Post-exposure prophylaxis protocol for exposure to blood-borne pathogens: an intervention to improve knowledge and practice among medical students in a South African hospital

Background:Globally, approximately three million healthcare workers experience a percutaneous injury each year. Medical students are at a particularly high risk of exposure to blood-borne pathogens. Despite this, the rate of non-reporting is still high. Objectives: The objectives of this study were to describe and improve the knowledge and practice of the post-exposure prophylaxis (PEP) protocol among medical students, through the implementation of quality-improvement interventions, with a view to improving the protocol. Methods: This was an intervention study conducted among third- to fifth-year students, in 2015 and 2016. The quality-improvement interventions took place over 11 months and included the issuing of laminated protocols, posters and lectures. Data from survey questionnaires were used to quantify the impact of these interventions. Student practice was measured by the number of correct steps of the protocol completed. McNemar and Wilcoxon signed-rank tests were used to test differences in the paired categorical data. Results: Of approximately 750 students who participated in the study intervention, 407 returned the initial questionnaire and 148 returned the post-intervention survey questionnaire. Eighty-six students (21.1%) completed both questionnaires. The blood-borne pathogen exposure rate prior to the intervention period was 28.0%. In the paired group, reporting of exposures increased from 12.2% in 2015 to 31.3% in 2016. Knowledge of the PEP protocol increased significantly in the paired group, from 17.4% to 40.2% (p < 0.001). Prior to the intervention, 91.7% completed fewer than half of the steps of the PEP protocol. This decreased significantly to 69.4% in the paired group, post-intervention (p = 0.03). Conclusion: Practice of the PEP protocol significantly improved after the intervention was implemented. In addition, there was a significant improvement in the knowledge of students about postexposure management. However, many exposures were still unreported post-intervention, indicating that more work is needed to improve reporting behaviour

Trends of blood-borne infectious diseases in a rural blood donation center of southeast Gabon (Koula-Moutou)

Introduction: blood-borne pathogens such as human immunodeficiency virus (HIV), hepatitis B and C (HBV and HCV) viruses and Treponema pallidum remain a major public health problem in sub-Saharan Africa. The purpose of this study was to assess the frequency and clinical implications of HIV, HBV, HCV and Treponema pallidum markers in blood donors in a rural area of Southeast Gabon (Koula-Moutou) from 2012 to 2017.Methods: hepatitis B surface antigen (HBsAg), anti-HIV, anti-HCV and anti-Treponema pallidum antibodies were screened using rapid diagnostic tests. Results: of a total of 5,706 blood donors, 1,054 (18.5%) were seropositive for at least one infectious marker and 59 (5.6%) had serologic evidence of multiple infections. The overall seroprevalence of HIV, HBsAg, HCV, and syphilis was 3.1%; 5.9%; 6.2% and 3.3%, respectively. HIV, syphilis and HCV distributions were associated with neither the sex nor the age of the donors. Only HBsAg seroprevalence was significantly higher in donors of the age group 26-35 years old compared to donors of the age group 36-45 years (OR = 1.43 (95% CI: 1.01-2.04), P = 0.045). There was a significant increase in the frequencies of HIV and syphilis and a regression of HBsAg and HCV among blood donors.Conclusion: this study presents the epidemiology of the main pathogens detected in blood donors in a rural area in Gabon. We found that the overall distribution of transfusion transmitted infectious diseases were lower than those observed in the general population but could be underestimated due to the use of rapid diagnostic tests (RDTs) in the screening process of the blood donations

Whole blood pathogen reduction technology and blood safety in sub-saharan Africa: a systematic review with regional discussion

Background: Despite vast improvements in transfusion services in sub-Saharan Africa over the last decade, there remain serious concerns on the safety and adequacy of the blood supply across the region. Objective: This review paper ascertains the role of pathogen reduction technology (PRT) in improving blood safety and supply adequacy in the region. Method: The state of blood safety in sub-Saharan Africa was reviewed. Meetings, seminars and correspondence were undertaken with key clinicians, scientists and professional bodies in the region, including the World Health Organization's Regional Office for Africa, to examine the suitability of PRT for improving the safety of whole blood transfusion, a prevalent transfusion format in the region. Results: Existing literature suggests that combining PRT with current blood safety measures(such as serology) would improve the safety and adequacy of the blood supply for transfusions in sub-Saharan Africa. This was echoed by the findings of the stakeholder meetings. Conclusion: Following a detailed appraisal of two leading PRT systems, the Mirasol® PRT System and the Cerus S-303 System, we suggest that companies conduct comprehensive toxicological evaluation of the agents used for PRT and publish this in the scientific literature. We also recommend that the safety and efficacy of these technologies should be established in a randomised clinical trial conducted in sub-Saharan Africa

Prevalence and determinants of occupational exposures to blood and body fluids among health workers in two tertiary hospitals in Nigeria

Background: Healthcare associated infections among health workers commonly follow occupational exposures to pathogens infecting blood or body fluids of patients. We evaluated the prevalence and determinants of occupational exposures to blood/body fluids among health workers in two tertiary hospitals in Nigeria. Methods: In a cross section study undertaken in two tertiary hospitals in North-central and South-south Nigeria in 2011; a structured self-administered questionnaire was used to obtain demographic data and occupational exposures to blood/body fluids in the previous year from doctors; nurses and laboratory scientists. Independent predictors of occupational exposures were determined in an unconditional logistic regression model. Results: Out of 290 health workers studied; 75.8; 44.7; 32.9; 33.9 and 84.4 had skin contact with patient's blood; needle stick injuries; cut by sharps; blood/body fluid splashes to mucous membranes and one or more type of exposures respectively. Ninety one percent; 86; 71.1; 87.6; 81.3; and 84.4 of house officers; resident doctors; consultant doctors; staff nurses; principal/chief nursing officers and laboratory scientists; respectively had one or more type of exposures in the previous year (P0.05). Professional group was found to be the only independent predictor of cut by sharps. House officers and nurses had higher and more frequent occupational exposures than other professional groups. Conclusion: Our results suggest high rates of occupational exposures to blood/body fluid among health workers in Nigeria; especially among newly qualified medical doctors and nurses. Health facilities in Nigeria ought to strengthen infection prevention and control practices while targeting high risk health workers such as house officers and nurses

Exposure to Blood among Mortuary Workers in Teaching Hospitals in South-West Nigeria

Background: Mortuary workers like other health workers are exposed to blood borne pathogens at work. A baseline assessment is important to plan for programmes to safeguard the health of workers. The aim of this study is to determine exposure rates to blood among mortuary workers in teaching hospitals in South West Nigeria. Methods: A descriptive cross sectional study was carried out between March and May 2008. All mortuary workers working in six (6) teaching hospitals; 80 in total were included in the study. Data was collected with the aid of a 15- item self administered questionnaire. Data was analysed with the aid of EPI-INFO 2002. Statistical associations were explored using odds ratio and confidence intervals. Results: A total of 76 respondents completed questionnaire giving a response rate of 95; 3 males and 1 female declined to participate; the mean age of respondents was 38.2 years; 48(72.6); 53(85.5) and 50(73.5) of the workers had been exposed to blood through cuts; blood splash and needle stick injury. Duration at work was significantly associated with blood splash. Workers who had worked 5years and above were 0.10 times (95confidence interval 0.00-.0.78) as likely to experience blood splash compared to those who had worked under 5 years. Only 5(10.4) of workers with needle stick injury had completed three doses of Hepatitis B vaccine. The specific confirmation by antibody titre was however not done in this study. Conclusion: Exposure to blood was very common with blood splash emerging as the most common route of exposure. There is a need for vaccination of all mortuary workers with three doses of Hepatitis B Vaccine to protect their health. In addition; education of workers on risks and institution of standard operating procedure are crucial to safeguard the health of mortuary workers

Knowledge of Blood-Borne Transmission Risk is Inversely Associated with HIV Infection in Sub-Saharan Africa

Introduction: Accurate; comprehensive knowledge of an infectious pathogen's modes of transmission helps people to avoid infection. Growing evidence suggests that blood-borne HIV transmission is widespread in sub-Saharan Africa. Methodology: I examined the association between knowledge of blood-borne HIV risk and prevalent HIV infection in Demographic and Health Survey data from 16 sub-Saharan African countries. I also searched three online databases for evidence of public education campaigns focused on blood-borne HIV risks in these countries. Results: Knowledge was moderately to strongly inversely related to HIV prevalence at the national level (i.e.; countries in which many respondents were aware of blood-borne risk had lower HIV prevalence than countries in which few respondents were aware of such risk). At the individual level; respondents who knew about blood-borne HIV risks were modestly less likely to be infected than those who did not show awareness of this risk; independent of demographic and sexual behavior variables. This relationship was stronger in southern Africa than in west; central; and east Africa. In parallel analyses; knowledge of condom use as a way to prevent HIV was positively associated with prevalent HIV infection at both the national and individual levels. West; central; and east African countries with low to moderate HIV prevalence had implemented public education campaigns that included a focus on blood-borne transmission risks. Such campaigns were absent from high prevalence countries in southern Africa. Conclusion: These findings suggest that knowledge of blood-borne HIV risk protects against HIV infection and that public education campaigns are important for spreading that knowledge

Occupational Exposure to Bloodborne Viruses amongst Medical Practitioners in Bloemfontein; South Africa

Background : The possibility of occupational exposure to bloodborne viruses such as HIV; hepatitis B virus (HBV) and hepatitis C virus (HCV) is an everyday reality to health care workers. This study reports on doctors' extent and outcome of exposure to bloodborne viruses in Bloemfontein. Methods : descriptive study was done. Doctors (n=441) actively involved in public and/or private medical practice were requested to anonymously complete a questionnaire regarding occupational exposure to bloodborne viruses (HIV; HBV; and HCV). Results : A response rate of 51.7 was obtained. More than half (54.2; 95 CI [ 47.7 ; 60.5 ]) of respondents were exposed to bloodborne viruses; 48.3 occurring with HIV positive patients and 4.3with known HBV positive patients; and no positive HCV patients. After exposure occurred; 68.9 of patients were tested for HIV; 10.9 for HBV and only 4.2 for HCV infection. The frequency of serological testing for doctors immediately after exposure was 65.3 for HIV; 21.7 for HBV and 8.2 for HCV. No seroconversion to HIV or HCV was reported; while two seroconversions to HBV were reported. Most exposures occurred as a result of needle stick injury (85) and occurred in the operating theatre during . The majority (59.8procedures 59.3)of exposed doctors did not take any prophylactic treatment and those who did; did not always complete the treatmentConclusion : The risk of seroconversion to HIV after occupational exposure was as expected; while seroconversion to HBV was less than expected. The lack of adequate follow up serological testing after occupational exposure is alarming. It is the responsibility of the occupationally exposed doctor to adequately comply with prophylactic measures and undergo serological testing to ensure the least possible risk of contracting infection from a bloodborne virus

Risque de contamination du personnel soignant par le VIH : statistiques occidentales

L'exposition au sang est tres frequente: fin 1993; 8313 cas en presence de sang contamine; 159 suivis de transmission de VIH. Le risque estime de contamination reste faible a 0;37 pour cent. Parmi le personnel contamine; les infirmieres representent la categorie du personnel soignant la plus importante avec plus de 90 pour cent des cas. Au moins un tiers des medecins infectes sont des chirugiens. Quant aux circonstances de contamination; l'inoculation est dans 90 pour cent des cas percutanee; le plus souvent par la main (55 pour cent); due a soi-meme (83 pour cent). L'agent contaminant le plus frequent est l'aiguille creuse; impliquee lors des phlebotomies et des manipulations des perfusions. Des controles serologiques a 8 jours; 3;6 et 12 mois permettent de deceler la majorite des seroconversions entre 3 et 6 mois. Une chimioprophylaxie par la Zidovudine se pratique. Son efficacite reste a demontrer. Le risque d'exposition au sang est important. Le taux bas de contamination est en relation avec une faible seroprevalence chez les patients (1 pour cent). Les infirmieres et les chirurgiens constituent 2 groupes a haut risque; la chimioprophylaxie doit etre evaluee