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Occupational Exposures and the Prevalence of Blood-Borne Pathogens in a Deployed Setting Data from a US Military Trauma Center in Afghanistan

Published online by Cambridge University Press:  02 January 2015

Jason F. Okulicz*
Affiliation:
Infectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas
Heather C. Yun
Affiliation:
Infectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas
Clinton K. Murray
Affiliation:
Infectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas
*
Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234 ([email protected])

Abstract

Objective.

Occupational exposures to blood and other bodily fluids occur in approximately 5 per 100 persons every year in US hospitals. Since the provision of health care in the deployed environment poses unique challenges to hospital personnel, it is important to characterize the rates of occupational exposures and understand the prevalence of blood-borne pathogens (BBPs) in host nations.

Methods.

A retrospective review of public health and laboratory records at a US military trauma center in Afghanistan from October 1, 2010, to March 31, 2012.

Results.

A total of 65 occupational exposures were reported, including 47 (72%) percutaneous and 18 (28%) mucocutaneous, with a yearly rate of 8.6 exposures per 100 persons. During 6-month deployment cycles, the majority of exposures (46.2%) occurred in the first 2 months after arrival in Afghanistan. Physicians reported the most exposures (26%), and the operating room (48%) was the most common hospital location. The prevalence of hepatitis B and hepatitis C among local national source patients (n = 59 ) was 8.9% and 2.3%, respectively, with no cases of HIV or syphilis detected. In contrast, there were no BBPs detected in coalition source (n = 12) or exposed (n = 57) patients.

Conclusions.

The characteristics of occupational exposures in this deployed environment were comparable to those of US-based hospitals. Standard practices used to reduce occupational exposures, such as use of personal protective equipment and safety devices, should continue to be prioritized in the deployed setting. Although BBP rates are not well defined in Afghanistan, our results were consistent with those of prior epidemiologic studies.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1. Beekmann, SE, Vaughn, TE, McCoy, KD, et al. Hospital blood-borne pathogen programs: program characteristics and blood and body fluid exposure rates. Infect Control Hosp Epidemiol 2001;22:7382.10.1086/501867Google Scholar
2. Dobie, DK, Worthington, T, Faroqui, M, Elliott, TSJ. Avoiding the point. Lancet 2002;359:1254.10.1016/S0140-6736(02)08245-4Google Scholar
3. Ippolito, G, Puro, V, Petrosillo, N, De Carli, G. Surveillance of occupational exposure to blood-borne pathogens in health care workers: the Italian national programme. Euro Surveill 1999;4: 3336.10.2807/esm.04.03.00055-enGoogle Scholar
4. Whitby, RM, McLaws, M-L. Hollow-bore needlestick injuries in a tertiary teaching hospital: epidemiology, education and engineering. Med J Aust 2002;177:418422.10.5694/j.1326-5377.2002.tb04881.xGoogle Scholar
5. Beekmann, SE, Vlahov, D, Koziol, DE, McShalley, ED, Schmitt, JM, Henderson, DK. Temporal association between implementation of universal precautions and a sustained, progressive decrease in percutaneous exposures to blood. Clin Infect Dis 1994; 18:562569.10.1093/clinids/18.4.562Google Scholar
6. Tarantola, A, Abiteboul, D, Rachline, A. Infection risks following accidental exposure to blood or body fluids in health care workers: a review of pathogens transmitted in published cases. Am J Infect Control 2006;34:367375.Google Scholar
7. Beekmann, SE, Henderson, DK. Protection of healthcare workers from blood-borne pathogens. Curr Opin Infect Dis 2005;18: 331336.10.1097/01.qco.0000171921.52433.50Google Scholar
8. Maki, DG, Kluger, DM, Crnich, CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:11591171.10.4065/81.9.1159Google Scholar
9. Nasir, A, Todd, CS, Stanekzai, MR, et al. Prevalence of HIV, hepatitis B and hepatitis C and associated risk behaviours amongst injecting drug users in three Afghan cities. Int J Drug Policy 2011;22:145152.10.1016/j.drugpo.2010.10.006Google Scholar
10. Rasoul, MZ, Wodak, A, Claeson, M, Friedman, J, Sayed, GD. Responding to HIV in Afghanistan. Lancet 2007;370:21672169.Google Scholar
11. Murray, CK, Johnson, EN, Conger, NG, Marconi, VC. Occupational exposure to blood and other bodily fluids at a military hospital in Iraq. J Trauma 2009;66:S62S68.10.1097/TA.0b013e31819cdfc8Google Scholar
12. Goob, TC, Yamada, SM, Newman, RE, Cashman, TM. Blood-borne exposures at a United States Army Medical Center. Appl Occup Environ Hyg 1999;14:2025.Google Scholar
13. Lovell, ME. Intra-operative injury and military surgeons. J R Army Med Corps 1992;138:3637.Google Scholar
14. Jackson, DS, Batty, CG, Ryan, JM, McGregor, WS. The Falklands War: army field surgical experience. Ann R Coll Surg Engl 1983; 65:281285.Google Scholar
15. Tribble, DR, Conger, NG, Fraser, S, et al. Infection-associated clinical outcomes in hospitalized medical evacuees after traumatic injury: trauma infectious disease outcome study. J Trauma 2011;71:S33S42.10.1097/TA.0b013e318221162eGoogle Scholar
16. White, MC, Lynch, P. Blood contact and exposures among operating room personnel: a multicenter study. Am J Infect Control 1993;21:243248.10.1016/0196-6553(93)90416-2Google Scholar
17. Gerberding, JL, Littell, C, Tarkington, A, Brown, A, Schecter, WP. Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital. N Engl J Med 1990; 322:17881793.10.1056/NEJM199006213222506Google Scholar
18. Panlilio, AL, Foy, DR, Edwards, JR, et al. Blood contacts during surgical procedures. JAMA 1991;265:15331537.Google Scholar
19. Popejoy, SL, Fry, DE. Blood contact and exposure in the operating room. Surg Gynecol Obstet 1991;172:480483.Google Scholar
20. Dia, A, Verret, C, Pommier de Santi, V, et al. Blood and body fluid exposures in the French military. Occup Med (Lond) 2012; 62:141144.10.1093/occmed/kqr179Google Scholar
21. Khanani, MR, Somani, M, Khan, S, Naseeb, S, Ali, SH. Prevalence of single, double, and triple infections of HIV, HCV and HBV among the MSM community in Pakistan. J Infect 2010;61: 507509.10.1016/j.jinf.2010.09.035Google Scholar
22. Todd, CS, Nasir, A, Stanekzai, MR, et al. Prevalence and correlates of HIV, syphilis, and hepatitis B and C infection and harm reduction program use among male injecting drug users in Kabul, Afghanistan: a cross-sectional assessment. Harm Reduci J 2011;8:22.Google Scholar
23. Todd, CS, Ahmadzai, M, Atiqzai, F, et al. Seroprevalence and correlates of HIV, syphilis, and hepatitis B and C virus among intrapartum patients in Kabul, Afghanistan. BMC Infect Dis 2008;8:119.10.1186/1471-2334-8-119Google Scholar
24. Scott, PT, Niebuhr, DW, McGready, JB, Gaydos, JC. Hepatitis B immunity in United States military recruits. J Infect Dis 2005; 191:18351841.10.1086/429965Google Scholar
25. Brodine, SK, Starkey, MJ, Shaffer, RA, et al. Diverse HIV-1 subtypes and clinical, laboratory and behavioral factors in a recently infected US military cohort. AIDS 2003;17:25212527.10.1097/00002030-200311210-00016Google Scholar
26. Spinella, PC, Dunne, J, Beilman, GJ, et al. Constant challenges and evolution of US military transfusion medicine and blood operations in combat. Transfusion 2012;52:11461153.10.1111/j.1537-2995.2012.03594.xGoogle Scholar
27. Deering, S, Rosen, MA, Ludi, V, et al. On the front lines of patient safety: implementation and evaluation of team training in Iraq. Jt Comm J Qual Patient Saf 2011;37:350356.Google Scholar