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      Incidencia de exposiciones accidentales a sangre y fluidos biológicos en el personal sanitario de un hospital comarcal Translated title: Incidence of accidental exposure to blood and body fluids among healthcare professionals in a community hospital

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          Abstract

          Resumen Objetivo: Conocer la incidencia anual de exposiciones accidentales a sangre y fluidos biológicos en el personal sanitario de un hospital comarcal, y describir sus características, situaciones asociadas y seguimiento. Método: Estudio longitudinal retrospectivo de los accidentes biológicos notificados anualmente, de forma voluntaria, por los trabajadores expuestos en la Fundació Hospital de l’Esperit Sant (en Santa Coloma de Gramenet, Barcelona) entre los años 2005 y 2014. Se realiza un estudio descriptivo de las variables relacionadas con el trabajador expuesto, la exposición, su mecanismo de producción y el paciente fuente de la exposición. Se han calculado las incidencias de exposición por cada 100 camas y por categoría laboral. Resultados: Se han declarado 318 exposiciones, el 89,62% percutáneas y el resto contaminaciones de piel no intacta o mucosas. La incidencia media de exposiciones percutáneas de todo el periodo ha sido de 17,6 por cada 100 camas/año (límites 10,3 en 2013 y 24,5 en 2005). Los médicos son el colectivo profesional con mayor riesgo (5,29 exposiciones por cada 100 médicos). Más del 50% se han producido en el área de cirugía. El 44,2% refiere una actividad profesional media en el centro igual o inferior a 1 año. El pinchazo ha sido la lesión percutánea más frecuente. No se han declarado casos de transmisión viral ocupacional. Conclusiones: La incidencia ocupacional de exposiciones percutáneas declaradas en el hospital sufre oscilaciones significativas a lo largo del periodo analizado. El riesgo de exposición está relacionado con la categoría laboral, la experiencia profesional, el área de trabajo y la actividad realizada.

          Translated abstract

          Abstract Objective: To determine the annual incidence of healthcare professionals’ accidental exposure to blood and body fluids in a community hospital and describe their characteristics, associated situations and follow-up. Method: A longitudinal, retrospective study of biological accidents voluntarily reported on a yearly basis by exposed healthcare professionals at Fundació Hospital de l’Esperit Sant (in Santa Coloma de Gramenet, Barcelona, Spain), between 2005 and 2014. A descriptive analysis of the variables related to the exposed professional, the exposure itself, its production mechanism and the source patient was conducted. The rate of exposure was calculated per 100 occupied beds and by job category. Results: 318 exposures were reported; 89.62% were percutaneous and the remainder were non-intact skin or mucous contamination. The mean percutaneous exposure incidence rate from 2005 to 2014 was 17.6 per 100 occupied beds/year (limits 10.3 in 2013 and 24.5 in 2005). Doctors were exposed to the greatest risk (5.29 exposures per 100 doctors). Over 50% occurred in a surgical setting. 44.2% of exposed healthcare professionals had been working at the centre for 1 year or less on average. Puncture was the most common percutaneous lesion. No cases of occupational viral transmission were reported. Conclusions: The rate of percutaneous exposure reported in this hospital fluctuated significantly throughout the analysis period. Risk of exposure is related to job category, work experience, the setting and the activity performed.

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          Most cited references26

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          Blood-borne viruses in health care workers: prevention and management.

          Three pathogens account for most cases of occupationally acquired blood-borne infection: hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The highest proportion of occupational transmission is due to percutaneous injury (PI) via hollow-bore needles with vascular access. We briefly review prevention and management of blood-borne pathogens in health care workers (HCWs) in developed countries. HCW compliance with standard precautions is necessary for prevention of PI. Safety-engineered devices are now being increasingly promoted as an approach to decreasing the rate of PI. Prevention of HBV transmission requires HCW immunization through vaccination against HBV. In non-vaccinated HCWs (or HCWs with an unknown antibody response to vaccination) exposed to an HbsAg-positive or an untested source patient, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible. Although no available prophylaxis exists for HCV, it is crucial to identify HCV exposure and infection in health care settings and to consequently propose early treatment when transmission occurs. Following occupational exposure with potential for HIV transmission, use of antiretroviral post-exposure prophylaxis must be evaluated. Patients need to be protected from blood-borne pathogen-infected HCWs, and especially surgeons performing exposure-prone procedures (EPPs) with risk of transmission to the patient. However, HCWs not performing EPPs should be protected from arbitrary administrative decisions that would restrict their practice rights. Finally, it must be emphasized that occupational blood exposure is of great concern in developing countries, with higher risk of exposure to blood-borne viruses because of a higher prevalence of the latter than in developed countries, re-use of needles and syringes and greater risk of sustaining PI, since injection routes are more frequently used for drug administration than in developed countries. Copyright © 2011 Elsevier B.V. All rights reserved.
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            A review of sharps injuries and preventative strategies.

            Exposure to bloodborne pathogens from sharps injuries continues to pose a significant risk to healthcare workers (HCW). The number of sharps injuries sustained by HCW is still unclear, primarily due to under-reporting. In this review a mean rate of 4.0% (range 1.0-6.2%) sharps injuries per 10000 HCW was calculated from eight studies involving more than 7000 HCW. Nurses and doctors were most at risk of sharps injuries, frequently from hollow-bore needles. Approaches to reduce this risk have included education and training on the safe handling and disposal of sharp devices, awareness campaigns and legislative action. More recently, preventative strategies have focused on needle protective devices, which may reduce the rate of sharps injuries. Introducing needle protective devices should be considered particularly in high-risk areas, after training, education, evaluation and cost-benefit analysis.
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              Occupational human immunodeficiency virus infection in health care workers: worldwide cases through September 1997.

              The average estimated risk of human immunodeficiency virus (HIV) infection for health care workers following a percutaneous or mucous exposure is <0.5% in incidence studies, although a case-control study suggests it is much higher for highest-risk percutaneous exposure. To characterize exposures resulting in HIV transmission, we reviewed available data on occupational cases reported worldwide, identifying 94 documented and 170 possible cases. The majority of documented infections occurred in nurses, after contact with the blood of a patient with AIDS by means of percutaneous exposure, with a device placed in an artery or vein. High-exposure job categories, e.g., midwives and surgeons, are represented mostly among possible cases. Transmission occurred also through splashes, cuts, and skin contaminations, and in some cases despite postexposure prophylaxis with zidovudine. Health care workers could benefit if these data were incorporated in educational programs designed to prevent occupational bloodborne infections.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                gs
                Gaceta Sanitaria
                Gac Sanit
                Ediciones Doyma, S.L. (Barcelona, Barcelona, Spain )
                0213-9111
                December 2017
                : 31
                : 6
                : 505-510
                Affiliations
                [1] Santa Coloma de Gramenet Cataluña orgnameUniversitat de Barcelona orgdiv1Fundació Hospital de l’Esperit Sant orgdiv2Servicio de Medicina Interna Spain
                Article
                S0213-91112017000600505
                10.1016/j.gaceta.2016.08.008
                8baa0c40-5575-479a-8ad7-b32c32be85ce

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 16 May 2016
                : 26 August 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 6
                Product

                SciELO Spain


                Riesgo biológico,Riesgo ocupacional,Personal sanitario,Biological risk,Occupational hazard,Healthcare professional

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