Mücahid Alp ARSLAN, Erol GÜRPINAR, Levent DONMEZ

Incidence of the exposure to blood and blood products and its relationship with the medical education accreditation among last grade medical students in Turkey

Objective: The primary aim of this study was to investigate the blood contact and needle-stick injury rates of final-year (year-6) medical students receiving their education and training at medical schools in different regions of Turkey and to analyse the relationships between blood contact and needle-stick injury and the personal variables of students and accreditation certifications of medical schools. Methods: In this retrospective cohort study, self-reporting questionnaires were completed anonymously by consenting final-year medical students. The study population (n=7900) included all final-year medical students attending the 76 medical schools of Turkey. Of the 76 medical schools, 13 were selected by tratified random sampling, according to their accreditation certification and geographical location, which resulted in 2786 final-year medical students being contacted for participation. Comparisons between groups were analysed using Cox proportional hazards regression. Results: Blood contact to intact skin was 75.2%, mucosal contact was 20.0%, percutaneous contact was 35.4%, and contaminated blood contact was 27.0% of medical students.The average percutaneous time-tocontact was 8.95±0.09 months, with the percutaneous contact rate approaching 50% in the 12th month of the hazard analysis. Percutaneous contact was significantly higher in students who received no formal occupational health and safety training (HR:1.29;95%CI:1.11-1.50) and who attended non-accredited medical schools (HR:1.45;95%CI:1.26-1.66). Percutaneous contact increased significantly in medical students with increasing invasive medical procedure applying scores (HR:1.06;95%CI:1.04-1.09). Conclusion: The final year of medical education and training is a high-risk period for percutaneous contact, with the evidence suggesting that the high risks could be mediated by implementing appropriate occupational health and safety education and training.

Keywords:

blood contact, needle-stick injury medical students, accreditation, occupational health and safety,

PDF

___

Akkaya S, Şengöz G, Pehlivanoğlu F, Güngör-Özdemir E, Akkaya-Tek Ş. Kesici ve Delici Alet Yaralanmalarıyla İlgili Anket Sonuçlarının Değerlendirilmesi. Klimik Dergisi. 2014;27(3):95-8.(available at: https://www.klimikdergisi.org/tr/kesici-ve-delici-alet-yaralanmalariyla-ilgili-anket-sonuclarinin-degerlendirilmesi-164625)
Hosoglu S, Akalin S, Sunbul M, Otkun M, Ozturk R. Predictive factors for occupational bloodborne exposure in Turkish hospitals. Am J Infect Control. 2009;37(1):65-9.doi: 10.1016/j.ajic.2008.02.004
Azap A, Ergonul O, Memikoglu KO, Yesilkaya A, Altunsoy A, Yilmaz Bozkurt G, Tekeli E. Occupational exposure to blood and body fluids among health care workers in Ankara, Turkey. Am J Infect Control 2005;33:48-52.
Wu Q, Xue XF, Shah D, Zhao J, Hwang L-Y, Zhuang G. Knowledge, Attitude, and Practices Regarding Occupational HIV Exposure and Protection among Health Care Workers in China Census Survey in a Rural Area. Journal of the International Association of Providers of AIDS Care (JIAPAC). 2016;15(5):363-9.
Smith DR, Wei N, Wang R-S. Needlesticks and sharps injuries among Chinese hospital nurses. Adv Exp Prev. 2004;7(1):11-2.
Prüss-Üstün A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Am J Ind Med. 2005; 48(6):482–490.
Ghasemzadeh I, Kazerooni M, Davoodian P, Hamedi Y, Sadeghi P. Sharp injuries among medical students. Global journal of health science. 2015;7(5):320.
Ouyang B, Li LD, Mount J, Jamal AJ, Berry L, SimoneC, et al. Incidence and characteristics of needlestick injuries among medical trainees at a community teaching hospital: A cross-sectional study. Journal of occupational health 2017;59(1):63-73.
Choi LY, Torres R, Syed S, Boyle S, Ata A, Beyer TD, Rosati C. Sharps and Needlestick Injuries Among Medical Students, Surgical Residents, Faculty, and Operating Room Staff at a Single Academic Institution. Journal of Surgical Education. Volume74/Number1 January/February 2017. 131-136. http://dx.doi.org/10.1016/j.jsurg.2016.06.003
Lauer AC, Reddemann A, Meier-Wronski CP. Bias H, Gödecke K, Arendt M, Peters H, Gross M. Needlestick and sharps injuries among medical undergraduate Students. American Journal of Infection Control. 42 (2014) 235-9. http://dx.doi.org/10.1016/j.ajic.2013.08.013
Dönmez L, Kaplan D, Yılmaz FB. Tıp fakültesi dönem 5 ve dönem 6 öğrencilerinin kan ve kan ürünleri ile İlgili temas durumları. 15. Ulusal Halk Sağlığı Kongresi, 2-6 Ekim 2012, Bursa, Sayfa 186-7.[In Turkish] (available at: https://halksagligiokulu.org/jm/index.php/component/booklibrary/119/view_bl/84/ulusal-halk-sagl-g-kongreleri/25/15-ulusal-halk-sagl-g-kongre-sagl-k-%20%20reformlar-kitab?tab=getmybooksTab&is_show_data=1&Itemid=119)
Akdemir M, Erengin H, Dönmez L. Akdeniz Üniversitesi Tıp Fakültesi son sınıf öğrencilerinin kan ve kan ürünleriyle temas ve iğne batması ile karşılaşma sıklıkları. Akd Tıp D 2019;1:32-40. DOI: 10.17954/amj.2018.933(available at: http://akdeniztipdergisi.org/pdf/pdf_ATD_196.pdf)
Kuruüzüm Z, Elmalı Z, Günay S, Gündüz S, Yapan Z. Occupational exposures to blood and body fluids among Health care workers: A questionary survey. Mikrobiyol Bul 2008;42(1):61-9.[In Turkish] (available at: http://www.mikrobiyolbul.org/managete/fu_folder/2008-01/2008-42-01-061-069.pdf)
Çelik Y, Akduman D, Kıran S. Sağlık çalışanları ve öğrencilerin kan ve vücut sıvılarıyla bulaşan enfeksiyonlar, enfeksiyon kontrol önlemleri hakkındaki bilgi düzeyleri, temas sıklıkları, serolojik durumları ve hepatit b aşılanma durumlarının değerlendirilmesi. Türkiye Klinikleri J Med Sci 2010;30(4):1246-55. [In Turkish] doi: 10.5336/medsci.2009-13735
Fauci AS, Lane HC. Human Immunodeficiency Virus Disease: AIDS. In: Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 19th ed. New York; Mc Graw Hill Education; 2015. p.1215-85. (available at: https://accessmedicine.mhmedical.com/content.aspx?bookid=1130§ionid=79720773 )
Dienstag JL. Acute Viral Hepatitis. In: Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 19th ed. New York; McGrawHill Education; 2015. p. 2004-23.(available at: https://accessmedicine.mhmedical.com/content.aspx?bookid=2129§ionid=159214492)
Al-Hazmi A. Knowledge, attitudes, and practice of medical students regarding occupational risks of hepatitis B virus in college of medicine, aljouf university. Annals of medical and health sciences research 2015;5(1):13-9. ( available at: https://pubmed.ncbi.nlm.nih.gov/25745570/ ) doi:10.4103/2141-9248.149765
Türk Karaciğer Araştırmaları Derneği, Viral Hepatitle Savaşım Derneği, 2017. Türkiye Viral Hepatitler Tanı ve Tedavi Kılavuzu 2017. Ankara.[Online],( available at https://www.vhsd.org/tr/article/desc/48317/tu-rkiye-viral-hepatitler-tani-ve-tedavi-kilavuzu-2-7.html)
TEPDAD (Tıp Eğitimi Programlarını Değerlendirme ve Akreditasyon Derneği). Mezuniyet Öncesi Tıp Eğitimi Akreditasyon Standartları 2018. (available online at http://tepdad.org.tr/uploads/files/ Belgeler%20ve%20formlar/5word-MOTE%20 2018%20STANDARTLARI.pdf)
TEPDAD (Tıp Eğitimi Programlarını Değerlendirme ve Akreditasyon Derneği). Mezuniyet Öncesi Tıp Eğitimi Programı Öz Değerlendirme Raporu Hazırlama Kılavuzu. Sürüm 4. 2018 (available online at http://tepdad.org.tr/uploads/files/Belgeler%20ve%20formlar/2018-%C3%96DR%20 Haz%C4%B1rlama%20K%C4%B1lavuzu%20.pdf)
Kermode M, Jolley D, Langkham B, Thomas MS, Crofts N. Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings. American journal of infection control 2005;33(1):34-41.
Zhang M, Wang H, Miao J, Du X, Li T, Wu Z. Occupational exposure to blood and body fluids among health care workers in a general hospital, China. American journal of industrial medicine 2009;52(2):89-98.
Kurt AÖ, Harmanoğulları LÜ, Ekinci Ö, Ersöz G. Bir Üniversite Hastanesi Temizlik Çalışanlarının Biyolojik Risk Bilgi, Tutum ve Davranışları. Mersin Üniversitesi Sağlık Bilimleri Dergisi 2015;8(2):37-47. (available at: https://dergipark.org.tr/tr/pub/mersinsbd/issue/19539/208016 )
Yoldaş Ö, Bulut A, Ertürk E, Çelik D, Karakaşoğlu Ü, Altındiş M. Sağlık çalışanlarında enfekte kan ve vücut sıvılarına maruziyet riskinin belirlenmesi. Kocatepe Tıp Dergisi 2014;15(3). (available at: https://dergipark.org.tr/tr/pub/kocatepetip/issue/17401/182181 )
Bernard JA, Dattilo JR, Laporte DM. The incidence and reporting of sharps exposure among medical students, orthopedic residents, and faculty at one institution. J Surg Educ. 2013 Sep-Oct;70(5):660-8. doi: 10.1016/j.jsurg.2013.04.010.
Kessler CS, McGuinn M, Spec A, Christensen J, Baragi R, Hershow RC. Underreporting of blood and body fluid exposures among health care students and trainees in the acute care setting: A 2007 survey. Am J Infect Control. 2011 Mar;39(2):129-34. doi: 10.1016/j.ajic.2010.06.023.
Schmid K, Schwager C, Drexler H. Needlestick injuries and other occupational exposures to body fluids amongst employees and medical students of a German university: incidence and follow up. J Hosp Infect. 2007 Feb;65(2):124-30. DOI: 10.1016/j. jhin.2006.10.002
Türk Tabipleri Birliği, 2010. Mezuniyet Öncesi Tıp Eğitimi Raporu 2010. Ankara. [Online], https://www.ttb.org.tr/kutuphane/mote_2010.pdf
Sabermoghaddam M, Sarbaz M, Lashkardoost H, Kaviani A, Eslami S, Rezazadeh J. Incidence of occupational exposure to blood and body fluids and measures taken by health care workers before and after exposure in regional hospitals of a developing country: a multicenter study. American journal of infection control 2015;43(10):1137-8.
Au E, Gossage JA, Bailey SR. The reporting of needlestick injuries sustained in theatre by surgeons: are we under-reporting? The Journal of hospital infection 2008;70(1):66-70.
Kassa G, Selenic D, Lahuerta M, Gaolathe T, Liu Y, Letang G, Courtenay-Quirk C, Mwaniki NK, Gaolekwe S, Bock N. Occupational exposure to bloodborne pathogens among health care workers in Botswana: Reporting and utilization of postexposure prophylaxis. Am J Infect Control. 2016 Aug 1;44(8):879-85. doi: 10.1016/j.ajic.2016.01.027.
Fritzsche C, Heine M, Loebermann M, Klammt S, Podbielski A, Mittlmeier T, Reisinger EC. Reducing the underreporting of percutaneous exposure incidents: A single-center experience. Am J Infect Control. 2016 Aug 1;44(8):941-3. doi: 10.1016/j.ajic.2016.02.003.