© Borgis - Postępy Nauk Medycznych 11/2014, s. 740-743
*Joanna Krzowska-Firych1, Agata Kozłowska1, Justyna Stempkowska1, Karolina Snopek2, Benjamin Khan2, Joanna Smelcerz2
Ekspozycja zawodowa na krew i płyny ustrojowe wśród pracowników służby zdrowia w Lublinie w latach 2011-2012
Occupational exposure to blood and body fluids among health care workers in Lublin province (eastern Poland) in 2011-2012
1Department of Infectious Diseases, Medical University, Lublin
Head of Department: Krzysztof Tomasiewicz, MD, PhD
2Clinical Research Association for Infectious Diseases (CRAID), Department of Infectious Diseases, Medical University, Lublin
CRAID Coordinator: Joanna Krzowska-Firych, MD, PhD
Streszczenie
Wstęp. Ekspozycja zawodowa pracowników ochrony zdrowia na krew i inny potencjalnie infekcyjny materiał stwarza istotne ryzyko zakażeń wywołanych przez wirusy zapalenia wątroby typu B (HBV) i typu C (HCV) oraz wirus nabytego niedoboru odporności (HIV).
Cel pracy. Celem pracy była ocena ilości i rodzaju ekspozycji z uwzględnieniem grup zawodowych wśród pracowników ochrony zdrowia, którzy ulegli ekspozycji zawodowej w latach 2011-2012 i byli konsultowani w Poradni Profilaktyki Poekspozycyjnej w Lublinie. Analizie poddano również skuteczność profilaktyki poekspozycyjnej u osób eksponowanych na HBV, HCV czy HIV.
Materiał i metody. Dane uzyskano poprzez retrospektywną analizę dokumentacji medycznej pracowników ochrony zdrowia, którzy po ekspozycji zawodowej byli konsultowani w Poradni Profilaktyki Poekspozycyjnej przy Katedrze i Klinice Chorób Zakaźnych UM w Lublinie w latach 2011-2012.
Wyniki. W latach 2011-2012 ogółem konsultowano 206 pracowników ochrony zdrowia, którzy ulegli ekspozycji zawodowej. W tej grupie 44,7% stanowiły pielęgniarki. U 144 (69,9%) osób doszło do zakłucia igłą. Badania krwi osób będących źródłem zakażenia wykazały obecność przeciwciał anty-HCV u 18 osób, antygenu HBs u 11 i przeciwciał anty-HIV u 5 osób. U żadnego pracownika po ekspozycji zawodowej nie doszło do zakażenia.
Wnioski. Zakłucie igłą stanowiło najczęstszą postać ekspozycji w badanej grupie. Największą liczbę ekspozycji odnotowano wśród pielęgniarek. Badania krwi osób będących źródłem zakażenia wykazały, że ekspozycje na HCV są częstsze niż na HBV. Profilaktyka poekspozycyjna była skuteczna u wszystkich eksponowanych osób.
Summary
Introduction. Occupational exposure to blood and body fluids among HCWs constitutes a significant risk of transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).
Aim. The aim of this study was to estimate the number, occupation, type of the exposure and the efficacy of PEP among HCWs exposed to blood or body fluids consulted at the Dispensary of Occupational Post-Exposure Prophylaxis of Diseases Transmitted With Blood in the Department of Infectious Diseases, Medical University of Lublin, Poland in 2011-2012.
Material and methods. We have retrospectively analyzed medical records from years 2011-2012 of all HCWs occupationally exposed to blood or body fluids consulted at the Dispensary of Occupational Post-Exposure Prophylaxis of Diseases Transmitted With Blood in the Department of Infectious Diseases, Medical University of Lublin, Poland.
Results. Since 2011-2012 206 exposed HCWs were consulted. There were 44.7% nurses. In 144 (69.9%) HCWs needlestick injury was noted. The serology of source persons blood revealed HCV antibody in 18 persons, HBs antygen in 11 and HIV antibodies in 5 people respectively. Infection caused by blood borne pathogens was not observed in exposed HCWs.
Conclusions. Needlestick injury was the most common form of exposure. The biggest group of HCWs reported exposures were nurses. Most HCWs were exposed to HCV than to HBV. PEP was succesfull in all exposed HCWs.
INTRODUCTION
Occupational exposure to blood or body fluids among health care workers (HCWs) constitutes a significant risk of transmission of blood borne pathogens (BBP). These exposures can lead to infection with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Blood borne pathogens may be transmitted through percutaneous or mucocutaneous exposure to body fluids especially via needlestick injuries (NSIs) and splash injuries (1).
It is estimated that more than 3 million health care workers worldwide experience percutaneous exposure to blood pathogens each year, resulting in approximately 1000 HIV, 66 000 HBV and 16 000 HCV new infections annually. The risk of transmission of HBV infection by a needlestick injury is between 6 and 30% for susceptible HCWs, without post-exposure prophylaxsis (PEP). The transmission rate of HCV is estimated between 1 and 10%. The risk of HIV infection from a positive source is estimated to be 0.3% from a single percutaneous exposure and 0.09% from mucous membrane exposure (2). According to World Health Report 2002, 2.5% of HIV cases among HCWs and 40% of hepatitis B and C cases among HCWs worldwide are the result of occupational exposure (3). Among health care workers seroprevalence of HBV is two to four times higher than in general population (4).
Needlestick injuries of HCWs are an important occupational hazard leading to infections with BBP and unsafe practices can increase the potential risk of occupational transmission (5).
Prevention of blood exposure accidents involves safe working procedures. Strategies are available to prevent infections including education of HCWs and reduction of invasive procedures (6).
In HCWs exposed to BBP the potential for transmissing HBV, HCV and HIV should be evaluated. The source patient’s serostatus for antibodies against HCV, HIV and HBsAg should be obtained. In exposed person baseline HBV, HCV and HIV immune status should be available (7). If the source patient is HBsAg-positive PEP is not recommended in previously vaccinated HCWs with known antibody response. In other HCWs PEP with HBV vaccine, hepatitis immunoglobulin or both must be started as soon as possible. In HCWs exposed to viremic HCV source patients monthly monitoring of alanine aminotransferase activity and anti-HCV antibodies at month six is recommended. Following occupational exposure with potential for HIV transmission, use of antiretroviral PEP should be evaluated based on the route of exposure, the material involved and evaluation of the source patient (8).
AIM
The aim of this study was to estimate the number, occupation, type of the exposure and the efficacy of PEP among HCWs exposed to blood or body fluids consulted at the Dispensary of Occupational Post--Exposure Prophylaxis of Diseases Transmitted With Blood in the Department of Infectious Diseases, Medical University of Lublin, Poland in 2011-2012. To asses the data a retrospective survey was undertaken.
MATERIAL AND METHODS
We have retrospectively analyzed medical records from years 2011-2012 of all HCWs occupationally exposed to blood or body fluids consulted at the Dispensary of Occupational Post-Exposure Prophylaxis of Diseases Transmitted With Blood in the Department of Infectious Diseases, Medical University of Lublin, Poland.
RESULTS
Since 2011 to 2012, 206 HCWs exposed to blood or body fluids were consulted at the Dispensary of Occupational Post-Exposure Prophylaxis of Diseases Transmitted with Blood in the Department of Infectious Diseases, MU of Lublin to evaluate the risk of HBV, HCV and HIV infection and to initiate PEP. In all exposed health care workers hepatitis B surface antigen (HBsAg), antibodies to HCV (anti-HCV) and antibodies to HIV were assessed on admission and in vaccinated HCWs the titer of HBs antibodies was measured. Blood from source patients was tested for HBs antigen, antibodies to HCV, and antibodies to HIV.
The study population consisted of 206 HCWs. Among them 67 were exposed in 2011 and 139 in 2012. There were 164 women (55 in 2011 and 109 in 2012) and 42 men (12 in 2011 and 30 in 2012). The mean age was 40 years, ranging from 22-62 years.
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Piśmiennictwo
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