Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: Surveillance of occupational blood and body fluids exposures (BBFE) in France is standardised since 2002 and conducted at national level through the Raisin network in collaboration with Geres (Groupe d’Etude sur le Risque d’Exposition des Soignants aux Agents Infectieux). Objective: To monitor and challenge BBFE in French hospitals.
Methods: Participation of healthcare facilities (HCF) to this surveillance network (called AES-Raisin) is voluntary and anonymous. BBFE were documented using a standardised questionnaire adapted from Geres studies. The questionnaire documents the nature, circumstances (mechanism, type of device, infectious status of the source) and follow-up of each BBFE. Incidence of BBFE is reported per 100 hospitalisation beds.
Results: In 2007, 15,605 BBFE were documented in 626 participating HCF, which accounted for 22 % of HCF and 46 % of hospitalisation beds in France, in steady increase since 2002. HCV or HIV status of the source was not known for more than 20 % of documented BBFE. Post-exposure prophylaxis (PEP) decreased at 4 % of exposed personnel (6.3% in 2002) and was discontinued in 41 % mainly because the source patient appeared secondary to be seronegative for HIV. Since 2004, sutures were the most frequent cause of BBFE associated with suture needles (more than subcutaneous injections) and accounted for 1,270 (10 %) of all BBFE occurred in surgery, obstetrics and in ICU or emergency rooms. Prevention through education and use of blunt suture needles is still a priority. Compliance to glove use increased from 58 % in 2002 to 67 % in 2007 as did the sharps disposal containers accessibility from 66 % in 2004 to 72 % leaving however a huge number of at-risk behaviors. Although in progress, the proportion of safety devices remained low in 2006 with 31 % for intravascular catheters and 32 % for needles for implantable devices. BBFE overall incidence was 7.5 per 100 beds. Considering that all French hospitals account for 448,505 beds, 33,628 BBFE could have occurred in France in 2007. Compared with 2004 (8.9% incidence and 41,429 estimated declared BBFE) we could estimate at nearly 8,000 the number of prevented accidents.
Conclusions: Our results led us to think that HCWs safety has been sharply increased during the past four years. To maintain and strengthen this tendency is the challenge of the new French 2009-2013 nosocomial infection prevention program with a one fourth BBFE incidence reduction objective.