Exposure incidents among medical students in a high-prevalence HIV setting

Abstract

Introduction: Occupational injuries in medical students are concerning, especially in countries with a high prevalence of bloodborne infections. With more HIV-infected patients on antiretroviral treatment, appropriate post-exposure prophylaxis (PEP) depends on knowledge of source patients' infection status and treatment response. This study determined the number and type of exposure incidents, reporting practices, and PEP use among medical students at the University of Pretoria, South Africa. Methodology: Data were collected from an anonymous voluntary questionnaire completed by medical students from years 1 to 6 of study as well as from incident records archived at the Department of Family Medicine. Data were described and tests of association performed in Stata 11. Results: Thirteen percent of students overall and 21% of senior students reported an incident in the preceding year. The majority of incidents occurred during phlebotomy, with fatigue and work pressure found to be major contributing factors. Underreporting was common and many students displayed a lack of risk awareness and a preference for managing the incident privately. Although 59% knew the HIV-status of the source patient, less than a third knew the viral load and only 16.9% the regimen. Side-effects on antiretroviral treatment used for PEP were common and only about three-quarters of the students completed the course. Conclusions: We recommend targeted training, especially in the senior years, together with improving the work environment through attention to working hours, sharps disposal and ready availability of safety devices, improved reporting systems, individualised PEP, and possibly the implementation of an occupational injury support line.

Occupational exposure to blood and body fluids and use of human immunodeficiency virus post-exposure prophylaxis amongst nurses in a Gauteng Province hospital

“…Human immunodeficiency virus PEP services are free and available in most of South African hospitals and clinics, so that HCWs can access the services immediately after accidental exposure to BBFs of the patients. However, several research studies show that many exposed HCWs fail to report the occurrence of the exposures (Ajibola et al 2014;De Vries et al 2011;Makhado & Davhana-Maselesele 2016;Mponela et al 2015;Rossouw, Van Rooyen & Richters 2017;Sabermoghaddam et al 2015;Sendo 2014). The researcher observed from the ongoing hospital statistics that the uptake of PEP was low, compared to accidental occupational exposures occurring in the wards.…”

Human immunodeficiency virus and hepatitis B virus infection prevention following occupational exposure among staff at a regional referral hospital in Western Kenya

“…We found a prevalence of 3.5% and 4.1% of occupational injuries over a 2-year period; this is likely to be underestimated because its computation relied on only the number of health workers who reported injuries and were documented in the register. The prevalence of sharp injuries among nurses in Ghana in 2016 was 28.9%,[ 16 ] and 21% among medical students in Pretoria[ 17 ] over a 1-year period; and 35.6% within a 3-month period in health workers in Egypt. [ 18 ]…”

“…[ 21 ] This is because the majority of injuries were reported by health workers and occurred after the procedure due to poor handling of the device or incorrect disposal techniques, respectively. [ 17 ]…”

“…[ 22 ] However, PEP completion rates were suboptimal (57%); lower than among medical students in Pretoria where close to three-quarters completed PEP. [ 17 ] With such a high HIV prevalence among hospital patients and suboptimal PEP completion rates, health workers in this region are at an increased risk of HIV infection. [ 3 28 ]…”

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

“…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.…”