SHOULD INFECTION-CONTROL PRACTITIONERS DO FOLLOW-UP OF STAFF EXPOSURES TO PATIENT BLOOD AND BODY FLU IDS

Background: The purpose of this study was to determine the efficiency of a joint infection control/occupational health program for the follo w-up of accidental blood or bloody body fluid exposures in health care workers. Methods: A comprehensive staff follow-up program far all blo od exposures with known patient sources was initiated in 1989, consist ing of patient follow-up by the Infection Control Department (risk ass essment for hepatitis B virus [HBV] and HIV infection and obtaining of consent for HIV testing) and staff follow-up by the Occupational Heal th Department. In 1992 a mailed survey was conducted to examine exposu re follow-up policies and responsibilities in large teaching hospitals across Canada. Results: A total of 924 blood exposures with known pat ient sources were reported between January 1989 and December 1993. HIV and HBV screening was obtained for 67.9% and 87.6% of patients assess ed as at low risk and 82.3% and 92.2% of those assessed as at high ris k for infection, respectively. Two previously unknown HIV-seropositive patients were identified, one of whom had been classified as at low r isk (one of 530 [0.19%] patients at low risk who underwent screening). Primary reasons for screening being missed were patient discharge (46 .3%) or communication problems (18.0%). The requirement for informed w ritten consent before HIV screening accounted for the difference in co mpleted HIV and HBV screens. Results of the hospital survey indicated that 40.8% of Canadian hospitals follow up all patients who are involv ed in blood exposures; however, most hospitals still rely on the physi cian to obtain consent (87.6%). Conclusions: Use of ICPs to screen pat ients involved in staff blood exposures during regular hours may be th e most efficient method of follow-up, particularly if supplemented by a backup team of health professionals on nights and weekends. Although screening all patients for HBV/HIV may detect patients with undisclos ed high-risk behaviors, institutions must decide whether the practice is cost-effective in areas of low prevalence.