Thesis (MMed (Occupational Medicine))--Stellenbosch University, 2013. / Introduction
Exposure incidents involving blood and body fluids represent a major hazard for medical
undergraduates. Every medical teaching university experiences the problem of
undergraduate medical students sustaining such incidents. Although Post Exposure
Prophylaxis (PEP) is readily available and accessible to medical undergraduates
following an incident, continuity and quality of care extends beyond the provision of PEP.
This includes follow up consultations after receiving PEP according to protocol.
Study Design
This study was performed at the Tygerberg Campus of Stellenbosch University in Cape
Town, South Africa to assess compliance with follow up consultations following an
exposure incident. The study base consisted of all the medical undergraduates who
reported an exposure incident at the Campus Health clinic. Cases were defined as
medical undergraduate students of Stellenbosch University who had reported an
exposure incident between January 2007 and December 2011. They were identified
using the clinic database and records.
Influential factors associated with the exposure incident, including compliance regarding
follow up consultations were obtained from standardised reporting forms and medical
records. The data was analysed in 2 sections, a cross sectional component (descriptive
and analytical) and a retrospective cohort component. Two student cohorts were
retrospectively followed from the beginning of their 3rd year to the end of their medical
curriculum (6th year).
Results
There were 280 exposure incidents reported in the study period, of which 174 were low
risk and were 106 high risk incidents for which PEP was prescribed (37.86% used PEP).
For those who had high risk exposures, 90.57% (n=96) attended the 6-week follow up
consultation, 48.11% (n=51) attended the 3 month visit and 34.91% (n=37) attended the 6
month follow up visit. There was an increase in the number of exposure incidents from
2010 (n=43) to 2011 (n=76). Internal medicine accounted for the most number of incidents (n=68), followed by Surgery
(n=51), Obstetrics and Gynaecology (n=44), and Paediatrics (n=42). Drawing blood was
the most common reported activity associated with exposures. Of notable importance
was recapping, disposing of needles and insertion of blood into sample tubes. These
activities accounted for 63 of the 280 exposure incidents. The 4th year students were the
least at risk for exposure incidents compared to 3rd, 5th, 6th years. The annual average
cumulative risk of having an exposure incident was found to be 5.7% (95%CI=4%-8%)
and 6.8% (95%CI=5%-9%) amongst the 2 student cohorts over the duration of 4 years
(clinical exposure time).
Recommendations
There is an urgent need for the number of exposure incidents to be reduced, e.g. needle
recapping and disposal, and insertion of blood in sample tubes cause numerous
preventable incidents. Various other strategies can be implemented in order to reduce
the number of incidents across all undergraduate years of study. It is envisaged that by
reducing the number of exposure incidents, there will be a subsequent decrease in the
number of individuals requiring PEP. The importance of ensuring compliance with regard
to follow up consultations needs to be emphasized. Factors that lead to noncompliance
need to be investigated in a separate study.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/85715 |
| Date | 12 1900 |
| Creators | Essop, Ziyaad Hoosain |
| Contributors | Meintjes, Willem Albertus Jacobus, Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Community Health. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 67 p. : ill. |
| Rights | Stellenbosch University |
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