Effectiveness of the Management Program of Bloodborne Occupational Exposures at a Tertiary Hospital in Vietnam

Background: Healthcare workers (HCW) are at increasing risk of occupational exposures (OE), especially to bloodborne pathogen. However, the management of bloodborne OEs for HCW are still insufficient in Vietnam

Objective: Monitor bloodborne OEs in HCWs and evaluate the impact of the management program

Methods: Prospective, cohort study

Intervention:A management program of bloodborne OEs has been established since July 2001 at Cho Ray hospital including: (1) Infection control department is responsible for managing bloodborne OEs and seting up the report system. (2) HCWs were followed up for 12 months after OEs, and were offered PEP if necessary, per CDC guidelines. (3) Continuous training for HCWs in infection control and safety techniques. (4) Sufficient provision of protective barrier equipment and needle disposal units.

Results: Between February 2000 and June 2009, 327 HCWs sustained bloodborne OEs, including percutaneous injuries exposure (N=245; =245/327*100 74.9%) and splashes (N=53;  =53/327*100 16.2%). Sixty seven cases were exposed to patients with HIV positive. There were no cases of seroconversion to HIV and HBV. One case had seroconversion to HCV. These cases were distributed every departments, but mainly in surgical sector (N=146; 44.6 %). Staff who had high risk were nurses (N=116; 35.5%), especially nurse students (N=34; 10.4%), cleaners (N=38; 11.6%) & surgeon (N=51; 15.6%). The majority of exposures occurred during surgical procedures (N=52;15.9%), injections (N=41; 12.7%), collecting rubbish, (N=48; 14.7%), drawing blood (N=26; 7.9%) and re-capping needles (N=31; 9.4%). Most injuries resulted from not complying with safety practice (N=236; 72.2%) or not using protective equipment (N=81; 24.7 %). Of 76 HCWs offered PEP, 26 (34.2%) failed to complete the full course of treatment mainly due to side effects. The most common side effects were headache, fatigue, dizziness.  The number of HIV-OEs before the initiation of the prevention program was 0.7/month in 2000 and 1.3/month in the first 6 months of 2001. After establishing prevention program, this number was reduced to 0.1/month in 2002, 0.4/month in 2004 and remained 0.3/ month in 2008 (p=0.007). Psychological burden to HCW after OEs is also reduced. Ordering of HIV test inappropriately (not for purpose of diagnosis but for precautions) was reduced significantly: 16% in-patients was ordered HIV test in 2001, reduced to 5.7% in 2008.

Conclusions: To reduce incidence of bloodborne EOs and its affect on HCWs, the infection control department should develop and establish the prevention program of OEs. The management, report, monitor and treatment of OEs should be applied as the routine work. Follow infection control guidelines, especially standard precaution is the most important factor in preventing of bloodborne OEs. Improvement in waste management, training on safety techniques are required in this setting.