Are Hospital-Based Health Care Providers at Risk?

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Clinical Infectious Diseases    2003;37:1006-1013
© 2003 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2003/3708-0002$15.00
MAJOR ARTICLE


Percutaneous Injury, Blood Exposure, and Adherence to Standard Precautions:
Are Hospital-Based Health Care Providers Still at Risk?

Bradley N. Doebbeling,1,2,3,a Thomas E. Vaughn,4 Kimberly D. McCoy,2 Susan
E. Beekmann,2 Robert F. Woolson,6 Kristi J. Ferguson,5 and James C. Torner3

1Program in Health Services Research, Veterans' Affairs Medical Center,
2Department of Internal Medicine, University of Iowa Carver College of
Medicine, and Departments of 3Epidemiology, 4Health Management and Policy,
and 5Community and Behavioral Health, University of Iowa College of Public
Health, Iowa City, Iowa; and 6Department of Biometry and Epidemiology,
Medical College of the University of South Carolina, Charleston

To examine factors associated with blood exposure and percutaneous injury
among health care workers, we assessed occupational risk factors, compliance
with standard precautions, frequency of exposure, and reporting in a
stratified random sample of 5123 physicians, nurses, and medical
technologists working in Iowa community hospitals. Of these, 3223 (63%)
participated. Mean rates of hand washing (32%54%), avoiding needle recapping
(29%70%), and underreporting sharps injuries (22%62%; overall, 32%) varied
by occupation (P < .01). Logistic regression was used to estimate the
adjusted odds of percutaneous injury (aORinjury), which increased 2%3% for
each sharp handled in a typical week. The overall aORinjury for never
recapping needles was 0.74 (95% CI, 0.600.91). Any recent blood contact, a
measure of consistent use of barrier precautions, had an overall aORinjury
of 1.57 (95% CI, 1.321.86); among physicians, the aORinjury was 2.18 (95%
CI, 1.343.54). Adherence to standard precautions was found to be suboptimal.
Underreporting was found to be common. Percutaneous injury and mucocutaneous
blood exposure are related to frequency of sharps handling and inversely
related to routine standard-precaution compliance. New strategies for
preventing exposures, training, and monitoring adherence are needed.
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Received 22 January 2003; accepted 21 May 2003; electronicallypublished 24 September 2003.     Financial support: Centers for Disease Control and Prevention/NationalInstitute for Occupational Safety and Health (cooperative agreement no.U60/CCU172173).     a Present affiliation: Department of Internal Medicine, IndianaUniversity School of Medicine, Indianapolis