To determine the prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers (CHCWs).

Cross-sectional risk assessment study with a confidential questionnaire and serological testing performed during 1999-2000.

Correctional systems in 3 states.

Among 310 participating CHCWs, the rate of percutaneous injury (PI) was 32 Pis per 100 person-years overall and 42 Pis per 100 person-years for CHCWs with clinical job duties. Underreporting was common, with only 25 (49%) of 51 Pis formally reported to the administration. Independent risk factors for experiencing PI included being age 45 or older (adjusted odds ratio [aOR], 2.41 (95% confidence interval (CI), 1.31-4.46]) and having job duties that involved needle contact (aOR, 3.70 [95% CI, 1.28-10.63]) or blood contact (aOR, 5.05 [95% CI, 1.45-17.54]). Overall, 222 CHCWs (72%) reported having received a primary hepatitis В vaccination series; of these, 150 (68%) tested positive for anti-hepatitis B surface antigen, with negative results significantly associated with receipt of last dose more than 5 years previously. Serologic markers of hepatitis В virus infection were identified in 31 individuals (10%), and the prevalence of hepatitis B virus infection was 2% (n = 7). The high hepatitis B vaccination rate limited the ability to identify risk factors for infection, but hepatitis C virus infection correlated with community risk factors only.

Although the wide coverage with hepatitis B vaccination and the decreasing rate of hepatitis C virus infection in the general population are encouraging, the high rate of exposure in CHCWs and the lack of exposure documentation are concerns. Continued efforts to develop interventions to reduce exposures and encourage reporting should be implemented and evaluated in correctional healthcare settings. These interventions should address infection control barriers unique to the correctional setting.

To determine the impact of a multifocused interventional program on sharps injury rates.

Sharps injury data were collected prospectively over a 9-year period (1990-1998). Pre- and postinterventional rates were compared after the implementation of sharps injury prevention interventions, which consisted of administrative, work-practice, and engineering controls (ie, the introduction of an anti-needlestick intravenous catheter and a new sharps disposal system).

Sharps injury data were collected from healthcare workers employed by a mid-sized, acute-care community hospital.

Preinterventional annual sharps injury incidence rates decreased significantly from 82 sharps injuries/1,000 worked full-time-equivalent employees (WFTE) to 24 sharps injuries/1,000 WFTE employees postintervention (P<.0001), representing a 70% decline in incidence rate overall. Over the course of the study, the incidence rate for sharps injuries related to intravenous lines declined by 93%, hollow-bore needlesticks decreased by 75%, and non-hollow-bore injuries decreased by 25%.

The implementation of a multifocused interventional program led to a significant and sustained decrease in the overall rate of sharps injuries in hospital-based healthcare workers.

To estimate the risk of exposure and infection with bloodborne pathogens, a seroepidemiologic survey was conducted among funeral service practitioners (FSPs) in Maryland.

Of 262 members of the Maryland State Funeral Directors Association, 130 (49%) volunteered to participate in the study. In addition to a brief questionnaire, designed to assess both occupational and non-occupational risk factors for bloodborne pathogen infection, participants were screened for markers of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and past hepatitis B virus (HBV). Titers for antibodies to hepatitis B surface antigen (anti-HBs) also were examined and compared with history of hepatitis B vaccination.

Seroprevalence for HIV, HBV, and HCV infection was 0.8%, 4.6%, and 0%, respectively. Nearly 19% of participants reported at least one bloodborne exposure in the past 6 months. The one HIV infection and all but two of the HBV infections were correlated with well-established non-occupational risk behaviors. Disposable gloves were worn by 96%, and eating, drinking, or smoking during embalming were infrequent. Sixty-one percent of FSPs reported having received one or more doses of hepatitis B vaccine at some time in the past. Of those who reported having received all three doses of vaccine, 67% had adequate titers to hepatitis B surface antibody, the marker of protection related to vaccination.

Compared with prior studies of FSPs, this study found a low rate of occupational exposures and a high rate of hepatitis B vaccination, suggesting improved compliance with recommendations for preventing transmission of bloodborne pathogens in the workplace.

To characterize the types of occupational exposures and injuries reported by emergency medical service (EMS) workers.

A blinded review of accidents/exposures among EMS workers employed by a Baltimore County fire department was conducted. Medical records for 1992 were reviewed.

Two hundred and twenty-six reports were filed by EMS workers (n = 197) employed by a large, urban fire department in 1992. The most commonly reported injuries were sprains (23%), strains (20%), and exposure to blood and body fluids (15%). The body site most commonly injured was the back (20%) followed by the respiratory system (10%). Most incidents were treated at the employee health clinic, and 13% of the incidents resulted in a hospital visit. Fifteen percent of the injuries resulted in more than seven lost work days. Most incidents were caused by stretcher mishaps, especially during transport of heavy patients. Walkway impediments (e.g., icy steps, wet leaves, broken and uneven pathways) also played an important role in creating slipping and tripping hazards.

These results suggest a variety of prevention strategies aimed at reducing accidents and exposures among EMS workers.