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Review 2: "Accidental Exposure to Body Fluids Among Healthcare Workers in a Referral Hospital in the Security-Challenged Region of South West Cameroon"

In general, reviewers found this preprint to be reliable, but could benefit from clarification on study operational definitions and limitations.

Published onApr 03, 2024
Review 2: "Accidental Exposure to Body Fluids Among Healthcare Workers in a Referral Hospital in the Security-Challenged Region of South West Cameroon"
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key-enterThis Pub is a Review of
Accidental Exposure to Body Fluids Among Healthcare Workers in a Referral Hospital in the Security-Challenged Region of South West Cameroon
Accidental Exposure to Body Fluids Among Healthcare Workers in a Referral Hospital in the Security-Challenged Region of South West Cameroon

Abstract Introduction Accidental exposure to body fluids (AEBs) increases the risk of blood-borne infections among susceptible HCWs. While 90% of the AEB reported occur in developed nations, developing countries bear 90% of the burden of healthcare associated infections, especially those of sub-Saharan Africa. Social insecurity may contribute further to the vulnerability of HCWs. Our study sought to determine the prevalence, reporting and management of AEBs among HCWs in the security-challenged Region of South-West Cameroon.Methods A cross-sectional study was carried out from February 2023 to April 2023, at the Buea Regional Hospital. Following informed consent, a 28-item interviewer-administered questionnaire to HCW was used. Data was entered and analyzed using R Statistics version 4.3.1.Results Out of the 230 HCWs that were approached, 200 were responded for a participation rate of >85%. The prevalence of AEB was high (93%). Exposures occurred while administering injections (37%), during blood sample collection (16%), delivery (11%), surgery (10.2%) and washing. The main risk factors for AEB included female gender (aOR=2.86) and those exercising in the medical (aOR=5.95), pediatrics (aOR=10.5), obstetrical (aOR=22.6), dental (aOR=26.3) units. Only 46.8% of AEBs were reported. Post-exposure management was carried out for 67.2% of the reported cases. Most HCW were unaware of the existence of an Infection Control Committee within the study setting, corroborating gaps in the observance of Standard Precautions.Conclusions Most HCWs experienced AEBs over the last year. There is a need to sensitize and enforce the observance of universal precautions among HCW of the Buea Regional Hospital. Such measures should be extended to other health facilities in related settings.

RR:C19 Evidence Scale rating by reviewer:

  • Potentially informative. The main claims made are not strongly justified by the methods and data, but may yield some insight. The results and conclusions of the study may resemble those from the hypothetical ideal study, but there is substantial room for doubt. Decision-makers should consider this evidence only with a thorough understanding of its weaknesses, alongside other evidence and theory. Decision-makers should not consider this actionable, unless the weaknesses are clearly understood and there is other theory and evidence to further support it.


Review: The paper, “Accidental Exposure to Body Fluids Among Healthcare Workers in a Referral Hospital in the Security-Challenged Region of Southwest Cameroon” examined healthcare workers exposures to patients’ blood along with post exposures management and the factors associated with the exposure. The paper might be considered for publication, but I also think the paper needs major revisions to avoid repetition, to improve precision and clarity. The method and result sections should be improved. Recommendations can be added. The manuscript could benefit from proofreading. 

This is a nice introduction, though exposure to blood can occur through various means. An operational definition of accidental exposures to body fluids is required. In the Methods section, the authors should clarifyhow the data was managed and the platform used for data organization before analysis in R. The authors should also define HCWs when first mentioned and specify the time of exposure (e.g., last 5 years). In the results, the authors should clarify what they mean by delivery (ex: child delivery?). What do they mean by washing? Washing hands/clothes, instruments? What does the author mean with “doing exercise”?

The authors should also consider streamlining the introduction and focusing more on blood-borne infections in healthcare settings. They should also consider shortening the discussion on healthcare-associated infections (HAIs). Minor suggestion: the shortened form of infection prevention and control should be IPC, not ICP.

In the methods section, the authors should first discuss the study site and population. There is no need to mention descriptive and analytic aims as it does not provide additional info here. In the abstract, the author mentioned the use of an interviewer-administered questionnaire, but in the method section of the main manuscript, it states that the questionnaire was self-administered. This discrepancy needs to be addressed and revised for accuracy.

In which platform was the data managed? What aspects of the data did you cross-check? Please ensure the correct citation of the R statistical package: You may consider something like this 'open-source statistical package R version XXX (R Foundation for Statistical Computing, Vienna, Austria). Available at: XXX.'

Exposure to blood can occur through various means, highlighting the necessity of establishing an operational definition for accidental exposures to body fluids. It's essential to clarify which variables were selected for inclusion in the multiple logistic regression model and the rationale behind their selection. Additionally, it's important to address whether the author conducted checks for collinearity within the model. If collinearity was assessed, specific details should be provided.

In the Results section, “occupational exposure" should be explicitly defined, specifying the nature of exposure (e.g., bloodborne pathogens, body fluids). Confidence intervals should be used when presenting odds ratios.Inconsistencies between the abstract and the main manuscript regarding gender as a risk factor for accidental exposure to body fluids (AEB) and needle stick injuries need to be resolved by double-checking the labelling of variables in tables 1 and 2. The authors should reduce the use of abbreviations for similar exposures, such as bloodborne pathogens (BBPs) and accidental exposures to body fluids (AEBs), to avoid confusion. The authors should also use two digits after the decimals consistently throughout the manuscript.

In the discussion section, it is imperative to provide a summary of the overall results before comparing them with findings from other studies. It's evident from the second paragraph that the relationship between political unrest and increased incidence is not immediately clear. Furthermore, the severity of needle stick injuries compared to splashes warrants separate discussion points within this section.

Regarding gender differences in exposure risks, the statement "Females were 2.9 times more likely to experience a splash exposure than male HCWs" echoes repetition of results section. Additionally, it is crucial to elucidate why males were at a higher risk of needle stick injuries, as indicated in Table 1. Moreover, the discussion should address study limitations and offer recommendations for future research. Under the limitation’s subsection, focus should be placed on the impact of these limitations on the study's conclusions and how the data were interpreted in light of these constraints. Additionally, providing a couple of recommendations can enhance the practical implications of the study's findings.

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