Post-vaccination anti-HBs testing among healthcare workers: More economical than post-exposure management for Hepatitis B.

OBJECTIVE: to compare the direct cost, from the perspective of the Unified Health System, of assessing the post-vaccination serological status with post-exposure management for hepatitis B among health care workers exposed to biological material. METHOD: cross-sectional study and cost-related, based on accident data recorded in the System of Information on Disease Notification between 2006 and 2016, where three post-exposure and one pre-exposure management scenarios were evaluated: A) accidents among vaccinated workers with positive and negative serological status tests for hepatitis B, exposed to known and unknown source-person; B) handling unvaccinated workers exposed to a known and unknown source-person; C) managing vaccinated workers and unknown serological status for hepatitis B and D) cost of the pre-exposure post-vaccination test. Accidents were assessed and the direct cost was calculated using the decision tree model. RESULTS: scenarios where workers did not have protective titles after vaccination or were unaware of the serological status and were exposed to a positive or unknown source-person for hepatitis B. CONCLUSION: the direct cost of hepatitis B prophylaxis, including confirmation of serological status after vaccination would be more economical for the health system.

Post-vaccination anti-HBs testing among healthcare workers: More economical than post-exposure management for Hepatitis B / Teste anti-HBs pós-vacinação entre trabalhadores da saúde: mais econômico que manejo pós-exposição para Hepatite B / Pruebas anti-HBs post-vacunación entre los trabajadores de la salud: más económico que el manejo post-exposición para la Hepatitis B

Objective: to compare the direct cost, from the perspective of the Unified Health System, of assessing the post-vaccination serological status with post-exposure management for hepatitis B among health care workers exposed to biological material. Method: cross-sectional study and cost-related, based on accident data recorded in the System of Information on Disease Notification between 2006 and 2016, where three post-exposure and one pre-exposure management scenarios were evaluated: A) accidents among vaccinated workers with positive and negative serological status tests for hepatitis B, exposed to known and unknown source-person; B) handling unvaccinated workers exposed to a known and unknown source-person; C) managing vaccinated workers and unknown serological status for hepatitis B and D) cost of the pre-exposure post-vaccination test. Accidents were assessed and the direct cost was calculated using the decision tree model. Results: scenarios where workers did not have protective titles after vaccination or were unaware of the serological status and were exposed to a positive or unknown source-person for hepatitis B. Conclusion: the direct cost of hepatitis B prophylaxis, including confirmation of serological status after vaccination would be more economical for the health system.

Objetivo: comparar o custo direto, sob a perspectiva do Sistema Único de Saúde, da avaliação do status sorológico pós-vacinação com o manejo pós-exposição para hepatite B entre trabalhadores da área da saúde expostos ao material biológico. Método: estudo transversal e de custo, realizado a partir dos dados de acidentes registrados no Sistema de Informação de Agravos de Notificação entre 2006 e 2016, em que foram avaliados três cenários de manejo pós-exposição e um de pré-exposição: A) acidentes entre trabalhadores vacinados com status sorológico positivo e negativo para hepatite B, expostos à pessoa-fonte conhecida e desconhecida; B) manejo dos trabalhadores não vacinados expostos à pessoa-fonte conhecida e desconhecida; C) manejo dos trabalhadores vacinados e status sorológico desconhecido para hepatite B e D) custo do teste pós vacinação pré-exposição. Os acidentes foram avaliados e o custo direto foi calculado utilizando o modelo árvore de decisão. Resultados: apresentaram maior custo os cenários em que os trabalhadores não possuíam títulos protetores após a vacinação ou desconheciam o status sorológico e foram expostos à pessoa-fonte positivo ou desconhecida para hepatite B. Conclusão: o custo direto da profilaxia para hepatite B, incluindo a confirmação do status sorológico após vacinação seria mais econômico para o sistema de saúde.

Objetivo: comparar el costo directo, desde la perspectiva del Sistema Único de Salud, de la evaluación del status serológico post-vacunación con el manejo post-exposición para la hepatitis B entre los trabajadores de la salud expuestos a material biológico. Método: estudio transversal y de costos, basado en datos de accidentes registrados en el Sistema de Información de Enfermedades Notificables entre 2006 y 2016, en el que se evaluaron tres escenarios de gestión posteriores a la exposición y uno previo a la exposición: A) accidentes entre trabajadores vacunados con status serológico positivo y negativo para hepatitis B, expuestos a una fuente de origen conocida y desconocida; B) manejo de trabajadores no vacunados expuestos a una fuente conocida y desconocida; C) manejo de trabajadores vacunados y estado serológico desconocido para hepatitis B y D) costo de la prueba de pre-exposición post-vacunación. Se evaluaron los accidentes y se calculó el costo directo utilizando el modelo de árbol de decisión. Resultados: los escenarios en los que los trabajadores no tenían títulos de protección después de la vacunación o desconocían el status serológico y estaban expuestos a una persona fuente positiva o desconocida para la hepatitis B reflejaron un costo más alto. Conclusión: el costo directo de la profilaxis para la hepatitis B, incluida la confirmación del status serológico después de la vacunación sería más económico para el sistema de salud.

Work accidents with biological material: factors associated with abandoning clinical and laboratory follow-up. / Acidente de trabalho com material biológico: fatores associados ao abandono do acompanhamento clínico-laboratorial.

OBJECTIVE: To analyze the epidemiology of abandoning clinical and laboratory follow-up among health workers who suffered accidents with biological material. METHOD: Cohort study based on reported work accidents with biological material in Goiânia/Goiás. Data were analyzed in Stata with descriptive and analytical statistics. RESULTS: 2,104 exposures of the 8,596 reported accidents were analyzed, most of them involving females with completed high school education and belonging to the nursing staff. The accidents predominantly occurred by percutaneous injury involving a needle with lumen during medication administration or vascular access. Follow-up abandonment rate was 41.5%. Predictive factors for discontinuing clinical and laboratory follow-up were age, occupation, use of personal protective equipment (gowns), the object involved in the accident, situation in the labor market, circumstance of exposure and recommended prophylactic conduct. CONCLUSION: Given the high abandonment rate found, it is suggested to implement strategies to ensure follow-up and reduce risks to health workers.

Acidente com material biológico sob a ótica dos estudantes de Enfermagem: reflexões para o ensino / Accidents to biological risk from the point of view of Nursing students: reflections on teaching

Objetivo: identificar atividades de risco para acidentes com material biológico segundo estudantes de enfermagem e o conhecimento das medidas frente ao acidente, descrever frequência e perfil dos acidentes e identificar o atendimento pósexposição Metodologia: estudo transversal, com estudantes de enfermagem de uma instituição de ensino superior no Centro- Oeste, Brasil. Dados obtidos por questionário eletrônico e analisados por estatística descritiva. Resultados: Participaram 126 estudantes, maioria mulheres (96,0%) que referiu orientação prévia acerca do risco biológico. Nenhum citou todas medidas pósexposição recomendadas. Manusear perfurocortante (64,4%) foi o maior risco relatado e a exposição mucosa a causa de três dos quatro acidentes relatados. Desses, dois foram informados aos docentes e seguidas as condutas indicadas. Conclusão: A maioria dos estudantes reconheceu o risco no manuseio de perfurocortante. Três estudantes (2,4%) sofreram acidente (um relatou dois) e três em mucosa. Informar ao docente foi a conduta pós-exposição mais citada, sendo que entre acidentados as condutas mais seguras foram adotadas sob orientação do docente. (AU)

Objective: to identify risk activities for accidents with biological material in the opinion of nursing students and the knowledge of the measures against an accident, to describe the frequency and profile of the accidents and to identify the post-exposure care. Methodology: cross-sectional study with nursing students from a higher education institution in the Center-West of Brazil. Data obtained by electronic questionnaire and analyzed by descriptive statistics. Results: A total of 126 students participated, most of them women (96.0%) who reported previous guidance on biological risk. None cited all recommended post-exposure measures. Handling sharps (64.4%) was the most reported risk behavior and mucosal exposure was the cause of three of the four reported accidents. Of these, two were informed to the teachers and followed the indicated behaviors. Conclusion: Most students recognize the risk in activities involving sharps, but few identify them in other activities involving body fluids. Three students (2.4%) suffered an accident (one reported two) and three in the mucosa. Informing the teacher was the most cited post-exposure behavior, and among the injured, the most secure behaviors were adopted under the guidance of the teacher. (AU)

Objetivo: identificar actividades de riesgo para accidentes con material biológico según estudiantes de enfermería y el conocimiento de las medidas frente al accidentes, describir frecuencia y perfil de los accidentes e identificar la atención post-exposición Metodología: estudio transversal, con estudiantes de enfermería en el Centro-Oeste, Brasil. Datos obtenidos por cuestionario electrónico y analizados por estadística descriptiva. Resultados: Participaron 126 estudiantes, mayoría mujeres, que han mencionado orientación previa sobre el riesgo biológico. Ninguno citó todas las medidas post-exposición recomendadas. El manejo de pinchazo fue el mayor riesgo reportado y la exposición mucosa a causa de tres de los cuatro accidentes reportados. De ellos, dos fueron informados a los docentes y seguidas las conductas indicadas. Conclusión: Tres estudiantes (2,4%) sufrieron accidente (uno relató dos) y tres en mucosa. El informe al docente fue la conducta post-exposición más citada, siendo que entre accidentados las conductas más seguras fueron adoptadas bajo orientación del docente. (AU)