Incidence of Visits for Health Care Worker Blood or Body Fluid Exposures and HIV Postexposure Prophylaxis Provision at Rhode Island Emergency Departments

Abstract

Objectives-To compare the incidence and types of emergency department (ED) visits for blood or body fluid exposures sustained by health care workers (HCWs) in Rhode Island and to identify factors predictive of HIV postexposure prophylaxis (PEP) utilization for these exposures.Methods-A retrospective study of ED visits for blood or body fluid exposures to all Rhode Island EDs from January 1995 to June 2001 was conducted. Average incidence rates (IRs) of visits by HCW occupation and type of exposure were estimated and compared. Logistic regression models were created to determine which HCWs were more likely to be offered and to accept HIV PEP.Results-Of 1551 HCW ED visits for occupational exposures, 72.5% sustained a percutaneous injury and only 2.5% were exposed to a source known to be HIV-infected. Hospital custodians had the highest IR of ED visits for percutaneous injuries (81 ED visits per year per 10,000 workers). Visits for all exposures increased over the study years and were most common during March, on weekends, and at 5:00 PM. Of all HCWs, 91.2% presented within 24 hours of their exposure and 98.2% presented within 72 hours. HIV PEP was offered to 469 HCWs and accepted 229 times. HCWs more likely to be offered HIV PEP were exposed to a known HIV-infected source (odds ratio [OR] = 6.38), sustained a significant exposure (OR = 4.98), presented to an academic hospital ED (OR = 2.60), were a member of the medical staff (OR = 2.02), and were exposed during the latter years of the study (OR = 1.23). HCWs were more likely to accept HIV PEP when it was offered if they were male (OR = 1.64) and presented to an academic hospital ED (OR = 2.72). Because of the complex sampling scheme used for these types of surveillance systems and the data collected for these types of studies, the estimates are limited to national-level data instead of state-or regional-level data and to selected occupations. NIH Public AccessOne of the major concerns about blood or body fluid exposures is the risk of acquiring an HIV infection. Since 1996, the CDC has recommended the use of HIV postexposure prophylaxis (PEP) to reduce the transmission of HIV after certain HCW exposures. [6][7][8][9] According to CDC guidelines, HIV PEP use should be dictated by the characteristics of the exposure and by the HIV status of the exposure source. According to Cardo et al, 10 the risk of acquiring an HIV infection is greater for percutaneous injuries that involve hollow-bore needles that have been in contact with an artery or vein, when blood is visible on the device, and when the source patient has AIDS. Studies of HIV PEP have shown that use is not always in accordance with recommendations, however. 9,11 In real-world clinical situations, details of the exposure and the status of the source may be limited. Therefore, other influences might prompt clinicians to prescribe HIV PEP.Many HCWs first seek medical attention for their blood or body fluid exposures from the ED. Examining HCW visits to EDs could reveal the frequency for which HCWs are...

Blood or Body Fluid Exposures and HIV Postexposure Prophylaxis Utilization among First Responders

“…They found that the yearly incidence of ED visits for blood or body fluid exposures was 127 ED visits per 10,000 first responders, 56 per 10,000 medical staff, and 51 per 10,000 nursing staff. 19 …”

HIV prone occupational exposures: epidemiology and factors associated with initiation of post-exposure prophylaxis

“…Currently, there are no published studies on PEP-uptake predictors following occupational exposures to HIV-positive source patients across different healthcare settings. Some follow-up experiences with PEP have been reported; however, these are limited by small numbers,34 limitation to specific settings35 and a focus on completion rather than uptake.…”

“…PEP prescription practices have been shown to vary in time, person and place. For example, an occupational injury incident study in Rhode Island Emergency departments found evidence for an association between PEP prescription and the (medical) profession of the recipient 35. Patel and colleagues38 found considerable differences in PEP prescription between A&E and occupational health staff, and prescribing PEP has been shown to depend on the personal characteristics of the prescribing doctor 39…”

Occupational exposure, drug toxicities and adherence to HIV post exposure prophylaxis: a cohort study at the teaching hospital in Erode district, Tamilnadu, India

“…12 Rhode Island Emergency Departments, a retrospective study of emergency department's visits for blood or body fluid exposures, 72.5% sustained a percutaneous injury and only 2.5% were exposed to a known source of HIV. 13 Jeremy JE Johnston et al, retrospective review of all emergency notes triaged as needle stick injury for from July 2001 to July 2002, observed a deferral and lack of urgency in the assessment and treatment of needle stick injuries. Nigerian study on PEP revels that 63% for the exposures due to needle stick injuries; Surgical operations and venopuncture were the common procedures at the time of exposure.…”