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Prevalence and Risk Factors for Bloodborne Exposure and Infection in Correctional Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

Robyn R. M. Gershon ,
Martin Sherman ,
Clifford Mitchell ,
David Vlahov ,
Melissa J. Erwin ,
Mary Kathleen Lears ,
Sarah Felknor ,
Rebecca A. Lubelczyk  and
Miriam J. Alter
Robyn R. M. Gershon*
Affiliation:
Mailman School of Public Health, Columbia University, New York, NY
Martin Sherman
Affiliation:
Department of Psychology, Loyola College, Johns Hopkins University, Baltimore, Maryland
Clifford Mitchell
Affiliation:
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
David Vlahov
Affiliation:
Center for Epidemiologic Studies, New York Academy of Medicine, New York, NY
Melissa J. Erwin
Affiliation:
Mailman School of Public Health, Columbia University, New York, NY
Mary Kathleen Lears
Affiliation:
School of Nursing, Johns Hopkins University, Baltimore, Maryland
Sarah Felknor
Affiliation:
School of Public Health, University of Texas, Houston
Rebecca A. Lubelczyk
Affiliation:
Bay State Correctional Center, Norfolk, Massachusetts
Miriam J. Alter
Affiliation:
University of Massachusetts Medical School, Correctional Health Division of Commonwealth Medicine, Worcester
*
Mailman School of Public Health, Columbia University, 600 West 168th Street, Fourth Floor, New York, NY 10032 (rg405@columbia.edu)
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Abstract

Objective.

To determine the prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers (CHCWs).

Design.

Cross-sectional risk assessment study with a confidential questionnaire and serological testing performed during 1999-2000.

Setting.

Correctional systems in 3 states.

Results.

Among 310 participating CHCWs, the rate of percutaneous injury (PI) was 32 Pis per 100 person-years overall and 42 Pis per 100 person-years for CHCWs with clinical job duties. Underreporting was common, with only 25 (49%) of 51 Pis formally reported to the administration. Independent risk factors for experiencing PI included being age 45 or older (adjusted odds ratio [aOR], 2.41 (95% confidence interval (CI), 1.31-4.46]) and having job duties that involved needle contact (aOR, 3.70 [95% CI, 1.28-10.63]) or blood contact (aOR, 5.05 [95% CI, 1.45-17.54]). Overall, 222 CHCWs (72%) reported having received a primary hepatitis В vaccination series; of these, 150 (68%) tested positive for anti-hepatitis B surface antigen, with negative results significantly associated with receipt of last dose more than 5 years previously. Serologic markers of hepatitis В virus infection were identified in 31 individuals (10%), and the prevalence of hepatitis B virus infection was 2% (n = 7). The high hepatitis B vaccination rate limited the ability to identify risk factors for infection, but hepatitis C virus infection correlated with community risk factors only.

Conclusion.

Although the wide coverage with hepatitis B vaccination and the decreasing rate of hepatitis C virus infection in the general population are encouraging, the high rate of exposure in CHCWs and the lack of exposure documentation are concerns. Continued efforts to develop interventions to reduce exposures and encourage reporting should be implemented and evaluated in correctional healthcare settings. These interventions should address infection control barriers unique to the correctional setting.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 1 , January 2007 , pp. 24 - 30
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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