array:20 [ "pii" => "13101924" "issn" => "15769887" "doi" => "10.1016/S1576-9887(07)73964-X" "estado" => "S300" "fechaPublicacion" => "2007-01-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Vacunas. 2007;8:4-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5 "formatos" => array:2 [ "HTML" => 3 "PDF" => 2 ] ] "itemSiguiente" => array:16 [ "pii" => "13101922" "issn" => "15769887" "doi" => "10.1016/S1576-9887(07)73965-1" "estado" => "S300" "fechaPublicacion" => "2007-01-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Vacunas. 2007;8:9-13" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "formatos" => array:2 [ "HTML" => 2 "PDF" => 1 ] ] "es" => array:11 [ "idiomaDefecto" => true "titulo" => "Evolución de la hepatitis A en Cataluña" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "9" "paginaFinal" => "13" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Trends in hepatitis A in Catalonia" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J Batalla, L Urbiztondo, M Martínez, E Borras, A Domínguez" "autores" => array:5 [ 0 => array:2 [ "Iniciales" => "J" "apellidos" => "Batalla" ] 1 => array:2 [ "Iniciales" => "L" "apellidos" => "Urbiztondo" ] 2 => array:2 [ "Iniciales" => "M" "apellidos" => "Martínez" ] 3 => array:2 [ "Iniciales" => "E" "apellidos" => "Borras" ] 4 => array:2 [ "Iniciales" => "A" "apellidos" => "Domínguez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13101922?idApp=UINPBA00004N" "url" => "/15769887/0000000800000001/v0_201308011459/13101922/v0_201308011459/es/main.assets" ] "itemAnterior" => array:16 [ "pii" => "13101945" "issn" => "15769887" "doi" => "10.1016/S1576-9887(07)73963-8" "estado" => "S300" "fechaPublicacion" => "2007-01-01" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Vacunas. 2007;8:3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:9 [ "idiomaDefecto" => true "titulo" => "Hacia el octavo año de la revista Vacunas" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "3" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Towards the eighth year of the journal VACUNAS" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L Salleras" "autores" => array:1 [ 0 => array:2 [ "Iniciales" => "L" "apellidos" => "Salleras" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13101945?idApp=UINPBA00004N" "url" => "/15769887/0000000800000001/v0_201308011459/13101945/v0_201308011459/es/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "titulo" => "Occupational exposure to human immunodeficiency virus in hospital health care workers in Spain" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "4" "paginaFinal" => "8" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "JR de Juanes, A García de Codes, MP Arrazola, A González MD" "autores" => array:4 [ 0 => array:3 [ "nombre" => "JR de" "apellidos" => "Juanes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "A" "apellidos" => "García de Codes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "MP" "apellidos" => "Arrazola" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "A" "apellidos" => "González MD" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Preventive Medicine Service. 12 de Octubre University Hospital. Madrid. Spain." "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Medical Department. Aventis Pasteur MSD. Madrid. Spain." "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Occupational exposure to human immunodeficiency virus in hospital health care workers in Spain" ] ] "textoCompleto" => "<br></br><br></br><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction</span></p><p class="elsevierStylePara">Prospective studies carried out on health care personnel accidentally exposed to blood or body fluids from infected patients suggest that the overall transmission rate for a percutaneous exposure is low. Four factors are closely associated with occupationally acquired HIV infection: deep injuries, needles used directly in the veins and arteries of patients, devices visibly contaminated with patient's blood and contact with terminally ill patients<span class="elsevierStyleSup">1,2</span>. Surveillance of occupational exposure to blood-borne pathogens among health care workers (HCW) is essential to understand how exposure and infection occur, to identify the main factors associated with an increased risk of exposure and transmission and to develop effective prevention strategies. In May 1998, the Centers for Disease Control (CDC) established guidelines for post-exposure prophylaxis (PEP) by using highly active antiretroviral therapy (HAART) with two or three antiretroviral drugs. Although the optimal interval within which PEP should be initiated has not been well defined, animal studies suggest that initiation of PEP soon after an exposure is necessary<span class="elsevierStyleSup">3</span>. Thus, it is essential to identify and report all occupational exposures as soon as they occur. We studied all cases of occupational exposure to HIV infection among health care workers in a large Spanish hospital during a 4-year period (1998-2002).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Methods</span></p><p class="elsevierStylePara">A prospective surveillance program for occupational exposure to blood borne pathogens among HCW of the Hospital 12 de Octubre, Madrid, Spain was set up by the Preventive Medicine Department in April 1985. This hospital has 1,300 beds and a total of 4,098 HCW: 1,667 nurses (1,337 women and 330 men); 1,278 nursing aids (1,264 women and 14 men); 650 staff physicians (227 women and 423 men); 400 intern physicians (260 women and 140 men); 46 laboratory technicians (42 women and 4 men) and 57 midwives (56 women and 1 man). The surveillance program was established to monitor occupational exposures and identify circumstances that may lead to exposures and transmission. This study presents the data on all cases of occupational exposure to HIV during a 4-year period (July 1998 to June 2002). The annual exposure rate (per 100 beds) and the attack rate (per 1,000 persons/year) were calculated by assuming that 16,392 health care workers were potentially at risk during the 4-year study period.</p><p class="elsevierStylePara">The procedure for assessing potential cases of occupational HIV exposure includes an interview to collect information on current and potential previous exposures to HIV (i.e. behaviours, transfusion risks or previous occupational exposures), including information on the source patient and details on the circumstances of the occupational exposure, i.e. date and time of the accident, type of device and procedure being performed, type of injury (percutaneous by needles/ cuts or mucocutaneous by splashing), date of reporting and setting or location of the accident (hospital room, surgical area, laboratory, intensive care unit, emergency department, x-ray/nuclear medicine or outpatient). Subjects undergo HIV serologic testing at baseline (by enzyme-linked immunoabsorbent assay) and follow up enzyme immune assay (EIA) testing at one, three, six and twelve months post-exposure. Antiretroviral post-exposure prophylaxis (PEP) is recommended according to the type of exposure, risk of HIV infection, current or underlying medical conditions and the circumstances of the exposure.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results</span></p><p class="elsevierStylePara">Seventy-five cases of occupational exposure to blood or other fluids from HIV positive patients were reported during the study period. Twenty-five cases occurred during the period July 1998-June 1999; 22 cases between July 1999-June 2000; 13 cases between July 2000-June 2001; and 15 cases between July 2001-June 2002. The mean age of exposed HCW was 35.8 years (SD: 10.4). Fifty-seven percent (43 cases) occurred in workers younger than 35 years, 20% (15 cases) in the 36-45 years age group and 23% (17 cases) in persons aged > 46 years. Seventy-five percent of cases (56/75) were women. The attack rate was 4.6 cases per 1,000 persons/year (4.4 cases in women and 5.2 cases in men). Most accidents (75%) were percutaneous injuries and the remainder were mucocutaneous exposures. Nurses reported the highest number of accidents, followed by intern physicians, who had the highest attack rate of percutaneous injuries (table 1). Laboratory technicians had the highest attack rate, mainly due to mucocutaneous exposures (table 1).</p><p class="elsevierStylePara"><img src="72v08n01-13101924tab01.gif"></img></p><p class="elsevierStylePara">The annual occupational exposure rate per 1,000 beds was 14. Sixty-seven percent (47/75) of accidents occurred during the morning shift (9 a.m.-3 p.m.), 20% (15/75) between 10 p.m. and 9 a.m., and 17% (13/75) between 3 p.m. and 10 p.m. Overall, 53% percent of exposures were reported within 24 hours, while 14% were reported three or more days after the accident (table 2). Reporting time improved during the study period and during the last year of the study more than 90% of cases were reported within 48 hours (table 2). The specific work settings or location for the 75 occupational exposures varied, with a substantial proportion occurring in surgical settings (36%), followed by hospital rooms (21%), the emergency department (16%), the laboratory (12%) and the intensive care unit (9%).</p><p class="elsevierStylePara"><img src="72v08n01-13101924tab02.gif"></img></p><p class="elsevierStylePara">Post-exposure prophylaxis (PEP) was prescribed to 53 individuals (table 3). PEP was not prescribed in 22 cases, either because they were considered to be of very low risk (17 cases) or due to delay in reporting the accident (5 cases), while 13 subjects refused to initiate PEP. Finally, 40 subjects initiated antiretroviral prophylaxis (table 3). PEP with 2 drugs (zidovudine and lamivudine) was prescribed to 72% and three drugs (zidovudine, lamivudine and indinavir) to 28%. Ninety percent of subjects completed the PEP program, 5% discontinued indinavir (and completed the program with zidovudine and lamivudine) and another 5% discontinued all drugs (one due to adverse effects and the other due to pregnancy. Table 4 shows compliance with serological controls at months 1, 3, 6 and 12 by professional category. Overall, 89% and 57% of subjects attended the serological controls at months 1 and 6, respectively, with laboratory technicians and nurses being the most compliant groups. Forty-five percent of subjects receiving antiretroviral prophylaxis attended the month 12 control, compared with 15% of those not receiving antiretroviral prophylaxis (table 4). There were no reported cases of documented seroconversion to HIV positive among those who received PEP and those who did not.</p><p class="elsevierStylePara"><img src="72v08n01-13101924tab03.gif"></img></p><p class="elsevierStylePara"><img src="72v08n01-13101924tab04.gif"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion</span></p><p class="elsevierStylePara">The annual number of occupational exposures to HIV in our hospital fell from 25 in 1998-1999 to 13 in 2000-2001 and 15 in 2001-2002. Increasing knowledge of the transmission of HIV and information on how exposures occur has led to measures, such as infection control guidelines, which have helped to reduce the risk of occupational HIV exposure. The majority of exposures reported in this study occurred in nurses, mainly due to percutaneous injury. This result is consistent with previous studies which showed that nurses are the most-frequently exposed group and also probably reflects the fact that nurses represent the largest group of medical professions<span class="elsevierStyleSup">4</span>. The majority of accidents occurred in persons younger than 35 years, supporting other studies which show that health care professionals have a higher risk of biological exposure during the first years of professional activity, which may indicate less skill in the handling of materials or a different perception of risk<span class="elsevierStyleSup">5,6</span>. However, some job categories for which a high exposure risk has been demonstrated, such as midwives, were underrepresented in the 75 cases reported here<span class="elsevierStyleSup">7,8</span>. This could be attributed to the fact that some exposures (i.e., prolonged skin contact with at-risk body fluids) are not perceived as real exposures and thus not reported. More than 60% of accidents occurred between 9 a.m. and 2 p.m., the period of greatest activity in the hospital, with the majority occurring in a surgical setting (36%) or hospital rooms (21%). Most accidents (75%) involved needles, showing that standard universal precautions are extremely important, but are not sufficient to prevent accidents<span class="elsevierStyleSup">9</span>. A promising approach for improving the safety of HCW is to provide enhanced safety during vascular access procedures.</p><p class="elsevierStylePara">Reporting time improved during the study period with 80% of accidents being reported within 24 hours in the last year of the study. This is important, as PEP is probably less effective when started more than 24-36 hours post-exposure<span class="elsevierStyleSup">10</span>. Seventy-five percent of exposed subjects received PEP and 90% of these completed the 4 weeks post-exposure prophylaxis. This percentage is similar to that described by Ippolito et al, but higher than in other studies (70%-80%)<span class="elsevierStyleSup">11,12</span>. The main reason for discontinuing Indinavir was the occurrence of side effects, as also shown in a previous study<span class="elsevierStyleSup">13</span>. There were no reports of seroconversion to HIV positive during the study period, confirming other studies which found that the risk of transmission in a single occupational exposure is very low<span class="elsevierStyleSup">14,15</span>.</p><p class="elsevierStylePara">Surveillance data on occupational HIV exposure remains an indispensable source of information that helps understanding of occupational HIV transmission, but the value of surveillance data always depends on individual reporting. HCW must continue to be educated about the risk of acquiring blood-borne pathogen infections, ways of effectively reducing these risks, and the benefit of timely reporting and follow-up of occupational exposures. Rational policies for minimizing the risk of occupational exposure, active monitoring programs for work-related injuries and exposures to blood-borne pathogens and improvements in the design of sharp medical instruments, are critical measures for creating a safer workplace.</p>" "pdfFichero" => "72v08n01a13101924pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec236053" "palabras" => array:4 [ 0 => "VIH" 1 => "Hospital" 2 => "Trabajadores sanitarios" 3 => "Profilaxis postexposición" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec236054" "palabras" => array:4 [ 0 => "HIV" 1 => "Hospital" 2 => "Healthcare workers" 3 => "Post-exposure prophylaxis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "Fundamento. El virus de la inmunodeficiencia humana (VIH) es un riesgo ocupacional para sanitarios expuestos a sangre positiva al VIH. En este estudio se realiza una vigilancia activa de todos los casos de exposición ocupacional a VIH entre trabajadores sanitarios en un hospital general durante un período de 4 años. Métodos. Estudio epidemiológico prospectivo de los accidentes con material biológico con fuente VIH positiva, declarados por los trabajadores de un hospital general durante el período comprendido entre julio de 1998 a junio de 2002. Se han estudiado variables del accidentado relacionadas con persona, lugar y tiempo, además de las serologías al inicio y durante el seguimiento protocolizado (1, 3, 6 y 12 meses). Se ha considerado una población trabajadora media anual estable por categorías. Resultados. Se han declarado 75 accidentes con fuente VIH positiva. El 48% ocurrió en el grupo de edad de 26-35 años y el 75% eran mujeres. La tasa de ataque fue de 4,6 casos por cada 1.000 personas/año. El colectivo profesional más accidentado fueron los ATS/DUEs que declararon el 43% de los accidentes, seguidos de los médicos internos residentes (28%). La mayoría de los accidentes (67%) ocurrió en el turno de la mañana y el 36% en áreas quirúrgicas. Se recomendó profilaxis postexposición (PEP) a un 71% de los expuestos y el 90% completó las 4 semanas de tratamiento protocolizado. El 89% se realizó la serología al mes y el 57% a los 6 meses de seguimiento. No se documentó ninguna seroconversión a VIH. Conclusiones. Los trabajadores sanitarios, independientemente de su categoría o lugar de trabajo, tienen un riesgo real de exposición ocupacional a la infección por VIH. Deben de ser informados del riesgo de adquirir la infección, las medidas para disminuir el riesgo y los beneficios de declarar las exposiciones ocupacionales." ] "en" => array:1 [ "resumen" => "Background. Human immunodeficiency virus (HIV) is an occupational risk in health workers exposed to HIV-positive blood. In the present study prospective surveillance of all cases of occupational exposure to HIV among health workers in a large Spanish hospital was performed over a 4-year period. Methods. We performed a prospective epidemiological study of all cases of occupational exposure to HIV infection from July 1998 to June 2002. Details on the source patient and exposed health worker, as well as place and time of exposure, were gathered. Serologic HIV tests were carried out at baseline and at 1, 3, 6 and 12 months. Results. A total of 75 occupational exposures were reported; 48% were in the group aged 26-35 years old and 75% were women. The attack rate was 4.6 cases per 1,000 persons/year. Nurses reported 43% of accidents, followed by interns and resident physicians (28%). Most accidents (67%) occurred in the morning shift and 36% in a surgical setting. Post-exposure prophylaxis (PEP) was recommended in 71% of exposed subjects and 90% completed the 4-week PEP program. Eighty-nine percent and 57% attended the month 1 and month 6 serologic follow-up visits, respectively. No case of documented seroconversion was reported. Conclusions. Health care workers, regardless of job category or healthcare setting, face a real risk of occupational exposure to HIV infection. These health professionals must continue to be educated about the risk of acquiring infections, ways of effectively reducing risks, and the benefit of timely reporting of occupational exposures." ] ] "multimedia" => array:8 [ 0 => array:6 [ "identificador" => "tbl1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "72v08n01-13101924tab01.gif" "imagenAlto" => 403 "imagenAncho" => 1126 "imagenTamanyo" => 22227 ] ] ] ] ] ] 1 => array:6 [ "identificador" => "tbl2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "72v08n01-13101924tab02.gif" "imagenAlto" => 328 "imagenAncho" => 1128 "imagenTamanyo" => 16018 ] ] ] ] ] ] 2 => array:6 [ "identificador" => "tbl3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "72v08n01-13101924tab03.gif" "imagenAlto" => 365 "imagenAncho" => 1143 "imagenTamanyo" => 16756 ] ] ] ] ] ] 3 => array:6 [ "identificador" => "tbl4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "72v08n01-13101924tab04.gif" "imagenAlto" => 528 "imagenAncho" => 1132 "imagenTamanyo" => 26965 ] ] ] ] ] ] 4 => array:5 [ "identificador" => "tbl5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 5 => array:5 [ "identificador" => "tbl6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 6 => array:5 [ "identificador" => "tbl7" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 7 => array:5 [ "identificador" => "tbl8" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Blood-Borne Virus Infection: The Occupational Risk." 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Occupational exposure to human immunodeficiency virus in hospital health care workers in Spain
Occupational exposure to human immunodeficiency virus in hospital health care workers in Spain
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Occupational exposure to human immunodeficiency virus in hospital health care workers in Spain
JR de Juanes, A García de Codes, MP Arrazola, A González MD
10.1016/S1576-9887(07)73964-XVacunas. 2007;8:4-8