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'Stat' workflow modifications to expedite care after needlestick injuries.

J L Smith1, R Banerjee2, D R Linkin3,4

  • 1The University of Texas Health Science Center at Houston, McGovern Medical School, UT Health, Houston, TX, USA.

Occupational Medicine (Oxford, England)
|January 5, 2021
PubMed
Summary

Implementing a stat workflow for human immunodeficiency virus (HIV) testing after needlestick injuries (NSIs) significantly reduced HIV post-exposure prophylaxis (PEP) dispensing rates for healthcare workers (HCWs). This intervention improves HCW well-being during critical exposure incidents.

Keywords:
HIVneedlestick injury (NSI)occupational healthorder setpost-exposure prophylaxis (PEP)

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Area of Science:

  • Occupational Health
  • Infectious Disease Prevention
  • Public Health Interventions

Background:

  • Post-exposure prophylaxis (PEP) for HIV is crucial for healthcare workers (HCWs) after needlestick injuries (NSIs).
  • Delays in source patient testing results for HIV can cause psychological distress and necessitate empiric PEP, leading to potential toxicities.
  • Current protocols emphasize prompt PEP initiation, often within hours of exposure.

Purpose of the Study:

  • To evaluate a 'stat' (immediate) workflow designed to expedite source patient HIV testing after NSIs.
  • To determine if this workflow reduced HIV testing order-result intervals.
  • To assess the impact on the frequency of HIV PEP prescriptions for exposed HCWs.

Main Methods:

  • Retrospective analysis of NSI records over a 6-year period.
  • Comparison of HIV testing order-result intervals and PEP dispensing rates before and after the 'stat' workflow implementation.
  • Statistical analysis to determine the significance of observed changes.

Main Results:

  • A total of 251 NSIs were identified, with similar monthly frequencies pre- and post-intervention.
  • Median HIV order-result intervals significantly decreased from 195 to 156 minutes (P < 0.05).
  • The proportion of HCWs receiving PEP significantly dropped from 50% to 23% (P < 0.001).

Conclusions:

  • A 'stat' workflow for prioritizing source patient HIV testing after NSIs is effective.
  • This intervention significantly reduces HIV PEP dispensing rates among HCWs.
  • The workflow may enhance HCW physical and psychological health during NSI events.