Exposure to Blood and Body Fluids: Where to Target Preventive Measures Based on Risk

Background: Occupational exposure to blood and body fluids (BBF) remains commonplace (and psychologically traumatic) to healthcare personnel.  In communities such as Washington DC, where the incidence of HIV, HCV, and HBV are high, there is of course a greater risk of acquisition of these infections.

Objective: With intent to more strategically target staff education and other preventative measures, we identified rates of exposure for higher-risk sub-sets by analyzing occupational groups and work settings.

Methods: Retrospective review of a 1999-2008 data set of BBF exposures at the Washington DC VAMC , a tertiary-care medical center with 167 acute-care beds,  and 120 nursing home (LTC). The data detailed type of exposure, setting where the exposure occurred, and the occupational group of the BBE-exposed personnel

Results: There were 564 occupational exposures to BBF during the study period, yielding an average of one exposure per week.  Needlesticks caused 66% (n=376) of the exposures, sharps 20% (115), splash/spill 10% (59), contact 2% (12), and “other” <1% .  Over the study period, there was an average of 4.9 exposures per 10,000 patient-days in acute care   Of these, there was a mean of 2.9 exposures per 10,000 patient-days of care on the ward, and a mean of 15.2 exposures per 10,000 patient-days of care in the ICU (see Figure).

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 In LTC, there was a mean 0.5 exposures per LTC 10,000 patient-days of care. In the outpatient clinics, there were 3.5 exposures to BBF per 100,000 visits, and only 2.6 exposures per 10,000 hemodialysis center visits.  Housestaff had the highest number of exposures to BBF at 196 (35% of all exposures).  The average rate of BBF exposure was 15.2 per 100 housestaff FTEs, which was ten-fold higher than the average rate of 1.6 per 100 non-housestaff FTEs. Nurses had the second highest number of exposures to BBF at 120 (21% of all exposures).  Technicians who routinely use needles for venipuncture had, over the whole 10 years, only 11 exposures. 

Conclusions: The prospect of a needlestick or other BBF exposure is more than a statistical risk: it can be a real and personal threat to many healthcare professionals. Highest rates of exposure occurred in the ICUs and acute care with very low rates in the outpatient settings and LTC. Concentrated education and training interventions should be directed toward housestaff and nurses working in these settings.  Low rates of exposure to BBF in some groups and areas with frequent use of sharps, including phlebotomists and the hemodialysis center, suggest that experience and training are key to prevention.