Per cutaneous inoculation (by needle or other instrument that pierces the skin) carries a low risk of HIV transmission of around 0.3% (95% CI 0.2 to 0.5);[9
] our study also did not report any HIV case.
Majority of people (63.7%) in this study who suffered occupational injuries were females. Male: female ratio whether in PLHIV or patients on ART show a male dominance, whereby the male female ratio is around 2:1. This study shows a female vulnerability in healthcare settings, which needs to be targeted through training of HCP with special emphasis on female employee (staff nurses, technicians, and helpers). Proportions of staff nurses (28.1%), medical officers (26.6%), and laboratory technicians (14.4%) in our study were high when compared with 19%, 18%, and 10%, respectively, by Baheti et al
. They all being highly vulnerable for increased risk for acquiring blood borne HIV exposures in care settings in India.[8
PEP is the cost-effective measurements in low and middle income countries in HIV care settings for HCP getting exposed to infectious materials.[10
] While 120 out of 278 are still in the window period; rest who could be tested were found non reactive. This may be due to the timely institution of effective PEP. It may not be true in all cases as 25 HCP had severe exposure and for another 30 we are unsure whether they took it for required 28 days or not. The fact that majority of them (55–57%) do not come for repeat testing is a worrying aspect. Staff still have the fear of stigmatization and afraid to know their HIV status, more so at the facility where they are working. All healthcare units should ensure to have adequate staff counselling and education about risk of infection after occupational exposure. Policies and procedures should be in place and the staff should be aware about the actions to be taken in the event of occupational exposure.
However, one encouraging fact was that most of the HCP (85%) exposed to occupational exposure had their baseline HIV test done, all being HIV non reactive. It is important that once PEP started, it should be taken for full duration of 28 days. More than 94% respondents who were prescribed the PEP took it for full 28 days. Rest discontinued it for the side effects to PEP regimen. Adverse effects due to PEP should be treated with core concern to continue PEP. Detailed counselling is required in such cases for better mental preparation for post PEP outcome as well.
HCPs should be educated to report occupational exposures immediately after the occurrence, particularly because hepatitis B vaccine and HIV - PEP is most effective if administered soon after the exposure. Exposed HCP of all cadres must be aware of the standard instructions for access to urgent advice of occupational exposure and the fact that HIV testing should be done at the baseline level and after the completion of the PEP at interval of 3 and 6 months to confirm the HIV status of exposed HCP.[2
Equally important for the HCP is to know how to minimize the injuries and about the round the clock availability of PEP, expected adverse events, and the strategies for managing them. It must be noted that PEP is not cent percent effective in preventing HIV seroconversion,[11
] Therefore, PEP cannot be considered to replace the universal precautions and avoiding occupational injuries. Persons who take PEP and are under follow up for 6 months should abstain from any high risk behaviour activity and not donate blood.[12
] Although preventing blood exposures is the primary means of preventing occupationally acquired blood borne diseases, appropriate post-exposure management is an important element of workplace safety. The study highlights the need of standardized protocols for management of exposure to blood borne pathogens. It also reflects the need for safe working environment in all hospitals. There is a need to report, investigate and follow-up needle stick injuries. Drugs for PEP for HIV should be available 24 hours readily in hospitals for immediate use by HCPs.
This study indicates the need to reinforce knowledge regarding various aspects of occupational PEP to health care personals especially those associated with nursing (staff nurse, nursing students), Resident doctors and Laboratory technicians. Another study from Ahmadabad[13
] has shown that by regular sensitization and universal precaution workshops increase the awareness among HCPs for reducing HIV infection risk and transmission and prevention through PEP.
Success of entire program depends up on (1) making PEP drugs available everywhere, (2) making the staff informed about avoiding injuries, following universal precautions and preparing them to take PEP as and when indicated with its all associated procedures.