The National Study to Prevent Blood Exposure in Paramedics addressed the problem of paramedics coming into contact with patient blood while treating the patient. Occupational exposure to blood is important because it is through contact with blood that paramedics can become infected with viruses such as HIV, HBV, and HCV. All of the over 150,000 paramedics in the United States are potentially at risk for these infections. Prevention of blood exposure is the primary means of protecting paramedics from these viruses. Yet before this study, policy makers and public health officials did not know how big the problem was. There were no data on the numbers of paramedics exposed for developing regulations and guidelines or planning and evaluating programs. To obtain the needed data, we conducted a national mail survey of licensed paramedics. The questionnaire and study design were developed with input from paramedics from around the country. We also conducted a separate analysis of California paramedics. California had an established needlestick prevention law that mandated the provision of safety-engineered medical devices (e.g., safety needles) to paramedics. Comparison of blood exposure rates between California paramedics and the national sample could reflect the effectiveness of this law. To select the national sample, 11 states were selected first. Individual paramedics were then selected from those states using lists obtained from state agencies. The final sample included 6,500 paramedics, 1,500 of whom were from California. The questionnaire asked about selected job characteristics, availability of PPE, availability and use of safety-engineered sharp devices, reporting of blood exposures, attitudes toward exposure and prevention, and management practices related to employee safety. Paramedics were also asked the number of times they were exposed to patient blood in the previous 12 months through each of five routes of exposure (sticks from needles or lancets after they had been used on patients; other percutaneous injuries; blood in eyes, nose, or mouth; bites that broke the skin; and blood on non-intact skin) and specific details about the two most recent exposures for each route. We found, first of all, that there is substantial exposure to blood among paramedics in the US. One fifth of paramedics had at least one exposure incident in the previous year. The overall incidence rate was 6.2 exposures per 10,000 calls, which represents over 50,000 total exposures per year. Exposures to the eyes, nose, and mouth were as frequent as needlesticks. Exposure rates in California were one fourth to one half the national rates. Secondly, preliminary analysis suggested that providing paramedics with selected items of PPE and safety devices is associated with reduced risk of exposure, and that many paramedics are not provided with the equipment and safety devices (e.g., goggles, face masks, safety IV catheters, safety lancets and syringes, and fluid-impermeable coveralls). Further analysis is needed to verify these findings. Thirdly, one quarter to two-thirds of paramedics did not report their exposure to the appropriate authority. This is a preliminary finding that requires verification. As prevention efforts move forward, monitoring data will be needed to guide and evaluate policy and programs. This is even more important because several factors that may affect blood exposure among paramedics are changing, such as the passage of needlestick prevention laws and involvement of paramedics in bioterrorism preparedness activities. A data collection system should be implemented to provide updated information on occupational blood exposure among paramedics. It is recommended that workplace interventions be implemented to increase the use of goggles, face masks, and face shields among paramedics. Guidelines should specify the provision of products that prevent blood from seeping behind the goggles/mask/shield. The lower blood exposure rates for California are strong evidence, but not proof, that legislation mandating the provision and use of safety-engineered medical devices is effective in preventing blood exposure among paramedics. In fact, the dramatic differences between the California and national rates suggest that this may be the single most effective measure available for reducing blood exposure in paramedics. However, our study was not designed to identify which aspects of the law, if any, caused the lower rates in California. Several states have since adopted needlestick prevention laws, and the national Needlestick Safety and Prevention Act was passed in 2000. In order to guide future legislation and improvements to these laws, it is recommended that a study be conducted to evaluate the effects of the laws on reducing blood exposure, and to identify which specific aspects of the laws are most effective. Occupational health agencies should implement intervention programs to change management and paramedic attitudes toward blood exposure to remove the stigma and negative consequences that impede reporting.
Constella Health Sciences, 2605 Meridian Parkway, Suite 200, Durham, NC 27713