Occupational exposures to blood-borne pathogens among healthcare workers in Rio de Janeiro, Brazil

Introduction
HCW frequently face the risk of occupational infection with blood-borne pathogens. The World Health Organization (WHO) estimated that 16,000 HCV, 66,000 HBV and 1,000 HIV infections may have occurred in the year 2000 worldwide among HCWs due to their occupational exposure to percutaneous injuries.

Methods
A program to prevent occupational exposures to blood-borne pathogens among HCWs and a surveillance system of these exposures were implemented in January of 1997 by the STD/AIDS Program of Rio de Janeiro City Health Department. This study was a cross sectional evaluation of all exposures to blood and body fluids among HCWs reported to the STD/AIDS Program that occurred between January 1997 and December 2010.

Results
From January 1997 to December 2010, 25,698 exposures to blood and body fluids were reported. The most involved HCW categories were: nurses/aides (44%) and physicians (17%), students and trainees (14%) followed by housekeepers (7%). Seven circumstances comprised nearly 75% of the reported exposures: during disposal (14%), recapping needles (13%), performing surgical procedures or handling surgical equipment (13%), handling trash (12%), performing percutaneous venepuncture (10%), IM/SQ/ID injections (8%) and during blood drawing (5%). Only 70% of exposed HCW were previously vaccinated against HBV. PEP for HIV was initiated for 46% of exposed HCWs.

Discussion
This study describes the results of a surveillance system of occupational exposure to blood-borne pathogens among HCWs in Rio de Janeiro, Brazil, during a fourteen-year period. Although Brazilian guidelines indicate that PEP is usually not recommended for exposures with insignificant or very low risk of HIV infection, PEP was prescribed to a large proportion of exposed HCWs under these circumstances. Although preventive measures such as antiretroviral drugs are available, this study shows that there are still a high number of easily preventable exposures. The implementation of more effective prevention strategies is urgently required in all levels.