Vinod K V, Hamide Abdoul, Dutta Tarun K, Harichandrakumar K T
Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantrinagar, Puducherry - 605 006, India.
Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantrinagar, Puducherry - 605 006, India.
Indian J Occup Environ Med. 2016 Sep-Dec;20(3):138-143. doi: 10.4103/0019-5278.203140.
Occupational exposures (OEs) to blood and body fluids (BBFs) pose significant risk of transmission of blood-borne infections (BBIs) to health care personnel (HCP) and are grossly underreported. We aimed to study the awareness of BBIs and their prevention, burden of OEs, assess factors contributing to them and their poor reporting and assess the practices for their prevention among HCP.
This cross-sectional study conducted at a tertiary care teaching hospital located in south India used a self-administered questionnaire to assess the awareness of BBIs, attitude and practice of HCP for prevention of OEs, and to quantify the burden of exposures. All formally self-reported OEs during the study period of 2 years were documented prospectively.
Majority (369/401, 92%) of HCP surveyed had fair general awareness of BBIs. Though 90% were aware of the concept of universal precautions (UPs), self-reported adherence to barrier precautions was acceptable in only 80%. Overall, 56% and 46% of HCP were aware of human immunodeficiency virus (HIV) and hepatitis B post-exposure prophylaxis (PEP) respectively. Eighteen percent (74/401) were either not vaccinated or incompletely vaccinated against hepatitis B. Recapping of used needles was reported by 79% (317/401). Nearly half (208/401) reported OEs over preceding year and 70% (146/208) of exposed had not formally reported them. Over the 2-year study period, 53 formally self-reported exposures were documented prospectively. Needle stick injuries accounted for 83% of the exposures, and appropriate personal protective devices were not being used during 47% of exposures. Though doctors had the highest awareness, they reported lowest adherence to barrier precautions and highest burden of exposures ( < 0.05).
Though majority of HCP had fair awareness of BBIs, it did not translate into adequate adherence to UPs and safe practices. High burden of OEs and their poor reporting emphasize the need to motivate our HCP to adhere to safe work practices and to promptly seek professional counselling after exposures. There is an urgent need to educate HCP about the availability and effectiveness of PEP for HIV and hepatitis B. A uniform national policy for prevention and reporting of OEs has to be framed.
医护人员职业暴露于血液和体液会带来血源性病原体感染传播的重大风险，且严重漏报。我们旨在研究医护人员对血源性病原体感染及其预防的认知、职业暴露负担，评估导致职业暴露及其漏报的因素，并评估医护人员的预防措施。
这项横断面研究在印度南部一家三级护理教学医院开展，采用自填式问卷评估医护人员对血源性病原体感染的认知、预防职业暴露的态度和措施，并量化暴露负担。对研究期间2年内所有正式自我报告的职业暴露进行前瞻性记录。
接受调查的大多数医护人员（369/401，92%）对血源性病原体感染有一定的总体认知。尽管90%的人了解普遍预防措施的概念，但自我报告的屏障预防措施依从性仅80%可以接受。总体而言，分别有56%和46%的医护人员了解人类免疫缺陷病毒（HIV）和乙肝暴露后预防（PEP）。18%（74/401）的人未接种或未完全接种乙肝疫苗。79%（317/401）的人报告有回套使用过的针头的情况。近一半（208/401）的人报告前一年有职业暴露，其中70%（146/208）的暴露者未正式报告。在2年的研究期间，前瞻性记录了53次正式自我报告的暴露。针刺伤占暴露的83%，47%的暴露发生时未使用适当的个人防护用品。尽管医生的认知度最高，但他们报告的屏障预防措施依从性最低，暴露负担最高（P<0.05）。
尽管大多数医护人员对血源性病原体感染有一定认知，但这并未转化为对普遍预防措施和安全措施的充分依从。职业暴露负担高且漏报严重，这强调需要激励医护人员坚持安全工作措施，并在暴露后及时寻求专业咨询。迫切需要对医护人员开展关于HIV和乙肝暴露后预防的可及性和有效性的教育。必须制定统一的国家职业暴露预防和报告政策。
