Prevalence of hepatitis B and C virus infection in barbers in the Sivas region of Turkey

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are among the most devastating health problems in the world, including Turkey. The route of transmission of HBV and HCV is mainly parenteral, a small number of epidemiological studies demonstrating that perinatal, sexual, household and occupational transmission occurs. Contact of a patient's blood or bodily fluids with non-intact skin is another mode of HBV and HCV transmission. Barbers in Turkey may often be exposed accidentally to the blood and bodily fluids of their customers. The aim of this study was to determine the prevalence of HBV and HCV infection in barbers. We conducted a study to determine the prevalence of antibodies against HBV and HCV among 176 barbers and 180 control subjects in the Sivas region of Turkey. The prevalence of HBV and HCV was found to be higher in barbers (39.8 and 2.8%, respectively) than in a comparison group (28.3 and 1.1%, respectively). No significant relationship was found with the duration of occupation. Among the seropositive subjects, it was found that most had been exposed to needle pricks or scissor cuts. Our data suggest that both HBV and HCV infections may constitute occupational hazards for barbers. The sources of infection could be not only such personal risk factors as 'sharps' injuries and scissor cuts, but may also include other unknown factors.     

Needlestick injury in clothing industry workers and the risks of blood-borne infection.

This paper identifies the hazard of a hollow needle device used extensively in the clothing industry and assesses the risk of transmission for HIV, Hepatitis B and Hepatitis C. A substantial risk of transmission is suggested and measures have been advised for its control. Occupational Health Physicians are advised to be aware of hollow needles in other industrial processes and where risks of cross-infection exist, the same safety considerations should be applied as in clinical medicine and veterinary work to avoid needlestick injuries. Needle sharing must be avoided.     

Transmission of hepatitis B and C viruses in outpatient settings--New York, Oklahoma, and Nebraska, 2000-2002

Transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) can occur in health-care settings from percutaneous or mucosal exposures to blood or other body fluids from an infected patient or health-care worker. This report summarizes the investigation of four outbreaks of HBV and HCV infections that occurred in outpatient health-care settings. The investigation of each outbreak suggested that unsafe injection practices, primarily reuse of syringes and needles or contamination of multiple-dose medication vials, led to patient-to-patient transmission. To prevent transmission of bloodborne pathogens, all health-care workers should adhere to recommended standard precautions and fundamental infection-control principles, including safe injection practices and appropriate aseptic techniques.     

Acquired immune deficiency syndrome: recommendations of a Working Party of the Hospital Infection Society

Unified procedures to control those infections that are transmitted by inoculation of blood are recommended. These should be applied to patients with acquired immune-deficiency syndrome (AIDS), AIDS-related complex, persistent generalized lymphadenopathy or hepatitis B, those with serological evidence of infection by human immunodeficiency virus or hepatitis B virus, and those in medical and social categories with a higher than average prevalence of such infections. When the identification of these categories of patient would be particularly difficult, the precautions should be applied to all patients, in situations of high risk for inoculation incidents. Rational infection-control measures, based on the known mode of spread, permit efficient management of infected patients, with satisfactory protection of staff and other patients.     

Needlestick and sharps injuries among health-care workers in Taiwan.

Sharps injuries are a major cause of transmission of hepatitis B and C viruses and human immunodeficiency virus in health-care workers. To determine the yearly incidence and causes of sharps injuries in health-care workers in Taiwan, we conducted a questionnaire survey in a total of 8645 health care workers, including physicians, nurses, laboratory technicians, and cleaners, from teaching hospitals of various sizes. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 per person in the past 12 months, respectively. Of most recent episodes of needlestick/sharps injury, 52.0% were caused by ordinary syringe needles, usually in the patient units. The most frequently reported circumstances of needlestick were recapping of needles, and those of sharps injuries were opening of ampoules/vials. Of needles which stuck the health-care workers, 54.8% had been used in patients, 8.2% of whom were known to have hepatitis B or C, syphilis, or human immunodeficiency virus infection. Sharps injuries in health-care workers in Taiwan occur more frequently than generally thought and risks of contracting blood-borne infectious diseases as a result are very high.     

Compliance with follow-up after occupational exposure to hepatitis C

BACKGROUND: Accidental percutaneous exposure to blood containing hepatitis C virus (HCV) is reported by health care workers more frequently than exposure to human immunodeficiency and hepatitis B virus. The transmission rate following such an exposure is approximately 1.9%. Little is known about the attendance rate of such staff for follow-up testing following exposure to HCV. AIM: To determine whether our follow-up programme for staff exposed to hepatitis C would allow the early detection and treatment of infected staff members. METHOD: We reviewed all staff exposures to hepatitis C reported to the occupational health department of a London teaching hospital over a 8-year period. RESULTS: Of 105 exposures, 21% of staff attended for early (6 or 12 weeks) and late (26 weeks) post-exposure follow-up. Thirty-seven per cent attended early follow-up only and 1% attended late having not attended early follow-up. Forty per cent did not attend any follow-up appointments with us. CONCLUSION: With the availability of effective treatment for early HCV infection, it is vital that occupational health departments encourage staff to attend at least for early follow-up. Access to HCV-RNA testing at this early stage should allow detection and early treatment of the small proportion who seroconvert.     

Contamination incidents among doctors and midwives: reasons for non-reporting and knowledge of risks

A 6-month retrospective self-administered questionnaire studyof 482 doctors and 380 midwives in two NHS Trusts was undertaken.The response rate was 384 (80%) and 293 (77%) respectively.The study revealed that only nine per cent of doctors and 46%of midwives had reported the contamination incidents they hadreceived. The doctors' main reason for non-reporting was ‘tootime consuming’ and midwives' was ‘did not consideranything could be done’, although their awareness of theactive management of contamination incidents by occupationalhealth departments was good. Seventy-seven per cent of doctorsand 69% of midwives underestimated the risk of contracting hepatitisB virus from a needlestick injury, whilst 52% of doctors and36% of midwives underestimated the risks of acquiring infectionwith HIV (human immunodeficiency virus) infection followingsuch an injury. Strategies for improving the knowledge of thepotential risks of contamination incidents and methods for facilitatingease of reporting are discussed.     

Needlestick and sharps injuries among nurses in the healthcare sector in a city of western Turkey

The aims of this study were to determine the rate of bloodborne infections after needlestick and sharps injuries in nurses at work, to estimate the number of vaccinations administered, and to assess whether universal precautions were being followed. The study involved 289 nurses working in five hospitals and six primary healthcare centres. Between 1 April 2002 and 31 June 2002, a total of 139 practising nurses were included in the study following a needlestick or sharps injury. The results of completed questionnaires were collated, and Chi-squared test was used for analysis. The rate of hollow-bored needle-related injuries was 76.2% (106/139). Most nurses (69.1%) did not report any details of their injuries and 32.4% (45/139) of nurses had not been vaccinated against hepatitis B virus (HBV). Only 5.3% of the nurses who responded to the compliance question indicated that they always complied with universal precautions. Of 139 nurses, 1.4% and 7.9% showed evidence of HBV infection and hepatitis C virus (HCV) infection, respectively. All those who had hepatitis B were aged 30 years or under, whereas most of those who were anti-HCV positive (81.8%) were over 30 years old (P < 0.05). Nurses working in the Turkish healthcare sector are frequently exposed to bloodborne infections. Precautions and protection from needlestick and sharps injuries are important in preventing infection of nurses. Education about the transmission of bloodborne infections, vaccination and post-exposure prophylaxis must be implemented. Further investigations are warranted to elucidate the risk to nurses of contracting these potentially serious infections.     

The impact of educational interventions on primary health care workers' knowledge of occupational exposure to blood or body fluids

AIM: To assess the impact of educational interventions on primary health care workers' knowledge of management of occupational exposure to blood or body fluids. METHODS: Cluster-randomized trial of educational interventions in two National Health Service board areas in Scotland. Medical and dental practices were randomized to four groups; Group A, a control group of practices where staff received no intervention, Group B practices where staff received a flow chart regarding the management of blood and body fluid exposures, Group C received an e-mail alert containing the flow chart and Group D practices received an oral presentation of information in the flow chart. Staff knowledge was assessed on one occasion, following the educational intervention, using an anonymous postal questionnaire. RESULTS: Two hundred and fifteen medical and dental practices were approached and 114 practices participated (response rate 53%). A total of 1120 individual questionnaires were returned. Face to face training was the most effective intervention with four of five outcome measures showing better than expected knowledge. Seventy-seven percent of staff identified themselves as at risk of exposure to blood and body fluids. Twenty-one percent of staff believed they were not at risk of exposure to blood-borne viruses although potentially exposed and 16% of exposed staff had not been immunized against hepatitis B. Of the 856 'at risk' staff, 48% had not received training regarding blood-borne viruses. CONCLUSIONS: We found greater knowledge regarding management of exposures to blood and body fluids following face to face training than other educational interventions. There is a need for education of at risk primary health care workers.     

Nosocomial transmission of hepatitis C virus associated with the use of multidose saline vials.

OBJECTIVE: To identify the source of an outbreak of acute hepatitis C virus (HCV) infection among 3 patients occurring within 8 weeks of hospitalization in the same ward of a Florida hospital during November 1998. DESIGN: A retrospective cohort study was conducted among 41 patients hospitalized between November 11 and 19, 1998. Patients' blood was tested for antibodies to HCV, and HCV RNA-positive samples were genotyped and sequenced. RESULTS: Of the 41 patients, 24 (59%) participated in the study. HCV genotype lb infections were found in 5 patients. Three of 4 patients who received saline flushes from a multidose saline vial on November 16 had acute HCV infection, whereas none of the 9 patients who did not receive saline flushes had HCV infection (P = .01). No other significant exposures were identified. The HCV sequence was available for 1 case of acute HCV and differed by a single nucleotide (0.3%) from that of the indeterminate case. CONCLUSION: This outbreak of HCV probably occurred when a multidose saline vial was contaminated with blood from an HCV-infected patient Hospitals should emphasize adherence to standard procedures to prevent blood-borne infections. In addition, the use of single-dose vials or prefilled saline syringes might further reduce the risk for nosocomial transmission of blood-borne pathogens.     

Blood‐borne viruses and their survival in the environment: is public concern about community needlestick exposures justified?

BACKGROUND: More than 30 million needle syringes are distributed per year in Australia as a component of harm-reduction strategies for injecting drug users (IDU). Discarded needle syringes create considerable anxiety within the community, but the extent of needlestick injuries and level of blood-borne virus transmission risk is unclear. We have undertaken a review of studies of blood-borne virus survival as the basis for advice and management of community needlestick injuries. METHODS: A Medline review of published articles on blood-borne virus survival and outcome from community injuries. RESULTS: Hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) can all survive outside the human body for several weeks, with virus survival influenced by virus titer, volume of blood, ambient temperature, exposure to sunlight and humidity. HBV has the highest virus titers in untreated individuals and is viable for the most prolonged periods in needle syringes stored at room temperature. However, prevalence of HBV and HIV are only 1-2% within the Australian IDU population. In contrast, prevalence of HCV is 50-60% among Australian IDUs and virus survival in needle syringes has been documented for prolonged periods. There have been no published cases of blood-borne virus transmission following community needlestick injury in Australia. CONCLUSION: The risk of blood-borne virus transmission from syringes discarded in community settings appears to be very low. Despite this, procedures to systematically follow up individuals following significant needlestick exposures sustained in the community setting should be developed.     

Preventing needlesticks in emergency medical system workers.

Emergency medical system (EMS) workers frequently use sharp devices in injury-prone circumstances that involve limited visibility, confined spaces, rapidly moving vehicles, and uncooperative victims. This study examined the efficacy of an automatic self-retracting lancet in reducing needlestick injuries and related direct and indirect costs. Subjects were 477 active-duty EMS workers. Counseling, laboratory testing (hepatitis B and C, hepatic function enzymes, and human immunodeficiency virus), antiviral prophylaxis, and immunizations were provided according to US Public Health Service guidelines. Baseline and biennial laboratory testing for hepatitis B and C and liver function enzymes were conducted. After the introduction of a spring-loaded automatic-retracting type glucometer lancet device, needlestick injuries decreased from 16 per 954 EMS worker-years to 2 per 477 EMS worker-years. The annualized cost of treatment declined from $8276 to $2068. The change to a self-retracting device decreased the number of needlestick injuries and was cost-effective with a minimal increase in device cost (annualized $366 per year).     

Prevalence of hepatitis C antibodies in a large sample of Belgian healthcare workers.

OBJECTIVE: To assess the risk of hepatitis C virus (HCV) infection among Belgian (Flemish) healthcare workers. DESIGN: A seroprevalence survey of HCV IgG antibodies. SETTING AND PARTICIPANTS: A systematic sample of 5,064 employees from 22 general hospitals in Flanders and Brussels, Belgium, was tested at the annual occupational medical examination. Together with demographic and occupational data, information was collected on the frequency of blood contact, needlestick injuries, and medical and surgical history. The blood samples were tested using the third-generation Abbott Screen Kit test, with confirmation by Matrix, LIA, and an in-house polymerase chain reaction and the Quantiplex-HCV b-DNA test. RESULTS: 21 persons were found to be positive for HCV markers. The overall prevalence was 0.41% (95% confidence interval [CI95], 0.24-0.59). A statistically significant association was found with a history of blood transfusion (odds ratio [OR], 4.14; CI95, 1.67-10.31) and with history of a clinically apparent hepatitis (OR, 3.98; CI95, 1.60-9.90). Although the ORs for the frequency of blood contact were slightly elevated (between 1.17 and 2.73), this association was not significant. Moreover, a history of needlestick injuries showed a nonsignificant OR of 1.28 (CI95, 0.53-3.09), and no statistically significant difference was found with a variety of duties and tasks. The ORs for potential occupational risk factors were adjusted according to age, gender, antecedents, and other confounders using a logistic regression analysis. Based on this procedure, the ORs decreased slightly. CONCLUSIONS: Flemish healthcare workers showed a lower HCV seropositivity than is seen in the general population; a history of blood transfusion and of clinically apparent hepatitis was most strongly associated with the presence of HCV markers. We concluded that employees in Flemish regional general hospitals are not at an overall increased risk for HCV infection, although occasional transmission through percutaneous injuries is possible, and prevention therefore remains imperative.     

Prevalence of hepatitis B surface antigen and antibody (hepatitis B virus markers) in personnel at a children's hospital

After two cases of acute hepatitis B infection occurred in phlebotomists at The Hospital for Sick Children in 1985, a seroprevalence survey of hepatitis B virus markers was undertaken. Directors in high-risk areas were advised by phone and memorandum to screen employees. Participation was entirely voluntary, and employees who did not respond were contacted six weeks after initial notification. Information obtained from each participant through a self-administered questionnaire included age, duration of employment in current pediatric occupation, history of blood transfusions, immune globulin prophylaxis, needlestick injury, and country of birth (North America/United Kingdom or other). Sera identified by code were tested by radioimmunoassay. Interactions were analyzed by using a multiple logistic regression model. A total of 10% of the personnel in high-risk areas, in which there was frequent exposure to blood or blood products, had hepatitis B markers in their blood, compared with 2% who did not have this exposure. Birthplace and occupation have independently significant effects on the likelihood of having hepatitis B markers. There appears to be an increased risk to employees in pediatric units, depending on the patient (and parent) population being served, although the risk may be lower than in adult hospitals.     

Sharps injuries in UK health care: a review of injury rates, viral transmission and potential efficacy of safety devices

AIMS: To review the literature on sharps injuries and occupational bloodborne virus transmission in health care in the UK and the worldwide evidence for injury prevention of sharps safety devices. METHODS: Literature review by online database and Internet resource search. RESULTS: Twenty-four relevant publications were identified regarding UK reported sharps injury rates. UK studies showed as much as a 10-fold difference between injuries reported through standard reporting systems (0.78-5.15 per 100 person-years) and rates estimated from retrospective questionnaires of clinical populations (30-284 per 100 person-years). National surveillance data from England, Wales and Northern Ireland gives a rate of 1.43 known hepatitis C virus or human immunodeficiency virus (HIV) transmissions to health care workers per annum. When extrapolated, this suggests an approximate rate of 0.009 such viral transmissions per 1000 hospital beds per annum. Risk of infection from sources with no risk factors is extremely small (less than one in one million for HIV transmission based on Scottish data). Thirty-one studies on the efficacy of sharps safety devices showed evidence of a reduction in injuries, with the greatest reductions achieved by blunt suture needles and safety cannulae. CONCLUSIONS: Although injuries remain common, confirmed viral transmission in the UK has been relatively rare. The degree of under-reporting of sharps injuries may be as much as 10-fold. Safety-engineered devices are likely to be effective at injury reduction.     

Needlestick injuries during medical training

Medical students are at risk of acquiring infections caused by needlestick injuries, although it is unknown when needlestick injuries are most likely to occur during medical training. The aim of this study was to define high-risk periods over the course of medical training. A cross-sectional study was conducted among medical students in the first, third, fourth and fifth years of training at two medical schools in Munich. Overall, 1317 (85%) students returned a questionnaire on demographic data, vaccination status against hepatitis B, lifetime prevalence of needlestick injuries, level of knowledge about measures after such accidents, and transmission risks. Lifetime prevalence of needlestick injuries was 23%, ranging from 12% in first year students to 41% in fourth year students. These accidents happened most commonly during medical internships, especially during blood-taking practices; an activity that usually starts during the third year of training. The frequency of respondents not vaccinated against hepatitis B also varied between first (21%) and fourth (6.6%) year students. Needlestick injuries occur frequently and early on in medical training. In order to decrease the risk of preventable infections, complete coverage of vaccination against hepatitis B should be achieved early in medical training.     

Haemoculture as a tool for diagnosing visceral leishmaniasis in HIV-negative and HIV-positive patients: interest for parasite identification.

Between May 1993 and June 1996, 65 adults infected with human immunodeficiency virus (HIV) and 30 HIV-negative patients (8 children and 22 adults) from the Mediterranean region with symptoms that included at least fever were examined for Leishmania. A total of 128 bone marrow and 128 peripheral venous blood samples were taken and cultured on NNN medium. At the initial diagnosis, 14 (6 HIV-positive and 8 HIV-negative) of 15 patients with a positive blood culture also had a positive bone marrow culture. Two patients (1 HIV-positive and the other HIV-negative) had a positive bone marrow culture but a negative blood culture. During post-therapeutic check-ups, 7 out of 8 patients with a positive blood culture (6 HIV-positive and 1 HIV-negative) also had a positive bone marrow culture. On the other hand, three patients (2 HIV-positive and 1 HIV-negative) had a positive bone marrow but a negative blood culture. Relapses were more frequent (9/65 vs. 3/30) and the demonstration of Leishmania in the blood was commoner (6/65 vs. 2/30) in the HIV-positive than the HIV-negative patients. Stocks were identified by their isoenzymes: MON-1 from four HIV-positive and eight HIV-negative patients, MON-28 from one HIV-positive patient and MON-29 from another. For each patient, the same zymodeme was found in bone marrow and blood cultures, both at initial diagnosis and at follow-up.     

Prevalence of hepatitis B virus markers in municipal solid waste workers in Keratsini (Greece)

AIM: To evaluate the prevalence of hepatitis B virus (HBV) markers among municipal solid waste workers (MSWWs) in Keratsini (Greece). METHODS: We assessed in a cross-sectional study the prevalence of biological markers of HBV infection (HbsAg, anti-Hbc, anti-Hbs) and their association with exposure to waste and other socio-demographic factors in 166 municipal employees in Keratsini (Greece). RESULTS: The prevalence of anti-Hbc (+) did differ significantly between exposed and non-exposed employees to waste. Older employees had a significantly higher prevalence of anti-Hbc (+). MSWWs who were anti-Hbc (+) were less educated than non-exposed employees. Logistic regression analysis has shown that the exposure to waste and age were independently associated with the anti-Hbc positivity. CONCLUSION: Occupational exposure to waste is possibly associated with the acquisition of HBV infection. Immunization of MSWWs should be considered to reduce the risk of HBV infection.     

Evaluation of potential reduction in blood and body fluid exposures by use of alternative instruments

BACKGROUND: Injuries from needlestick, sharps injuries and splashes lead to exposure to blood and body fluids with the potential for transmission of blood-borne viruses. AIMS: To identify alternative instruments, which if used would improve worker safety. METHODS: Retrospective review of 161 injuries with identification of safer alternative products for instruments that caused injury. The proportion of injuries that could be prevented was calculated [with 95% confidence intervals (CI)]. RESULTS: The average rate of injury was 7.8/1000 employees per annum (95% CI, 6.8-9.4/1000). In the 2 years the highest rates of injury occurred in pre-registration house officers (164/1000; 95% CI, 64-264/1000), phlebotomists (154/1000; 95% CI, 15-291/1000) and senior house officers (45/1000; 95% CI, 13-77/1000). An upper estimate of 65% (95% CI, 58-72%) of incidents would have been preventable with a change to alternative devices. CONCLUSIONS: Change to the use of intrinsically safer instrumentation has the potential to prevent injury to healthcare workers.     

Efficacy of glove combinations in reducing cell culture infection after glove puncture with needles contaminated with human immunodeficiency virus type 1.

OBJECTIVE: To study the effect of various latex and treated glove combinations in reducing the frequency of human immunodeficiency virus (HIV) infection of tissue culture cells after puncture by surgical needles contaminated with infectious human immunodeficiency virus type 1 (HIV-1). DESIGN: One, two, or three layers of sterile latex glove material, or two latex layers with intermediate cotton or Kevlar (with or without the virucidal compound nonoxynol-9) were used to cover 24-well cell culture dishes containing MT2 cells in cell culture medium. Surgical needles wet with cell culture medium containing HIV-1 (HTLV IIIA strain) were passed through the glove materials into the culture medium in the wells of the culture dishes. The culture medium in each well was then assayed biweekly for HIV-1 p24 antigen as a test for infection of cells in the well. RESULTS: The rate of HIV-1 infection of cell cultures after glove puncture was greater than 90% with a single latex surgical glove barrier, 23% to 60% with double or triple layers of latex gloves, less than 8% with an intermediate cotton glove impregnated with 4% nonoxynol-9, 6% with an intermediate Kevlar glove, and 0% with an intermediate Kevlar glove impregnated with nonoxynol-9. CONCLUSIONS: An intermediate glove of Kevlar or of Kevlar or cotton impregnated with virucidal compound nonoxynol-9 between standard latex gloves may improve surgical glove safety, compared with latex gloves alone with respect to needlestick transmission of HIV-1. The experimental model used may permit rapid investigation of other glove systems as barriers to the transfer of infectious agents through gloves by needlestick.