Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

408 Abstracts 23331-23336

12th World AIDS Conference

Preventing these exposures would result in the prevention of 1) occupationally
acquired infections, 2) possible adverse effects related to PEP, and 3) emotional
distress to exposed HCWs, and also result in cost-savings
233311 Risk factors for HIV/AIDS transmission in a hospital
setting in Yaounde, Cameroon
Dora N.S. Mbanya1, J. Ateudjieu2, L. Kaptue2. 1B.P 8046 Yaounde 8e; 2Dept.
Haematology, University Yaounde I, Cameroon
Issue: In most developing countries ignorance, poverty and the lack of structures
and trained personnel remain major contributing factors to the spread of disease
to and from health workers.
Project: To evaluate some of the risk factors for HIV/AIDS transmission and
the preventive measures adopted by health workers in a hospital of Yaounde,
both by using pre-structured questionnaires and observations.
Results: All categories of health workers were included in the 409 respondents
of the study. About 75% of workers always recap needles after use; and 60.7%
have had at least one needle-prick injury in the last year. These accidents were
not reported or recorded in all cases. Only 45.4% wash their hands before any
activity within the hospital (including handling of patients) compared to 70.9%
who always wash hands after. Gloves and other barrier-protection material were
not often made available to workers - the 52.7% who always used gloves in doing
risky jobs mostly bought for themselves. 34.7% of workers always washed and/or
disinfected gloves for reuse. About 15% of workers admitted to simple washing
and/or disinfection of metallic instruments before reuse, while 16.8% still sterilize
and reuse surgical blades.
Lessons learned: Most health workers in developing countries of sub-Saharan
Africa are still obliged through ethical or other reasons to provide health care
under very risky conditions. In the era of HIV/AIDS only continuous education
of personnel and constant provision of work guidelines in all services of the
hospital as well as compliance with universal precautions will minimize disease
transmission in health institutions.
23332 1 Profile of occupational exposures to blood and body
fluids among health care workers in Rio de Janeiro City,
Brazil
Betina Durovni, C.S. Rapparini, R.C.M. Ferreira, S.C. Cavalcante, V. Saraceni,
W. Toschi. Rio de Janeiro City Health Secretariat, Rua Sacopa 109/507, Lagoa
22471-180 Rio de Janeiro, Brazil
Objective: Describe the profile of occupational exposures among health care
workers (HCWs) with special attention to HIV risk and post-exposure prophylaxis
(PEP)
Methods: Five hundred and fifty six occupational exposures reported to the Rio
de Janeiro city Health Secretariat/AIDS program from January to December 1997,
were analyzed in order to access information concerning the job category, injury
type and circumstances, source patient information, time interval and regimen for
HIV PEP.
Results: From the 556 cases reported 80.6% were women, mean age 35 years
(SD ~ 9.9), 32.2% were nurse auxiliaries, 27.2% were physicians and 15.7%
were cleaning workers. The most frequent type of exposure were percutaneous
injuries (84.4%) that occurred mainly on the hands (65.7% on the fingers and
10.4% on other areas). The most common causes of injuries happened: during
a procedure (18.3%), while recapping a used needle (17.6%), during the management of a trash bag or inappropriate waste container and devices left on
inadequate place (13.3%). Blood was involved in 75.5% of the exposures. 71.2%
of the source patients were identifiable and 27.8% of them were HIV-positive.
PEP was prescribed for 358 (64.4%) HCWs, 80.4% received the drugs within 24
hours and 40.2% of them within 2 hours.
Conclusions: Most of the exposures were preventable showing the need of
an educational strategy concerning biosafety. PEP has been taken in a reasonable time interval. The analysis of the injury circumstances can be helpful in the
development of new safety devices.
123333 Needlestick injuries in referal hospitals for HIV diseases
in Japan
Satoshi Kimura1, K. Kidouchi2, M. Aoki3, S. Oka3, S. Hitomi4. 1Dept. of Infection
Control, Facult. of Med., Univ. of Tokyo 7-3-1 Hongo, Bunkyo, Tokyo; 2Nagoya
Higashi Municipal Hospital, Nagoya; 3National Medical Center, Tokyo;
4University of Tokyo, Tokyo, Japan
Objectives: To clarify the frequency and cause of needlestick injuries (NSIs)
among health care workers (HCWs) in order to develop better preventive procedures in Japan.
Methods: We asked all of 324 referal hospitals for HIV diseases to report NSls
during a year of 1996. Japan version of EPINet (The Japan EPINet) form was
used as reporting system. This is the largest study on NSIs ever conducted in

Japan.
Results and Discussion: Of 324, reply was obtained from 204 hospitals (63%),
and a total of 4,786 NSIs from 198 hospitals were evaluable. The frequency of
NSIs was 4.2/100 beds/year (range 3-21). 13 accidents (0.3%) occurred with
needles contaminated with HIV, 2,381 (50%) with HCV and 540 (11%) with HBV.
Remainig 1,852 accidents occurred with needles from patients who were negative
or not tested for bloodborne infections. 7 HCWs acquired HCV infections, but

nobody was infected with HIV and HBV in this study period. Considering the fact
that the average prevalence of HCV positivity among inpatients is estimated to
be 5~10% in Japan, it may be allowed to assume that actual frequency of NSIs is
20-40/100 beds/year. The frequency is 27-33/100 beds/year in USA (G. Ippolito,
et al.).
NSIs occurred most frequently (28%) on "recapping the needles", followed by
"after use and before discarding" (23%), and "during use" (18%). The frequency
on recapping is as low as 4% in USA (J. Jagger, et al.).
This work was supported by a Grant for Promotion of AIDS Research from The
Ministry of Health and Welfare of Japan.
Conclusions: Frequency of actual NSIs is estimated to be 20-40/100 beds/year
in Japan, the figure being very close to those reported in USA. Education to avoid
recapping and introduction of safety devices are needed in Japan, because the
rate of NSIs on recapping is extremely high.
23334 Work accidents:Epidemiological analysis and
seroconversion rates
StellaMaris Oliva1 2, O. GarciaMessina2, L. Redini2, G. Ortega2, O.M. Bases2,
A. Maranzana2, J. Benetucci2. 1 Vidt 2069 20 A 1425 Buenos Aires; 2Hospital
Muhiz Ward 17/Fundai Foundation, Buenos Aires, Argentina
Objective: To assess the epidemiological features of work accidents and the risk
of seroconversion to HIV.
Method: Between 1987 and 1992, 261 work accidents reported: 164 women
(63%), 97 men (37%). Average age: 36. Nurses: 132 (50.5%), doctors: 61 (23.4%),
laboratory technicians and biochemists: 18 (6.9%), dentisi: 4 (1.5%), surgeon assistant: 1 (0.4%), others (maids, sanitation workers, safety control staff): 45
(17.2%). Kind of exposure: needle injuries: 209 (80%), mucosal exposure: 40
(15%), superficial contact: 10 (4%), bites: 1 (0.5%), scratches: 1 (0.5%). Glove
wearing: 13 (5%), no glove wearing 8 (3%), loss of information: 240. Between
1986 and 1991, there were 172 accidents (66%) and between 1992 y 1997, only
89 (34%)
Results: Baseline serology was carried out in 149 people (57%) through EIA;
control at 6th (n = 120), 12th (n = 92) and 24 th week (n = 90) through EIA, W.
blot, alcaline immunocomplex dissociation Ag p24 and Nested PCR. Nested PCR
was performed in 34 patients as from june 1996. In 62 cases the source was
know as HIV-1+. Prophylaxis post exposure (PPE) was accepted by 36 patients
(14%); 20 of them received only ZDV; 10 ZDV/3TC and 6 ZDV/3TC/IDV. One
seroconversion was reported at 12th week post exposure (EIA+, Wb+, Ag p24 -
and Nested PCR+) favoured by high risk percutaneous lesion (needle injury and
blood inoculation) and absence of PPE (not prescribed at her workplace).
Conclusion: 1) Most exposed sex: female; mpost frequent exposure: nurses
and doctors. 2) needle injuries lesions prevailed. 3) There was little observance
of biosafety recommendations. 4) PPE was successful in every case. 5) Infection
rate was high: 1/90 accidents controlled in 6 months (1.11%) favoured by the high
percentage in losses of follow up
1233351 Health care workers exposure (HCWE): Analysis of 113
cases
Pedro Chan, Maria Jose Rolon, H. Perez, S. Aronson, Z. Lovay Zulma,
0. Cando, R. Peikert, P. Cahn. Infectologia, Hospital Fernandez, Angel Peluffo
3932 (1181), Buenos Aires, Argentina
Objective: To describe features of HCWE in a general hospital in Buenos Aires.
Methods: Data was collected on all personnel who presented HCWE between
June 1995 and December 1997. We analysed: occupation, time on duty, type of
accident, use of adequate biosafety measures, prior vaccination for hepatitis B,
prophylaxis ARV, side effects and seroconversion.
Result: We recorded: 113 HCWE: 65 percutaneous injuries, 27 by needle
disposal, 11 recapping, 9 ocular exposures and I human bite. Occupation: 28
residents, 20 nurses, 13 housekeeper/maintenance, 11 clinical laboratory, 11 nonsurgical MD, 5 surgical MD and 13 other: 57% of the accidents occurred during
their first year of work and 64.6% of HCWE refered adequate biosafety measures.
HBV vaccination: 54+, 50 non-vaccinated, 9 without data. Postexposure prophylaxis (CDC recommendations): 4 AZT, 4 dual NRTI, 6 triple therapy (AZT + 3TC
+ PI). In two HCWE classified as high risk, triple therapy was discontinued when
the source patient was diagnosed as HIV-. Source were HIV+ in 36% of cases.
Of the 14 HCWE who received prophylaxis, 3 had side effects: fatigue, anemia
and rash wich required discontinuation of AZT. There were no seroconversions
at six months follow-up.
Conclusions: Despite ongoing medical education, HCWE without adequate
biosafety measures are still being registered. Less than 50% were vaccinated for
HBV. Residents are at higher risk, mostly during their first year on duty, followed
by nurses and housekeeper Percutaneous injury was the most frequent exposure.
Permanent HCW education is essential in order to avoid unnecesary levels of
risk.

S23336 Risk of HIV infection in health care workers after
occupational exposure
Giuseppe Ippolito, V. Puro, N. Petrosillo. Siroh study group; CTR. Rif AIDS
IRCCS L.Spallanzani via Portuense 292 00149 Rome, Italy
Objective: To determine the incidence of HIV infection following occupational
exposure in health care workers