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Frerichs, R.R. HIV and needlestick injuries

SEA-AIDS Network, March 6, 1997

Posted in response to:

BANGKOK POST, February, 26, 1997

"State to compensate infected health staff -- Maximum payment is B1.5 million each

The cabinet yesterday approved payment of compensation to medical practitioners at state hospitals and medical students who contracted the Aids virus during their work.

According to the Finance Ministry proposal, medical staff and students infected with HIV will be entitled to a compensation not exceeding 1.5 million baht. Their spouses and children who contracted the virus will each be entitled to 500,000 baht and 300,000 baht, respectively. In case of death their lawful children, spouses or parents will be entitled to one million baht compensation. A panel will be set up to consider the cases and recommend compensation.

R.R. Frerichs Posting

An article in the Bangkok Post last week (February 26, 1997) points again to the consequences of needlestick injuries, an issue we have discussed in past HIV/AIDS workshops.

Such injuries are especially troublesome for HIV testing programs that attempt to screen many high risk people in a short period of time. For your information I have enclosed abstracts of two past articles that describe the risk to medical staff. The first focuses on the situation in the United States while the second addresses the problem in Nigeria, a country that may be similar with respect to needlestick injuries to Thailand.

Notice in the Buergler et al article that the risk of HIV infection varies greatly, depending on the prevalence of HIV in the served population. The solution that several clinics have adopted here in the United States is to switch to saliva-based tests, recognizing both the inherent safety of this approach and the preference of patients for non-invasive testing.

Several companies now offer such tests, opening the door to competitive pricing. Perhaps a shift to saliva will be considered in Thailand, a country where this approach to testing has been thoroughly evaluated (see Aids 8885-894, 1994 for details). Such a shift would also open the door to widespread testing, necessary to slow transmission of the virus among spouses and between wife and offsprings.

Buergler, J.M., Kim, R., Thisted, R.A., Cohn, S.J., Lichtor, J.L., and Roizen, M.F. Risk of human immunodeficiency virus in surgeons, anesthesiologists, and medical students. Anesthesia and Analgesia 75(1)118-124, 1992.

We postulated that three factors determined the occupational risk of infection from the human immunodeficiency virus (HIV) for surgeons, anesthesiologists, and medical students first, the risk of needlestick exposure per year (range for surgeons 3.8-6.2, weighted average 4.2; range for anesthesiologists 0.86-2.5, weighted average 1.3; range for third-year medical students 0-5, best estimate 5); second, the risk of seroconversion from a needlestick exposure (0.42%-0.50%); and third, prevalence of HIV in the population served (0.32%-23.6%, depending on geographic location). Thus, the calculated range for occupational risk of HIV infection for a surgeon over a 30-yr period (assuming no change in HIV prevalence or benefit from protective measures) was 0.17% - 13.9%; for an anesthesiologist, 0.05% - 4.50%. The corresponding range of occupational risk for a medical student during the third year was 0.007% - 0.59%. The range of risk is large because the variation in prevalence of HIV infection from one area to another is great. The authors validated the methodology first by using an equation, with estimates from the literature for factors in the equation, to calculate the risk of infection for hepatitis B and then by comparing the results with known rates of infection in the prevaccine era. Calculated occupational risk of hepatitis B infection for anesthesiologists was in the lower range of actual prevalence of infection (calculated range 2.32% - 20.6%; known range 6% - 26%). Calculated risk versus prevalence for surgeons was fairly close (7.31%-53.4% versus 24.4%). (ABSTRACT TRUNCATED AT250 WORDS)

Adegboye, A.A., Moss, G.B., Soyinka, F., and Kreiss, J.K. The epidemiology of needlestick and sharp instrument accidents in a Nigerian hospital. Infection Control and Hospital Epidemiology 15(1)27-31, 1994.

OBJECTIVES: To characterize the epidemiology of percutaneous injuries of healthcare workers (HCWs) in Ile-Ife, Nigeria.

DESIGN: A cross-sectional survey of a random sample of HCWs regarding details of needlestick and sharp instrument injuries within the previous year.

SETTING: University hospital and clinics in Ile- Ife, Nigeria.

PARTICIPANTS: Hospital personnel with potential occupational exposure to patients' blood.

RESULTS: Needlestick accidents during the previous year were reported by 27% of 474 HCWs, including 100% of dentists, 81% of surgeons, 32% of nonsurgical physicians, and 31% of nursing staff. The rate of needlestick injuries was 0.6 per person-year overall2.3 for dentists, 2.3 for surgeons, 0.4 for nonsurgical physicians, and 0.6 for nursing staff. Circumstances associated with needlestick injuries included unexpected patient movement in 29%, handling or disposal of used needles in 23%, needle recapping in 18%, accidental stick by a colleague in 18%, and needle disassembly in 10%. Sharp instrument injuries were reported by 15% of HCWs and most commonly involved broken glass patient specimen containers (39%). Almost all HCWs were aware of the potential risk of HIV transmission through percutaneous injuries, and 91% considered themselves very concerned about their occupational risk of HIV acquisition.

CONCLUSIONS: The high frequency of percutaneous exposure to blood among HCWs in this Nigerian hospital potentially could be reduced by simple interventions at modest cost.