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Review 1: "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 1: "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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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
Description

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:

  • 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.

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