Occupational blood and body fluid exposure incidents amongst undergraduate medical students over a period of 5 years

[摘要] IntroductionExposure incidents involving blood and body fluids represent a major hazard for medicalundergraduates. Every medical teaching university experiences the problem ofundergraduate medical students sustaining such incidents. Although Post ExposureProphylaxis (PEP) is readily available and accessible to medical undergraduatesfollowing an incident, continuity and quality of care extends beyond the provision of PEP.This includes follow up consultations after receiving PEP according to protocol.Study DesignThis study was performed at the Tygerberg Campus of Stellenbosch University in CapeTown, South Africa to assess compliance with follow up consultations following anexposure incident. The study base consisted of all the medical undergraduates whoreported an exposure incident at the Campus Health clinic. Cases were defined asmedical undergraduate students of Stellenbosch University who had reported anexposure incident between January 2007 and December 2011. They were identifiedusing the clinic database and records.Influential factors associated with the exposure incident, including compliance regardingfollow up consultations were obtained from standardised reporting forms and medicalrecords. The data was analysed in 2 sections, a cross sectional component (descriptiveand analytical) and a retrospective cohort component. Two student cohorts wereretrospectively followed from the beginning of their 3rd year to the end of their medicalcurriculum (6th year).ResultsThere were 280 exposure incidents reported in the study period, of which 174 were lowrisk and were 106 high risk incidents for which PEP was prescribed (37.86% used PEP).For those who had high risk exposures, 90.57% (n=96) attended the 6-week follow upconsultation, 48.11% (n=51) attended the 3 month visit and 34.91% (n=37) attended the 6month follow up visit. There was an increase in the number of exposure incidents from2010 (n=43) to 2011 (n=76). Internal medicine accounted for the most number of incidents (n=68), followed by Surgery(n=51), Obstetrics and Gynaecology (n=44), and Paediatrics (n=42). Drawing blood wasthe most common reported activity associated with exposures. Of notable importancewas recapping, disposing of needles and insertion of blood into sample tubes. Theseactivities accounted for 63 of the 280 exposure incidents. The 4th year students were theleast at risk for exposure incidents compared to 3rd, 5th, 6th years. The annual averagecumulative risk of having an exposure incident was found to be 5.7% (95%CI=4%-8%)and 6.8% (95%CI=5%-9%) amongst the 2 student cohorts over the duration of 4 years(clinical exposure time).RecommendationsThere is an urgent need for the number of exposure incidents to be reduced, e.g. needlerecapping and disposal, and insertion of blood in sample tubes cause numerouspreventable incidents. Various other strategies can be implemented in order to reducethe number of incidents across all undergraduate years of study. It is envisaged that byreducing the number of exposure incidents, there will be a subsequent decrease in thenumber of individuals requiring PEP. The importance of ensuring compliance with regardto follow up consultations needs to be emphasized. Factors that lead to noncomplianceneed to be investigated in a separate study.

[发布机构] Stellenbosch University