Hepatitis C virus infection in healthcare workers: risk of exposure and infection.

OBJECTIVES: To determine the incidence of hepatitis C virus (HCV) infection among healthcare workers (HCWs) at a university hospital, the proportion of HCWs having non-A, non-B hepatitis (NANBH) who were anti-HCV positive, and the rate of HCV transmission following a HCV-positive needlestick injury. DESIGN: Longitudinal analysis of a dynamic (cohort) population. MEASUREMENTS: From 1980 through 1989, HCWs who had clinical NANBH were identified, and from 1987 through 1989, HCWs who reported a blood or body fluid exposure and the patients who were the source of the exposure were screened for antibodies to HCV. SETTING: A 732-bed, university hospital and outpatient clinics. RESULTS: Over the 10-year period, six cases of occupationally acquired NANBH were observed, for an incidence of 21 cases per 100,000 HCWs per year (standardized incidence ratio, 2.96; 95% confidence interval [CI95], 1.83 to 4.36). Four of the six cases were confirmed to be HCV infection. From 1987 through 1989, 176 (12.7%) of 1,387 patients who were the source of an exposure were anti-HCV positive. Exposures that occurred in the emergency department were more likely to be anti-HCV positive than were exposures from all other locations (relative risk [RR] = 1.7; P = 0.009). Of HCWs who had an HCV-positive needlestick injury and whose serum had been tested for anti-HCV at least 5 months after the exposure, 3 (6.0%) of 50 seroconverted. From 1987 through 1989, the incidence of HCV infection among HCWs was 54 cases per 100,000 HCWs per year. CONCLUSION: The incidence of clinical NANBH among HCWs in this study is approximately three times higher than that of non-HCWs. HCWs are at significant risk for exposure to and acquisition of HCV.

Decline of clinical hepatitis B in workers at a general hospital: relation to increasing vaccine-induced immunity.

Hepatitis B is a well-recognized occupational hazard of health-care workers that can be prevented with vaccination. However, because data on the current epidemiology of hepatitis B virus (HBV) in this population are limited, no consensus exists regarding the requirement for immunization. In 1980-1989, 4,908 exposures of health-care workers to patients' blood and/or other body fluids were reported and evaluated at a general hospital. During this period, 4.8% of patients to whom health-care workers were exposed were positive for hepatitis B surface antigen (HBsAg). In exposed workers, the rate of protective immunity to HBV (measured by antibody to HBsAg) increased from 14% in 1980 to 55% in 1989. Hepatitis B vaccine became available at this hospital in 1983. The increase in antibody to HBsAg was not associated with an increase in antibody to HBV core antigen; this finding suggests that the increase in immunity was primarily vaccine induced. The incidence of reported clinical hepatitis B in health-care workers decreased from 82/100,000 in 1980-1984 to zero in 1985-1989 (odds ratio = 20.06; P = .0012). Thus, in this study, a program of hepatitis B immunization for health-care workers was associated with a significant decline in clinical HBV infection despite continued exposure to patients positive for HBsAg.

Effect of educational programs, rigid sharps containers, and universal precautions on reported needlestick injuries in healthcare workers.

OBJECTIVE: To evaluate the effect of infection control programs on reported needlestick injuries in a general hospital. DESIGN: Surveillance of all reported needlestick injuries at the University of Cincinnati Hospital was maintained by the infection control department for five years, from 1985 through 1989. Data on individual workers were collected, tabulated on a monthly basis, and reviewed continually to monitor trends in injuries. During this time, the effects of each of three new infection control programs on reported injuries were evaluated sequentially. SETTING: A 700-bed general hospital that serves as the main teaching hospital of the University of Cincinnati. PARTICIPANTS: All employees of University Hospital who reported to personnel health for management of needlestick injuries. INTERVENTIONS: In 1986, an educational program to prevent injuries was initiated and continued throughout the surveillance period. In 1987, rigid sharps disposal containers were placed in all hospital rooms. In 1988, universal precautions were introduced with an intensive inservice. RESULTS: Surveillance identified 1,602 needlestick injuries (320/year) or 104/1,000/year. After the educational program began, reported injuries increased rather than decreased, and this was attributed to increased reporting. Subsequently, after installation of the new disposal containers, reported injuries returned to the levels seen prior to the educational program, but recapping injuries showed a significant decrease from 63/year to 30, or 20/1,000/year to 10. This decrease was observed in nurses but not in other healthcare workers. After universal precautions were instituted, total injuries increased slightly, but recapping injuries remained at 50% of the levels reported prior to the use of rigid sharps disposal containers. CONCLUSIONS: The three infection control programs failed to produce a major reduction in reported needlestick injuries, except for a decrease in recapping injuries associated with the placement of rigid sharps disposal containers in all patient rooms. These observations indicate that new approaches are needed to reduce needlestick injuries.