Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Am J Kidney Dis. 2012 Oct;60(4):617-25. doi: 10.1053/j.ajkd.2012.05.013. Epub 2012 Jun 26.
Occupational exposure management is an important element in preventing the transmission of bloodborne pathogens in health care settings. In 2008, the US Centers for Disease Control and Prevention conducted a survey to assess procedures for managing occupational bloodborne pathogen exposures in outpatient dialysis facilities in the United States.
A cross-sectional survey of randomly selected outpatient dialysis facilities.
SETTING & PARTICIPANTS: 339 outpatient dialysis facilities drawn from the 2006 US end-stage renal disease database.
Hospital affiliation (free-standing vs hospital-based facilities), profit status (for-profit vs not-for-profit facilities), and number of health care personnel (≥100 vs <100 health care personnel).
Exposures to hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV); provision of HBV and HIV postexposure prophylaxis.
We calculated the proportion of facilities reporting occupational bloodborne pathogen exposures and offering occupational exposure management services. We analyzed bloodborne pathogen exposures and provision of postexposure prophylaxis by facility type.
Nearly all respondents (99.7%) had written policies and 95% provided occupational exposure management services to health care personnel during the daytime on weekdays, but services were provided infrequently during other periods of the week. Approximately 10%-15% of facilities reported having HIV, HBV, or HCV exposures in health care personnel in the 12 months prior to the survey, but inconsistencies were noted in procedures for managing such exposures. Despite 86% of facilities providing HIV prophylaxis for exposed health care personnel, only 37% designated a primary HIV postexposure prophylaxis regimen. For-profit and free-standing facilities reported fewer exposures, but did not as reliably offer HBV prophylaxis or have a primary HIV postexposure prophylaxis regimen relative to not-for-profit and hospital-based facilities.
The survey response rate was low (37%) and familiarity of individuals completing the survey with facility policies or national guidelines could not be ascertained.
Significant improvements are required in the implementation of guidelines for managing occupational exposures to bloodborne pathogens in outpatient dialysis facilities.
职业暴露管理是预防医疗机构血源性病原体传播的重要环节。2008 年，美国疾病控制与预防中心（CDC）进行了一项调查，以评估美国门诊透析机构管理职业性血源性病原体暴露的程序。
对随机抽取的门诊透析机构进行横断面调查。
从 2006 年美国终末期肾病数据库中抽取了 339 家门诊透析机构。
医院附属关系（独立机构与医院附属机构）、盈利状况（营利性与非营利性机构）以及卫生保健人员数量（≥100 人与<100 人）。
报告乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）职业性血源性病原体暴露情况；提供乙型肝炎病毒和 HIV 暴露后预防。
我们计算了报告职业性血源性病原体暴露并提供职业暴露管理服务的机构比例。我们分析了不同类型机构的血源性病原体暴露情况和暴露后预防措施的提供情况。
几乎所有（99.7%）受访者都有书面政策，95%的机构在工作日白天为卫生保健人员提供职业暴露管理服务，但在一周的其他时间服务提供频率较低。在调查前 12 个月内，约有 10%-15%的机构报告在卫生保健人员中发生 HIV、HBV 或 HCV 暴露，但在管理此类暴露的程序上存在差异。尽管 86%的机构为暴露的卫生保健人员提供 HIV 预防，但只有 37%的机构指定了主要的 HIV 暴露后预防方案。营利性和独立机构报告的暴露较少，但与非营利性和医院附属机构相比，提供乙型肝炎病毒预防的可能性较低，也不太可能制定主要的 HIV 暴露后预防方案。
调查的应答率较低（37%），无法确定完成调查的个人对机构政策或国家指南的熟悉程度。
需要在门诊透析机构管理职业性血源性病原体暴露的指南实施方面进行重大改进。
