Occupational blood and body fluid exposures and human immunodeficiency virus post-exposure prophylaxis amongst intern doctors

Abstract

BackgroundHealthcare workers (HCWs) are constantly vulnerable to occupational blood and body fluid exposures (OBBFEs). Exposed HCWs experience emotional, physical and psychological trauma. Less experienced HCWs, such as intern doctors, are more prone to OBBFEs.ObjectivesThe aim of this study was to investigate the prevalence and practices pertaining to OBBFEs amongst a select group of intern doctors in the Gauteng province of South Africa.MethodsA quantitative cross-sectional descriptive study using a questionnaire based on a practical model was used. Intern doctors were recruited from four major hospitals in Gauteng.ResultsA total of 175 intern doctors participated in the study. There was a total of 182 (mean = 1.04, standard deviation [s.d] 0.88) reported OBBFEs amongst 136 (77.7%) subjects. The exposures occurred predominantly whilst subjects were working in surgery (n = 50, 27.5%), obstetrics and gynaecology (n = 49, 26.9%) and internal medicine (n = 48, 26.4%) departments; were superficial wounds (n = 69, 37.9%); were acquired during vascular puncture or intravenous line insertion (n = 69, 37.9%); and occurred when subjects were working >12 h shifts (n = 101, 55.5%). Human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP) was initiated in 141 (77.5%) out of the 182 exposures. Only 90 (63.8%) subjects completed the recommended 28-day course of PEP. Two (1.1%) subjects reported that they had acquired HIV infection as a consequence of the OBBFE.ConclusionOccupational blood and body fluid exposures are common amongst intern doctors. It is recommended that regular training, health education and monitoring compliance should be incorporated during the induction of medical intern doctors in hospitals. The availability of PEP regimens with better tolerability will encourage compliance.

High post-exposure prophylaxis uptake but low completion rates and HIV testing follow-up in health workers, Harare, Zimbabwe

“…All HCWs at the clinic started triple drug therapy within 48 hours in line with national guidelines. This is a faster uptake compared with South Africa [13], but similar to that reported from Malawi [7].…”

“…Third, the proportion of HCWs recorded as completing PEP was just over 10%, much lower than that recorded in other studies from Botswana, Tanzania and South Africa where rates of completion ranged from 23% to 71% [10,12,13,23,24]. The reasons are unclear as the register did not record why the PEP course was not completed, but it may have been due to stigma related to HCWs having to queue and collect medication at the OI clinic, failure to record PEP completion in the register, side effects of medication or belief that the 28-day course was unnecessary or not effective.…”

“…It is likely, however, that these HCWs were also HIVnegative as most of them started PEP treatment. The uptake of PEP was higher than that reported recently from Tanzania, Cameroon, Botswana and South Africa where uptake ranged from 12% to 78% [8,10,12,13,22,23]. All HCWs at the clinic started triple drug therapy within 48 hours in line with national guidelines.…”

“…Published studies from African countries in the last ten years point to a lack of awareness and uptake of PEP amongst HCWs and students after occupational injury to HIV [7][8][9][10][11][12][13]. This is further compounded by poor follow-up and lack of HIV testing after completion of medication.…”

Occupational exposure to HIV among nurses at a major tertiary hospital: Reporting and utilization of post-exposure prophylaxis; A cross-sectional study in the Western Cape, South Africa

“…During 2008, 42 out of 53 (79.2%) intern doctors reported exposure to blood or body fluids of which 64% were percutaneous injuries and 36% mucosal [16]. Similarly, in 2019 at the Far East Rand Hospital in the Gauteng Province, 136 out of 175 (77.7%) reported exposure to blood and body fluids among interning doctors [17]. To our knowledge, data on nurses' exposure to HIV at the workplace in South Africa are scarce.…”