Review 1: "Accidental Exposure to Body Fluids Among Healthcare Workers in a Referral Hospital in the Security-Challenged Region of South West Cameroon"

RR:C19 Evidence Scale rating by reviewer:

• Reliable. The main study claims are generally justified by its methods and data. The results and conclusions are likely to be similar to the hypothetical ideal study. There are some minor caveats or limitations, but they would/do not change the major claims of the study. The study provides sufficient strength of evidence on its own that its main claims should be considered actionable, with some room for future revision.

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Review: Through a cross-sectional survey of HCWs, a high percentage (93%) were accidentally exposed to body fluids. While only 47% reported their exposures, 67% of those carried out some form of post exposure management. Infection control and prevention efforts including universal precautions must be prioritized to protect healthcare workers who experience accidental exposure to body fluids.

The strength of the evidence for this manuscript is reliable. The cross-sectional survey which took place in one hospital in Cameroon had a robust response rate and included healthcare workers (HCWs) in a wide variety of specialties. It would have been informative to see the instrument itself to gauge what was measured. Some editing is needed and there is an opportunity to revisit the references to remove some that are more dated.

Most HCWs experienced accidental exposure to body fluids (AEBs) in the year the survey was conducted. Occupational exposure to body fluids occurred both from needle stick injuries and from splashing events. Findings highlighted that hollow needle, suture needle, and scissors are the primary instruments involved in AEBs, which may benefit from further assessment of policies and procedures to ensure safety guidelines when using these instruments in this hospital. Female HCWs, particularly in obstetric units, may be at higher risk for splash exposures due to the procedures occurring in their specialty area. Of concern, the abstract stated that female gender was a risk factor for AEB but male gender was reported as being at greater risk for needle stick injuries so the abstract result appears overstated and at odds with the finding in the body of the manuscript. Barriers staff encountered included time limitations, limited water for washing, and lack of PPE (i.e. face shields). While the authors discussed security challenges in this region of Cameroon, there was no measurement of the impact of the security challenges on the outcomes, unless that was in the instrument we were not able to assess. The barriers reported (time, water access, PPE) could have been experienced without those security challenges. 

In addition to the need for an infection control and prevention team that provides education and monitoring of activities, review of current clinical practice and instrument use may provide further insight into improvements that can be made to protect HCWs from AEBs when providing care in this particular hospital and conceivable in others.

Findings from this article provide detail to the large percentage of HCWs that are accidentally exposed to body fluids (AEB) due to their occupation in this hospital in Cameroon. Surveyed HCWs were unaware of how to report AEBs, perceived minimal risk from exposure, or a lack of time, all of which may impact their compliance with standard precautions and increase their risk of AEBs. Furthermore, limited resources such as available water for washing, or PPE, were reported barriers when HCWs attempt to adhere to standard precautions in this hospital. The need for infection control and prevention is critical to protect HCWs at this hospital and others.