Registration of blood exposure accidents in The Netherlands by a nationally operating call center.

OBJECTIVE: Healthcare providers and other employees, especially those who do not work in a hospital, may not easily find help after the occurrence of a blood exposure accident. In 2006, a national call center was established in The Netherlands to fill this gap. METHODS: All occupational blood exposure accidents reported to the 24-hours-per-day, 7-days-per-week call center from 2007, 2008, and 2009 were analyzed retrospectively for incidence rates, risk assessment, handling, and preventive measures taken. RESULTS: A total of 2,927 accidents were reported. The highest incidence rates were reported for private clinics and hospitals (68.5 and 54.3 accidents per 1,000 person-years, respectively). Dental practices started reporting incidents frequently after the arrangement of a collective financial agreement with the call center. Employees of ambulance services, midwife practices, and private clinics reported mostly high-risk accidents, whereas penitentiaries frequently reported low-risk accidents. Employees in mental healthcare facilities, private clinics, and midwife practices reported accidents relatively late. The extent of hepatitis B vaccination in mental healthcare facilities, penitentiaries, occupational health services, and cleaning services was low (<70%). CONCLUSION: The national call center successfully organized the national registration and handling of blood exposure accidents. The risk of blood exposure accidents could be estimated on the basis of this information for several occupational branches. Targeted preventive measures for healthcare providers and other employees at risk can next be developed.

Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit.

INTRODUCTION: Absolute lymphocytopenia has been reported as a predictor of bacteremia in medical emergencies. Likewise, the neutrophil-lymphocyte count ratio (NLCR) has been shown a simple promising method to evaluate systemic inflammation in critically ill patients. METHODS: We retrospectively evaluated the ability of conventional infection markers, lymphocyte count and NLCR to predict bacteremia in adult patients admitted to the Emergency Department with suspected community-acquired bacteremia. The C-reactive protein (CRP) level, white blood cell (WBC) count, neutrophil count, lymphocyte count and NLCR were compared between patients with positive blood cultures (n = 92) and age-matched and gender-matched patients with negative blood cultures (n = 92) obtained upon Emergency Department admission. RESULTS: Significant differences between patients with positive and negative blood cultures were detected with respect to the CRP level (mean ± standard deviation 176 ± 138 mg/l vs. 116 ± 103 mg/l; P = 0.042), lymphocyte count (0.8 ± 0.5 × 109/l vs. 1.2 ± 0.7 × 109/l; P < 0.0001) and NLCR (20.9 ± 13.3 vs. 13.2 ± 14.1; P < 0.0001) but not regarding WBC count and neutrophil count. Sensitivity, specificity, positive and negative predictive values were highest for the NLCR (77.2%, 63.0%, 67.6% and 73.4%, respectively). The area under the receiver operating characteristic curve was highest for the lymphocyte count (0.73; confidence interval: 0.66 to 0.80) and the NLCR (0.73; 0.66 to 0.81). CONCLUSIONS: In an emergency care setting, both lymphocytopenia and NLCR are better predictors of bacteremia than routine parameters like CRP level, WBC count and neutrophil count. Attention to these markers is easy to integrate in daily practice and without extra costs.