Epidemiology and management of occupational exposure to blood borne viral infections in a resource poor setting: the case for availability of post exposure prophylaxis

Abstract

Objectives: The aim of this study was to demonstrate the epidemiology and risk of occupational exposure to HIV, HBV and HCV among health care workers (HCWs) and highlight areas where greater training is required.

Methods: The study population included 13 health care workers; 5 males (38.5%) and 8 females (61.5%), mean age 34.15 +/- 6.8 years including 3 doctors (23.1%), 2 laboratory scientist (15.4%), 1 laboratory technician (7.7%), 6 medical students (46.2%) and 1 trainee laboratory assistant (7.7%). The care and follow-up provided to the health care workers in the 500 -bed tertiary health hospital that had percutaneous exposure to patient's blood between June 2002 and June 2005 were analyzed. All exposed health care workers were evaluated and offered follow up counseling. Five milliliters of blood from each of the HCWs and the source patients were screened by immmuno-enzymatic testing for HIV, HBV, and HCV.

Results: Exposures were concentrated in few areas of the hospital; pediatrics (46.2%); surgery (15.4%); obstetrics and gynecology (7.7%) and laboratory unit (30.8%) (divided by 2 = 7.72, p = 0.05). Risk of exposure was significantly higher among females (61.5%) compared to males (38.5%) (divided by 2 = 29.96, p = 0.001). All exposed HCWs were seen and offered post exposure prophylaxis within 24 hours of exposure. All the exposed health care workers were sero-negative to HIV, HBsAg and anti-HCV at exposure. The source patients were known in all cases. Evidence of HIV was present in 5 (38.5%); 1 (7.7%) had HBV while none had HCV infection. Of all the HCWs who completed the follow-up, only 1(7.7%) confirmed case of HBV seroconversion occurred in a HCW who was not previously vaccinated against HBV but who received post exposure HBV vaccination. Exposure rate was significantly higher among house officers 7 (53.9%) followed by registrars 3 (23.1%) and laboratory scientist 3 (23.1) (divided by 2 = 74.79, p = 0.0001).

Conclusions: There is need to address the issue of occupational exposure in Africa by providing training on universal precaution, phlebotomy, modifying procedures that have high risk, developing institutional policy for handling of sharps and post-exposure management of health care workers, provision of protective HBV vaccine for all HCWs coupled with the provision of post exposure prophylaxis for exposed HCWs.