1. Riscobiologico.org Prevention of occupational exposures to blood-borne pathogens among HCW in Brazil: Using surveillance data to guide the use of safety-engineered devices C. Rapparini 1, V. Saraceni 1,2, G.C. Fernandes 1,3, A.A. Machado 1,4, PSBio Network - Surveillance System of Occupational Exposures to Blood-borne Pathogens among HCWs/Brazil 1 Projeto Riscobiologico.org / UFRJ, Rio de Janeiro, Brazil 2 SMSDC-RJ, Rio de Janeiro, Brazil 3 Santa Casa de Misericórdia, Juiz de Fora, Brazil 4 Faculdade de Medicina de Ribeirão Preto USP, Ribeirão Preto, Brazil

2. Riscobiologico.org DISCLOSURE Unrestricted Educational Grants The Project has received Unrestricted Educational Grants from different companies over the last years, such as BD and BBraun as well as small funds to participated in different meetings and to present lectures in meetings organized by several different companies. The network of healthcare workers and facilities, founders and collaborators represents a voluntary network. Riscobiologico.org Website Mailing list Surveillance System

3. Riscobiologico.org BACKGROUND - HCW frequently face the risk of occupational infection with blood-borne pathogens. -Most exposures among HCW are caused by percutaneous injuries with sharp objects contaminated with blood or body fluids. -- The Hierarchies of Control is a most critical underlying concept in preventing occupational injuries and ilnesses. - New regulatory policies in Brazil require that employers must promote sharps substitution for safety devices.

4. Riscobiologico.org Safety devices HINGED ARM / SNAP DOWN RETRACTING NEEDLERETRACTING http://www.osha.gov/SLTC/etools/hospital/hazards/sharps/sharps.html#bluntingneedles

5. Riscobiologico.org METHODS - Projeto Riscobiologico.org is a non-profit university- based research group for the prevention of occupational infections among HCWs, founded in August of 2000 in Brazil. - Voluntary network with standardized methods for recording occupational exposures to blood-borne pathogens. - 22 collaborating centers in Brazil - 20 hospitals x 2 non-hospitals - 16 private x 6 public - 2 university x 20 non-university

6. Riscobiologico.org RESULTS N=6,688 exposures to blood or bloody fluids reported, N=5,487 Percutaneous injuries (82.0%) HCW categories: -nurses/aides/students (52.6%) -physicians/residents/students (17.8%) -housekeepers (7.2%). Circumstances associated with percutaneous injuries: -finger/heelstick (13.4%) – (84.0% with hypodermic needles ) -peripheral venous access/IV line (12.5%) -surgeries including suture (11.9%) -SQ/ID injections (9.0%) -phlebotomy (6.8%)

7. Riscobiologico.org RESULTS - Percutaneous exposures occurred: -18.1% needle/sharp in the trash, in linen, left on tray, on floor -15.4% IV access -14.4% disposal - 9.4% recapping needles -- Hollow-bore needles were responsible for 72.5% of all sharps injuries. -- Seven devices are responsible for nearly 80% of all injuries: -52.0% hypodermic needles/disposable syringes -17.6% IV devices - winged steel needles (5.8%),IV catheter stylets (5.4%), scalpe (4.8%), phlebotomy needles (1.6%). -8.2% suture needles -1.8% lancets

8. Riscobiologico.org CONCLUSION High number of cases associated with easily preventable exposures. Although safety devices are available/mandatory in Brazil, their use is still not widespread. Besides the need for safety devices to prevent exposures more prone to cause blood-borne virus transmission (e.g. IV devices) It seems reasonable to include safety lancets for fingerstick blood glucose measurements as a priority considering its high frequency and not negligible risk.