Exposure of healthcare
workers in England, Wales, and Northern Ireland to bloodborne
viruses between July 1997 and June 2000: analysis of
2001;322:397-398 ( 17 February )
consultant epidemiologist a, Winnie Duggan,
research nurse a, Juliet Baker,
research nurse a, Mary Ramsay,
consultant epidemiologist a, Dominique Abiteboul,
occupational physician b, on behalf of
the Occupational Exposure Surveillance Advisory Group.
Disease Surveillance Centre, Colindale, London NW9 5EQ, b Study
Group on Occupational Blood Exposure, Faculté Bichat, Paris
Cedex 18, France
to: B Evans firstname.lastname@example.org
transmission of bloodborne viruses to healthcare workers can
have serious consequences not only for clinical practice but
also, because of the requirements of health and safety
legislation, for their employers.
In spite of guidance and education,
however, many healthcare workers continue to be exposed
to bloodborne viruses from percutaneous,
mucocutaneous, or other injuries. An enhanced
system of surveillance of occupational exposure to bloodborne
viruses was introduced in mid-1997, developing the
passive system that was set up after the first
reported case (in 1984) in the United Kingdom of
HIV seroconversion associated with needlestick injury.
1997 occupational health departments have been requested
to complete a brief form outlining the circumstances of any
work related exposure to potentially infectious material from
patients who are known to be positive for HIV antibodies
or hepatitis C antibodies, or for hepatitis B
surface antigens. For exposures to HIV or hepatitis
C virus, the follow up at six weeks includes more
information about the incident, baseline testing of both the
healthcare worker and the source patient, and, for exposure
to HIV, details of post-exposure prophylaxis.
A total of
813 initial reports were received of exposure of
healthcare workers to bloodborne viruses between July 1997 and
June 2000: 725 reports of exposure to only one of
the bloodborne viruses, 83 to two, and five to
all three. After records with missing information
were excluded, the most commonly reported exposed
groups were nurses and midwives (45% (308/678) of the health
professionals exposed) and doctors (38% (255/678)) (table),
and percutaneous injuries were the most commonly
reported type of exposure (70%).
follow up reports were received for 507 of the incidents.
These recorded that 64% (323) involved exposure during a
procedure, 20% (100) after the procedure but before disposal
of equipment, and 13% (64) during or after disposal; in
4% (20) the nature of the incident was not
reported. Post-exposure prophylaxis was recorded
for 138 of the healthcare workers exposed to HIV: 43 were
known to have fully completed four weeks of treatment, 19 workers
completed the course for some drugs, and 38 completed
none. In 38 workers post-exposure prophylaxis was
started but the length of treatment was not
recorded. Side effects caused by post-exposure
prophylaxis were recorded in 77 healthcare workers.
transmission occurred among 293 exposures to HIV despite
post-exposure prophylaxis, and none in 462 exposures to
hepatitis C virus. However, reports of follow up at
six months have not been received for all of these.
the cooperation of occupational health departments, the
enhanced surveillance system has been successful both in increasing
the number of incidents reported and in expanding its coverage
to hepatitis B and C. The case of HIV transmission
described above brings the total number of
occupationally acquired HIV infections reported in
the United Kingdom to five. A further 11 reported cases
among healthcare workers in the United Kingdom are associated
with work overseas in areas of high prevalence of HIV.
The low rate of completion of the recommended
course of post-exposure prophylaxis indicates the
importance of regular support during the four weeks
of the course.
2000 a six month follow up form was introduced that asks
retrospectively for evidence of the healthcare worker's post-exposure
infection status. Although transmissions of HIV among
healthcare workers after recorded exposures are unlikely to
go unrecognised, assessing transmission rates of hepatitis
C virus requires routine testing. No seroconversions
have occurred among the 142 healthcare workers
for whom post-exposure testing for hepatitis C
virus has been formally reported (95% confidence interval
0% to 3.35%), indicating a lower risk of transmission of
this virus than has been reported elsewhere.
However, only 102 exposures were due to
percutaneous needlestick injury, and only 65 of
these were from a hollow bore needle. Such exposures probably
do carry a considerable risk of transmission of hepatitis
C virus. One report of such a transmission was received,
but the exposure occurred in 1996, before the
enhanced surveillance period.
exposures to hepatitis B virus among vaccinated individuals
may not be well reported, the 151 occupational exposures
recorded here indicate the continuing importance of
maintaining rigorous programmes of vaccination of
Occupational Exposure Surveillance Advisory Group, which gave
helpful comments, comprised: Mark Bale and David Mullooly
(Health and Safety Executive); Janet Carruthers, Paul
Grime, and Lynne Risi (occupational health
department, King's College Hospital); Eric Monteiro
(genitourinary medicine clinic, Leeds General Infirmary);
Susan Turnbull (Department of Health); Sian Williams
(occupational health department, Royal Free
Hospital); David Goldberg and Fiona Raeside
(Scottish Centre for Infection and Environmental Health);
Howard Vaile, Caroline Ireland, and Stella Sawyer
(occupational health department, Chelsea and
Westminster Hospital); Carole Fry (Department of
Health); and Jane Watts (occupational health department, Charing
Cross Hospital). We thank Janet Mortimer of the Communicable
Disease Surveillance Centre for providing constructive
comments on drafting, and Pauline Rogers for
JB and then WD were supported by a grant from the Health and
interests: None declared.
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