A survey of occupational risk exposures and behaviour of healthcare workers.

UNLABELLED: To reduce the risk of transmission of microorganisms standard precautions are taken for all patients expected to be exposed to blood, body fluids, or have contacts with mucous membranes and non-intact skin. These preventive measures are by far the best way to protect healthcare workers from adverse infections. AIM: To analyze occupational risk exposure of healthcare workers occurring when the latter come into contact with blood or other potentially infectious liquid in order to assess some aspects of the application of standard preventive measures. PATIENTS AND METHODS: 680 healthcare workers (186 physicians, 330 nurses, and 164 hospital orderlies) were included in an anonymous survey conducted at St George University Hospital, Plovdiv in 2009. The questionnaire consisted of 14 questions grouped in 3 clusters. Occupational risk exposure was defined as recommended by the Centers for Disease Control and Prevention (CDC). We used descriptive statistics, parametric and non-parametric analysis. RESULTS: Occupational exposure was reported by 81% of the respondents for the last year with predominance of percutaneous injuries (62%). Nurses sustained the most risk exposures (86%). We found a correlation between the job category and the occupational exposure (chi2 = 14.3, df = 2, p < 0.001). No correlation was found between length of service and injury intensity (chi2 = 1.69, df = 2, p > 0.05). Immunisation against hepatitis virus B infection received 64.3 +/- 3.8% of the healthcare personnel. Immunization covered 48.2% of the ancillary workers, which is less than the mean coverage for the respondents. Job position was found to correlate with the immunisation coverage (chi2 = 24.41, df = 2, p < 0.001). Ninety-two percent of the healthcare workers used personal protective equipment (disposable gloves), but only 74.6% of them did this during emergencies (p < 0.001). CONCLUSION: Post-exposure follow-ups and the overall behaviour pattern after occupational risk exposure are random and non-systematic in nature. A better prevention of healthcare personnel would require a long-term training with constant knowledge upgrading, invasive procedures perfection and permanent control.

Immune response and immunologic memory in medical personnel vaccinated with hepatitis B vaccine.

UNLABELLED: The occupation-related nature of Hepatitis B viral infection in medical personnel has been well documented in a lot of studies. The only reliable way of prevention of this infection is immunisation with hepatitis B vaccine. AIM: To follow-up the primary immune response after immunisation with recombinant vaccine and its duration in adult immunocompetent subjects. MATERIALS AND METHODS: One hundred sixty-five health-care workers working at St. George University Hospital, Plovdiv in 2009/2010 were included in the study and allocated to two groups. Group 1 (N1 = 70) was followed up for the primary immune response after immunization; group 2 (N2 = 95) was with documented immunization in 1998/1999 (n = 81) and in 1994/1995 (n = 14). Tests based on ELISA for quantitative determination of anti-HBs in mIU/ml were used. The measurement were performed at the National Reference Laboratory of Viral Hepatitis at the NCIPD, Sofia. Descriptive statistics, non-parametric and parametric tests, qualitative correlation were used to analyse data. RESULTS: Group 1 mean age was 40.3 +/- 2.6 years; anti-HBs concentration of > or = 10 mIU/ ml was found in 92.8%. No association between the immune response and the commonly involved factors such as gender, age, overweight, smoking, etc., was found. In group 2, anti-HBs concentration of > or = 10 mIU/ml was found in 77.9%: it was in 75.3% in those immunized 10 years before, and in 92.9% in those immunized 15 years before (t = 0.24, p > 0.05). A booster dose of the vaccine was received by 15/21 subjects from group 2 (those immunized 10 years before that) with anti-HBs < 10 mIU/ml. After the booster, 9/15 produced anti-HBs in protective concentrations (anamnestic immune response). The actual level of seroprotection among the immunized more than 10 years ago was 92%. CONCLUSION: This study and the documentation of the primary postvaccinal immunity in high-risk medical personnel will help specify if additional hepatitis B vaccine shots are needed.