Winifred L. Boal

The national study to prevent blood exposure in paramedics: rates of exposure to blood

ObjectiveThe purpose of this analysis is to present incidence rates of exposure to blood among paramedics in the United States by selected variables and to compare all percutaneous exposure rates among different types of healthcare workers.MethodsA survey on blood exposure was mailed in 2002–2003 to a national sample of paramedics. Results for California paramedics were analyzed with the national sample and also separately.ResultsThe incidence rate for needlestick/lancet injuries was 100/1,000 employee-years [95% confidence interval (CI), 40–159] among the national sample and 26/1,000 employee-years (95% CI, 15–38) for the California sample. The highest exposure rate was for non-intact skin, 230/1,000 employee-years (95% CI, 130–329). The rate for all exposures was 465/1,000 employee-years (95% CI, 293–637). California needlestick/lancet rates, but not national, were substantially lower than rates in earlier studies of paramedics. Rates for all percutaneous injuries among paramedics were similar to the mid to high range of rates reported for most hospital-based healthcare workers.ConclusionsParamedics in the United States are experiencing percutaneous injury rates at least as high as, and possibly substantially higher than, most hospital-based healthcare workers, as well as substantially higher rates of exposure to blood on non-intact skin.

Blood-Borne Pathogens among Firefighters andEmergency Medical Technicians

Objective. Firefighters andemergency medical services (EMS) personnel have the potential for occupational exposures to blood, which increases their risk for occupational blood-borne infection. To address this concern, the authors conducted a literature review of occupational blood exposures, the seroprevalence of blood-borne pathogens among these workers, andthe seroprevalence of blood-borne pathogens among the patients they serve. Methods. A MEDLINE search was conducted, andall identified articles that described surveys of exposures to blood or surveillance of blood-borne infections among firefighters and/or emergency medical technicians (EMTs) in the United States were reviewed. For hepatitis B, only seroprevalence surveys conducted after the 1992 requirement by the Bloodborne Pathogens Standard to offer vaccination to potentially exposed employees were included.Results. From these data, the expected number of annual occupational hapatitis C virus seroconversions was estimated to be between 5.8 and118.9 per 100,000 employee-years for EMT–paramedics, between 3.4 and33.7 per 100,000 for firefighter–EMTs, andup to 3.6 per 100,000 for firefighters (non-EMT). Conclusions.This review suggests there are a limited number of studies addressing this issue, andthese studies have numerous limitations. Despite the expected occupational seroconversions andrecognizing the limitations in drawing conclusions from these studies, it appears that firefighters andEMS personnel do not have an elevated seroprevalence of hepatitis C virus compared with the general population. Improved exposure surveillance programs would clarify exposure risks andidentify potential interventions for firefighters andEMS personnel.

Injuries and illnesses treated at the World Trade Center, 14 September-20 November 2001.

INTRODUCTION In response to the 11 September 2001 terrorist attacks on the World Trade Center (WTC), the United States Public Health Service (USPHS) deployed Disaster Medical Assistance Teams (DMATs) and the Commissioned Corps to provide on-site, primary medical care to anyone who presented. Patients included rescue and recovery workers, other responders, and some members of the general public. OBJECTIVE A descriptive analysis of WTC-USPHS patient records was conducted in order to better understand the short-term impact of the WTC site on the safety and health of individuals who were at or near the site from 14 September-20 November 2001. METHODS The Patient Treatment Record forms that were completed for each patient visit to these USPHS stations over the 10-week deployment period were reviewed. RESULTS Patient visits numbered 9,349, with visits peaking during Week 2 (21-27 September). More than one-quarter of the visits were due to traumatic injuries not including eye injuries (n = 2,716; 29%). Respiratory problems comprised more than one-fifth of the complaints (n = 2,011; 22%). Eye problems were the third most frequent complaint (n = 1,120; 12%). With respect to the triage class, the majority of visits fell into the lowest category of severity (n = 6,237; 67%). CONCLUSION USPHS visits probably were skewed to milder complaints when compared to analyses of employer medical department reports or hospital cases; however, given the close proximity of the USPHS stations to the damage, analysis of the USPHS forms provides a more complete picture of the safety and health impact on those who were at or near the WTC site.

Influenza vaccination among workers—21 U.S. states, 2013

Background: Influenza illnesses can result in missed days at work and societal costs, but influenza vaccination can reduce the risk of disease. Knowledge of vaccination coverage by industry and occupation can help guide prevention efforts and be useful during influenza pandemic planning. Methods: Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry‐occupation module were analyzed. Influenza vaccination coverage was reported by select industry and occupation groups, including health care personnel (HCP) and other occupational groups who may have first priority to receive influenza vaccination during a pandemic (tier 1). The t tests were used to make comparisons between groups. Results: Influenza vaccination coverage varied by industry and occupation, with high coverage among persons in health care industries and occupations. Approximately half of persons classified as tier 1 received influenza vaccination, and vaccination coverage among tier 1 and HCP groups varied widely by state. Conclusions: This report points to the particular industries and occupations where improvement in influenza vaccination coverage is needed. Prior to a pandemic event, more specificity on occupational codes to define exact industries and occupations in each tier group would be beneficial in implementing pandemic influenza vaccination programs and monitoring the success of these programs.

Tdap Vaccination Among Healthcare Personnel—21 States, 2013

INTRODUCTION Outbreaks of pertussis can occur in healthcare settings. Vaccinating healthcare personnel may be helpful in protecting healthcare personnel from pertussis and potentially limiting spread to others in healthcare settings. METHODS Data from 21 states using the 2013 Behavioral Risk Factor Surveillance System industry/occupation module were analyzed in 2016. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination status was self-reported by healthcare personnel along with their occupation, healthcare setting/industry, demographics, and access to care factors. To compare groups, t-tests were used. The median state response rate was 44.0%. RESULTS Among all healthcare personnel, 47.2% were vaccinated for Tdap. Physicians had higher Tdap coverage (66.8%) compared with all other healthcare personnel except nurse practitioners and registered nurses (59.5%), whose coverage did not statistically differ from that of physicians. Tdap vaccination coverage was higher among workers in hospitals (53.3%) than in long-term care facilities (33.3%) and other clinical settings, such as dentist, chiropractor, and optometrist offices (39.3%). Healthcare personnel who were younger, who had higher education, higher annual household income, a personal healthcare provider, and health insurance had higher Tdap vaccination coverage compared with reference groups. Tdap vaccination coverage among healthcare personnel in 21 states ranged from 30.6% in Mississippi to 65.9% in Washington. CONCLUSIONS Improvement in Tdap vaccination among healthcare personnel is needed to potentially reduce opportunities for spread of pertussis in healthcare settings. On-site workplace vaccination, offering vaccines free of charge, and promoting vaccination may increase vaccination among healthcare personnel.