Bodily Fluid Exposure Reporting is an Issue Among OR Nurses

An alarmingly high number of blood and bodily fluid exposures go unreported by operating room (OR) nurses in Thailand, a new study has confirmed.

The study, which is in press at the International Journal of Nursing Studies, also found that these exposures had profound effects for the healthcare workers involved, including increased levels of stress and anxiety, as well as insomnia. The authors believe their findings highlight the need for comprehensive education and training for OR nurses in proper protocols for avoiding exposure as well as reporting and managing exposures should they occur “to prevent blood-borne infections and other negative health consequences,” noted Nongyao Kasatpibal, a co-author on the study and a member of the faculty in the Division of Nursing Sciences at Chiang Mai University in Thailand.

The research team, which included teaching faculty at several nursing schools in Thailand as well as Joanne D. Whitney, PhD, RN, associate dean for research, School of Nursing, University of Washington, surveyed 2,500 OR nurses at 247 public and private hospitals in the southeast Asia nation. In all, 2,031 of the nurses surveyed returned completed questionnaires.

Not surprisingly, the majority of the respondents, 62.5 percent, had experienced a blood or bodily fluid exposure, typically as a result of a needle-prick from a used syringe and/or fluid line, in the course of their work. Interestingly, though, 60.9 percent of these OR nurses opted not to report the exposures. The most commonly cited reasons for not reporting these exposures were that the blood/fluid came from a “low-risk” source (40.2 percent) or that the exposures were not important enough to report (16.3 percent).

According to Kasatpibal, the rate of underreporting in the US, for example, is likely less than 50 percent at present due to the fact there are governmental agencies involved in educating healthcare professionals on proper management of blood and bodily fluid exposures. However, few studies have taken a comprehensive look at the risk for blood and/or bodily fluid exposure among OR personnel and the degree to which such incidents are reported. One study, published in Clinical Infectious Diseases back in 2003, revealed that nearly 40 percent of registered nurses working at community hospitals in Iowa had experienced an exposure, and that roughly one third of these incidents had gone unreported.

What makes the Thailand study particularly unique is that it highlights the shortcomings in post-exposure response at participating hospitals. Indeed, many of the survey respondents failed to practice safe post-exposure protocols. For example, 9.8 percent of the respondents who experienced an exposure failed to clean the affected area immediately. Furthermore, 18 percent “squeezed out” the wound and 71.1 percent used antiseptic solution to clean out a puncture wound.

The study also revealed that these exposures had profound effects on the OR nurses who experienced them. More than half (58.5 percent) of the respondents said they sought out counseling following an exposure and 16.3 percent reported that they underwent antiretroviral prophylaxis. In addition, high numbers of respondents (23.8 percent and 43.9 percent, respectively) underwent serologic testing for hepatitis B and C. Furthermore, 57.7 percent and 24.2 percent, respectively, of respondents said they experienced increased anxiety or stress following exposure, and 10.2 percent suffered insomnia.

“We are concerned that underreporting may have long-term effects on stress levels and job performance,” said Kasatpibal. “Our findings have shown that the main personal impacts were anxiety, stress, and insomnia, [but] other documented impacts are sick leave and social stigma, [and] that may also affect physical and social well-being. Most of these cases had experience with percutaneous exposure [from HIV-positive patients]. Closed surveillance and in-depth counseling should be provided in these cases.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.