RESUMO
OBJECTIVE: To examine whether healthcare students reactions towards PLHIV would be significantly different based on their knowledge of resources available for accidental HIV exposure, personal knowledge of someone living with HIV and attendance at HIV relevant sessions. DESIGN AND METHODS: A survey was conducted with 344 health-care students from the Faculty of Medical Sciences of the UWI St. Augustine. Participants emotional reactions towards PLHIV, perception of occupational risk for HIV, awareness of availability of post exposure prophylaxis (PEP), personal knowledge of someone with HIV and attendance at HIV relevant sessions in the past year were measured. Independent t-tests were used to analyse the data. RESULTS: Independent t-tests indicated a significant effect of awareness of the availability of post-exposure prophylaxis (PEP) on fear, (p =.02), and prejudicial evaluation (p =.03). Students who were aware of the availability of PEP at their institution had lower mean scores for fear (M = 4.59, SD = 2.44) and prejudicial evaluation (M = 21.47, SD = 6.75) than those who were unaware of the availability of PEP, fear (M = 5.21, SD = 2.40) prejudicial evaluation (M = 23.18, SD = 7.01) CONCLUSION: Healthcare providers should be informed of the resources available in case of accidental HIV exposure and the conditions under which they can be accessed. This knowledge and awareness may contribute to attenuating students fears and consequently their reactions toward HIV patients.
Assuntos
Estudantes de Medicina , Conhecimentos, Atitudes e Prática em Saúde , Exposição Ocupacional , Transmissão de Doença Infecciosa do Paciente para o Profissional/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controleRESUMO
In May 2004, a 48-year-old male surgeon, resident in Bucaramanga, Colombia, suffered a superficial cut with a scalpel to the lateral aspect of the mid-phalanx of the second finger of the left hand while performing a pulmonary decortication surgical procedure for tuberculous empyema with pulmonary entrapment. The injury healed normally but, approximately 2 weeks after the event, an erythematous, nonpainful papule of approximately 3 mm in diameter developed, and increased progressively to 7 mm 3 days after its initial appearance. At this time, the papule showed spontaneous secretion of a clear liquid and superficial ulceration (Fig. 1). Approximately 3 weeks after the injury, a Gram stain of the liquid was performed; it showed no bacteria but a moderate leukocyte reaction. Because of the high suspicion of possible tuberculous infection, bacilloscopy of the liquid was performed, and was positive (++) for acid-fast bacteria (Fig. 2). The liquid was cultured and grew Mycobacterium tuberculosis. The culture was sent to the Laboratory of Mycobacteria at the National Institute of Health, Bogota, Colombia for drug resistance testing. Susceptibility was demonstrated against streptomycin, isoniazid, rifampicin, and ethambutol. During this time, the patient presented an ipsilateral painful axillary adenopathy of about 2.5 cm in diameter. The patient consulted with an infectologist, who initiated a Directly Observed Therapy Short Course (DOTS) regimen [first phase (8 weeks): daily, except Sundays, streptomycin 1 g intramuscularly, pyrazinamide 1500 mg orally, isoniazid 300 mg, and rifampicin 600 mg; second phase (18 weeks): twice weekly rifampicin 600 mg and isoniazid 500 mg], accompanied by daily pyridoxine to prevent secondary effects from isoniazid. After 3 weeks of treatment, the finger lesion had disappeared. Treatment was undertaken as described above, with the patient reporting symptoms of vertigo, nausea, epigastralgia, and mild myalgia as the adverse effects of medication. A chest x-ray was taken and reported to be normal. The axillary adenopathy disappeared approximately 6 months after the injury. Nearly 3.5 years after the incident, the patient has not presented any type of symptomatology.
Assuntos
Empiema Tuberculoso/transmissão , Cirurgia Geral , Transmissão de Doença Infecciosa do Paciente para o Profissional/métodos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Cutânea/etiologia , Acidentes de Trabalho , Antituberculosos/uso terapêutico , Empiema Tuberculoso/diagnóstico , Empiema Tuberculoso/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonectomia/métodos , Medição de Risco , Resultado do Tratamento , Tuberculose Cutânea/diagnóstico , Tuberculose Cutânea/tratamento farmacológicoRESUMO
BACKGROUND: Exposure to bloodborne pathogens poses a serious risk to health care workers (HCWs). Surveillance systems of occupationally acquired human immunodeficiency virus (HIV) infection have been developed in several countries, mainly in the developed world. The purpose of this study was to identify cases of occupationally acquired HIV infection among HCWs in Brazil. METHODS: A systematic literature review was conducted. The databases searched were MEDLINE and LILACS (1981 to 2004), academic dissertations and theses (1987 to 2004), abstracts from national and international meetings during the last 10 years, and local and national bulletins. Reference lists to identify other relevant articles were checked. RESULTS: The database searches generated a total of 60,770 titles. Two hundred and nineteen references were finally analyzed. Four documented cases of occupational HIV infection were identified. All of the cases involved nursing staff and were percutaneous exposures. Seventy-five percent occurred after a procedure involving a needle placed directly into a vein or artery. Most (75%) had source patients with probable high viral load and low CD4 count. Two cases represented HIV seroconversion despite initiation of postexposure prophylaxis. Only one case (1/4; 25%) presented acute retroviral illness. CONCLUSION: After an extensive literature search, 4 documented occupational HIV infection cases were identified, only 1 of which had been published in a scientific journal. Our findings were consistent with the majority of documented infections worldwide. Surveillance systems are indispensable to establish and formulate rational policies for minimizing the risk of occupational infection, not only from HIV but also from hepatitis B and C viruses and other bloodborne pathogens.