Accidentes ocupacionales y conocimiento sobre precauciones universales en internos universitarios costarricenses

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Abstract

Justificación y objetivo: los internos universitarios (estudiantes de medicina en su último año) son vulnerables a accidentes ocupacionales con agujas y otros objetos cortantes, especialmente debido a su inexperiencia y falta de entrenamiento aunados a su deseo de realizar una serie de nuevas actividades y procedimientos. No existe información en nuestro país con respecto a la frecuencia de este tipo de accidentes en internos universitarios de la carrera de medicina. El objetivo del presente estudio fue estudiar la frecuencia y tipo de accidentes ocupacionales sufridos con mayor frecuencia por internos de medicina y evaluar su conocimiento sobre precauciones universales. Metodología: Se realizó un estudio descriptivo de corte transversal a través de una encuesta directa y anónima. De todos los internos de medicina que trabajaban en el Valle Central de octubre de 2001 a enero de 2002 se seleccionó una muestra aleatoria de 201 internos (poder 95%, error 5%). A la población seleccionada se le aplicó una encuesta precodificada, la cual consistía en 20 preguntas estructuradas, la mayoría cerradas y tres abiertas relacionadas con la ocurrencia de accidentes ocupacionales en los médicos internos, número, tipo, acciones tomadas tras el accidente y conocimientos sobre precauciones universales. Posteriormente se hizo un análisis descriptivo de los resultados obtenidos. Resultados: de todos los participantes, 90% habían trabajado más de 3 meses como médicos internos. Más de la mitad habían realizado al menos 3 meses de rotación en una área médica y 3 meses en una área quirúrgica. La muestra incluyó estudiantes de 5 universidades diferentes. Sólo un 37% de los internos encuestados habían recibido la vacunación contra virus de la hepatitis B. Del total de internos, 64% admitió haber sufrido al menos un accidente ocupacional con sangre de algún paciente, un 20% admitió haber sufrido 3 o 4 accidentes. De los internos que admitieron haber sufrido accidentes ocupacionales con agujas, el 78% refirió no haber hecho nada luego del accidente, la mayoría dijeron desconocer que tenían que hacer. Del total de la muestra, un 93% de los internos conocían poco o nada sobre las precauciones universales y sólo 6% pudieron mencionar 3 medidas correctas relacionadas con éstas. Conclusión: una proporción alta de internos universitarios en medicina en Costa Rica sufre accidentes ocupacionales de riesgo durante su primer año de práctica médica. La mayoría de estos jóvenes médicos no toman medidas adecuadas para prevenir enfermedades de transmisión parenteral luego de los accidentes, especialmente por su falta de preparación y porque su conocimiento de precauciones universales es pobre

Translated abstract

Background and aim: medical students are vulnerable to occupational accidents with needles and other cutting devices, because of their inexperience and lack of training despite their desire to do a lot. There is no information in our country regarding the frequency of such accidents in medical interns. The aim of the present study was to study the frequency and type of occupational accidents suffered by medical interns and their knowledge about the universal precautions. Methods: cross sectional study. Of all the medical interns working in the central part of the country during October 2001 and January 2002 a randomized sample of 201 was selected (power 95%, error 5%). To this population as guided survey was applied. The survey consisted in 20 structured questions, most closed and three opened, enquiring about number of occupational accidents, types, what was done at the moment, and knowledge of the universal precautions. Results: Of all the participants 90% had been working at lease 3 months as medical interns (last year of the medical career). Over half had done both a 3 months medical rotation and a 3 months surgical rotation. The sample included students from the 5 Universities with the career of medicine. Only 37% of the interns surveyed had received anti-HBV vaccination. Sixty four percent of them admitted they had suffered at least one occupational accident with patient's blood; 20% of these admitted had suffered between 3 and 4 accidents. Of the interns that admitted had suffered occupational accidents with needles, 78% did nothing after the accident, most of them because they didn't know what should be done. Of the total sample, 93% of the interns knew little or nothing about the universal precautions; only 6% could mention three correct measures for universal precaution. Conclusion: a very high proportion of medical interns in Costa Rica suffers risky occupational accidents early in their medical practice. Most of these young doctors do nothing to prevent themselves from occupational transmitted diseases, mainly due to lack of knowledge. Their knowledge regarding universal precautions is very poor

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Most cited references 11

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Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis.

(2001)

This report updates and consolidates all previous U.S. Public Health Service recommendations for the management of health-care personnel (HCP) who have occupational exposure to blood and other body fluids that might contain hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV). Recommendations for HBV postexposure management include initiation of the hepatitis B vaccine series to any susceptible, unvaccinated person who sustains an occupational blood or body fluid exposure. Postexposure prophylaxis (PEP) with hepatitis B immune globulin (HBIG) and/or hepatitis B vaccine series should be considered for occupational exposures after evaluation of the hepatitis B surface antigen status of the source and the vaccination and vaccine-response status of the exposed person. Guidance is provided to clinicians and exposed HCP for selecting the appropriate HBV PEP. Immune globulin and antiviral agents (e.g., interferon with or without ribavirin) are not recommended for PEP of hepatitis C. For HCV postexposure management, the HCV status of the source and the exposed person should be determined, and for HCP exposed to an HCV positive source, follow-up HCV testing should be performed to determine if infection develops. Recommendations for HIV PEP include a basic 4-week regimen of two drugs (zidovudine [ZDV] and lamivudine [3TC]; 3TC and stavudine [d4T]; or didanosine [ddI] and d4T) for most HIV exposures and an expanded regimen that includes the addition of a third drug for HIV exposures that pose an increased risk for transmission. When the source person's virus is known or suspected to be resistant to one or more of the drugs considered for the PEP regimen, the selection of drugs to which the source person's virus is unlikely to be resistant is recommended. In addition, this report outlines several special circumstances (e.g., delayed exposure report, unknown source person, pregnancy in the exposed person, resistance of the source virus to antiretroviral agents, or toxicity of the PEP regimen) when consultation with local experts and/or the National Clinicians' Post-Exposure Prophylaxis Hotline ([PEPline] 1-888-448-4911) is advised. Occupational exposures should be considered urgent medical concerns to ensure timely postexposure management and administration of HBIG, hepatitis B vaccine, and/or HIV PEP.