Evaluating a decade of exposures to blood and body fluids in an inner-city teaching hospital.

OBJECTIVE: To analyze a decade of hospital staff and student exposures to blood and body fluids (BBF) and to identify risk factors relevant to prevention strategies. DESIGN: Retrospective review of a 1999-2008 data set of BBF exposures. The data, maintained by occupational health staff, detailed the type of exposure, the setting in which the exposure occurred, and the occupational group of the BBF-exposed personnel. SETTING: Washington DC Veterans Affairs Medical Center (VA-DC), an inner-city tertiary care hospital. PARTICIPANTS: All healthcare workers and staff at the VA-DC. METHODS: Review of database. RESULTS: A review of 10 years of data revealed 564 occupational exposures to BBF, of which 66% were caused by needlesticks and 20% were caused by sharp objects. Exposures occurred most often in the acute care setting (which accounted for 39% of exposures) and the operating room (which accounted for 22%). There was a mean of 4.9 exposures per 10,000 acute care patient-days, 0.5 exposures per 10,000 long-term care patient-days, and 0.35 exposures per 10,000 outpatient visits. Housestaff accounted for the highest number of all exposures (196 [35%]). There were, on average, 15.2 exposures per 100 housestaff full-time equivalents. An average of only 1 exposure per year occurred in the hemodialysis center. CONCLUSIONS: Occupational exposures to BBF remain common, but rates vary widely by setting and occupational group. Overall rates are steady across a decade, despite the use of various antiexposure devices and provider education programs. Targeting occupational groups and hospital settings that have been shown to have the highest risk rates should become foundational to future preventative strategies.

Bacterial contamination of health care workers' white coats.

BACKGROUND: Patient-to-patient transmission of nosocomial pathogens has been linked to transient colonization of health care workers, and studies have suggested that contamination of health care workers' clothing, including white coats, may be a vector for this transmission. METHODS: We performed a cross-sectional study involving attendees of medical and surgical grand rounds at a large teaching hospital to investigate the prevalence of contamination of white coats with important nosocomial pathogens, such as methicillin-sensitive Stapylococcus aureus, methicillin-resistant S aureus (MRSA), and vancomycin-resistant enterococci (VRE). Each participant completed a brief survey and cultured his or her white coat using a moistened culture swab on lapels, pockets, and cuffs. RESULTS: Among the 149 grand rounds attendees' white coats, 34 (23%) were contaminated with S aureus, of which 6 (18%) were MRSA. None of the coats was contaminated with VRE. S aureus contamination was more prevalent in residents, those working in inpatient settings, and those who saw an inpatient that day. CONCLUSION: This study suggests that a large proportion of health care workers' white coats may be contaminated with S aureus, including MRSA. White coats may be an important vector for patient-to-patient transmission of S aureus.