Occupational exposure to blood and other bodily fluids at a military hospital in Iraq

BACKGROUND: Exposure to bloodborne pathogens, namely HIV, hepatitis B, and hepatitis C, remains a risk for healthcare workers. Given the austere and challenging environments in a combat zone, it is unclear to what extent blood and other bodily fluid occupational exposures pose a risk of infection for military healthcare workers deployed to a level III military treatment facility in support of Operation Iraqi Freedom. METHODS: This is a retrospective review of electronic infection control records at the Air Force Theater Hospital in Iraq in which blood and other bodily fluid occupational exposure data were available: October 1, 2005 through May 31, 2006 and January 15, 2007 through April 30, 2007. RESULTS: During the first study period, there were 46 exposures for an average monthly exposure of 5.8 (range, 2-16 per month). The majority of exposures were percutaneous fingersticks (74%), whereas the remainder were splashes (17%) or not documented (9%). During the second study period, there were 19 exposures with percutaneous device and splash exposure encompassing 68% and 32% of cases, respectively. The majority of occurrences were in the intensive care unit (53%) and primarily among nurses (37%). Overall, there were 65 exposures per 1,000 persons during the year review. CONCLUSIONS: During the time periods evaluated, a substantial number of blood and other bodily fluid exposures occurred in a combat zone military healthcare facility. This finding is comparable to US civilian institutions. Maintaining programs for preventing, tracking, and implementing postexposure prophylaxis remain a worthy and achievable goal at every military treatment facility, regardless of the austerity of the environment.