Bloodborne exposures at a United States Army Medical Center

With the ultimate goal of minimizing exposures, we conducted a hazard analysis on bloodborne disease transmission at our hospital to identify appropriate control interventions. We utilized basic principles of occupational epidemiology to gather information on the severity and extent of exposures. Because we suspected inadequate reporting of needlestick injuries, we collected 339 reported exposures of health care workers; we conducted a survey of all workers requiring universal precautions training for bloodborne pathogens. The annual incidence of exposures reported was 93.7 per 1000 workers who required this training. Sharps accounted for 83.5 percent of these exposures. Exposure sources demonstrated 4.3 percent positive for HIV, 4.4 percent positive for hepatitis B, and 7.1 percent positive for hepatitis C. The survey indicated that blood/body fluid exposures were underreported by at least fourfold. House officers were most at risk. At-risk behaviors were identified by the significant differences in knowledge of HIV transmission and work practices between groups reporting no or single exposures versus groups reporting multiple exposures. Increased emphasis should be placed on education, reporting exposures, and training house officers in procedures requiring the use of hollow bore needles. This study shows how the use of occupational epidemiology principles and methods were utilized in conducting a thorough hazard analysis and in identifying appropriate control methods.