Occupational exposure to blood and body fluids among Cuban healthcare workers from three levels of medical care: Ascertaining the value of a reporting system

Introduction
About three million healthcare workers experience percutaneous exposures to bloodborne pathogens each year, more than 90 % of which occur in developing countries, and most are preventable. The objective of the study was to describe the extent of occupational exposure to blood and body fluids (BBF) among Cuban healthcare workers from three levels of medical care and ascertain the usefulness of a reporting system in order to design effective prevention programs.

Methods
A cross-sectional survey of healthcare workers from three levels of medical care in Havana City was conducted in two steps. First, we gathered data related to occupational exposure to BBF (e.g demographics, frequency of sharps injuries and handling BBF). Second, we introduced the EPINetTM reporting system in one of the healthcare institution in order to evaluate its use, as there was no reporting system previously in place in any of the three levels.

Results
Response rate amongst the 891 respondents (72 from primary care, 480 from secondary care and 339 from tertiary care) was 98 %; 62.6 % answered sustaining at least one percutaneous injury in the last year (15.5 % reported and 84.5 % unreported). Most exposures (73.9 %) occurred in nurses, followed by doctors (62.9 %) and housekeeping (51.1 %), with frequencies higher in secondary care, followed by tertiary care, and least frequently in primary care. Contact of skin with blood was the most common source of exposure (33.0 %), followed by needlesticks (32.6 %) and other sharps exposure (15.9 %). We found that EPINetTM was consistent with the required information for prevention and control of these exposures and their health impacts.

Discussion
This study showed that a BBF reporting system would be useful at all three levels of medical care.