Temporal trend of accidents due to percutaneous exposure in a public hospital in Brazil, 2007-2019

Pereira, Renan Sallazar Ferreira; Santos, Cecília Angelita dos; Pimenta, Adriano Marçal

doi:10.1590/0034-7167-2022-0046

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (06) • 2022 • https://doi.org/10.1590/0034-7167-2022-0046 copy

Temporal trend of accidents due to percutaneous exposure in a public hospital in Brazil, 2007-2019

Tendencia temporal de los accidentes por exposición percutánea en un hospital público en Brasil, 2007-2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to analyze the temporal trend of accidents due to percutaneous exposure in a public hospital in Brazil, between 2007 and 2019, according to sociodemographic and professional characteristics.

Methods:

analysis of time series of accidents due to percutaneous exposure that occurred in health workers. Sociodemographic and professional variables, accident profile, post-accident behavior and accident incidence rates were evaluated. The Prais Winsten regression was used for trend analysis and calculation of the annual percentage change, with a significance level of 5%.

Results:

761 occupational accidents were recorded. There was a downward trend in the rate of percutaneous injuries among female workers (-0.012%; p=0.009), who had secondary education (-0.011%; p=0.035) and among all health professional categories (-0.010%; p =0.019). There was an increasing trend (0.018%; p= 0.050) among workers with ≥ 61 months of professional experience.

Conclusions:

the analysis showed a decreasing incidence of percutaneous accidents, which can be explained by multiple factors.

Descriptors:
Health Personnel; Accidents; Occupational; Needlestick Injuries; Hospitals; Interrupted Time Series Analysis.

Variable	Total
Variable	n	%
Sex
Male	196	25.8
Female	565	74.2
Age (years)
18-29	286	37.6
30-39	321	42.2
40-49	112	14.7
≥ 50	42	5.5
Education (levels)
High school	409	53.7
Higher education	352	46.3
Professional category
Nurse	91	12.0
Technician and Nursing assistant	410	53.9
Physician	242	31.8
Other technical professionals^* * Laboratory technician and assistant; pathology technician; radiology technician; dental assistant.	8	1.1
Other higher-level professionals^**	10	1.3
Time at the institution (months)
≤ 60	635	83.4
≥ 61	126	16.6

Variable	Total
Variable	n	%
Location of accident (sector)
ICUs	129	17.0
Surgery Center	217	28.5
Emergency / first aid	205	26.9
clinical-surgical ward	123	16.2
Others^* * Others: blood bank; PHD; outpatient clinic; NHE; pediatrics; CME; maternity; Clinical Laboratory. †Others: glass; scissors; lancet; bone fragment; razor blade; drain; chipped wood; glue bottle; pacemaker needle. ‡Others: leg; thigh; arm; forearm. #Others: needle recapping; withdrawal of points; debridement; trichotomy; assistance with movement needs; restriction; material preparation.	87	11.4
Shift in which the accident occurred (period)
Morning day	253	33.3
Daytime afternoon	313	41.1
Nocturnal	195	25.6
Type of sharp material
Needle with lumen	510	67.0
Suture needle	119	15.6
Scalpel blade	61	8.0
Surgical instruments	46	6.0
Others^†	25	3.3
Presence of security device
No	383	50.3
Yes	135	17.7
Non applicable	243	31.9
Affected body region
Fingers	621	81.6
Hands	121	15.9
Others^‡	19	2.5
Circumstance of the accident
Improper sharps disposal	160	21.0
Adm. medication/vascular access/blood collection	322	42.3
Surgical/dental procedure	176	23.1
In material decontamination/organization/processing	43	5.7
Others^#	60	7.9
Use of personal protective equipment
Yes	663	87.1
No	98	12.9

Variable	Total
Variable	n	%
Source and professional status^* * Serological status based on hepatitis B virus surface antigen (HBsAg) detection test/examination, hepatitis B virus core antigen antibodies (anti-HBc), hepatitis C virus antibodies (anti-HCV) and antibodies against the human immunodeficiency virus (anti-HIV) antigen. †Responder: is defined as a person who has an adequate level of antibody to hepatitis B surface antigen (anti-HBs) ≥ 10 IU/L. ‡Non-responder/non-reactive: inadequate vaccination is defined as Anti-HBs < 10 IU/L. #Refers to the monitoring of workers exposed to the human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV). ##Unknown evolution: case in progress/forwarded to follow up in another institution.
Only from the professional	124	16.3
From the source and the professional	637	83.7
Source type (serological result)
Unknown	122	16.0
Negative (uninfected source patient)	584	76.7
Indeterminate (indeterminate - false positive/negative)	10	1.3
Positive for HIV/hepatitis B or C	45	5.9
Anti-HBs test result
Responder† (reagent)	716	94.1
Non-responder^‡	43	5.7
No results	2	0.3
Number of doses received of the hepatitis B vaccine
No registration of doses	4	0.5
< 3 doses	14	1.8
Three doses (full schedule)	698	91.7
4-6 doses	45	5.9
Indication of post-exposure prophylaxis (PEP) for HIV
Yes	34	4.5
No	727	95.5
Indication of PEP for HBV
Yes	37	4.9
No	724	95.1
Conducts before the accident with exposure to HCV
Yes (clinical laboratory follow-up)^#	176	23.1
No	585	76.9
Evolution of the case
Discharge without serological conversion	747	98.2
High with serological conversion	0	0.0
Abandonment of clinical laboratory follow-up	2	0.3
Unknown evolution^##	12	1.6

Variable						%								Yearly change (%)	p value^* * Linear trend Waldman test obtained by Prais-Winsten regression. Values in bold denote significant differences.
Variable	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	Yearly change (%)
Sex
Male	0.4	0.6	0.2	0.5	0.4	0.4	0.2	0.3	0.2	0.4	0.3	0.4	0.3	-0.010	0.061
Female	0.5	0.6	0.5	0.4	0.5	0.4	0.4	0.4	0.4	0.4	0.4	0.4	0.4	-0.012	0.009
Age (you)
18-29	0.9	0.8	0.8	0.7	0.8	0.8	0.7	0.7	0.6	1.0	0.7	0.9	1.0	0.008	0.377
30-39	0.4	0.5	0.4	0.4	0.5	0.4	0.3	0.3	0.4	0.4	0.4	0.5	0.4	-0.004	0.398
40-49	0.2	0.4	0.2	0.3	0.2	0.2	0.3	0.2	0.2	0.2	0.3	0.2	0.2	-0.007	0.083
≥ 50	0.3	0.5	0.2	0.2	0.2	0.1	0.0	0.1	0.2	0.0	0.0	0.3	0.2	-0.016	0.160
Education (levels)
High school	0.4	0.6	0.5	0.4	0.4	0.4	0.3	0.4	0.4	0.4	0.4	0.3	0.3	-0.011	0.035
Higher education	0.5	0.6	0.3	0.4	0.5	0.5	0.4	0.3	0.3	0.4	0.3	0.5	0.4	-0.009	0.167
Professional category
Nurse	0.9	1.1	0.7	0.2	0.5	0.4	0.5	0.4	0.3	0.2	0.2	0.7	0.5	-0.036	0.122
Technician and assistant of nursing	0.5	0.6	0.5	0.4	0.5	0.4	0.4	0.4	0.5	0.4	0.5	0.4	0.4	-0.009	0.096
Physician	0.3	0.5	0.3	0.5	0.5	0.5	0.3	0.4	0.2	0.5	0.3	0.5	0.4	-0.001	0.923
Other technical professionals^†	0.2	0.0	0.6	0.0	0.0	0.0	0.0	0.0	0.0	0.3	0.0	0.0	0.1	-0.011	0.303
Other higher-level professionals^‡	0.9	0.0	0.0	0.7	0.0	0.1	0.0	0.0	0.0	0.0	0.0	0.2	0.0	-0.031	0.062
Time at the institution (months)
≤ 60	0.5	0.6	0.4	0.4	0.5	0.5	0.4	0.3	0.4	0.6	0.4	0.5	0.5	-0.001	0.895
≥ 61	0.0	0.0	0.1	0.2	0.2	0.2	0.2	0.3	0.2	0.1	0.2	0.3	0.2	0.018	0.050

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[1] Corresponding author: Renan Sallazar Ferreira Pereira E-mail: renansallazar@gmail.com