Incidence of visits for health care worker blood or body fluid exposures and HIV postexposure prophylaxis provision at Rhode Island emergency departments

Abstract

Objectives: To compare the incidence and types of emergency department (ED) visits for blood or body fluid exposures sustained by health care workers (HCWs) in Rhode Island and to identify factors predictive of HIV postexposure prophylaxis (PEP) utilization for these exposures.

Methods: A retrospective study of ED visits for blood or body fluid exposures to all Rhode Island EDs from January 1995 to June 2001 was conducted. Average incidence rates (IRs) of visits by HCW occupation and type of exposure were estimated and compared. Logistic regression models were created to determine which HCWs were more likely to be offered and to accept HIV PEP.

Results: Of 1551 HCW ED visits for occupational exposures, 72.5% sustained a percutaneous injury and only 2.5% were exposed to a source known to be HIV-infected. Hospital custodians had the highest IR of ED visits for percutaneous injuries (81 ED visits per year per 10,000 workers). Visits for all exposures increased over the study years and were most common during March, on weekends, and at 5:00 PM. Of all HCWs, 91.2% presented within 24 hours of their exposure and 98.2% presented within 72 hours. HIV PEP was offered to 469 HCWs and accepted 229 times. HCWs more likely to be offered HIV PEP were exposed to a known HIV-infected source (odds ratio [OR] = 6.38), sustained a significant exposure (OR = 4.98), presented to an academic hospital ED (OR = 2.60), were a member of the medical staff (OR = 2.02), and were exposed during the latter years of the study (OR = 1.23). HCWs were more likely to accept HIV PEP when it was offered if they were male (OR = 1.64) and presented to an academic hospital ED (OR = 2.72).

Conclusions: The IRs of ED visits for exposures varied by occupation, and there were clear temporal trends for these visits. Despite the existence of federal guidelines for HIV PEP for occupational blood or body fluid exposures, factors other than characteristics of the exposure, such as type of hospital, occupation, and gender, may be influencing HIV PEP utilization.

FIGURE 1

Temporal trends of ED visits for blood or body fluid exposures. The open circle in the plot for year shows the actual number of visits for the first 6 months of 2001. The number of visits was doubled to give an approximation for the entire year.