High risk for occupational exposure to HIV and utilization of post-exposure prophylaxis in a teaching hospital in Pune, IndiaReport as inadecuate




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BMC Infectious Diseases

, 8:142

First Online: 21 October 2008Received: 31 May 2008Accepted: 21 October 2008

Abstract

BackgroundThe risk for occupational exposure to HIV has been well characterized in the developed world, but limited information is available about this transmission risk in resource-constrained settings facing the largest burden of HIV infection. In addition, the feasibility and utilization of post-exposure prophylaxis PEP programs in these settings are unclear. Therefore, we examined the rate and characteristics of occupational exposure to HIV and the utilization of PEP among health care workers HCW in a large, urban government teaching hospital in Pune, India.

MethodsDemographic and clinical data on occupational exposures and their management were prospectively collected from January 2003–December 2005. US Centers for Diseases Control guidelines were utilized to define risk exposures, for which PEP was recommended. Incidence rates of reported exposures and trends in PEP utilization were examined using logistic regression.

ResultsOf 1955 HCW, 557 exposures were reported by 484 HCW with an incidence of 9.5 exposures per 100 person-years PY. Housestaff, particularly interns, reported the greatest number of exposures with an annual incidence of 47.0 per 100 PY. Personal protective equipment PPE was used in only 55.1% of these exposures. The incidence of high-risk exposures was 6.8-100 PY n = 339; 49.1% occurred during a procedure or disposing of equipment and 265 80.0% received a stat dose of PEP. After excluding cases in which the source tested HIV negative, 48.4% of high-risk cases began an extended PEP regimen, of whom only 49.5% completed it. There were no HIV or Hepatitis B seroconversions identified. Extended PEP was continued unnecessarily in 7 35% of 20 cases who were confirmed to be HIV-negative. Over time, there was a significant reduction in proportion of percutaneous exposures and high-risk exposures p < 0.01 and an increase in PEP utilization for high risk exposures 44% in 2003 to 100% in 2005, p = 0.002.

ConclusionHousestaff are a vulnerable population at high risk for bloodborne exposures in teaching hospital settings in India. With implementation of a hospital-wide PEP program, there was an encouraging decrease of high-risk exposures over time and appropriate use of PEP. However, overall use of PPE was low, suggesting further measures are needed to prevent occupational exposures in India.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2334-8-142 contains supplementary material, which is available to authorized users.

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Author: Amita Gupta - Shuchi Anand - Jayagowri Sastry - Anandini Krisagar - Anita Basavaraj - Shreepad M Bhat - Nikhil Gupte - Rob

Source: https://link.springer.com/



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