Occupational exposure to blood borne pathogens among healthcare workers and preventative strategies

Abstract

The risk of occupational exposure to blood borne pathogens via percutaneous inoculation injuries (Plls), has been well documented (Public Health Laboratory Service, 1999). Most recently, Plls were the second most frequently reported injury by HCWs within hospitals in the UK (National Audit Office, 2003). In the USA, it is estimated that between 300,000 and 1 million Plls occur annually (Occupational Safety and Health Administration, 2001), whereas in the UK, it is estimated that 100,000 Plls are sustained each year (Godfrey, 2001). The true incidence of Plls is, however, unclear due to under reporting (Pugliese et al., 2001). Preventative strategies, including hepatitis B vaccination, training, education and universal precautions were implemented in an attempt to reduce the risk of occupational exposure to blood borne pathogens. Although these strategies had some impact in reducing this risk, HCWs continued to be exposed to blood borne pathogens, with a number seroconverting to hepatitis C and HIV (Thomas, 2002). The most recent preventative strategy has been needle protective devices (NPDs). With advancements in technology, NPDs have become the focus for reducing the risk of exposure to blood borne pathogens, particularly following American legislation in 2001 (Pugliese et al., 2001). However, technological advancement has out paced HCWs' ability to comprehensively evaluate these products for usability, acceptability and efficacy in reducing Plls, particularly in the UK. BD SafelonTM Pro (SLP) was a new NPD, not previously used in the clinical setting. The study, undertaken at University Hospital Birmingham NHS Trust, initially evaluated the product as acceptable to HCWs, however during the clinical trial, blood splash during the catheterisation procedure was a potential risk of mucocutaneous inoculation injury to HCWs. Consequently, the product was modified and a non-clinical trial found improved acceptability and reduced blood splash. The number of reported Plls were evaluated over a two year period. HCWs utilised various methods to report incidents, frequently not complying with current Trust policy. To gain further insight into the number of Plls sustained by HCWs, an under reporting study was undertaken for both clinical and ancillary staff. Percutaneous inoculation injuries were not always reported, most frequently due to pressure of workload and self assessment of the incident. Ancillary staff also sustained Plls and near miss incidents due to inappropriately disposed sharp devices. Indeed, HCWs' knowledge of inoculation injuries, the risk of transmission of blood borne pathogens and the reporting procedure was inadequate. Furthermore, HCWs did not routinely wear gloves when handling sharp devices.