Hostname: page-component-7c8c6479df-ph5wq Total loading time: 0 Render date: 2024-03-27T15:09:34.326Z Has data issue: false hasContentIssue false

The Nature and Frequency of Blood Contacts Among Home Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

Elise M. Beltrami*
Affiliation:
HIV Infections Branch, Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Margaret A. McArthur
Affiliation:
Mt Sinai and Princess Margaret Hospitals, Toronto, Canada
Allison McGeer
Affiliation:
Mt Sinai and Princess Margaret Hospitals, Toronto, Canada
Maxine Armstrong-Evans
Affiliation:
Mt Sinai and Princess Margaret Hospitals, Toronto, Canada
Demie Lyons
Affiliation:
Mikalix and Company, Boston, Massachusetts
Mary E. Chamberland
Affiliation:
HIV Infections Branch, Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Denise M. Cardo
Affiliation:
HIV Infections Branch, Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Centers for Disease Control and Prevention, Mailstop E-68, 1600 Clifton Rd, Atlanta, GA 30333

Abstract

Objective:

To estimate the frequency of, and assess risk factors for, percutaneous, mucous membrane, and cutaneous blood contacts sustained by healthcare workers (HCWs) during the delivery of infusion therapy and the performance of procedures involving sharp instruments in the home setting.

Design:

Prospective surveillance of percutaneous, mucous membrane, and cutaneous blood contacts.

Setting:

Eleven home healthcare agencies in the United States and Canada from August 1996 through June 1997.

Participants:

HCWs who provided home infusion therapy or performed procedures using hollow-bore needles and other sharp instruments in the home setting.

Methods:

Each participating worker recorded information about the procedures performed and blood contacts experienced during each of his or her home visits for a 2- to 4-week period using standard questionnaires. HCWs also completed questionnaires regarding job duties, reporting of previous occupational blood contacts, and their use of protective barriers in the home setting.

Results:

Participating HCWs provided information about 33,606 home visits. A total of 19,164 procedures were performed during 14,744 procedure visits. Fifty-three blood contacts occurred during these visits, for a blood-contact rate of 2.8 blood contacts per 1,000 procedures and 0.6 percutaneous injuries per 1,000 procedures with needles or lancets. Gloves were worn for 52%, masks for 5%, gowns for 3%, and protective glasses or goggles for 2% of all procedure visits. HCWs used barriers for 53% of visits during which at least 1 procedure was performed and for 27% of other visits.

Conclusions:

HCWs involved in home health care are at risk for blood contact. Infection control barrier use was low in our study. The majority of skin contacts could have been prevented by glove use.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.National Association for Home Care. Basic Statistics About Home Care. Washington, DC: The Association; 1997.Google Scholar
2.Graham, DR, Kledermans, MM, Klemm, LW, Semenza, NJ, Shafer, ML. Infectious complications among patients receiving home intravenous therapy with peripheral, central, or peripherally placed central venous catheters. Am J Med 1991;91(suppl 3B):95S100S.Google Scholar
3.Tokars, JI, Culver, DH, Mendelson, MH, Sloan, EP, Farber, BF, Flinger, DJ, et al. Skin and mucous membrane contacts with blood during surgical procedures: risk and prevention. Infect Control Hosp Epidemiol 1995;16:703711.Google Scholar
4.Tokars, JI, Bell, DM, Culver, DH, Marcus, R, Mendelson, MH, Sloan, EP, et al. Percutaneous injuries during surgical procedures. JAMA 1992;267:28992904.Google Scholar
5.Panlilio, AL, Welch, BABell, DM, Foy, DR, Parrish, CM, Perlino, CAet al. Blood and amniotic fluid contact sustained by obstetric personnel during deliveries Am J Obstet Gynecol 1992;167:703708.CrossRefGoogle ScholarPubMed
6.O'Neill, TM, Abbott, AV, Radecki, SE. Risk of needlesticks and occupational exposures among residents and medical students. Arch Intern Med 1992;152:14511456.Google Scholar
7.Stotka, JL, Wong, ES, Williams, DS, Stuart, CG, Markowitz, SM. An analysis of blood and body fluid exposures sustained by house officers, medical students, and nursing personnel on acute-care general medical wards: a prospective study. Infect Control Hosp Epidemiol 1991;12:583590.CrossRefGoogle ScholarPubMed
8.Marcus, R, Culver, DH, Bell, DM, Srivastava, PU, Mendelson, MH, Zelenski, RJ, et al. Risk of human immunodeficiency virus infection among emergency department workers. Am J Med 1993;94:363370.Google Scholar
9.Marcus, R, Srivastava, PU, Bell, DM, McKibben, PS, Culver, DH, Mendelson, MH, et al. Occupational blood contact among prehospital providers. Ann Emerg Med 1995;25:776779.CrossRefGoogle ScholarPubMed
10.Reed, E, Daya, MR, Jui, J, Grellman, K, Gerber, L, Loveless, MO. Occupational infectious disease exposures in EMS personnel. J Emerg Med 1993;11:916.CrossRefGoogle ScholarPubMed
11.Backinger, CL, Koustenis, GH. Analysis of needlestick injuries to health care workers providing home care. Am J Infect Control 1994;22:300306.Google Scholar
12.Centers for Disease Control and Prevention. Recommendations for prevention of HrV transmission in health-care settings. MMWR 1987;36(suppl 2):1S18S.Google Scholar
13.Centers for Disease Control and Prevention. Update: Universal Precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. MMWR 1988;37:377-382,387388.Google Scholar
14.Wong, ES, Stotka, JL, Chinchilli, VM, Williams, DS, Stuart, CG, Markowitz, SM. Are Universal Precautions effective in reducing the number of occupational exposures among health care workers? A prospective study of physicians on a medical service. JAMA 1991;265:11231128.CrossRefGoogle ScholarPubMed
15.Fahey, BJ, Koziol, DE, Banks, SM, Henderson, DK. Frequency of nonparenteral occupational exposures to blood and body fluids before and after Universal Precautions training. Am J Med 1991;90:145153.CrossRefGoogle ScholarPubMed
16.Centers for Disease Control and Prevention. Public health service guidelines for the management of health-care worker exposures to HrV and recommendations for postexposure prophylaxis. MMWR 1998;47(RR-7):133.Google Scholar
17.Occupational exposure to bloodborne pathogens—OSHA Final rule. Fed Regist 1991;56:6400464182.Google Scholar
18.Health Canada. Infection control guidelines: preventing the transmission of bloodborne pathogens in health care and public service settings. Can Commun Dis Rep 1997;23 S3:142.Google Scholar
19.McCormick, RD, Meisch, MG, Ircink, FG, Maki, DG. Epidemiology of hospital sharps injuries: a 14-year prospective study in the pre-AIDS and AIDS eras. Am J Med 1991;91 (suppl 3B):301S307S.Google Scholar
20.Jagger, J, Pearson, RD. Universal Precautions: still missing the point on needlesticks. Infect Control Hosp Epidemiol 1991;12:211213.Google Scholar
21.Hersey, JC, Martin, LS. Use of infection control guidelines by workers in healthcare facilities to prevent occupational transmission of HBV and HP/: results from a national survey. Infect Control Hosp Epidemiol 1994;15:243252.Google Scholar
22.Centers for Disease Control and Prevention. Evaluation of safety devices for preventing percutaneous injuries among health-care workers during phlebotomy procedures—Minneapolis-St Paul, New York City, and San Francisco, 1993-1995. MMWR 1997;46:2025.Google Scholar
23.O'Neill, TM, Abbott, AV, Radecki, SE. Risk of needlesticks and occupational exposures among residents and medical students. Arch Intern Med 1992;152:14511456.CrossRefGoogle ScholarPubMed
24.McGeer, ASimor, AE, Low, DE. Epidemiology of needlestick injuries in house officers. J Infect Dis 1990;162:961964.CrossRefGoogle ScholarPubMed
25.Hamory, BH. Underreporting of needlestick injuries in a university hospital. Am J Infect Control 1983;11:174177.CrossRefGoogle ScholarPubMed
26.Mast, ST, Woolwine, JD, Gerberding, JL. Efficacy of gloves in reducing blood volumes transferred during simulated needlestick injury. J Infect Dis 1993;168:15891592.CrossRefGoogle ScholarPubMed