Of the 1600 HCWs recruited, 1386 (87%) agreed to participate. Among the 1386 HCWs studied, 53% were nurses and 46% were physicians; 1100 (79%) were females and 283 (20%) were males. About 45% were 45 years of age and older, only 57 HCWs (4%) were 25 years of age and younger; 844 (61%) were married. The participating HCWs were from the departments of surgery (29%), internal medicine (19%) and intensive care (18%). The other HCWs were obstetricians and gynaecologists (15%), dialysis physicians and nurses (7%), paediatricians (7%) and laboratory workers (5%).
Nosocomial risk events were reported by the majority of HCWs, including accidental needlestick injury (45%, with 20% reported of having more than five contaminated needlestick incidents), cuts with contaminated instruments (38%) and blood splashes (46%, with 15% reported of having five or more such incidents).
In bivariate analyses, males were more likely than females to report needlesticks (55% versus 43%, PR 1.3; 95% CI 1.1–1.5), blood splashes (65% versus 42%, PR 1.6; 95% CI 1.4–1.7) and cuts (56% versus 33%, PR 1.7; 95% CI 1.5–1.9). Physicians were more likely to report blood splashes and accidental cuts with contaminated instruments than nurses (blood splashes—55% versus 40%, PR 0.7; 95% CI 0.6–0.8 and cuts—42% versus 36%. PR 0.8; 95% CI 0.7–0.9).
Different types of events predominated in subjects working in different hospital departments. Blood splashes were most common among obstetricians and gynaecologists (70% had at least one episode, with 21% having five or more cases of blood splash); while surgeons had the highest frequency of cuts with a contaminated instrument—almost half of them reported at least one incident. The frequency of needlestick injuries was highest among dialysis physicians and nurses (58% reported a needlestick accident).
The highest frequency of cuts with a contaminated instrument occurred during a false move (e.g. hand slipped) during the procedure (71% of cuts among physicians and 63% among nurses), see . The next most frequent cause of cuts was reassembling devices (10% among both physicians and nurses) and handling a device used by a colleague (6 and 7%). The highest proportion of accidental needlestick injuries was attributed to a false move during a procedure (60% of accidents among physicians and 46% among nurses) and to the recapping of used needles (22% among physicians and 39% among nurses), see . Most blood splash events occurred during direct patient contact (87% among physicians and 81% among nurses).
Circumstances related to the occupational exposure to blood among HCWs, Georgia 2006–07
Demographic, occupational and medical factors related to systematic glove use among HCWs, Georgia, 2006–07
The use of barrier precautions during patient contact was unusual, including use of gloves (only 32% reported of always using gloves), face masks (27% never used) and eye shields (76% never used). In bivariate analyses, the factors significantly associated with consistent glove use were gender (females using gloves more consistently than males), occupation (nurses using gloves more often than physicians) and type of job (the highest glove use rate was among obstetricians/gynaecologists, dialysis personnel and surgeons), see . In multivariate analysis, for always using gloves, only job type was significantly related when adjusted for other factors.
Only 29% of HCWs knew that needles should be placed in sharps containers after use, 23% thought that they should be recapped, 28% thought that they should be placed in disinfection solution, and 18% stated that they did not know the correct way to handle contaminated needles. The majority (75%) of HCWs reported that they did not know how endoscopic equipment should be cleaned.
None of the participating HCWs were infected with HIV. The overall prevalence of HCV infection was 5%; anti-HBc was positive among 29% of study participants, and 2% were HBsAg carriers. The prevalence differed significantly by city. HCV prevalence was 4, 4, 6, 8 and 12% (P < 0.05) in the five cities, where participating hospitals were located.
A history of occupational exposure, such as a blood splash, cut with a contaminated instrument and a needlestick injury, was not significantly associated with HBV and HCV infection status. The highest HCV prevalence was found in the 36–45 age group (8% infected). In contrast, HBsAg was most prevalent among the youngest HCWs—5% of those younger than 25 years of age were positive.
HCV infection status was significantly associated with occupation and gender (). Physicians were almost twice as likely to be infected with HCV as compared with nurses (PR = 1.8; 95% CI 1.1–3.0). Male HCWs were 2.7 times (95% CI 1.6–4.2) as likely to be infected with HCV as compared with nurses. In contrast, HBV infection was more prevalent among nurses (for HBsAg, PR = 2.6; 95% CI 1.1–6.0 and for anti-HBc, PR = 1.2; 95% CI 1.0–1.4). HCWs in the surgical department (6%) and ICU (6%) tended to have higher HCV rates than those in internal medicine (4%), but these differences were not statistically significant.
Demographic and occupational characteristics of HCWs by hepatitis markers, Georgia, 2006–07