Health care worker risk of bloodborne pathogen transmission: An American public health success story

Occupational bloodborne pathogen infection is a long-recognized risk for health care workers (HCWs), but it was the AIDS epidemic that triggered aggressive prevention initiatives targeting exposures to bloodborne pathogens. The resulting advances produced a major public health success story in the US. Occupational hepatitis B infections have decreased more than 99% since 1983 due to hepatitis B vaccination. Occupational HIV infections have become rare since combination anti-retroviral therapy for patients and HIV post-exposure prophylaxis for HCWs was introduced in 1997; no new cases have been reported since 2001. Some occupational hepatitis C infections have been cured in recent years with interferon therapy. Using multi-hospital EPINet surveillance data at the University of Virginia, we observed an overall reduction in sharps injury (SI) rates greater than 35% since 1993. Reductions for high-risk vascular access procedures exceed 50%. We attribute this to the elimination of unnecessary sharps, a national law requiring adoption of safety-engineered sharp devices, and improved sharps disposal. Standardized surveillance programs such as EPINet have facilitated the sharing of SI data, the identification of device-associated risks, and the efforts of manufacturers to improve device safety. HCWs in developing countries, where the need for protective measures is greatest, have limited access to these advances. Vaccinations, treatments, barrier-garments, safe disposal and safety-devices are relatively unavailable. We propose that global standards for HCW protection be established, and this presentation will outline recommendations. These standards would be a major step toward protecting the health of caregivers in all countries.