Professional exposure of health workers to percutaneous skin lesions and prevention strategies

Profesionalna izloženost tjelesnim tekućinama u obavljanju svakodnevnih radnih aktivnosti značajan je problem za sve djelatnike u zdravstvu. Profesionalno su izložene medicinske sestre odnosno tehničari, liječnici, spremačice te ostalo pomoćno osoblje koje dolazi u susret s medicinskim otpadom. Također, ugroženi su i studenti medicine, studenti visokih zdravstvenih škola te učenici srednjih škola medicinskih zanimanja koji u zdravstvenim ustanovama borave u nastavno - obrazovne svrhe. Situacije koje nose rizik prijenosa su perkutane ozljede, odnosno ozljede oštrim predmetima koje podrazumijevaju ubodne incidente, posjekotine i ogrebotine, mukokutane ozljede kod kojih dolazi do prskanja tjelesnih tekućina, te ugrizi. Incidencija ozljeda uzrokovanih oštrim predmetima među zdravstvenim djelatnicima u Republici Hrvatskoj iznosi 0,64 incidenata na jednog zdravstvenog djelatnika godišnje, a najveći rizik infekcije nose ubodni incidenti šupljim iglama jer pri tome može doći do inokulacije kontaminirane krvi u organizam izložene osobe. S obzirom na to da ovakvi oblici izloženosti razvijaju u osoba i najveći strah od infekcije, oni se češće i prijavljuju. Procjenjuje se da se na godišnjoj razini u RH dogodi oko 32.000 incidenata koji većinom ostaju neprijavljeni. Jasno je da nije svaki ubod, porezotina ili ozljeda zabrinjavajući, ali kako bi znali razlikovati što jest zabrinjavajuće, potrebno je procijeniti ozljedu. Najprije se ocjenjuje vrsta ekspozicije - perkutana ozljeda opasnija je od mukokutane, zatim vrsta i količina tekućine/krvi, serostatus izvornog bolesnika na prisutnost HBsAg, prisutnost protutijela na HCV i HIV, te prijemčivost izložene osobe koja se temelji na podacima o procjepljenju i titru zaštitnih protutijela, te imunološkom statusu za HBV, HCV i HIV. Najvažnija mjera i odgovornost svakog djelatnika jest primarna prevencija koja obuhvaća pridržavanje standardnih mjera zaštite u vidu higijene ruku, korištenja osobnih zaštitnih sredstava, sigurnog odlaganja medicinskog otpada, odgovornog ponašanja pri manipulaciji oštrim predmetima te specifična imunizacija protiv virusa hepatitisa B. Pristup u prevenciji ozljeda oštrim predmetima u svim zdravstvenim ustanovama trebao bi obuhvaćati prevenciju rizika, edukaciju, efikasno i pravilno zbrinjavanje ukoliko je već došlo do incidenta. Važno je da su svi zdravstveni i nezdravstveni djelatnici dobro upoznati s rizicima, radom na siguran način, postupcima u slučaju incidenta kao i sa specifičnom predekspozicijskom profilaksom.Professional exposure to body fluids in performing daily work activities is a major problem for all health professionals. Professional nurses, that is, technicians, doctors, cleaning staff and other medical staff who are in direct contact with medical waste, are professionally exposed. Also, the students of medicine and the students of secondary schools for medical professions who are staying in health care institutions for educational purposes, are also endangered. There are also situations where the transmission risk of percutaneous injuries, or injuries on sharp objects that involve stinging incidents, cuts and scratches, mucocutaneous injuries in which sprays of body fluids occur, and bites. The incidence of injuries caused by sharp objects among health care workers in the Republic of Croatia is 0.64 incidents per health worker annually, the highest risk of infection is caused by stinging incidents with hollow needles, because in this way the inoculation of contaminated blood can occur in the organism of the exposed person. Given that, these forms of exposure develop in the person an enormous fear of infection and therefore they are more likely to be infected and reported. It is estimated that at the annual level in Croatia there are about 32,000 incidents that remain largely unreported. It is clear that not every stab or injury need to be considered and dangerous, but in order to be able to distinguish what is worrying, it is necessary to estimate the injury. First, the type of exposure is evaluated - percutaneous injury is more dangerous than mucocutane, then the type and amount of fluid / blood, the serological status of the original patient in the presence of HBsAg, the presence of an antibody on HCV and HIV, and the susceptibility of the exposed person based on the fetal data and the titre of protective antibodies and immune status for HBV, HCV and HIV. The most important measure and responsibility of each healthcare professional is primary prevention that includes compliance with standard measures of protection in the form of hand hygiene, use of personal protective equipment, safe disposal of medical waste, responsible behavior in handling sharp objects and specific immunization against hepatitis B. Access to the prevention of injuries to sharp objects in all health facilities should include risk prevention, education, effective and proper care if an incident has already occurred. It is important that all health and non-health workers are well aware of the risks, working in a safe way, in the event of an incident, and with a specific pre-exposure prophylaxis