Sin W Wy, Lin A Wc, Chan K Cw, Wong K H
Special Preventive Programme, Centre for Health Protection, Department of Health, Kowloon Bay Health Centre, Hong Kong.
Hong Kong Med J. 2016 Oct;22(5):472-7. doi: 10.12809/hkmj164897. Epub 2016 Aug 26.
Needlestick injury or mucosal contact with blood or body fluids is well recognised in the health care setting. This study aimed to describe the post-exposure management and outcome in health care workers following exposure to hepatitis B, hepatitis C, or human immunodeficiency virus (HIV) during needlestick injury or mucosal contact.
This case series study was conducted in a public clinic in Hong Kong. All health care workers with a needlestick injury or mucosal contact with blood or body fluids who were referred to the Therapeutic Prevention Clinic of Department of Health from 1999 to 2013 were included.
A total of 1525 health care workers were referred to the Therapeutic Prevention Clinic following occupational exposure. Most sustained a percutaneous injury (89%), in particular during post-procedure cleaning or tidying up. Gloves were worn in 62.7% of instances. The source patient could be identified in 83.7% of cases, but the infection status was usually unknown, with baseline positivity rates of hepatitis B, hepatitis C, and HIV of all identified sources, as reported by the injured, being 7.4%, 1.6%, and 3.3%, respectively. Post-exposure prophylaxis of HIV was prescribed to 48 health care workers, of whom 14 (38.9%) had been exposed to known HIV-infected blood or body fluids. The majority (89.6%) received HIV post-exposure prophylaxis within 24 hours of exposure. Drug-related adverse events were encountered by 88.6%. The completion rate of post-exposure prophylaxis was 73.1%. After a follow-up period of 6 months (or 1 year for those who had taken HIV post-exposure prophylaxis), no hepatitis B, hepatitis C, or HIV seroconversions were detected.
Percutaneous injury in the health care setting is not uncommon but post-exposure prophylaxis of HIV is infrequently indicated. There was no hepatitis B, hepatitis C, and HIV transmission via sharps or mucosal injury in this cohort of health care workers.
在医疗环境中，针刺伤或黏膜接触血液或体液是广为人知的情况。本研究旨在描述医护人员在针刺伤或黏膜接触过程中暴露于乙型肝炎、丙型肝炎或人类免疫缺陷病毒（HIV）后的暴露后管理及结果。
本病例系列研究在香港的一家公立诊所进行。纳入了1999年至2013年期间被转介至卫生署治疗性预防诊所的所有发生针刺伤或黏膜接触血液或体液的医护人员。
共有1525名医护人员在职业暴露后被转介至治疗性预防诊所。大多数人遭受了经皮损伤（89%），尤其是在操作后清洁或整理过程中。62.7%的情况下佩戴了手套。83.7%的病例能够确定源患者，但感染状况通常未知，据受伤者报告，所有已确定源患者的乙型肝炎、丙型肝炎和HIV基线阳性率分别为7.4%、1.6%和3.3%。48名医护人员接受了HIV暴露后预防治疗，其中14人（38.9%）接触了已知感染HIV的血液或体液。大多数人（89.6%）在暴露后24小时内接受了HIV暴露后预防治疗。88.6%的人出现了与药物相关的不良事件。暴露后预防治疗的完成率为73.1%。在随访6个月（或接受HIV暴露后预防治疗的人员随访1年）后，未检测到乙型肝炎、丙型肝炎或HIV血清转化。
医疗环境中的经皮损伤并不罕见，但HIV暴露后预防治疗的指征并不常见。在这组医护人员中，未发生通过锐器或黏膜损伤传播乙型肝炎、丙型肝炎和HIV的情况。
