The Berufsgenossenschaft for the healthcare (Gesundheitswesen) and welfare services (BGW) (Institution for Statutory Accident Insurance and Prevention) is the compensation board for all non-governmental healthcare and welfare providers in Germany. A total of 500,000 enterprises with about six million paid workers are covered by the BGW. The BGW’s database on compensation claims concerning the occupational disease number 3101, “infectious disease with human-to-human transmission”, was used for this analysis. The database allows a distinction to be made between the most frequent infectious diseases. Furthermore accidental blood contact reported to the compensation board can be identified. Contact with blood (or other body fluids) splashed onto the skin or the mucous membranes is coded as accidental blood contact (ABC). No information is available on whether the ABC occurred on intact or non-intact skin or on skin or mucous membranes. Injuries caused by used needles, scalpels or knives are coded as needlestick injuries (NSIs).
The reporting of suspected cases of ODs is compulsory for physicians and companies after first diagnosis. In the standardised data set, a further distinction is made between ODs that are mandatorily reportable and those that are not. Reporting ABC is not mandatory. ABC in the form of splashes is documented as an OID. It is reported to the compensation board because the cost of post-exposure prevention is covered by the board. NSIs are documented as working accidents. They must only be reported if they cause sick leave of more than three days, which they do not normally. However, they are reported in order to obtain compensation for the cost of post-exposure prevention independent of any sick leave.
The distinction between infectious diseases was introduced at different times and is available only for the most important infectious diseases. Claims of OIDs were analysed for 2009. Time trends over five years were analysed for claims concerning tuberculosis (TB), latent tuberculosis infection (LTBI), scabies, methicillin-resistant Staphylococcus aureus (MRSA), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), ABC and NSIs. As the data set allows a distinction to be made between hepatitis B virus (HBV) and hepatitis C virus (HCV) starting in 1995, time trends are given for the 15 years between 1995 and 2009 for these infections. LTBI was considered present if the interferon-γ release assay (IGRA) was positive and active TB was excluded by X-ray.
We calculated rates of OIDs per 100,000 employees and of NSIs and ABC per 1,000 employees. In order to reduce variation by chance, these rates were calculated as an average for the last five years.
The prevalence of OIDs, ABCs and NSI were analysed for selected working areas in healthcare. These working areas correspond to clustered occupational groups, including settings with comparable risks of accidents and diseases, which are used in combination with compensation money to calculate insurance premiums. For the analyses, four working areas were selected: 1.) hospitals and other clinical facilities (referred to as hospitals in the following), 2.) medical surgeries with all kind of specialisations (referred to as surgeries), 3.) nursing homes, hospices, and other long-term care facilities (referred to as nursing homes), 4.) outpatient medical and social care, emergency medical services (referred to as outpatient care). The remaining occupational groups – including veterinary practices, hairdressing, administration, day care, social welfare services and facilities for the handicapped – were pooled (referred to as others in the following). Five-year trends for the most frequent infectious diseases were analysed separately for these working areas. Regulations for using safety devices were bolstered in Germany in 2008. Therefore claims of NSIs and ABC were analysed depending on working areas for 2008 and 2009 in order to see whether the new regulations had decreased the number of NSIs or ABC in the different working areas. Costs for NSIs and ABC were extracted from the data set for a five-year period.