Quality control for handling of accidental blood exposures.

A regional counselling service was established to handle all accidental blood exposures using a standardized protocol. Levels of risk were assessed using an algorithm. Accidents that posed a risk for the transmission of hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV) were classified as 'high risk', whereas accidents that posed a risk for HBV alone were classified as 'low risk'. Medical interventions were implemented according to the level of risk. During a one-year period, all accidents were registered and analysed for adherence to the standard protocol. In 2003, the centre handled 454 incidents. Of these, 36 (7.9%) incidents were assessed as no risk, 329 (72.5%) were assessed as low risk, and 67 (14.8%) were assessed as high risk. Due to incomplete registration, 22 (4.8%) incidents could not be analysed further. In total, 36% of the incidents with risk for HBV transmission and 40% of the incidents with risk for HCV and HIV transmission were not handled according to the proposed protocol. Breaches consisted of over-reaction (25/396) as well as insufficient response (123/396). Potentially inadequate treatment occurred for HIV postexposure prophylaxis in 12 of 63 incidents. Incomplete follow-up for HCV occurred in 11 of 63 incidents, and lack of HBV immunoglobulin administration occurred in five of 396 incidents, including three high-risk incidents. In 21 of 396 low-risk exposures, the breaches in protocol resulted from late reporting. It remains difficult to achieve an acceptable level of standardized care when using standard operational procedures. Documentation and evaluation of flaws are essential to improve the system.

Differences between hospital- and community-acquired blood exposure incidents revealed by a regional expert counseling center.

OBJECTIVE: One year (2003) regional analysis of all blood exposure incidents from hospitals as well as from the community. DESIGN: Establishment of an easily accessible regional expert counseling center, operating 24 h a day, for all accidental blood exposures. Tasks of the center were to register incoming calls, to inform and counsel the victim, to assess the risk of the incident, and to provide a plan of further actions, including prophylactic measures. SETTING: A Dutch region (Northeast Brabant) with 500,000 inhabitants and two major hospitals (1,786 beds). RESULTS: A total of 454 incidents (1.2 per day) were recorded. Only half of the incidents occurred in the hospital setting (n = 234), whereas the others (n = 220) took place in the community setting. Nearly all (95%, n = 432) incidents occurred during work, and most of them (84%, n = 385) were related to health care activities. In the hospital setting injuries occurred with physicians (13%), nursing staff (45%), operating room (OR) staff (13%), ancillary (18%), others (10%). In the community setting, incidents took place among healthcare workers (48%), detention and police officers (10%), civilians (10%), general practitioners/dentists and their staff (8%), cleaning staff (4%) and work-related incidents not falling into any of the above categories (7%). More low risk incidents took place outside the hospital (87% vs. 68% in hospital), while high-risk incidents predominantly occurred within the hospital setting (23% vs. 6%). The hepatitis-B immunization rate was significantly lower in victims from the community than in those working in hospitals (38% vs. 96%). Reports from incidents in the community setting were delayed. CONCLUSIONS: Incidents that expose individuals to blood-borne pathogens occur equally frequent in the hospital and non-hospital (community) setting. Therefore, a regional expert counseling center, accessible around-the-clock, for all types of blood-exposure incidents is needed. Blood-exposure prevention programs should aim at a reduction of high-risk incidents within hospitals, and at increasing the awareness for vaccination and early reporting within the community setting.