Splash and non-intact skin bloodborne pathogen exposure risk factors in the Philadelphia fire department

Background: Few data are available regarding risk factors for non-intact skin and mucous membrane exposures (e.g., splashes of blood/ body fluids) among first responders. Also, few studies evaluate detailed health databases of fire department populations. Bloodborne pathogen (BBP) infections – hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) – are preventable. We investigated BBP and other potentially infectious materials (OPIM) exposures in Philadelphia Fire Department (PFD) paramedics. Methods: 52 mucous membrane and 38 non-intact skin exposures to BBP and OPIM recorded by the PFD from 2001 to 2011 were analyzed. Demographics, clinical factors, outcomes, and exposure factors were studied. Rates of exposures were calculated using call volume. Results: There were no seroconversions to HIV, HBV, or HBC. Mucous membrane exposure rate was 194/1,000,000 calls; non-intact skin exposure rate was 156/1,000,000 calls; these rates were at least 6.25 times lower than reported elsewhere. Exposures occurred most often on Mondays, Wednesdays and Fridays. Patient actions causing multiple exposures included: spitting in eyes, biting, scratching, other assault and removing members' mask; other frequent events were breached gloves and fluid splash from endotracheal tubes. Conclusions: To our knowledge this is the first such detailed study of paramedic non-intact skin and mucous membrane exposures. While no BBP seroconversions occurred, exposure remains a threat to first-responder health. For prevention, a Standard Operating Procedure has been written for the PFD. Members should complete HBV vaccine series and use personal protective equipment and work practices that minimize risk of exposure.