Occupational blood and body fluid exposure incidents amongst undergraduate medical students over a period of 5 years
Thesis (MMed (Occupational Medicine))--Stellenbosch University, 2013.
Introduction Exposure incidents involving blood and body fluids represent a major hazard for medical undergraduates. Every medical teaching university experiences the problem of undergraduate medical students sustaining such incidents. Although Post Exposure Prophylaxis (PEP) is readily available and accessible to medical undergraduates following an incident, continuity and quality of care extends beyond the provision of PEP. This includes follow up consultations after receiving PEP according to protocol. Study Design This study was performed at the Tygerberg Campus of Stellenbosch University in Cape Town, South Africa to assess compliance with follow up consultations following an exposure incident. The study base consisted of all the medical undergraduates who reported an exposure incident at the Campus Health clinic. Cases were defined as medical undergraduate students of Stellenbosch University who had reported an exposure incident between January 2007 and December 2011. They were identified using the clinic database and records. Influential factors associated with the exposure incident, including compliance regarding follow up consultations were obtained from standardised reporting forms and medical records. The data was analysed in 2 sections, a cross sectional component (descriptive and analytical) and a retrospective cohort component. Two student cohorts were retrospectively followed from the beginning of their 3rd year to the end of their medical curriculum (6th year). Results There were 280 exposure incidents reported in the study period, of which 174 were low risk and were 106 high risk incidents for which PEP was prescribed (37.86% used PEP). For those who had high risk exposures, 90.57% (n=96) attended the 6-week follow up consultation, 48.11% (n=51) attended the 3 month visit and 34.91% (n=37) attended the 6 month follow up visit. There was an increase in the number of exposure incidents from 2010 (n=43) to 2011 (n=76). Internal medicine accounted for the most number of incidents (n=68), followed by Surgery (n=51), Obstetrics and Gynaecology (n=44), and Paediatrics (n=42). Drawing blood was the most common reported activity associated with exposures. Of notable importance was recapping, disposing of needles and insertion of blood into sample tubes. These activities accounted for 63 of the 280 exposure incidents. The 4th year students were the least at risk for exposure incidents compared to 3rd, 5th, 6th years. The annual average cumulative risk of having an exposure incident was found to be 5.7% (95%CI=4%-8%) and 6.8% (95%CI=5%-9%) amongst the 2 student cohorts over the duration of 4 years (clinical exposure time). Recommendations There is an urgent need for the number of exposure incidents to be reduced, e.g. needle recapping and disposal, and insertion of blood in sample tubes cause numerous preventable incidents. Various other strategies can be implemented in order to reduce the number of incidents across all undergraduate years of study. It is envisaged that by reducing the number of exposure incidents, there will be a subsequent decrease in the number of individuals requiring PEP. The importance of ensuring compliance with regard to follow up consultations needs to be emphasized. Factors that lead to noncompliance need to be investigated in a separate study.