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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.
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