Cut and puncture accidents involving health care workers exposed to biological materials

The first report of occupational acquisition of HIV appeared in 1984, and, by June, 1997, the Centers for Disease Control and Prevention (CDC) had reported 52 documented cases of sero-conversion following occupational exposure to HIV-1 by health care workers of those cases. 47 (90.3%) were exposed to blood. The most frequent type of accident reported was percutaneous needlestick injury. Prospective studies have estimated that the risk of HIV transmission following percutaneous exposure to infected blood is 0.3% (Confidence Interval 95% = 0.2% to 0.5%). Following a mucous membrane exposure, the risk is 0.09% (CI 95% = 0.006% to 0.5%). The risk of hepatitis B acquisition ranges from 6% to 30%, and hepatitis C acquisition, 3% to 10%. Since 1992, the São Paulo Hospital s Hospital Infection Prevention and Control Service (SPCIH) has notified and treated all workers exposed to accidents involving biological materials. In the last six years, we have handled approximately 1,300 cases of reported accidents, of which 90% were percutaneous, most involving needlesticks. Such cases were frequently caused by the inadequate disposal and recapping of needles. In these accidents, 20% of the source patients were HIV positive, 10% were hepatitis C positive, and 7.6% were hepatitis B positive. This review summarizes the guidelines for a standardized response when dealing with accidents involving health care workers. Transmission of hepatitis B and HIV can be reduced if adequate preventive measures are taken in advance. If proper prophylaxis is not being done, it should be initiated immediately.