| Abstract|| |
Occupational exposure poses a significant risk of transmission of blood-borne pathogens to healthcare workers (HCWs). Adherence to standard precautions, awareness about post exposure prophylaxis is poor in developing countries. This retrospective study analyzes the self-reported cases of occupational exposure in a tertiary care hospital. During the study period, 105 HCWs sustained occupational exposure to blood and body fluids. Majority of the victims 36 (34.2%) were interns and the clinical practice that led to the occupational exposure was withdrawal of blood (45.7%). Good infection control practices and emphasis on appropriate disposal are needed to increase the occupational safety for HCWs.
Keywords: Needle stick injury, occupational exposure, post exposure prophylaxis
|How to cite this article:|
Priya N L, Krishnan K U, Jayalakshmi G, Vasanthi S. An analysis of multimodal occupational exposure leading to blood borne infections among health care workers. Indian J Pathol Microbiol 2015;58:66-8
|How to cite this URL:|
Priya N L, Krishnan K U, Jayalakshmi G, Vasanthi S. An analysis of multimodal occupational exposure leading to blood borne infections among health care workers. Indian J Pathol Microbiol [serial online] 2015 [cited 2019 Aug 25];58:66-8. Available from: http://www.ijpmonline.org/text.asp?2015/58/1/66/151191
| Introduction|| |
An "occupational exposure" that may place a health care worker (HCW) at risk of blood borne infection is defined as a percutaneous injury (e.g., needle stick or cut with a sharp instrument), contact with the mucous membranes of the eye or mouth, contact with non-intact skin or contact with intact skin when the duration of contact is prolonged with blood or other potentially infectious body fluids. 
Occupational exposure pose a significant risk of transmission of blood borne pathogens such as human immunodeficiency virus (HIV), hepatitis B virus and hepatitis C virus to HCWs. According to the Centers for Disease Control and Prevention, approximately 384,000 percutaneous injuries occur annually in US hospitals, with about 236,000 of these resulting from needle sticks involving hollow bore needles. EPINet data for 2003 reports a rate of approximately 27 needle stick injuries (NSIs) per 100 beds in teaching hospitals.  Adherence to standard precautions, awareness about post exposure prophylaxis (PEP) is poor in developing countries among HCWs and documentation of exposures are suboptimal. , There are very few studies in India documenting the frequency, PEP protocols followed and consequences of NSIs. ,,
On this background, this retrospective study was undertaken to analyze the self-reported cases of occupational exposure in a tertiary care hospital.
- To determine the occurrence of occupational exposure of patients blood or body fluids in HCWs.
- To explore the nature and circumstances of the occupational exposure.
| Materials and Methods|| |
The study hospital is a tertiary care hospital with in-patient bed strength of 2700. Any HCW who had sustained an occupational exposure of blood and body fluids reports to anti-retroviral therapy centre of the hospital immediately and then referred to Integrated Counseling and Testing Center (ICTC) for HIV testing. At the ICTC, an occupational exposure register with protocols for management and follow up is maintained. Pretest and posttest counseling done and relevant proforma filled up, including personal details of HCW, place of work, time, date and type of injury, time of reporting of injury and first aid measures taken.
Blood sample of the source and the exposed HCW are subjected to baseline HIV testing by rapid test as per NACO guidelines. Based upon the exposure code and the source code, PEP is initiated and the HCW is followed-up at 6 weeks, 12 weeks and 6 months for HIV seroconversion. The blood sample of the source is also tested for Hepatitis B surface antigen (HBsAg) by rapid tests. The epidemiology of occupational exposure among HCWs in this tertiary care hospital was analyzed and reviewed for the period between January 2010 and December 2013.
| Results|| |
During the study period,105 HCW sustained occupational exposure to blood and body fluids. Among them 36 (34.2%) were interns, 21 (20%) were post graduate students, 17 (16.2%) were staff nurses, 15 (14.3%) were nursing students, 9 (8.6%) were paramedical workers and 7 (6.7%) were laboratory technicians [Table 1].
Blood was the most common body fluid associated with occupational exposure. The commonest type of occupational exposure was per cutaneous exposure (NSI) accounting for 85% followed by mucous membrane splash (13%) and exposure on intact skin (2%) [Table 2].
The analysis of the clinical practice that led to the occupational exposure revealed that 45.7% occurred during blood withdrawal, 24.7% during surgical procedures, 23% occurred due to improper disposable of sharps. Other clinical practices associated with occupational exposure included transferring of needles (3.8%) and biopsy procedures (2.8%) [Table 3]. A large proportion occurred because of incorrect handling such as recapping and improper disposal of the sharps. About 12% of HCWs reported the occupational exposure from 3 days to 3 months after the incident.
The source responsible for the NSI was not traceable in 29% of the incidents. Known sources accounted for 71% of the injuries. Of the known sources, 16 were positive for HIV and 4 were positive for HBsAg. Among the HIV positive exposures, 5 (31.3%) were CRRIs, 5 (31.3%) were postgraduate students, staff nurses 2 (12.5%) nursing students 3 (18.8%), and sanitary worker 1 (6.3%). Out of 16 HIV positive exposures, only 4 HCWs reported for continuous follow up at 6 weeks, 12 weeks and 6 months and were sero negative for HIV.
| Discussion|| |
Per cutaneous injuries, caused by needle sticks and other sharps are serious concern for all HCWs and pose a significant risk of occupational transmission of blood borne pathogens. The present study analyzed the nature and circumstances of occupational exposure in a busy tertiary care government hospital. The causes include various factors like type and design of needle, recapping activity, transferring specimens, collision between HCWs or sharps, during clean up, manipulating needles in patient line related work, handling devices or failure to dispose of the needle in puncture proof containers. 
Among the HCWs, interns were most prone to NSI (34.2%) followed by postgraduate students (16.2%). This can be a reflection of the larger number of exposure prone procedures conducted by these categories, or of their inexperience. In a study conducted by Muralidhar et al. 2010,  interns contributed to 17% and junior and senior residents contributed to 20% of the NSIs. Among the clinical practice that led to occupational exposure in our study, blood withdrawal was the commonest (45.7%), followed by surgical procedures (24.7%) and improper disposal of sharps (23%). This was similar to the study conducted by Jayanth et al. 2009,  where blood collection contributed to 59.3%, surgical procedure 22%, recapping 8.5% and improper disposable of sharps 18.6%.
In this study, 16 source cases were HIV seropositive and PEP was initiated for all these cases. They were advised to come for follow up after 6 weeks, 12 weeks and 6 months to detect HIV sero conversion. However, only four cases reported for complete follow up period and were found to be HIV negative after 6 months. This was similar to a study by Rele et al.  in which 10 staff who sustained injury with HIV positive source remained sero negative after the complete follow up period. The poor follow up of these cases have to be improved for an accurate analysis of the magnitude of the problem.
Infection due to blood borne pathogens can be greatly reduced by strictly practicing infection control guidelines. The epidemiology of occupational exposure for HCWs in developing countries is not well documented, and their health and safety remains a neglected issue. 
Under reporting of occupational exposure among HCWs is a widely prevalent problem. Gross under reporting of NSI should not lead health care administrators to underestimate the problem. Although the risk may be low, the psychological trauma as well as legal implications that follow such injuries can be considerable.  All health care organizations should train HCWs in infection control procedures and the importance of reporting occupational exposures. Preventive strategies have to be devised and reporting of NSI need to be made mandatory.
| References|| |
Jayanth ST, Kirupakaran H, Brahmadathan KN, Gnanaraj L, Kang G. Needle stick injuries in a tertiary care hospital. Indian J Med Microbiol 2009;27:44-7.
Shriyan A, Roche R, Annamma. Incidence of occupational exposures in a tertiary health care center. Indian J Sex Transm Dis 2012;33:91-7.
WHO. Reducing risks. Promoting Healthy Life. The World Health Report 2002. Geneva: World Health Organization; 2002.
Chogle NL, Chogle MN, Divatia JV, Dasgupta D. Awareness of post-exposure prophylaxis guidelines against occupational exposure to HIV in a Mumbai hospital. Natl Med J India 2002;15:69-72.
Tetali S, Choudhury PL. Occupational exposure to sharps and splash: Risk among health care providers in three tertiary care hospitals in South India. Indian J Occup Environ Med 2006; 10:35-40.
Rele M, Mathur M, Turbadkar D. Risk of needle stick injuries in health care workers - A report. Indian J Med Microbiol 2002;20:206-7.
Pery J, Parker G, Jagger J. EPINET report: 2003 percutaneous injury rates. Adv Expo Prev 2005;7:2-45.
Muralidhar S, Singh PK, Jain RK, Malhotra M, Bala M. Needle stick injuries among health care workers in a tertiary care hospital of India. Indian J Med Res 2010;131:405-10.
Kermode M, Jolley D, Langkham B, Thomas MS, Crofts N. Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings. Am J Infect Control 2005;33:34-41.
Dr. N Lakshmi Priya
Institute of Microbiology, Madras Medical College, Chennai - 600 003, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]