hour [2]. Thirty-four per cent (64/189) of healthcare workers exposed to HIV who initiated HIV PEP, did so within an hour of their exposure, and cumulatively 89% (169/189) started HIV PEP within 24 hours. There were no new HIV seroconversions in 2005 reported to the scheme; with the total number of UK documented HIV seroconversions remaining at five.
Percutaneous injuries, the majority of which involved hollowbore needles, were the most commonly reported type of exposure. Reports of exposures increased by 49% from 206 in 2002 to 306 in 2005. Reports of percutaneous injuries to source patients infected with hepatitis C have also seen an increase of 37% over the same time period, from 81 in 2002 to 111 in 2005. The number of reports involving medical professionals have increased by 78%, from 73 in 2002 to 130 in 2005; a greater percentage increase in reports over time than for nursing professionals (47%; from 102 to 150 between 2002 and 2005 respectively). Although doctors and dentists comprise a much smaller group of healthcare workers, they reported a similar number of injuries, which suggests they have a higher injury rate.
The report highlights that preventable injuries are still occurring. Between 1997 and 2005, nearly half the incidents that occurred in the ward (45%; 425/954) were after the procedure had taken place. A lot of these incidents could have been prevented with proper adherence to the safe handling and disposal of sharps and clinical waste. There is guidance in place that details the recommended procedures for the prevention of exposure to bloodborne viruses in the healthcare setting [3] and Trusts should ensure that healthcare workers are aware and adequately trained on the implementation of these precautions in order to protect themselves from exposures. Employers should also have adequate systems in place, 24 hours 7 days a week; for the reporting and management of occupational exposures, and ensure that all staff members know how to report such incidents, in line with current guidance [2]. Primary Care Trusts working with local Health Protection Units should ensure that arrangements are in place for managing occupational exposures to healthcare workers occurring outside the hospital environment. In addition, Microbiologists and Virologists working with Occupational Health, Infectious Disease, and GUM colleagues are encouraged to ensure that appropriate and timely testing and follow-up arrangements are available and consistent with national guidance.
Incidents of healthcare workers occupationally exposed to bloodborne viruses in England, Wales and Northern Ireland, should be reported to Jane Aston/Sarah Tomkins at the Centre for Infections (tel: 020 8327 7152/7095).
References
1. Health Protection Agency Centre for Infections, National Public Health Service for Wales, CDSC Northern Ireland and Health Protection Scotland. Eye of the Needle. United Kingdom Surveillance of Significant Occupational Exposures to Bloodborne Viruses in Healthcare Workers. London: HPA, November 2006. Available at:
<http://www.hpa.org.uk/publications/2006/eye_needle/default.htm>.
2. HIV Post-Exposure Prophylaxis: Guidance from the UK Chief Medical Officers Expert Advisory Group on AIDS. London: Department of Health, February 2004.
3.Expert Advisory Group on AIDS and the Advisory Group on Hepatitis. Guidance for clinical health care workers: protection against infection with bloodborne viruses. London: UK Health Departments; 1998.
