An investigation into occupational blood and body fluid exposure among emergency medical care providers within the public sector emergency medical service in eThekwini

Abstract

Introduction Occupational exposure to blood and body fluid (BBF) is an issue of serious concern for health care workers (HCWs) and presents a major risk factor for the transmission of infectious diseases such as the hepatitis B virus (HBV), hepatitis C virus (HCV), and the human immunodeficiency virus (HIV). Emergency medical care (EMC) providers, particularly those working in the developing countries, appear to be at even greater risk due to nature of their prehospital work and the environment in which this work is undertaken. Purpose To investigate the knowledge, practices and exposure to BBF among public sector EMC providers in the eThekwini metropole, as part of a process of informing contextually relevant recommendations for the mitigation and management of BBF exposure in the prehospital environment. Methodology The study used a mixed methodological approach and was conducted in two phases. During the first phase quantitative data was collected using a questionnaire which was distributed to a randomly selected and representative sample of EMC providers employed by the Emergency Medical Rescue Services (EMRS) in eThekwini. Phase two included the collection of qualitative data through structured interviews which were conducted with the information-rich respondents who had participated in phase one. Through methodological triangulation, the data from Phase one and Phase two were integrated to obtain an in-depth understanding of the knowledge, practices and exposure to BBF among public sector EMC providers in the eThekwini metropole. Results A total of 41 (43%) of the 96 participants indicated that they had been exposed to BBF at some point in their careers. The majority (n = 26, 63%) of such BBF exposures was due to needlestick injuries (NSI) with the procedure involved in gaining intravenous (IV) access accounting for most (n = 14, 34%) of the BBF exposures. The main contributing factor in relation to most (n = 25, 61%) of the exposures was combative patients. There was a significant relationship between the qualifications of the EMS providers and the type of BBF exposure (p = .016). It was found that a higher proportion of intermediate life support (ILS) providers sustained NSI compared to advanced life support (ALS) and basic life support (BLS) providers, whilst a higher percentage of ALS providers sustained BBF exposure to their eyes, while basic life support providers sustained more BBF exposures to broken skin as compared to ALS and ILS providers. Seventy nine percent (n = 76) of the respondents were unable to identify all of the presented risks of their BBF exposure, while 80.2% (n = 77) did not know where their organisation’s BBF exposure guideline was kept. There was a significant relationship between the EMC providers’ qualification and their knowledge of the risks of BBF exposure (p = .01), with ILS providers identifying more risks associated with BBF exposures compared to ALS and BLS providers. Half of the respondents (n = 48) were unable to identify all the presented examples of universal precautions. The association between qualifications and knowledge of universal precautions was significant (p= .002). Advanced life support and ILS providers demonstrated greater knowledge of BBF exposure compared to BLS providers. Inadequate BBF exposure training and a lack of clear direction regarding BBF exposure protocols were identified as possible reasons for the inadequate knowledge of both the risks of BBF exposure and universal precautions. Most (n = 87, 90.6%) of the respondents indicated that they always used gloves when there was a perceived risk of BBF exposure, while 27.1% (n = 26) and 15.6% (n = 15) indicated that they never used eye protection and facemasks respectively. Possible reasons for the infrequent use of personal protective equipment (PPE) include the unavailability of PPE, and EMC providers not anticipating the BBF exposure. The majority of the respondents (n = 74, 77.1%) indicated that they always recapped needles, 95.8% (n = 92) removed needles from syringes and 46.9% (n = 45) disposed of sharps containers when completely full. Conclusion The study found that the EMC providers employed by the EMRS in eThekwini do not possess adequate knowledge of either BBF exposure or universal precautions, which may be one of the contributing factors to the high prevalence of BBF exposures revealed in this study. As the burden of disease continues to grow, urgent intervention is required to mitigate BBF exposure in all HCWs, but particularly in the case of EMC providers who are frontline staff who often have no prior knowledge of the patients they may see before the initial contact. As informed by this study interventions may include the provision of BBF exposure training, the circulation of effective BBF exposure guidelines and the adequate availability of PPE.