ReviewBlood-borne viruses in health care workers: Prevention and management
Introduction
Twenty-six different viruses have been shown to be responsible for occupational transmission in the literature.1 Three pathogens account for most cases due to their prevalence in patients and the severity of infections they cause: hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Pruss-Ustun et al.2 estimated that, in the year 2000, 16,000 HCV, 66,000 HBV and 1000 HIV infections may have occurred worldwide among health care workers (HCWs) due to their occupational exposure to percutaneous injuries (PIs).
In the present paper, we review data on management and prevention of blood-borne viruses in HCWs, focusing on HBV, HCV and HIV. For this purpose, systematic search was performed of Medline literature databases for papers published from January 1995 to March 2010 using the following search terms: health care workers, hepatitis C, hepatitis B/vaccination, HIV-1, injections/practices/utilization, equipment/re-use, personal protective equipment, infection control/standards, needle stick injuries/epidemiology, standard precautions, safety-engineered devices and post-exposure prophylaxis. We also searched for national guidelines on management and prevention of blood-borne viruses in HCWs via websites of public health institutes in specific countries (Centers for Disease Control, Health Protection Agency, CCLIN), and international guidelines via the WHO website (specifically, the Safe Injection Global Network).
Section snippets
Occupational risk of exposure to and transmission of blood-borne pathogens
Although case reports have documented transmission of these viruses as a result of splashes of blood from infected patients onto HCW mucous membranes, the highest proportion of transmission occurs through PI with hollow-bore needles for vascular access, i.e. blood-drawing and intravenous/arterial catheters.3, 4, 5, 6 Risk of transmission is closely related to work practices. Surgeons and laboratory assistants have been identified as having the highest risk of PI.7, 8, 9 When PI occurs, the risk
Preventing PI
Preventive methods and standard precautions for protecting both HCWs and patients from infection with blood-borne pathogens include hand washing after patient contact, use of barrier precautions (e.g. gloves), minimal manual manipulation of sharp instruments/devices (e.g. avoidance of needle recapping) and disposal in specific resistant containers.14 Regular training sessions targeting both long-term HCWs, students and residents at high risk of injury15 can help to ensure compliance with
HBV vaccination of HCWs
All HCWs in contact with patients, blood or other body secretions should be vaccinated for HBV. HBV vaccination protects HCWs not only against HBV infections but also against delta virus infections occurring only in individuals positive for HBV surface antigen.28, 29 However, vaccine coverage remains disparate in western countries, and poor vaccine coverage has been reported in some countries despite recommendations.30 To ensure wider hepatitis B vaccine coverage, vaccination should be carried
Management of HCWs exposed to blood-borne pathogens
The exposed site should be washed with soap and water. The potential for transmitting HBV, HCV and HIV should be evaluated based on the type of exposure and body material involved. The risk of transmission of these viruses increases with deep injuries and procedures involving hollow-bore needles.3, 13 The source patient's serostatus for antibodies against HIV, HCV and HBsAg should be obtained. If the source patient is at risk of recent HIV or HCV infection on the basis of recent exposure (e.g.,
Preventing transmission from HCWs to patients
The Society for Healthcare Epidemiology of America (SHEA) has recently reviewed data on HCW-to-patient transmission.53 Reports of HBV, HCV and HIV transmission from HCWs to patients exist.54 Occupational transmission of blood-borne viruses to patients almost exclusively occurs via infected HCWs such as surgeons performing EPPs. EPPs are “those where there is a risk that injury to the worker may result in exposure of the patient's open tissues to the blood of the worker. These procedures include
Conclusion
Here we have briefly reviewed prevention and management of blood-borne pathogens in HCWs in developed countries. It is important to emphasize the fact that occupational blood exposure is of great concern in developing countries; indeed, a high proportion of worldwide occupationally acquired HCV, HBV and HIV infections occur in these countries. HCWs are exposed to patients with a higher prevalence of blood-borne viruses than in developed countries. Moreover, re-use of needles and syringes in the
Conflict of interest
S. Deuffic-Burban received grants from Roche and Janssen-Cilag. Y. Yazdanpanah received travel grants, honoraria for presentations at workshops and consultancy honoraria from Bristol-Myers Squibb, Gilead, Glaxo-SmithKline, Merck, Pfizer, Roche and Tibotec. None of the authors report any association that might pose a conflict of interest.
Acknowledgments
The authors thank Céline Ciotti and Gérard Pellissier from the Groupe d’Etude sur le Risque d’Exposition au Sang (GERES) for their valuable assistance on research data of occupational exposure in the world.
Funding: None.
Ethical approval: Not required.
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