Page 234 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 3 of 6 Original Research

protocols/policies were user-friendly (n = 126, 72.0%). The TABLE 2: Description of the 182 occupational blood or body fluid exposures
amongst study subjects.
majority of subjects were aware of where to report an OBBFE Variables n %
(n = 145, 82.8%) and were also aware of where to acquire the Department where exposure occurred
antiretroviral therapy starter pack after an exposure (n = 148, Surgery 50 27.5
84.6%). There were no statistically significant differences Obstetrics and Gynaecology 49 26.9
between those who had and those who had not experienced Internal Medicine 48 26.4
an OBBFE. Emergency Department 21 11.6
Paediatrics 8 4.4
The majority of exposures occurred whilst working in Orthopaedics 3 1.6
surgery (n = 50, 27.5%), obstetrics and gynaecology (n = 49, Anaesthesia 3 1.6
26.9%) and internal medicine (n = 48, 26.4%) departments, Psychiatry 0 0.0
with superficial wounds (no blood seen) being the most Use of personal protective equipment (PPE) during exposure
common wound type (n = 69, 37.9%). The majority of Gloves 177 97.3
exposures were acquired during vascular puncture and/or Goggles 30 16.5
Face mask
14.3
26
intravenous line insertion (n = 69, 37.9%) and occurred Plastic apron 20 10.9
when subjects were working > 12 h shifts (n = 101, 55.5%). Procedure being performed or aetiology of exposure
More than three-quarter of exposures were reported within Vascular puncture/intravenous line insertion 69 37.9
24 h of the incident (n = 152, 83.5%). Only 149 (81.9%) Wound suturing 43 23.7
subjects had a follow-up blood test done after the exposure Assisting in surgical procedures 21 11.6
(see Table 2). Putting up a chest drain 11 6.0
Recapping used needles 11 6.0
Overfilled sharps container 11 6.0
Two (1.1%) subjects reported that they had acquired HIV
infection after the exposure. Both of these subjects reported Putting blood into specimen bottle 10 5.5
HIV seroconversion on repeat testing within 4 months of the Amniotic fluid splash 6 3.3
Nature of exposure
exposure. Both subjects were men between the ages of 24 Superficial wound (blood not seen) 69 37.9
and 30 years, were working in their second year of medical Deep wound (blood seen) 63 34.6
internship, sustained a deep needle stick injury to their Mucocutaneous exposure 38 20.9
finger, reported the incident within 24 h, initiated and Non-intact skin exposure 12 6.6
completed the 28-day two-drug regimen of antiretroviral Action taken after exposure
therapy, did not use a third antiretroviral agent and were Follow each step of local policy 87 47.8
wearing gloves. The first subject sustained his injury from a Wash exposure area and/or replace gloves and continue 73 40.1
hollow bore needle whilst inserting an intravenous line, Ignore and continue 22 12.1
whilst the second subject sustained his injury from a suturing Circumstances around exposure 101 55.5
Working shift > 12 h
needle whilst inserting an intercostal drain. Unfortunately, Tiredness/fatigue 37 20.2
the questionnaire did not enquire whether participants Working without supervision 19 10.4
engaged in risky sexual behaviour around the time of the Poor instruments 16 8.8
exposure. No assistant present 7 3.8
Poor lightings 2 1.1
Initiation of antiretroviral therapy, drug regimens used and How soon after the incident was the exposure reported?
compliance with HIV PEP are described in Figure 1. Overall, Within 24 h 152 83.5
HIV PEP was initiated in 141 (77.5%) out of the 182 exposures. 24–48 h 10 5.5
However, the recommended 28-day course of therapy was > 72 h 12 6.6
only completed in 90 (63.8%) out of the 141 cases where PEP 48–72 h 6 2 3.3
1.1
Didn’t report the incident
was initiated.
Was a follow-up blood test done?
Yes 149 81.9
Amongst the 136 subjects who had experienced their first No 33 18.1
exposure, 107 (78.7%) had initiated and 68 (63.6%) had Infection acquired after the exposure
completed the 28-day course of PEP. Amongst the 30 subjects None 180 98.9
who had experienced their second exposure, 22 (73.3%) had HIV 2 1.1
initiated and 14 (63.6%) had completed PEP. Amongst the Hepatitis B or C 0 0.0
nine subjects who had experienced their third exposure,
eight (88.9%) had initiated and five (62.5%) had completed More than one-third (n = 51, 36.2%) of subjects who had
PEP. Amongst the five subjects who had experienced their initiated HIV PEP did not complete the 28-day course of
fourth exposure, three had initiated and two (66.7%) had therapy. The most common reasons for not completing the
completed PEP. Amongst the two subjects who had therapy included gastrointestinal side effects (n = 17,
experienced their fifth exposure, one (50.0%) had initiated 33.3%), the subject ‘felt terrible’ on medication (n = 16,
and completed PEP. 31.4%) and the source patient tested negative for HIV

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