Blood exposure among paramedics: incidence rates from the national study to prevent blood exposure in paramedics.

PURPOSE: The aim of the study is to estimate incidence rates of occupational blood exposure by route of exposure (needlesticks; cuts from sharp objects; mucous membrane exposures to the eyes, nose, or mouth; bites; and blood contact with nonintact skin) in US and California paramedics. METHODS: A mail survey was conducted in a national probability sample of certified paramedics. RESULTS: Proportions of paramedics who reported an exposure in the previous year were 21.6% (95% confidence interval [CI], 17.8-25.3) for the national sample and 14.8% (95% CI, 12.2-17.4) for California. The overall incidence rate was 6.0/10,000 calls (95% CI, 3.9-8.1). These rates represent more than 49,000 total exposures and more than 10,000 needlesticks per year among paramedics in the United States. Rates for mucocutaneous exposures and needlesticks were similar (approximately 1.2/10,000 calls). Rates for California were one third to one half the national rates. Sensitivity analysis showed that potential response bias would have little impact on the policy and intervention implications of the findings. CONCLUSION: Paramedics continue to be at substantial risk for blood exposure. More attention should be given to reducing mucocutaneous exposures. The impact of legislation on reducing exposures and the importance of nonintact skin exposures need to be better understood.

Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998.

OBJECTIVE: To construct a single estimate of the number of percutaneous injuries sustained annually by healthcare workers (HCWs) in the United States. DESIGN: Statistical analysis. METHODS: We combined data collected in 1997 and 1998 at 15 National Surveillance System for Health Care Workers (NaSH) hospitals and 45 Exposure Prevention Information Network (EPINet) hospitals. The combined data, taken as a sample of all U.S. hospitals, were adjusted for underreporting. The estimate of the number of percutaneous injuries nationwide was obtained by weighting the number of percutaneous injuries at each hospital by the number of admissions in all U.S. hospitals relative to the number of admissions at that hospital. RESULTS: The estimated number of percutaneous injuries sustained annually by hospital-based HCWs was 384,325 (95% confidence interval, 311,091 to 463,922). The number of percutaneous injuries sustained by HCWs outside of the hospital setting was not estimated. CONCLUSIONS: Although our estimate is smaller than some previously published estimates of percutaneous injuries among HCWs, its magnitude remains a concern and emphasizes the urgent need to implement prevention strategies. In addition, improved surveillance could be used to monitor injury trends in all healthcare settings and evaluate the impact of prevention interventions.

Antiretroviral drug resistance in human immunodeficiency virus-infected source patients for occupational exposures to healthcare workers.

OBJECTIVE: To assess the prevalence of HIV antiretroviral resistance among source patients for occupational HIV exposures. DESIGN: Blood and data (eg, stage of HIV, previous antiretroviral drug therapy, and HIV RNA viral load) were collected from HIV-infected patients who were source patients for occupational exposures. SETTING: Seven tertiary-care medical centers in five U.S. cities (San Diego, California; Miami, Florida; Boston, Massachusetts; Albany, New York; and New York, New York [three sites]) during 1998 to 1999. PARTICIPANTS: Sixty-four HIV-infected patients who were source patients for occupational exposures. RESULTS: Virus from 50 patients was sequenced; virus from 14 patients with an undetectable (ie, < 400 RNA copies/mL) viral load could not be sequenced. Overall, 19 (38%) of the 50 patients had primary genotypic mutations associated with resistance to reverse transcriptase or protease inhibitors. Eighteen of the 19 viruses with primary mutations and 13 wild type viruses were phenotyped by recombinant assays; 19 had phenotypic resistance to at least one antiretroviral agent. Of the 50 source patients studied, 26 had taken antiretroviral agents in the 3 months before the occupational exposure incident. Sixteen (62%) of the 26 drug-treated patients had virus that was phenotypically resistant to at least one drug. Four (17%) of 23 untreated patients had phenotypically resistant virus. No episodes of HIV transmission were observed among the exposed HCWs. CONCLUSIONS: There was a high prevalence of drug-resistant HIV among source patients for occupational HIV exposures. Healthcare providers should use the drug treatment information of source patients when making decisions about post-exposure prophylaxis.