Blood borne virus (BBV) infection has long been recognized as an important hazard for patients and healthcare workers (HCW) since the 1960s
. BBVs are viruses that are carried in blood of some people and they are potential for causing severe disease in certain people and few or no symptoms in others. The virus spreads to another person, whether the carrier of the virus is ill or not. The main BBVs of concern are hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV), which all cause hepatitis, a disease of the liver; whereas the human immunodeficiency virus (HIV) causes the acquired immune deficiency syndrome (AIDS), affecting the immune system. BBVs can also be found in body fluids other than blood, such as, semen, vaginal secretions and breast milk. BBVs constitute a major occupational hazard for healthcare workers (HCW), especially in highly resource constrained countries
To some degree it is inevitable that HCWs sustain injuries from sharp objects such as needles, scalpels and splintered bone during execution of their healthcare duties. In addition, HCW’s mucosa may be exposed to droplets or splashes of blood, saliva and urine. Patients showing erratic behavior may inflict bite and scratch wounds. These incidents, herein being referred to as occupational exposure, carry the risk of transmission of infectious agents of which HIV, HBV and HCV are the most relevant
. In the context of hospital settings, the most common exposures are needle-stick injuries and splashes with body fluids, blood being most potent of all
[4–6]. As the prevalence of the HIV infection continues to rise, HCWs in all geographic regions can expect an increasing frequency in the number or incidences of contacts to patients with HIV/AIDS.
Accidental injuries of both percutaneous and muco-cutaneous types are quite common as shown by studies conducted in developed and developing countries
[4, 7–9]. Sub-Saharan Africa has the highest prevalence of HIV-infected patients and the highest incidences of occupational exposures
[10–12]. Therefore, preventive measures and response to blood exposure accidents are necessary to mitigate the risk of exposure.
Despite following ‘universal precautions’, accidental exposure may occur while performing invasive procedures and handling high risk fluids
[12, 13]. Studies have extensively reported suboptimal and non-uniform adherence to standard precautions by HCWs in developing countries as in developed ones
[12, 14, 15]. It is evident the occurrence of percutaneous injury and muco-cutaneous blood exposure is inversely related to routine standard precaution compliance
Avoiding occupational blood exposures by adhering to universal precautions and post exposure management are integral components of a complete program to prevent HIV infection following occupational exposure and are important elements of workplace safety. There are two main strategies for managing occupational exposure to blood. The first approach is to provide empirical treatment with two or more antiretroviral drugs unless additional information (e.g., the result of an HIV test in the source patient or a detailed description of the exposure) suggests that this treatment is not warranted. The second approach is to conduct a thorough assessment of the exposure (including an HIV test in the source patient if HIV infection has not already been diagnosed) and then initiate antiretroviral treatment only if the exposure poses a risk of HIV transmission. However, this will only be practical if exposed HCWs report the event.
The prescription of antiretroviral therapy as post-exposure prophylaxis (PEP) following significant potential exposure to HIV has now become routine.Thus, it is important that individuals with potential risk of exposure are aware of the procedures to follow and know where their first point of contact should be if an incident occurs. PEP is a medical response to prevent transmission of pathogens after potential exposure and refers to comprehensive management instituted to minimize the risk of infection following potential exposure to HIV. This includes first aid, counseling, risk assessment, relevant laboratory investigations based on the informed consent of the exposed person and source and depending on the risk assessment, the provision of short term (28 days) of antiretroviral drugs, along with follow-up evaluation
[16, 17]. PEP for HIV exposure is best when started within golden period of <2 hours and there is little benefit after 72 hours. Knowledge on the exposure mechanisms, transmission risks and prevention methods could assist hospital staff and managers to create a safe working environment free of unnecessary fear or anxiety
. In Tanzania, there is no information on factors that influence the practice of managing occupational exposure to HIV by HCWs. Therefore, the objective of this study was to determine the prevalence of self-reported occupational exposure to HIV among HCWs and explore factors that influence the practice of managing occupational exposures by HCWs in Tanzania.