Methods: All HCWs attended at emergency room with diagnosis of OEBF, from Jan 2014 to Jan 2015, were prospective follow-up for six month.
Results: We follow-up 958 consecutive HCWs with OEBF (76.3% women), mainly nurse technicians (325 [34%]) and nurses (187 [20%]). The most frequent place of exposure was the surgical ward (126 [13%]). Percutaneous injuries were the most common (808 [84%]) and in 433 of the cases (45%) hollow needles were involved. In 417 (44%) cases of OEBF, the fluid involved was blood. There were 73 (7.6%) positive sources: 58 (6.1%) HIV, 6 (0.6%) HBV and 9 (0.9%) HCV. Antiretroviral therapy (ART) was indicated to 67 HCWs: 63/67 (94%) zidovudine/lamiduvine; 1 tenofovir/emtricitabine and 3 received also lopinavir/r. Adverse effects to ART were present in 21/67 (31%) HCWs, mainly digestive intolerance (19 HCWs), but only 5/67 (7.4%) HCWs demanded to stop ARV. No confirmed seroconversion for HBV and HCV occurred. For HIV, 1 HCW seroconverted at 1st month's control after exposure. His accident was considered as a low risk and he did not receive prophylaxis, but he had proper risk factors for infection (MSM with untreated HIV (+) partner). Only 336 (35%) HCWs completed the 6-month follow-up. HCWs with exposure to an unknown source had lower compliance (123/402, 30.6%) than HCWs with exposure to a known source (199/519, 38%) or partially known source (14/37, 37%)(p = 0.04). In the subgroup of exposures with known source, compliance was lower in those negative for the 3 virus (181/488, 37%) than those positive for one of them (32/68, 47%), (p= 0.01).
Conclusion: The observed adherence to the follow-up was quite low and indicates that improvement must be done in this area. It is remarkable the low adherence to follow-up among HCWs exposed to an unknown source. The suboptimal tolerance to ART supports the current trend to prefer other nucleoside analogs, such as tenofovir and emtricitabine, as 1st choice therapy in this setting.