Risk Factors for Occupational Blood Exposure, Compliance with Policies of Infection Prevention and Control, and Costs Associated with Post Exposure Management Among Nursing Staff

Figures & data

Table 1 Departmental Distribution of Occupational Exposure Personnel

Department	Number of Exposures	Percentage (%)
Neurosurgery	25	10.5
Emergency Department	23	9.7
Cardiology	17	7.1
Neurology	14	5.9
Gastroenterology	12	5.0
Respiratory Medicine	11	4.6
Hematology	11	4.6
Otorhinolaryngology	8	3.4
Urology Surgery	8	3.4
Endocrinology	7	2.9
Disinfection Supply Center	7	2.9
Urology	6	2.5
Operating Theater	6	2.5
Cardiac Surgery	6	2.5
Ophthalmology	6	2.5
Dermatology	5	2.1
Gynecology	4	1.7
Oral Medicine	4	1.7
Anesthesiology	4	1.7
Biliary Minimally Invasive Surgery	3	1.3
Hepatobiliary Surgery	3	1.3
Laboratory Department	3	1.3
Rehabilitation	3	1.3
Oral Surgery	3	1.3
Immunorheumatology	3	1.3
Hemodialysis Department	3	1.3
Other Departments	33	13.9

Table 2 Univariate Analysis of Risk Factors Unique to OBEs Among Nursing Staff

	Item	Value	Observation Group [Number (%)]	Control Group [Number (%)]	χ^2	P-value	OR value	95% CI
General Information
X1	Gender	Female	126 (93.33)	52 (50.49)	56.890	0.000	13.73	6.30–29.92
		Male	9 (6.67)	51 (49.51)
X2	Age	≤ 25 years	51 (37.78)	23 (22.33)	6.507	0.011	2.11	1.18–3.77
		> 25 years	84 (62.22)	80 (77.67)
X3	Length of Service	> 5 years	79 (58.52)	86 (83.50)	17.140	0.000	0.28	0.15–0.52
		≤ 5 years	56 (71.78)	17 (16.50)
X4	Employed	Yes	119 (88.15)	32 (31.07)	82.077	0.000	16.50	8.46–32.19
		No	16 (11.85)	71 (68.93)
X5	Student	Yes	16 (11.85)	63 (61.17)	64.069	0.000	0.09	0.04–0.16
		No	119 (88.15)	40 (38.83)
X6	Junior	Yes	88 (65.19)	7 (6.80)	83.052	0.000	25.68	11.03–59.78
		No	47 (34.81)	96 (93.21)
X7	Intermediate	Yes	30 (22.22)	19 (18.45)	0.509	0.475	1.26	0.67–4.40
		No	105 (77.78)	84 (81.55)
Source of Exposure
X8	HBV	Yes	34 (25.19)	40 (38.83)	5.081	0.024	0.53	0.30–0.92
		No	101 (74.81)	63 (61.17)
X9	HCV	Yes	11 (8.15)	11 (10.68)	0.446	0.504	0.74	0.31–1.79
		No	124 (91.85)	92 (89.32)
X10	AIDS	Yes	4 (2.96)	3 (2.91)	0.001	0.982	1.02	0.22–4.65
		No	131 (97.04)	100 (97.09)
X11	Syphilis	Yes	7 (5.19)	7 (6.80)	0.274	0.601	0.75	0.26–2.21
		No	128 (94.81)	96 (93.20)
X12	Type of Exposure	Sharps Injury	130 (96.30)	80 (77.67)	19.527	0.000	7.48	2.73–20.45
		Skin and Mucosal Exposure	5 (3.70)	23 (22.33)
Place of Exposure
X13	Surgery Department	Yes	61 (45.19)	48 (46.60)	0.047	0.828	0.95	0.57–1.58
		No	74 (54.81)	55 (53.40)
X14	Internal Medicine	Yes	58 (42.96)	44 (42.72)	0.001	0.970	1.01	0.60–1.70
		No	77 (57.04)	59 (57.28)
X15	Emergency Department	Yes	16 (11.85)	70 (67.96)	79.703	0.000	0.06	0.03–0.12
		No	119 (88.15)	33 (32.04)
X16	Patient Ward	Yes	66 (48.89)	28 (27.18)	11.571	0.001	2.56	1.48–4.44
		No	69 (51.11)	75 (72.82)
X17	Treatment Room	Yes	19 (14.07)	3 (2.91)	8.676	0.003	5.46	1.57–18.99
		No	116 (85.93)	100 (97.09)
X18	Emergency Department	Yes	12 (8.89)	8 (7.77)	0.096	0.757	1.16	0.46–2.95
		No	123 (91.11)	95 (92.23)
X19	Operating Theater	Yes	11 (8.15)	43 (41.75)	37.601	0.000	0.12	0.06–0.26
		No	124 (91.85)	60 (58.25)
Nature of Exposure
X20	Hand	Yes	117 (86.67)	86 (83.50)	0.469	0.494	1.29	0.63–2.64
		No	18 (5.93)	17 (16.50)
X21	Right hand	Yes	50 (37.04)	21 (20.39)	7.736	0.005	2.30	1.27–4.16
		No	85 (62.96)	82 (79.61)
X22	Left hand	Yes	77 (57.04)	65 (63.11)	0.894	0.344	0.78	0.46–1.31
		No	58 (42.96)	38 (36.89)
X23	Thumb	Yes	39 (28.89)	17 (16.50)	4.980	0.026	2.06	1.08–3.90
		No	96 (71.11)	86 (83.50)
X24	Index finger	Yes	33 (24.44)	28 (27.18)	0.230	0.631	0.87	0.48–1.56
		No	102 (75.56)	75 (72.82)
X25	Middle finger	Yes	21 (15.56)	20 (19.42)	0.611	0.434	0.76	0.39–1.50
		No	114 (84.44)	83 (80.58)
X26	Left thumb	Yes	24 (17.78)	13 (12.62)	1.183	0.277	1.50	0.72–3.11
		No	111 (82.22)	90 (87.38)
X27	Left index finger	Yes	20 (14.81)	21 (20.39)	1.273	0.259	0.68	0.35–1.33
		No	115 (85.19)	82 (79.61)
X28	Right thumb	Yes	15 (11.11)	4 (3.88)	4.155	0.042	3.10	1.00–9.62
		No	120 (88.89)	99 (96.12)
X29	Right index finger	Yes	12 (8.89)	7 (6.80)	0.348	0.555	1.34	0.51–3.53
		No	123 (91.11)	96 (93.20)
X30	First-time Exposure	Yes	108 (80.00)	89 (86.41)	1.682	0.195	0.63	0.31–1.27
		No	27 (20.00)	14 (13.59)
PPE
X31	Glove	Yes	1 (0.74)	0 (0.00)	0.766	0.381	1.01	0.99–1.02
		No	134 (99.26)	103 (10.00)
X32	PPE	Utilization	1 (0.74)	0 (0.00)	0.766	0.381	1.01	0.99–1.02
		Not Utilized	134 (99.26)	103 (10.00)
Exposure Incident
X33	Needle Withdrawal	Yes	19 (14.07)	2 (1.94)	10.689	0.001	8.27	1.88–36.38
		No	116 (85.93)	101 (98.06)
X34	Sharps Disposal	Yes	23 (17.04)	5 (4.85)	8.353	0.004	4.03	1.47–10.98
		No	112 (82.96)	98 (95.15)
Contaminated Items
X35	Needle	Yes	115 (85.19)	67 (65.05)	13.166	0.000	3.09	1.66–5.77
		No	20 (14.81)	36 (34.95)
X36	Standard Injection Needle	Yes	41 (30.37)	17 (16.50)	6.094	0.014	2.21	1.17–4.17
		No	94 (69.63)	86 (83.50)
X37	ABG Needle	Yes	1 (0.74)	21 (20.39)	26.884	0.000	0.03	0.00–0.22
		No	134 (99.26)	82 (79.61)
X38	Insulin Needle	Yes	15 (11.11)	1 (0.97)	9.580	0.002	12.75	1.66–98.19
		No	120 (88.89)	102 (99.03)
X39	Scalp Acupuncture Needle	Yes	8 (5.93)	0 (0.00)	6.316	0.012	1.063	1.02–1.11
		No	127 (94.07)	103 (100.00)
X40	Suture Needle	Yes	15 (11.11)	21 (20.39)	16.714	0.000	0.150	0.05–0.41
		No	120 (88.89)	82 (79.61)
Time of Exposure
X41	Back-to-School Season (September-October)	Yes	26 (19.26)	16 (15.53)	0.007	0.932	0.977	0.58–1.65
		No	109 (80.74)	87 (84.47)
X42	Fourth Quarter	Yes	40 (29.63)	35 (33.98)	0.512	0.474	0.818	0.47–1.42
		No	95 (70.37)	68 (66.02)

Table 3 Logistic Regression Analysis of the Incidence of OBEs Among Nursing Staff

Variable	b	Sb	Wald χ2	P	OR	95% CI
Female	2.650	0.675	15.417	0.000	14.15	3.77–53.12
≤ 25 years	4.525	1.340	11.401	0.001	92.32	6.68–1276.67
Junior	5.867	1.321	19.713	0.000	353.21	26.50–4708.13
Treatment Room	4.479	1.766	6.432	0.011	88.13	2.77–2807.70
Sharp injury	2.893	1.091	7.031	0.008	18.05	2.13–153.23
ABG Needle	−4.006	1.387	8.347	0.004	0.02	0.00–0.28
Suture Needle	−1.856	0.797	5.425	0.020	0.16	0.03–0.75

Table 4 Percentage of HCWs Performing Local Emergency Management Post-Occupational Exposure

Type of Exposure		Observation Group		Control group		χ^2	P-value	OR value	95% CI
		Total Number of Cases	Number and Percentage of Correctly Managed Cases (%)	Total Number of Cases	Number and Percentage of Correctly Managed Cases (%)
Sharp injury	Blood Expression	130	128 (98.46)	80	71 (88.75)	9.410	0.002	8.11	1.71–38.58
	Irrigation	130	127 (97.69)	80	75 (93.75)	2.100	0.147	2.82	0.66–12.15
	Disinfection	130	123 (94.62)	80	74 (92.50)	0.382	0.537	1.43	0.46–4.40
	0 Points	130	0 (0.00)	80	2 (2.50)	3.281	0.070	1.03	0.99–1.06
	1 Point	130	5 (3.85)	80	6 (7.50)	1.332	0.248	0.49	0.15–1.67
	2 Points	130	2 (1.54)	80	2 (2.50)	0.245	0.621	0.61	0.08–4.41
	3 Points (Correct)	130	123 (94.62)	80	70 (87.50)	3.370	0.066	2.51	0.92–6.89
Skin or Mucosal Exposure	Irrigation (3 Points for Correct Action)	5	5 (100.00)	23	23 (100.00)	NA	NA	NA	NA
Overall Correct Management Rate	–	135	128 (94.81)	103	93 (90.29)	1.802	0.179	1.97	0.72–5.96

Abbreviation: NA, Statistical Measure Not Calculable.

Table 5 Actual Review Rates for the Two Groups

Post-Exposure	Observation Group		Control Group		χ^2	P-value
	Number Of Cases That Should Be Reviewed	Number of Cases that was Actually Reviewed (%)	Number of Cases that Should be Reviewed	Number of Cases that was Actually Reviewed (%)
First Month	4	2 (50.00)	3	0 (0.00)	2.100	0.147
Second month	11	6 (54.55)	10	5 (50.00)	0.043	0.835
Third month	49	29 (59.18)	54	24 (44.44)	2.234	0.135
Fourth month	49	22 (44.90)	54	8 (14.81)	11.262	0.001

Table 6 Actual Review Status Following Exposure to HBV, Hepatitis C Virus, Syphilis, and AIDS Viruses

Post-Exposure	Observation Group		Control Group		χ^2	P-value	OR value	95% CI
	Number of Cases that Should be Reviewed	Number of Cases that was Actually Reviewed (%)	Number of Cases that Should be Reviewed	Number of Cases that was Actually Reviewed (%)
HBV
3 Months	34	9 (26.47)	40	13 (32.50)	0.320	0.572	0.75	0.27–2.05
6 Months	34	4 (11.76)	40	4 (10.00)	0.059	0.808	1.20	0.28–5.21
HCV
3 Months	11	7 (63.64)	11	5 (45.45)	0.733	0.392	2.10	0.38–11.59
6 Months	11	3 (27.27)	11	3 (27.27)	0.000	1.000	1.00	0.15–6.53
Syphilis Virus
2 Months	7	5 (71.43)	7	5 (71.43)	0.000	1.000	1.00	0.10–10.17
HIV
1 Months	4	2 (50.00)	3	0 (0.00)	2.100	0.147	0.50	0.19–1.33
2 Months	4	1 (25.00)	3	0 (0.00)	0.875	0.350	0.75	0.43–1.32
3 Months	4	1 (25.00)	3	0 (0.00)	0.875	0.350	0.75	0.43–1.32
6 Months	4	0 (0.00)	3	0 (0.00)	NA	NA	NA	NA

Abbreviation: NA, Statistical Measure Not Calculable.

Table 7 Overview of Costs of Infection Prevention and Control for Nursing Staff and Non-Nursing Staff

Management Action	Item	Observation Group		Control Group		Total Cost (RMB)
		Cost Per Case (RMB)	Percentage (%)	Cost Per Case (RMB)	Percentage (%)	Cost Per Case (RMB)	Percentage (%)
Testing items	Preoperative Basic Panel	32,980	69.7	15,640	52.87	48,620	63.2
	Quantitative Hepatitis B Panel	10,150	21.4	11,025	37.27	21,175	27.5
	ALT	78	0.2	102	0.34	180	0.2
	HCV Antibody Test	1365	2.9	1235	4.17	2600	3.4
	Hepatic Function Panel	1190	2.5	952	3.22	2142	2.8
	TP-PA	480	1.0	480	1.62	960	1.3
	HIV Antibody	500	1.0	150	0.51	650	0.8
	Urinalysis	148	0.3	0	0.00	148	0.2
	CBC with Differential	112	0.2	0	0.00	112	0.2
	Renal Function Panel	340	0.7	0	0.00	340	0.4
	Total	47,343	100.0	29,584	100.00	76,927	100.0
	Average Cost per Individual for Testing	350.69		287.22		323.22
Preventive pharmacotherapy	Hepatitis B Immunoglobulin	1600	99.4	2240	99.31	3840	99.6
	Tetanus Antitoxin	0	0.0	15.6	0.69	15.6	0.4
	Benzathine Penicillin	10.34	0.6	0	0.00	10.34	0.3
	Total	1610.34	100.0	2255.6	100.00	3856.94	100.0
	Average Cost per Individual for Prophylactic Medication	230.05		250.62		275.50
Total		48,953.34		31,839.6		80,783.94
Per capita		362.62		309.12		339.43

Figure 1 Schematic Diagrams of an Adjustable Medical Surgical Support (a–d) and a High-Fit Facial Protective Mask (e–i). (a) Schematic illustration of the main structure of the novel utility model; (b) Schematic illustration of the hanging buckle main body structure of the utility model; (c) Schematic illustration of the tray main body structure of the utility model; (d) Schematic illustration of the support frame main body structure. The labels for a-d include: 1-telescopic column; 2-hanging buckle main body; 3-tray main body; 4-base stand; 5-caster wheel; 6-waste bin; 7-support frame main body; 8-hook plate; 9-hook column; 10-suspension buckle; 11-tray casing; 12-divider; 13-fixed sleeve column; 14-fixed groove; 15-upper sleeve column; 16-support frame housing; 17-clasp; 18-lower baffle; 19-fixed clamp sleeve. (e) Structural schematic of the high-fit facial protective mask of this utility model. (f) Cross-sectional view along the A-A line in Figure 1. (g) Cross-sectional view along the B-B line in Figure 1. (h) Schematic of the end of the detachable sealing strip. (i) Cross-sectional view of the high-fit facial protective mask in another technical scheme of the utility model. The labels for e-i include: 10-mask shell; 11-metal fixation bar; 12-mask band; 20-detachable sealing strip; 21-side strip; 211-inner side strip; 2111-housing cavity; 2112-skin-contact contour; 212-outer side strip; 2121-raised section; 22-lower strip; 23-cleft; p-zygomatic bone.