Hospital bloodborne pathogens programs: Program characteristics and blood and body fluid exposure rates

OBJECTIVE: To describe hospital practices and policies relating to bloodbor ne pathogens and current rates of occupational exposure among healthcare wo rkers. PARTICIPANTS AND METHODS: Hospitals in Iowa and Virginia were surveyed in 1 996 and 1997 about Standard Precautions training programs and compliance. T he primary outcome measures were rates of percutaneous injuries and mucocut aneous exposures. RESULTS: 153 (64%) of 240 hospitals responded. New employee training was of fered no more than twice per year by nearly one third. Most (79%-80%) facil ities monitored compliance of nurses, housekeepers, and laboratory technici ans; physicians rarely were trained or monitored. Implementation of needles tick prevention devices was the most common action taken to decrease sharps injuries. Over one half of hospitals used needle-less intravenous systems; larger hospitals used these significantly more often. Protected devices fo r phlebotomy or intravenous placement were purchased by only one third. Mos t (89% of large and 80% of small) hospitals met the recommended infection c ontrol personnel-to-bed ratio of 1:250. Eleven percent did not have access to postexposure care during all working hours. Percutaneous injury surveill ance relied on incident reports (99% of facilities) and employee health rec ords (61%). The annual reported percutaneous injury incidence rate from 106 hospitals was 5.3 injuries per 100 personnel. Compared to single tertiary- referral institution rates determined more than 5 years previously, current injury rates remain elevated in community hospitals. CONCLUSIONS: Healthcare institutions need to commit sufficient resources to Standard Precautions training and monitoring and to infection control prog rams to meet the needs of all workers, including physicians. Healthcare wor kers clearly remain at risk for injury. Further effective interventions are needed for employee training, improving adherence, and providing needle-st ick prevention devices (Infect Control Hosp Epidemiol 2001;22:73-82).