Working in health care can be risky, study hints

NEW YORK (Reuters Health) - A new study from the Centers for Disease Control and Prevention shows that health care workers are more likely to die from bloodborne infections and related illnesses than people working in other occupations.

“There is evidence that over the past 20 to 25 years health care workers have been more likely to die of these kinds of infections than other workers are,” Dr. Sara E. Luckhaupt of the CDC’s National Institute for Occupational Safety and Health (NIOSH) in Cincinnati told Reuters Health.

“What we can’t say is how much of this is occupational exposure and how much is non-occupational exposure, so it’s important to think about both,” she added. Past investigations have suggested that most of these infections were not contracted on the job.

Needlesticks and other accidents on the job expose nurses, doctors and other health care workers to infection with HIV (the virus that causes AIDS), hepatitis B, and hepatitis C, Luckhaupt and her NIOSH colleague Dr. Geoffrey M. Calvert note in a report in the American Journal of Industrial Medicine.

The researchers had previously found that male health care workers are at increased risk of HIV and viral hepatitis. They conducted the current study to examine whether death from these infections is also higher among workers in the field.

Luckhaupt and Calvert looked at data from the National Occupational Mortality Surveillance system for 1984 to 2004 on 248,550 deaths from HIV, hepatitis B, hepatitis C, and liver cancer and cirrhosis, both of which can be consequences of viral hepatitis.

For men, they found, working in health care more than doubled the likelihood of dying from HIV, while it nearly doubled mortality from hepatitis B. Deaths due to hepatitis C and cirrhosis were also somewhat more likely among men who worked in health care. But for women, only death from hepatitis C was more frequent in health care workers.

Based on occupation, male nurses were at the highest risk of HIV and hepatitis B mortality, while female nurses were actually 31 percent less likely to die of HIV than women working outside the health care industry.

“The greatest limitation to our study was that information was not available on possible confounding factors such as sexual risk behaviors, history of blood transfusions, intravenous drug use, and alcohol use,” the researchers write. However, they add, past studies suggest that most bloodborne infections among health care workers are not job-related. Work in the health care industry could be a stand-in for other risk factors, they suggest.

“Research is needed to understand why, despite their probably high degree of knowledge about the transmission of HIV and hepatitis, male health-care workers still engage in these risk behaviors,” Luckhaupt and Calvert write. “Targeted interventions to decrease the risk of bloodborne pathogens among health-care workers may need to be gender-specific.”

SOURCE: American Journal of Industrial Medicine, November 2008.