Individual and occupational consequences of exposure to biological material among nursing workers


Maria Helena Palucci MarzialeI; Heloisa Ehmke Cardoso dos SantosII; Marli Elisa Mendes TrovóIII

I Full Professor, University of São Paulo at Ribeirão Preto College of Nursing, Brazil. E-mail: marziale@eerp.usp.br
II RN. Master's student, University of São Paulo at Ribeirão Preto College of Nursing, Brazil. E-mail: heloisa.santos@usp.br
III Occupational Health Nurse, Hospital das Clínicas, University of São Paulo at Ribeirão Preto Medical School Hospital das Clínicas. Brazil. E-mail: memtrovo@hcrp.com.br
IV Acknowledgements: São Paulo Research Foundation.

DOI: http://dx.doi.org/10.12957/reuerj.2015.9481




Preventing accidents from exposure to contaminated material is a challenge for workers and institutions. This descriptive study of the consequences of labor accidents with biological material, for nursing staff and the hospital, involved 69 nursing workers exposed to biological material in 2013. Data were drawn from the records of the Specialized Safety Engineering and Occupational Medicine Service, and entered on the Labor Accident Prevention Network's electronic protocol. Semistructured interviews were conducted of 42 workers who had suffered accidents and 19 head nurses. Data were analyzed using descriptive statistics and tabulated. The accidents caused respondents primarily concern, insecurity and fear. Occupational exposure to biological material incurred leaves of absence for workers and treatment costs for the institution.

Keywords: Health occupational; accident occupational; exposure occupational; accident prevention.




Occupational accidents are considered to be unexpected events that happen while exercising professional activities, independently of the employment and social security situation of the affected workers. This type of accident entails potential or immediate health damage, provoking bodily injuries or functional disorders that direct or indirectly cause death and permanent or temporary loss or reduction of the working capacity1,2.

Occupational exposure to potentially contaminated biological material is frequent in the health sector. This type of occupational accident is related to the biological agents, which can transmit more than 20 pathogens presents in blood or potentially infecting bodily fluids (semen, vaginal secretion, liquor, synovial, pleural, peritoneal, pericardial and amniotic fluid) and potentially non-infecting organic fluids (sweat, tears, feces, urine and saliva). The pathogens of major epidemiological importance are: the viruses causing Human Immunodeficiency (HIV-AIDS), hepatitis C (HCV) and hepatitis B (HBV)2,3.

The objective in this study was to analyze the occurrence, characteristics and consequences of occupational accidents involving exposure to biological material for nursing workers and for the employment institution.

In that context, and as members of the Occupational Accident Prevention Network (REPAT/USP), the development of this study is justified to expand the knowledge on the consequences of the accidents and to support the planning of strategies to prevent the occurrence of occupational accidents involving exposure to potentially contaminated biological material.



The global estimates of the World Health Organization for occupational accidents involving sharps contaminated with biological material correspond to three million events/year among health workers, two million with exposure to HBV, 900,000 to HCV and 170,000 to HIV4.

The risk factors for HCV after occupational exposure depend on the degree of contact with blood or sharps and the prevalence of the virus among the patients, and the average transmission risk corresponds to 1.8%. As for HVB, the risk can range between 6 and 30% and, what HIV is concerned, the occupational transmission risk is approximately 0.3 to 0.5% in case of percutaneous exposure, 0.1% when the mucosa are exposed and, in case of non-intact skin, the risk is less than 0.1% 5.

Occupational accidents involving exposure to potentially contaminated biological material among health professionals is considered a source of concern in many countries, due to the losses they entail for workers and their families and for the employers and governmental institutions6.

The researchers emphasize biological risks as occupational risks, as it is the main form of occupational exposure related to the direct or indirect manipulation of biological material among health workers3.

The nursing professionals are the most frequent victims of occupational accidents involving exposure to biological material, as they represent the main group of health workers who spend most time with the patients, delivering direct and continuous care, being exposed to biological and sharp material at all times5,7-9.

In Brazil, the category of auxiliary nurses is the most affected by this type of accident, due to the particularities of the tasks performed in patient care, the long work hours and the stressful work routine3,9,10.

These accidents entail consequences that affect workers in the physical and emotional spheres. The feelings the nursing professionals most express after occupational exposure to biological material are fear, guilt and despair11. Therefore, they cannot be considered random or occasional events, because they can be avoided if the workers and employment institutions adopt a preventive focus, including highlights in the public policies.

To reduce the occurrence of occupational accidents involving exposure to biological material, the health services need to offer appropriate work conditions, individual protection equipment (IPE), material with safety devices, supervision and control of the adoption of safe procedures, health education actions, to grant the professionals the information needed on ways to prevent the occupational risks they are exposed to, for them to adopt fundamental and necessary biosafety measures12. In addition, the need for immunization to Hepatitis B is highlighted, ranging from the worker's admission and further back-up control of vaccination doses. When the accident happens, the physician can recommend secondary prevention measures, such as antiretroviral prophylaxis, depending on the accident characteristics.

Considering the prevention of these accidents as a challenge in recent decades, many studies have been developed on the theme, which have contributed to the advancement of scientific knowledge and to the adoption of strategies to prevent the accidents. Since 2003, REPAT/USP has contributed in that sense by developing collaborative research between Occupational Health researchers and professionals from hospitals in different Brazilian regions. These research results have revealed that this type of occupational accidents remains a considerable problem, due to the incipient attention paid to their notification in some hospitals, even if legally required, because of the non-compliance with standard precautions, the workers' lack of information on how to prevent accidents, and the non-compliance with prophylactic treatment post-exposure to potentially contaminated material13.



The descriptive study was developed at a teaching hospital in the interior of the State of São Paulo, involving nursing workers from the hospital who were victims of occupational accidents involving exposure to biological material in 2013.

Initially, the secondary data on the occupational accidents were surveyed by consulting the records of the Occupational Safety and Medicine Service (SESMT), which were registered on the electronic protocol of REPAT/USP in 2013. This tool permits the collection and registering of information on the workers' sociodemographic and occupational characteristics, causes and conducts after the accident involving exposure to biological material. Next, semistructured interviews were held with the nursing workers who were victims of accidents and with their respective heads who accepted to participate in this study.

In the first phase, all occupational accidents registered in the SESMT in 2013 were included. In the second phase, the nursing workers who were victims of the accidents registered in the first phase and their immediate heads were included. Workers and heads fired or retired and on leave at the time of the data collection (July till December 2013) were excluded. Among the 69 nurses workers victims of occupational accidents involving exposure to biological material registered in 2013, 17 (24.6%) did not accept to participate in the interview and 10 (14.5%) did not comply with the inclusion criteria adopted in this study. Hence, in the second research phase, 42 (60.8%) workers and 19 (67.8%) heads participated.

For the interviews, a specific script was used for the workers and another for the heads. The authors constructed these tools based on the literature. Five occupational health experts assessed the tools and considered them appropriate to the study objectives, with pertinent and clear questions. The individual interviews were scheduled and held at the subjects' workplace, at a room free from interruptions. All interviews were recorded with the subjects' consent and then transcribed, when the data were grouped. Both the data collected on the REPAT/USP form and the interview data were analyzed using the quantitative approach. The results were submitted to statistical analysis and displayed in tables.

Approval for the research was obtained from the Research Ethics Committee at the study hospital, protocol 5154/2010, and the subjects signed the Free and Informed Consent Form.



In 2013, according to information form the Human Resource sector of the hospital that participated in this study, 1915 nursing workers were active at the institution, including 1068 auxiliary nurses, 351 nursing technicians, 470 nurses and 26 nursing attendants. Among these workers, 69 occupational accidents involving exposure to biological material were registered among nursing workers in that year of the SESMT.

Among the 69 records, it was verified that 47 (68.1%) accidents happened among auxiliary nurses, 14 (20.3%) among nurses and 8 (11.6%) among nursing technicians.

As to the characteristics of the workers who were victims of accidents, 65 (94.2%) are women and 4 (5,8%) men, mainly single - 33 (47.8%) and between 30 and 39 years of age - 32 (46.4%).

The surgical clinic was the place in the hospital where most occupational accidents occurred involving exposure to biological material, according to information from the 42 accident victims who participated in the interviews.

What the tasks the professionals were doing at the moment of the occupational accidents are concerned, it was verified in the interviews that most accidents occurred during intravenous puncture - 15 (35.71%), followed by the disposal of sharps – 9 (21.42%), as shown in Table 1.

TABLE 1: Tasks performed by nursing workers during occupational accident involving exposure to biological material/ REPAT-USP.São Paulo, 2013.

After analyzing the consequences for the professionals caused by the occupational accident involving exposure to biological material, 34 (81%), the following stood out: concern – 8 (19.04%), lack of emotional control – 7 (16.66), fear – 6 (14.28%), despair – 3 (7.14%) and insecurity – 2 (4.76%). In addition, it should be highlighted that 8 (19.04%) workers informed no consequences whatsoever, according to Table 2.

TABLE 2: Consequences of occupational accident involving exposure to biological material among nursing workers/ REPAT-USP. São Paulo, 2013.

Among 28 immediate heads, 19 (67.8%) agreed to participate in the research. It was observed that, for 11 (57.9%) heads interviewed, the absence of the accident victim for some hours was the main consequence for the institution after the occupational accident involving exposure to biological material according to Table 3.

TABLE 3: Consequences of occupational accident involving exposure to biological material according to heads of nursing workers / REPAT-USP. São Paulo, 2013.



Most of the occupational accidents involving exposure to biological material occurred among the auxiliary nurses. This result is in line with other studies as this professional category is the most numerous at the Brazilian health institutions, executing many tasks that require the handling of sharps and contact with blood and bodily fluids2,14-16.

Concerning the variables related to the sociodemographic characteristics, most occupational accident victims involving exposure to biological material are female and single. These results differ from other studies, where most workers were married17-18. As regards age, the accidents happened more frequently among workers between 30 and 39 years of age.

The accidents happened at different locations or services in the hospital, with the highest frequency at the surgical clinical ward. These results are in line with other studies, where the same service also registered the largest number of this kind of accidents, due to the great concentration of patients under medication treatment, administered through the enteral and parenteral routes (through catheters, needles and tubes), and also due to the handling of sharps19-21. Nevertheless, the range of locations where the accidents happened may indicate that, besides the specificity of the technical procedures performed and the type of care the nursing workers delivered at the different services, aspects of work management and the preventive actions adopted to prevent the accidents need to be assessed.

As to the task done when the accident involving exposure to biological material happened, intravenous puncture prevailed. This situation was also observed in other studies of accidents while handling needles, catheters, blades and dressing equipment19,22,23.

The consequences of occupational exposure to biological material are not only related to the contamination of nursing workers, as many of them are victims of psychological traumas, due to the time spent waiting for the serum test results and the monitoring during months before being sure about the non-seroconversion11,24.

Studies indicate that occupational exposure to contaminated material interferes in the victims' quality of life and causes stress to workers, families and colleagues25.

In this research, the occupational accidents involving exposure to biological material among nursing workers entailed not only emotional consequences (concern, lack of control, fear, despair, insecurity, scare), but also adverse reactions to the use of antiretroviral therapy (nausea, vomiting, diarrhea and general unease). Studies indicate that this type of accident causes fear, guilt, concern and anxiety, feelings of stigmatization and low self-esteem in the professionals exposure to contaminated biological material2,11,26.

Around the world, occupational accidents involving exposure to biological material entail consequences for governments and institutions, due to the economic and social implications they entail27, regarding the costs of medical treatment post-exposure, disability and absenteeism of the victims28.

The main consequences of the accidents for the institution, according to the heads, were absenteeism (for some hours), which made them reorganize the work scale, the other workers' overload and the economic loss related to the costs of antiretroviral treatment to prevent contamination by HIV and of other drugs.



This study permitted the identification of events, characteristics and consequences of occupational accidents involving exposure to biological material for nursing workers and the employment institution. The majority were women and auxiliary nurses. The most frequent accidents happened during venipuncture according to the interviewees. They consider that this type of accident caused concern, loss of emotional control, fear, despair, insecurity and adverse reactions of antiretroviral therapy use. For their immediate heads, the main consequence was the absence from work for some hours.

Based on the results obtained, it can be concluded that the nursing professionals, heads and managers of the health institutions cannot naturalize these occupational accident events involving exposure to potentially contaminated biological material, as they determine unwanted consequences for the workers, their families, work teams and the employment institution, besides surplus costs for the public purse, whose financial resources could be employed in further health promotion and occupational accident prevention actions. Greater attention to professional nursing education is needed, regarding the acknowledgement of occupational risks, ways to prevent them and conducts to adopt when the accidents happen.

The employment institution should assess the strategies adopted and implement more effective measures to prevent accidental occupational exposure to potentially contaminated biological material.



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Direitos autorais 2015 Heloisa Ehmke Cardoso dos Santos, Maria Helena Palucci Marziale, Marli Elisa Mendes Trovó

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