Differences between hospital- and community-acquired blood exposure incidents revealed by a regional expert counseling center.

OBJECTIVE

One year (2003) regional analysis of all blood exposure incidents from hospitals as well as from the community.

DESIGN

Establishment of an easily accessible regional expert counseling center, operating 24 h a day, for all accidental blood exposures. Tasks of the center were to register incoming calls, to inform and counsel the victim, to assess the risk of the incident, and to provide a plan of further actions, including prophylactic measures.

SETTING

A Dutch region (Northeast Brabant) with 500,000 inhabitants and two major hospitals (1,786 beds).

RESULTS

A total of 454 incidents (1.2 per day) were recorded. Only half of the incidents occurred in the hospital setting (n = 234), whereas the others (n = 220) took place in the community setting. Nearly all (95%, n = 432) incidents occurred during work, and most of them (84%, n = 385) were related to health care activities. In the hospital setting injuries occurred with physicians (13%), nursing staff (45%), operating room (OR) staff (13%), ancillary (18%), others (10%). In the community setting, incidents took place among healthcare workers (48%), detention and police officers (10%), civilians (10%), general practitioners/dentists and their staff (8%), cleaning staff (4%) and work-related incidents not falling into any of the above categories (7%). More low risk incidents took place outside the hospital (87% vs. 68% in hospital), while high-risk incidents predominantly occurred within the hospital setting (23% vs. 6%). The hepatitis-B immunization rate was significantly lower in victims from the community than in those working in hospitals (38% vs. 96%). Reports from incidents in the community setting were delayed.

CONCLUSIONS

Incidents that expose individuals to blood-borne pathogens occur equally frequent in the hospital and non-hospital (community) setting. Therefore, a regional expert counseling center, accessible around-the-clock, for all types of blood-exposure incidents is needed. Blood-exposure prevention programs should aim at a reduction of high-risk incidents within hospitals, and at increasing the awareness for vaccination and early reporting within the community setting.