Prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers

Objective. To determine the prevalence and risk factors for bloodborne exposure and infection in correctional healthcare workers (CHCWs). Design. Cross-sectional risk assessment study with a confidential questionnaire and serological testing performed during 1999-2000. Setting. Correctional systems in 3 states. Results. Among 310 participating CHCWs, the rate of percutaneous injury ( PI) was 32 PIs per 100 person-years overall and 42 PIs per 100 person-years for CHCWs with clinical job duties. Underreporting was common, with only 25 (49%) of 51 PIs formally reported to the administration. Independent risk factors for experiencing PI included being age 45 or older ( adjusted odds ratio [aOR], 2.41 [95% confidence interval (CI), 1.31-4.46]) and having job duties that involved needle contact ( aOR, 3.70 [ 95% CI, 1.28-10.63]) or blood contact ( aOR, 5.05 [95% CI, 1.45-17.54]). Overall, 222 CHCWs ( 72%) reported having received a primary hepatitis B vaccination series; of these, 150 (68%) tested positive for anti-hepatitis B surface antigen, with negative results significantly associated with receipt of last dose more than 5 years previously. Serologic markers of hepatitis B virus infection were identified in 31 individuals (10%), and the prevalence of hepatitis C virus infection was 2% (n=7). The high hepatitis B vaccination rate limited the ability to identify risk factors for infection, but hepatitis C virus infection correlated with community risk factors only. Conclusion. Although the wide coverage with hepatitis B vaccination and the decreasing rate of hepatitis C virus infection in the general population are encouraging, the high rate of exposure in CHCWs and the lack of exposure documentation are concerns. Continued efforts to develop interventions to reduce exposures and encourage reporting should be implemented and evaluated in correctional healthcare settings. These interventions should address infection control barriers unique to the correctional setting.