Cut and puncture accidents involving health care workers exposed to biological materials

Abstract

The first report of occupational acquisition of HIV appeared in 1984, and, by June, 1997, the Centers for Disease Control and Prevention (CDC) had reported 52 documented cases of seroconversion following occupational exposure to HIV-1 by health care workers of those cases. 47 (90.3%) were exposed to blood. The most frequent type of accident reported was percutaneous needlestick injury. Prospective studies have estimated that the risk of HIV transmission following percutaneous exposure to infected blood is 0.3% (Confidence Interval 95% = 0.2% to 0.5%). Following a mucous membrane exposure, the risk is 0.09% (CI 95% = 0.006% to 0.5%). The risk of hepatitis B acquisition ranges from 6% to 30%, and hepatitis C acquisition, 3% to 10%. Since 1992, the São Paulo Hospitals Hospital Infection Prevention and Control Service (SPCIH) has notified and treated all workers exposed to accidents involving biological materials. In the last six years, we have handled approximately 1,300 cases of reported accidents, of which 90% were percutaneous, most involving needlesticks. Such cases were frequently caused by the inadequate disposal and recapping of needles. In these accidents, 20% of the source patients were HIV positive, 10% were hepatitis C positive, and 7.6% were hepatitis B positive. This review summarizes the guidelines for a standardized response when dealing with accidents involving health care workers. Transmission of hepatitis B and HIV can be reduced if adequate preventive measures are taken in advance. If proper prophylaxis is not being done, it should be initiated immediately.

Hepatitis B in healthcare workers: prevalence, vaccination and relation to occupational factors

“…In this study, 456 reported accidents with biological materials occurred and source-patient serology tested 21% positive for the HIV, HBV or HCV pathogens, thus increasing the risk of blood-borne pathogen transmission. This frequency was relatively higher when compared to that found by Kelen et al [22] and Lanphear et al [23], but lower than that found by Marino et al [24].…”

The assessment of infection control in dental practices in the municipality of São Paulo

“…This type of accident, mainly with exposure to blood or bodily fluids should be treated as urgency, as the fastest the prophylaxis is initiated, the better the prognosis. 26 In our data we identified 47.88% of dental surgeons who reported accidents with potentially contaminated material. However, biological risk was overlooked in 74.15% of these incidents, since only 25.85% sought specialized medical assistance and of these, 42.10% were instructed to begin antiretroviral chemoprophylaxis and 5.26% received vaccination against hepatitis B.…”

“…In a study by Lima et al, 32 an anesthetic needle (19.4%) and an exploratory probe Nº 5 (16.4%) were the most frequently mentioned instruments. Appropriate care of the injured and exposed area is essential, highlighting: do not squeeze or enlarge in any way the lesion and cleanse the injured skin 26 with soap and water (52.04%), chlorhexidine (15.84%) or antiseptic liquids such as povidone-iodine 10% PVPI (2.04%) or alcohol 70% (11.54%). The use of irritant solutions such as hypochlorite (10.18%) and hydrogen peroxide (8.37%), seen in our study, are not recommended as an antiseptic as they worsen the wound and facilitate infection.…”

Potential spread of multidrug-resistant coagulase-negative staphylococci through healthcare waste

“…The selective pressure of antibiotics and other medicines, as well as chemical compounds commonly discharged as healthcare residues, can lead to the proliferation of these pathogens [2]. These organisms, mainly bacteria, may show antimicrobial resistance and are potential contaminants for hospital surfaces and materials [3].…”

“…As they are discharged with untreated residues, these microbial strains may contaminate both the hospital sewer systems and final disposal systems, such as sanitary landfills [3].…”