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Perceptions that influence occupational exposure reporting

AORN Journal, August, 2003 by Sonya Osborne

Statistics on occupational exposures of health care workers to blood-borne pathogens are disturbing. In 1996, the estimated total annual occupational exposures to blood or other body substances in the United States was 786,885 exposures, at a rate of 30 exposures per 100 hospital beds occupied daily. (1) In Australia, national monitoring of occupational exposures to bloodborne pathogens began in 1995, and the estimated total exposures in Australia in 1998 was 1,718, at a rate of 25 exposures per 100 hospital beds occupied daily. (2) In addition, from the analysis of documented cases, disease transmission rates for HIV and hepatitis C after occupational exposure are estimated at 0.3% and 1% to 10%, respectively, in the United States, (3,4) and 0.32% and 1.6%, respectively, in Australia. (2)

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Although, standard precautions were introduced in the 1980s, research continues to report less than 100% compliance among health care professionals with measures demonstrated to decrease disease transmission. (5-15) The consequences of an occupational exposure to bloodborne pathogens extend beyond transmission of infection. Consequences related to health can include liver disease and subsequent transplantation complications, chronic disabilities, and premature death. (1) Consequences related to employment can include punitive disciplinary action, job discrimination, denial of worker's compensation claims, and loss of employment potential. (1) Personal consequences can include anxiety, alteration in sexual practices, or postponement of pregnancy. (1) The possibility of incurring these consequences emphasizes the need for prevention of exposure to bloodborne infections in high-risk environments.

The focus of this article is compliance with occupational exposure reporting. It is anticipated that results from this study will be used to inform the development of appropriate strategic measures to improve perioperative nurses' compliance with occupational exposure reporting.

OCCUPATIONAL EXPOSURE IN THE OR

Perioperative nursing is a high-risk nursing specialty. The nature of the work environment and the conditions in which surgical procedures take place put perioperative nurses at increased risk for occupational exposure and occupationally acquired disease transmission. The incidence of cutaneous and mucocutaneous exposure in the OR far exceeds that of percutaneous exposure and may occur in 30% to 50% of surgical procedures. (16,17) The greatest risk for occupational transmission of bloodborne infections, however, is from exposure by percutaneous injury from needles and other sharp objects, which occurs in up to 15% of surgical procedures. (16,17)

The occupational exposure risk in the OR is considered low compared to hospital-wide risk, probably because of inadequate reporting of exposures in the OR. (18) In the early 1990s, studies were conducted on risk of exposure, compliance with standard precautions and infection control policies and procedures, and lack of reporting of occupational exposures in ORs in the United States. (12,17,19,20) Previous research also compared both self-reported and observed data and questioned the reliability of self-reported data. (15) Occupational exposures among health care workers have been substantially underreported, (7,21-25) and OR personnel underreport by as much as 25%. Unfortunately, hospitals typically rely on incident reports to determine the frequency of exposures and the need for improving measures to decrease or prevent them. (22)

Reporting occupational exposures provides several benefits for perioperative nurses, including early initiation of prophylactic treatment and possible prevention of future medical, (1,3,4,26) social, (1) and financial (21,27) problems associated with acquiring a bloodborne infection. Studies have concluded that treatment with prophylactic agents within 24 hours of exposure decreases the risk of some disease transmission. (26) Reporting also may decrease the anxiety associated with an occupational exposure. In light of these benefits, it is in the best interest of perioperative nurses to report all occupational exposures promptly to put in motion a process of future protection for themselves and their family members.

PURPOSE OF THE STUDY

There has been a significant amount of international research on benefits of and compliance with standard precautions as well as some research, though not as much, on types, frequency, and risk of occupational exposures among different categories of health care workers in a variety of clinical settings. There is a dearth of research about perioperative nurses' compliance rates for reporting occupational exposures, however, and no studies have been found that investigate the significance of specific influences on compliance with reporting in general or, specifically, among perioperative nurses in Australia.

The purpose of this study was to assess attitudes, beliefs, and level of compliance with standard precautions and occupational exposure reporting. Two research questions guided the study.

Health Care Industry

Perceptions that influence occupational exposure reporting

AORN Journal, August, 2003 by Sonya Osborne

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