ORIGINALPAPER .R . Prevalence of Occupational Exposure To
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International Journal of Caring Sciences September-December 2013 Vol 6 Issue 3 420 . O R I G I N A L P A P E R .r . Prevalence of Occupational Exposure to Pathogens and Reporting Behaviour among Cypriot Nurses Georgios Efstathiou, RN, PhD Nursing Officer, Ministry of Health, Nicosia, Cyprus Evridiki Papastavrou, RN, PhD Assistant Professor, Department of Nursing, Cyprus University of Technology, Limasol, Cyprus Vasilios Raftopoulos, RN, PhD Assistant Professor, Department of Nursing, Cyprus University of Technology, Limasol, Cyprus Anastasios Merkouris, RN, PhD Associate Professor, Department of Nursing, Cyprus University of Technology, Limasol, Cyprus Correspondence: Georgios Efstathiou, 3 Apostolou Petrou, 2049, Strovolos, Nicosia, Cyprus. E-mail.: [email protected] Abstract Background: Occupational exposure to pathogens forms a major concern among nurses, the largest team among healthcare professionals. Unfortunately, international literature marks high rates of occupational exposure to pathogens among nurses. Data from these studies allow to the implementation of prevention programs to avoid such incidences. Aim: To assess the prevalence of Cypriot nurses’ occupational exposure to pathogens as well as their reporting behaviour following such incidences. Methodology: A cross sectional survey has been conducted among a convenience sample of 577 nurses, during March and May 2010. Results: Our analysis demonstrated that almost half of Cypriot nurses (48.4%) had at least one incidence of occupational exposure to pathogens, with more than 20% of the exposed nurses having been exposed via more than one mode. The majority of them have made a report of the incident, according to the policy of their hospital. Main reasons for not reporting such a critical incident included being too busy and forgetfulness. Conclusions: The results indicate that exposure to pathogens among Cypriot nurses is high, a fact that puts them into danger for acquiring an infection. A risk management program should be implemented to reduce such incidents. Key words: healthcare associated infections, nurse, occupational exposure, prevalence, risk management Introduction infection via several modes (Twitchell 2003a, Twitchell 2003b). Standard Precautions (Siegel et It is estimated that worldwide, about 35–40 million al. 2007) have been described as an effective health care professionals provide their services to means for protecting health care professionals and patients (WHO 2010). Unfortunately, occupational patients from healthcare associated infections exposure to pathogens among health care (Cullen et al. 2006, Siegel et al. 2007). They are professionals poses a great risk for acquiring a easy to follow and implement; nevertheless, serious or even lethal health care associated www.internationaljournalofcaringsciences.org International Journal of Caring Sciences September-December 2013 Vol 6 Issue 3 421 previous literature has demonstrated that health pathogens via surgical instruments (carriers) which care professionals, for various reasons, do not have not been appropriately disinfected. Finally, comply with them (Sadoh et al. 2006, Gammon et droplets (which are too large to remain airborne al. 2008, Jeong et al. 2008, Delobelle et al. 2009). and can travel only a short distance of no more than As a result, every year, many heath care 1 m) containing pathogens can be generated from a professionals suffer from one or more incidences of patient during talking, sneezing, coughing, or exposure to pathogens during their clinical practice during procedures like suctioning or bronchoscopy. (Smith et al. 2006, Vaz et al. 2010). Nurses form Such droplets can also cause occupational exposure the largest group of health care professionals and in a health care professional. are more vulnerable to an occupational exposure Among health care professionals, medical doctors, (Kosgeroglu et al. 2004). nurses, cleaners, and medical and nursing students Background are those mostly in risk for an occupational exposure to pathogens (Hsieh et al. 2006, Smith et Occupational exposure al. 2006, Vaz et al. 2010), with nurses being at the top of the exposed groups (Perry et al. 2009). Occupational exposure to pathogens among health care professionals has been defined as any contact Although there is no clear reason for this, it can be attributed to the fact that nurses are, among other of skin, eyes, mucus membranes or any other parenteral contact with blood or other potentially health care professionals, the group with the closest infected fluids or materials that takes place during and most frequent contact with patients for providing nursing care (Maltezou et al. 2008). their daily clinical practice (OSHA 2009). It can occur via different modes (Efstathiou et al. 2011a). Therefore, this fact makes them more vulnerable to infection. The most frequent mode is via a percutaneous (sharp) injury, more frequently via a needle stick It is estimated that in the United States of America, injury (WHO 2011). This is attributed to the 600,000–800,000 needle stick injuries occur provision of care to patients that usually requires annually (CDC 2004, WHO. 2011). In the United the use of sharp instruments, e.g. needles or Kingdom, it is estimated that 17% of all the scalpels (Wang et al. 2003). accidents among health care professionals is attributed (second after injuries during patient Unfortunately, misuse of such instruments, ignorance of proper use, improper discard, and moving) to sharp accidents, with 40,000–100,000 incidents per year (Godfrey 2001, NHS. 2005, needle recapping pose a serious danger for percutaneous injuries. It is estimated that 20 O'Connor 2009). In France, 8.9 incidences of sharp pathogens can be transmitted via a sharp injury, injuries occur per 100 occupied beds (Venier et al. 2007); in Australia, 19 incidences of sharp injuries with more serious and more frequently reported the hepatitis B and C viruses (HBV and HCV) and the occur per 100 occupied beds (WHO. 2011); and in Canada, 14.22 incidences of sharp injuries occur human immunodeficiency virus (HIV) (Wilburn & Eijkemans 2004, Deuffic-Burban et al. 2011). per 100 occupied beds (Nguyen et al. 2001). Pathogens that are airborne (can travel in the air on Furthermore, in Germany, 500,000 incidences of sharp injuries occur annually (Hofmann et al. dust particles or on small respiratory droplets) may be inhaled and can cause respiratory infections. 2002), and in Switzerland 3.14 sharp injuries occur per 100 full-time health care professionals Such pathogens can cause infections with mild (e.g. common flu) to severe symptoms (e.g. (Glenngard & Persson 2009). tuberculosis). Direct contact with a patient’s non- Worldwide, the number of health care intact skin can lead to the transmission of several professionals sustaining a sharp injury with an pathogens, e.g. methicillin-resistant instrument contaminated with HIV is 327,000, with Staphylococcus aureus (MRSA). The same applies HBV is 2.1 million, and with HCV is 926,000 for indirect contact, e.g. the transmission of (Pruss-Ustun et al. 2005). According to the World www.internationaljournalofcaringsciences.org International Journal of Caring Sciences September-December 2013 Vol 6 Issue 3 422 Health Organisation, every year, 9% of the health Directive 2010/32/EU (Council of the European care professionals suffer from a sharp injury (Al- Union 2010) requires from the EU member states Benna 2010). to include in their national legislations, by 11th March 2013, that everybody will be able to make a Reports from Greece estimate that 74.5% of all report of an exposure (although it will not be health care professionals who have received post mandatory to make such a report). Furthermore, the exposure prophylaxis antiretroviral therapy have EU makes the suggestion of developing a common been exposed to blood (Konte et al. 2007). reporting system, in order to facilitate the exchange There are also reports of bacterial infection to and benchmarking of data. The above directive is health care professionals during respiratory care, referred to all the users of health care services and intubation or physiotherapy (Low & Wilder-Smith to medical and nursing students. Already, many 2005, Wilder-Smith & Low 2005, Chandler et al. European counties (Cyprus, United Kingdom, 2006, Baba et al. 2009, Lacy & Horn 2009) Austria, Germany, and Greece) (Salzer et al. 2011) following an airborne or droplet transmission of a have implemented such mechanisms. variety of pathogens, including MRSA, SARS and group Streptococcus A. In the Cypriot hospitals, an informal mechanism exists for reporting incidences, including Finally, reports among health care professionals occupational exposure. This mechanism is not have also been made concerning contact exposure mandatory, but healthcare professionals are to pathogens (skin or mucus membranes exposure) encouraged to make such reports. A reporting form (Gessessew & Kahsu 2009, Amuwo et al. 2011). is required to be filled by the exposed person, asking for details on the incidence (when, how, Exposure reporting system etc.), but it is not known if all cases of exposure are Although occupational exposure to pathogens reported via this mechanism. No published data are should be reported, a large proportion of health available either on exposure to pathogens or care professionals fail to do so (Makary et al. 2007, incidence reporting among any health care group in Azadi et al. 2011, Kostun & Goldsmith 2011). Cyprus. Reasons for not reporting