Hepatitis C: waiting for the grim reaper

Age and years in practice as factors associated with needlestick and sharps injuries among health care workers in a Portuguese hospital

Health care workers are attributed to the group at highest risk of occupationally acquired bloodborne diseases as the result of contact with blood and body fluids. A cross sectional study was conducted between November 2009 and February 2010 in the North of Portugal, to identify potential risk factors for needlestick and sharps injuries. A questionnaire was provided to 363 health care professionals. Logistic regression was used to identify risk factors associated to needlestick and sharps injuries, calculating odds ratio (OR) and their 95% confidence interval (CI). Sixty-five percent of health care workers (64.5%, 234/363) reported needlestick and sharps injuries in the previous 5 years. Of the injured workers, 74.8% were nurses. Of the total injuries reported, the commonest were from syringe needle unit. The multivariate logistic regression model showed that the strongest risk factor was having more than 10 years or more of work in health services (OR 3.37, 95% CI 1.82, 6.24). Another significantly related factor was being over 39 years-old (OR 1.94, 95% CI 1.03, 3.63). In Portugal, there is a lack of epidemiological evidence related to needlestick and sharps injuries. Considering that patients infected with hepatitis B and C virus are commonly encountered in the hospital environment and that the prevalence of HIV infection in Portugal is one of the highest in Europe, these results should be considered in the design of biosafety strategies at the Hospital Center.

Assessing the role of syringe dispensing machines and mobile van outlets in reaching hard-to-reach and high-risk groups of injecting drug users (IDUs): a review

Reaching hard-to-reach and high-risk injecting drug users (IDUs) is one of the most important challenges for contemporary needle syringe programs (NSPs). The aim of this review is to examine, based upon the available international experience, the effectiveness of syringe vending machines and mobile van/bus based NSPs in making services more accessible to these hard-to-reach and high-risk groups of IDUs. A literature search revealed 40 papers/reports, of which 18 were on dispensing machines (including vending and exchange machines) and 22 on mobile vans. The findings demonstrate that syringe dispensing machines and mobile vans are promising modalities of NSPs, which can make services more accessible to the target group and in particular to the harder-to-reach and higher-risk groups of IDUs. Their anonymous and confidential approaches make services attractive, accessible and acceptable to these groups. These two outlets were found to be complementary to each other and to other modes of NSPs. Services through dispensing machines and mobile vans in strategically important sites are crucial elements in continuing efforts in reducing the spread of HIV and other blood borne viruses among IDUs.

Severity of liver disease in hepatitis C infection contracted through injecting drug use

BACKGROUND

Injecting drug use (IDU) is currently the most common route of hepatitis C virus (HCV) transmission in Australia and many other Western countries. Most reports on the natural history of HCV have examined populations that included patients from all risk groups, but it is possible that this increasingly important subgroup is different.

AIMS

To assess the severity of liver disease in individuals who acquired HCV through IDU.

METHODS

Three hundred and forty-six patients with confirmed HCV infection and a history of IDU, who had had a liver biopsy performed were recruited from a liver clinic. Demographic data, liver function tests and hepatitis B serology were obtained on all patients. A detailed drug use history and HCV viral studies were also available in a subgroup of 142 patients.

RESULTS

Mean age of the group was 34 years and 73% were male. Mean duration of HCV infection was 14.6 years. Forty one per cent were infected with genotype 3a, 19% - 1a, 17% - 1 (nonsubtypable), 14% - 1b and 4% - 2b. Cirrhosis was present in 12% of patients. Patients with cirrhosis (38 years) were older than those with chronic hepatitis (34 years; p=0.0003) and had a longer duration of infection (17.2 vs 14.3 years; p=0.003). On multivariate analysis, however, patient age was the only factor independently associated with cirrhosis (odds ratio 4.2; 95% confidence interval 1.4-12.6).

CONCLUSION

While cirrhosis is less common in this group than in other HCV infected populations, its prevalence may increase as these patients are followed over a longer period of time.