Among the 650 participants, 170 (26.2%) were residents, 195 (30%) medical interns, 207 (31.8%) nurses, and 78 (12%) were nurse aids while 53.4% of them reported a needlestick injury (NSI) and/or mucosal exposure to patients' body fluids (). The frequency of exposures was different among four groups (p<0.001). In addition, 60.3% of the participants reported more than one exposure.
Prevalence of needlestick injuries and/ or mucosal exposure to patients' body fluids among health care workers.
Recapping the needle was reported by 76 (26.5%), suturing by 71 (24.7%) and intravenous (IV) catheter insertion by 70 (24.4%) individuals. Involvement in surgical procedures was seen in 47 (16.4%), and blood sampling in 42 (14.6%) cases as the most prevalent causes. The most prevalent causes differed among different subgroups while among residents included involvement in surgical procedures (43.6%), suturing (37.6%), and recapping the needles (15.8%); but medical interns mentioned suturing (50.8%), arterial blood gas sampling (26.2%), and recapping (15.4%). Meanwhile IV catheter insertion (42.2%), recapping the needle (40%), and blood sampling ( 24.4%) were recognized to be the most prevalent causes of the injuries among nurses which was similar to nurse-aids (IV catheter insertion, recapping the needles, and blood sampling as the most prevalent causes with prevalence rate of 58.1%, 45.2%, and 35.5%, respectively).
The restlessness and movements during the procedure was a factor contributing to at least one of the dangers (24.4%). The history of body fluids splash on their own mucosal membranes was shown in 181 (27.8%) of the HCWs (40% of the residents, 24.1% of the medical interns, 24.6% of the nurses, and 19.2% of the nurse aids). The prevalence rate of body fluids splashes on the mucosal membranes among the different subgroups was not different.
Surgical procedures, suturing, IV catheter insertion, and removing the IV catheters were recognized as the most prevalent causes of body fluids splashes on the mucosal membranes.
Protective equipments such as masks, glasses, and shields have been used in 35.9% of these individuals (70.6%, 27.6%, 5.9%, and 6.7% of the residents, medical interns, nurses, and nurse-aids, respectively) (p<0.001); 91.2% of the individuals with a history of body fluids splash had mucosal exposure as a result of ignoring the utilization of the protective equipments or improper utilization.
Among HCWs with a history of either cutaneous injury or mucosal exposure to body fluids of the patients, 19.9% (17.1% of the residents, 21.6% of medical interns, 20.7% of the nurses as well as 22.2% of the nurse- aids, p>0.05) were referred to a specialist (internal medicine or infectious diseases) while 79.4% of these referrals occurred within 24 hours of exposure. Forty percent of the HCWs with a history of needle stick or mucosal exposure to body fluids of the patients noted that they had tried to assess the situation based on their own knowledge and expertise. This included 54.7% of the residents, 30.7% of the medical interns, 43.4% of the nurses, and 11.1% of the nurse-aids (p<0.001); 23.4% of them (18.7%, 25.9%, 23.9%, and 75% of the residents, medical interns, nurses, and nurse- aids, respectively) never reviewed the profile of the source patients (p>0.05). In order to find out the appropriate approach to the problem, 14.4% of the exposed population referred to the textbooks. This included 19.4% of the residents as well as 15.9% of the medical interns and 2.8% of the nurses. None of the nurse-aids referred to the textbooks.
In 54.5% of the HCWs with a positive history of either needle stick or mucosal exposure (60.7% of the residents, 47.7% of the medical interns, 59.5% of the nurses, and 36.1% of the nurse- aids), the profile of the patients who had been the source of contamination regarding blood borne viral infections were reviewed (p<0.003); 5.8% (3 cases) of them had noted that their patient was infected with HIV, while 38.4% (20) had patients with HBV, 23.1% (12) had patients with HCV, and 11.6% (6) were infected with HIV and HCV at the same time. In addition, 9.6% (5) had mentioned their patients had both HBV and HCV; and 11.5% (6) had noted that the patients had a triple infection.
Only 20% of the HCWs whose patients were HIV+ had received PEP (two residents and 1 nurse; and none of the 5 exposed medical interns had received PEP (p>0.05). Considering the onset of the treatment, the number of medications, and their types, it seemed that PEP was conducted properly in the residents, while the only exposed nurse did not receive the proper prophylaxis. Among exposures to HIV+ patients, 46.7% of the HCWs reviewed their own seroconversion; only one of them was followed properly. There was no significant difference among the subgroups in their seroconversion assessment.
Among exposures to HBsAg+ patients, 25.8% of the exposed HCWs (22.2% of the medical interns, 71.4% of the nurses, and 20% of the nurse-aids) received hepatitis B immunoglobuline (HBIG) during 72 hours after exposure; none of the residents received HBIG (p<0.001). History of vaccination, and reassurance about the effective serum antibody titer was the most frequent reason mentioned in case the individuals did not receive HBIG (56.5%).