Literature Review (Risk of infection after a needlestick injury) Study Year Author Name of article design Population Risk of HIV/HBV/HCV Results Recommendations 2007 Kubitschke A, Induction of Cohort Health care • The risk of developing acute HCV infection after • After experiencing a needle • Future study trials should use a et al hepatitis C virus study workers exposure to HCV by an HCV-contaminated needle stick injury, all HCWs in the uniform needle stick injury score to (HCV)-specific T (HCWs) has been reported to be between 0-5% with the study remained anti-HCV identify patients at risk for infection. cells by needle majority of studies reporting seroconversion rates negative throughout follow- stick injury in the below 1%. up. absence of HCV- • Overall, the risk of a surgeon acquiring HCV • The study demonstrated for viraemia through occupational exposure is considered to be the first time the induction below 0.03% per annum, even when treating of HCV-specific T-cell patients with a high prevalence of HCV. responses by injury with HCV-contaminated needles in HCWs. 2007 Bairy I, et al Exposure to blood- na HCWs • The risk of HIV transmission after a percutaneous na na born viruses exposure to HIV infected blood has been among healthcare estimated to be approximately 0.3% and after a workers in a tertiary mucous membrane exposure it is about 0.09%. care hospital in • The risk of developing hepatitis B on exposure to south India HBsAg and HBeAg positive patients was 22-31% whereas by comparison, exposure from HBsAg positive by HBeAg negative blood was 1-6%. The average incidence of anti-HCV seroconversion after accidental percutaneous exposure from an HCV positive source is 1.8% (range 0-7%). 2006 Chen MY, et Post-exposure Cross- Junior • The rate of transmission of HIV following • The study demonstrated • It is of great importance to improve al prophylaxis for sectional doctors precautious exposure in the healthcare setting has that doctors in training had the level of knowledge about human study been shown to be three per 1,000 injuries. an inadequate level of occupational exposure to HIV immunodeficiency knowledge about post- among junior hospital doctors. This virus: knowledge exposure prophylaxis should include education and and experience of (PEP). A substantial written policy on PEP that is easily junior doctors proportion of doctors were accessible to doctors. uncertain about how quickly the drugs should be administered. 2005 CDC Updated U.S. na HCWs • The risks for occupational transmission of HIV • No vaccine currently exists na Public Health vary with the type and severity of exposure. to prevent HIV infection, Service Guidelines • The average risk for HIV transmission after a and there is no cure. for the percutaneous exposure to HIV-infected blood has Management of been estimated to be approximately 0.3% (95% CI Occupational = 0.2-0.5%), and after a mucous membrane Exposures to HIV exposure, approximately 0.09% (95% CI = 0.006- and 0.5%). Recommendations for Postexposure Prophylaxis 2005 Yazdanpanah Risk factors for Case- HCWs na • The risk of HCV • The results of the study highlight Y, et al hepatitis C virus control transmission to a HCW the need for widespread adoption transmission to study after percutaneous of needlestick-prevention devices health care workers exposure increased for in health care settings, together after occupational deep injuries and with other preventive measures, - 1 - Literature Review (Risk of infection after a needlestick injury) Study Year Author Name of article design Population Risk of HIV/HBV/HCV Results Recommendations exposure: a procedures involving such as education, to reduce the European care- hollow-care needle risk of occupational infection for control study placement in the source HCWs. patient's vein or artery. 2004 Berry AJ Needle stick and na HCWs • The rate of clinical HBV infection appears to be na • The CDC has recommended other safety issues range 22-31%, and serologic evidence of HBV vaccination for HCWs and trainees occurs in 37-62% of individuals after a without current immunity. percutaneous exposure to blood that is positive for • Because postexposure prophylaxis both hepatitis B surface antigen and hepatitis B e- may be more effective when antigen. administered shortly after an • Studies suggested that the transmission rate after occupational exposure, evaluation percutaneous exposure to HCV is 0.5% (range 0- of HCW who is potentially exposed 10%). to HIV should take place as soon • The overall risk of HIV infection after percutaneous as possible (within hours rather exposure to HIV-infected material in the health than days). care setting is 0.3% and after mucous membrane exposure is 0.09%. 2001 CDC Updated U.S. na HCWs • The risk of HBV infection is primarily related to the • Currently, the genetically na Public Health degree of contact with blood in the work place and engineered hepatitis B Service Guidelines also to the hepatitis B e-antigen (HBeAg) status of vaccine is recommended for the the source person. IN the studies of HCW who for all HCWs who are Management of sustained injuries from needles contaminated with occupationally exposed to Occupational blood containing HBV, the risk of developing blood and has a 96% Exposures to HBV, clinical hepatitis if the blood was both hepatitis B vaccine efficacy rate. HVC, and HIV and surface antigen (HBsAg)- and HBeAg-positive was • According to CDC, ~71% of Recommendations 22-31%. The risk of developing serologic evidence workers who are at risk for for Postexposure of HBV infection was 37-62%. occupational exposure to Prophylaxis • By comparison, the risk of developing clinical blood had been vaccinated hepatitis from a needle contaminated with HBsAg- by 1995. The Department positive, HBeAg-negative blood was 1-6%, and of Health and Human the risk of developing serologic evidence of HBV Services (HHS) has infection, 23-37%. established a goal of • HCV is not transmitted efficiently through increasing hepatitis B occupational exposure to blood. The average vaccine coverage within incidence of anti-HCV seroconversion after this group to 98% by 2010. accidental percutaneous exposure from an HCV- • Currently, no vaccine is positive source is 1.8% (range 0-7%), with one available to prevent HCV study indicating that transmission occurred only infection. from hollow-bore needles compared with other sharps. • The transmission of HCV rarely occurs from mucous membrane exposures to blood, and no transmission in HCWs has been documented from intact or non-intact skin exposures to blood. 1999 Dillman CM Hepatitis C: A na HCWs • Studies showed a low of 1.2% and a high of 10% Na • Recommendations should include danger to probability of HCV infection following a needle strict adherence to Universal healthcare worker stick. Precautions and annual education on HCV for all HCWs. Also, HCV testing should be done for both the source patient and the HCW, regardless of known status. - 2 - Literature Review (Risk of infection after a needlestick injury) Study Year Author Name of article design Population Risk of HIV/HBV/HCV Results Recommendations 1999 NIOSH Preventing na HCWs • After a needlestick exposure to an infected patient, na na needlestick injuries a HCW's risk of infection depends on the pathogen in health care involved, the immune status of the worker, the settings severity of the needlestick injury, and the availability and use of appropriate post-exposure prophylaxis. • HIV has an average transmission rate of 0.3% per percutaneous injury. • The rate of HBV transmission to susceptible HCWs ranges from 6-30% after a single needlestick exposure to an HBV-infected patient. But such exposures are a risk only for HCWs who are not immune to HBV. • Prospective studies of HCWs exposed to HCV through a needlestick or other percutaneous injury have found that the incidence of anti-HCV seroconversion averages 1.8% (range 0-7%) per injury. 1998 Patterson Surgeon's concern Cross- Surgeons • With percutaneous exposure to infected blood, the • Most surgeons in the study • More education regarding the risk JMM, et al and practices of sectional seroconversion rates for HIV are reported to be underestimated the of exposure and seroconversion protection against study 1/300, whereas the seroconversion rates for HBV seroconversion rates of rates may increase compliances bloodborne are 6-30% and for HCV is 4-10%. HIV, HBV and HCV with with protection against bloodborne pathogens exposure to infected blood. pathogens. They also do not routinely use double gloves. 1995 Shapiro CN Occupational risk HCWs • The risk of transmission is at least 30% after a na na of infection with needlestick exposure with blood from an HBeAg- hepatitis B and positive source, whereas the risk of transmission hepatitis C virus is from HBeAg-negative blood is less than 6%. • The risk of HCV transmission after a needlestick contaminated with blood from an anti-HCV positive source has been estimated to be approximately 10%, based on results from second-generation tests and PCR used to detect infection among needlestick recipients. - 3 - .