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Global Occupational Exposure to Blood and Body Fluids among Healthcare Workers: Systematic Review and Meta-Analysis

Global Occupational Exposure to Blood and Body Fluids among Healthcare Workers: Systematic Review... Hindawi Canadian Journal of Infectious Diseases and Medical Microbiology Volume 2022, Article ID 5732046, 16 pages https://doi.org/10.1155/2022/5732046 Review Article Global Occupational Exposure to Blood and Body Fluids among Healthcare Workers: Systematic Review and Meta-Analysis Dechasa Adare Mengistu , Gebisa Dirirsa , Elsai Mati , Dinku Mekbib Ayele , Kefelegn Bayu , Wegene Deriba , Fekade Ketema Alemu , Yohannes Mulugeta Demmu , Yohanis Alemeshet Asefa , and Abraham Geremew Department of Environmental Health, College of Health and Medical Science, Haramaya University, P.O. Box 235, Harar, Ethiopia Correspondence should be addressed to Dechasa Adare Mengistu; dechasaadare@gmail.com Received 11 January 2022; Accepted 19 May 2022; Published 3 June 2022 Academic Editor: Vijay Singh Gondil Gondil Copyright © 2022 Dechasa Adare Mengistu et al. �is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Occupational exposure to blood and body „uids has become a serious public health problem for healthcare workers and is a major risk for the transmission of various infections such as human immune-de‡ciency virus, hepatitis B virus, and hepatitis C virus. �is systematic review and meta-analysis aims to determine the career time and previous one-year global pooled prevalence of occupational exposure to blood and body „uids among healthcare workers. Methods. For the review, the articles published in English were searched using the electronic databases (SCOPUS/Science Direct, PubMed, Web of Science, Google Scholar, CINAHL, MEDLINE, Cochrane Library, DOAJ, and MedNar) with a combination of Boolean logic operators (AND, OR, and NOT), Medical Subject Headings (MeSH), and keywords. A quality assessment was conducted to determine the relevance of the articles using JBI critical appraisal tools. Furthermore, several steps of assessment and evaluation were taken to select and analyze the relevant articles. Results. Of the 3912 articles identi‡ed through the electronic database search, 33 that met the inclusion criteria were included in the ‡nal analysis. �e current study found that the global pooled prevalence of blood and body „uids among healthcare workers during career time and in the previous one year accounted for 56.6% (95% CI: 47.3, 65.4) and 39.0% (95% CI: 32.7, 45.7), respectively. Based on subgroup analysis by publication year, survey year, and World Health Or- ganization regions, the highest prevalence of blood and body „uid exposure in the last 12 months was observed among articles published between 2004 and 2008 (66.3%), conducted between 2003 and 2008 (66.6%), and conducted in the Southeast Asia Region (46.9%). �e highest career time prevalence was 60.6%, 71.0%, and 68.4% for articles published between 2015 and 2020, conducted between 2015 and 2019, and reported in the African region, respectively. Conclusion. �e current study revealed a high prevalence of occupational exposure to blood and body „uids among healthcare workers and suggests the need to improve occupational health and safety services in healthcare systems globally. and other blood-borne pathogens, including cytomegalo- 1. Introduction virus, herpes simplex virus, and parvovirus B19 [4]. Occupational exposure to blood-borne pathogens as a result Healthcare workers are at high risk of being infected with of contact with human blood and body „uids has become a various occupational-related diseases as a result of exposure serious health concern for healthcare workers (HCWs) to blood-borne pathogens [1, 5, 6]. globally [1]. Occupational exposure to blood and body „uids �e risk of transmission of infection after exposure to (BBFs) constitutes a risk of transmission of blood-borne infected blood is 0.3% times greater for human immu- pathogens, such as human immune-de‡ciency virus (HIV), node‡ciency virus-infected blood than for uninfected hepatitis B virus (HBV), and hepatitis C virus (HCV) [2–5], blood, while it is estimated to be up to 100 times greater for 2 Canadian Journal of Infectious Diseases and Medical Microbiology Record identified through Record identified through additional database searches (N= 2714). search (N=198) Record identified Excluded articles (n =337) Review articles (n=112). Record aer duplication Editorial paper, reports, short removed (n=1482). communication, preprint (n=214]. Articles not published in English language (n=11). Record screened by title and abstract (n= 1145). Excluded articles (n=454) Non relevant articles (n= 217) Not available in full tests (n=198) Full-text articles assessed Not specified the country, period for Eligibility (n=691). and study, study participants Excluded articles (n=658) Studies included in a Not reported outcome of the systematic review (n=33). interest (n=378) Unclear objectives (n=89) Unclear methods (n=114) Unclear outcome (n=77) Studies included in Meta- analysis (n=33). Figure 1: Study selection process of included articles for systematic review and meta-analysis, 2021. the hepatitis B virus and from 3 to 10% for the hepatitis C 2. Materials and Methods virus [7, 8]. Among the above infections (HBV, HCV, and 2.1. Protocol Registration and Search Strategy. (e research HIV), only HBV had a vaccine until the time of this study protocol was registered in the PROSPERO international [7]. prospective register of systematic reviews According to the World Health Organization (WHO) (CRD42017077201). (e Preferred Reporting Items for report, about three million HCWs are exposed to blood- Systematic Reviews and Meta-Analysis (PRISMA) guideline borne pathogens each year, of which 170,000 are exposed to was used to perform this systematic review [12]. HIV infections, 2 million to HBV infections, and 0.9 million to HCV infections [9]. Most of the time, healthcare pro- viders get exposure through the splash of blood or other 2.2. Eligibility Criteria body fluids into the eyes, nose, or mouth or nonintact skin exposure, and percutaneous injury occurs as a result of a 2.2.1. Inclusion Criteria. (e studies that met the following break in the skin caused by a needlestick or sharps con- inclusion criteria were included in the systematic review and taminated with blood or body fluids [9]. meta-analysis: Several studies, including systematic reviews and meta- (i) Study population: healthcare workers regardless of analysis, have been conducted and published on the prev- their occupation alence of BBFs among HCWs in different settings, such as at country or region levels. And also, a few studies reported the (ii) Outcomes: study reporting quantitative outcomes global prevalence of occupational exposure to needlestick (magnitude, frequency, rate, or prevalence of BBFs injuries [10], the prevalence and device-related causes of in lifetime and/or last year) needlestick injuries [11], percutaneous injury [1], and the (iii) Language: studies written in English prevalence of exposure to blood and body fluids in Africa (iv) Types of articles: peer-reviewed full text, original, [6]. and published articles However, there is no evidence regarding the global prevalence of blood and body fluids among healthcare (v) Publication year: not specified (not limited) workers. (erefore, this is the only study that provides a (vi) Study region or country: not specified (not limited) global prevalence of blood and body fluid exposure among healthcare workers, which can be used as evidence and input to reduce the burden of BBF exposure and may prompt the 2.2.2. Exclusion Criteria. Studies that did not report 12 development of appropriate policies, systems, and processes. months or career time prevalence (such as 3 or/and 6 Furthermore, this systematic review and meta-analysis es- months) of BBFs, case reports, case series, review articles, timated the regional levels, last year, and career time surveillance data, reports, conference abstracts, personal prevalence of BBFs among HCWs. opinions, articles written in non-English, high risk of bias Eligibility Identification Included Screening Canadian Journal of Infectious Diseases and Medical Microbiology 3 Table 1: Overall characteristics of articles included in the systematic review and meta-analysis, 2021. Survey Pub. 12 Study Socioeco Risk of Author N Lifetime Participant Setting Country year year months design status bias Kasatpibal 2011- Cross- 2016 2031 40.0 NA Nurses Hospital (ailand Developing Low et al. [40] 2012 sectional Doctors, nurses, clinical officers, laboratory Mbaisi et al. Cross- 2010 2013 305 25.0 NA personnel, Hospital Kenya Developing Low [41] sectional dentists, supportive staff, and students Nurses, health officers, health assistants, Yenesew and medical Healthcare Cross- 2012 2014 317 65.9 76.0 Ethiopia Developing Low Fekadu [19] doctors, facilities sectional laboratory technicians, and dentists Markovic- Healthcare Cross- Denic et al. 2012 2015 983 26.9 56.5 Hospital Serbia Transition Moderate workers sectional [25] Health Mbah et al. Doctors and Cross- 2013 2020 444 25.5 NA center and South Africa Developing Low [20] nurses sectional hospital Nurses, physicians, Engin et al. cleaning staff, Cross- 2010 2014 300 58.3 Hospital Turkey Developing Moderate [42] student nurses, sectional and laboratory technicians Physician, nurses, laboratory technicians, and Mandic´ et al. Cross- 2013 2018 5247 39.0 66.0 support staff Hospital Serbia Transition Low [24] sectional such as cleaners and workers in laundry and sterilization Sabbah et al. 2011/ Physician and Cross- 2013 277 30.0 NA Hospital Lebanon Developing Low [43] 12 nurses sectional Nurse, medical doctor, laboratory Abere et al. Cross- 2018 2020 277 65.3 87.0 technology, Hospital Ethiopia Developing Low [17] sectional health officer, midwife, pharmacy Physicians and Musa et al. Cross- Bosnia and 2013 2014 196 35.7 63.3 nurses/ Hospital Transition Low [44] sectional Herzegovina technicians Markovic- ´ Nurses and Cross- Denic´ et al. 2011 2013 216 25.9 60.6 Hospital Serbia Transition Moderate doctors sectional [23] Nurse, laboratory, Yasin et al. Cross- 2017 2019 282 39.0 58.5 medical doctor, Hospital Ethiopia Developing Low [2] sectional midwife, and others 4 Canadian Journal of Infectious Diseases and Medical Microbiology Table 1: Continued. Survey Pub. 12 Study Socioeco Risk of Author N Lifetime Participant Setting Country year year months design status bias Dental Shaghaghian Cross- 2011 2015 191 80.0 Dental students school Iran Developing Low et al. [27] sectional department Cross- Yi et al. [29] 2015 2018 548 65.9 Nurses Hospital China Developing Low sectional Rasweswe Cross- 2014 2020 94 43.0 Nurses Hospital South Africa Developing Moderate and Peu [22] sectional Nurses, midwives, CHOs, CHEWs, Primary Nmadu et al. laboratory Cross- 2011 2016 172 68.0 healthcare Nigeria Developing Low [38] technicians, sectional centers pharmacy technicians, and ward attendants Hospitals Shitu et al. Cross- 2020 2021 424 46.7 NA Midwives and health Ethiopia Developing Low [18] sectional centers Doctors, nurses, anesthetists, Yang et al. midwives, Cross- 2019 2021 33,156 24.5 NA Hospital China Developing Moderate [30] laboratory sectional personnel, and others Doctors, surgeons, nurses, Ditorguena midwives, Cross- 2018 2019 136 67.6 Hospital Togo Developing Moderate et al. [45] laboratory sectional technicians, and nursing assistants Doctors, nursing staff, lab staff, Tertiary Fazili et al. Cross- 2014 2017 2763 25.0 sanitation staff, care India Developing Moderate [34] sectional administration, institute laundry, and linen Physicians, residents, medical interns, nurses, Farsi et al. Cross- 2010 2012 200 57.5 laboratory Hospital Iran Developing Low [28] sectional personnel, housekeepers, cleaners, and others Nurses, Selladurai laboratory, Cross- and Shireen 2014 2019 240 54.5 NA technicians, Hospital India Developing Moderate sectional [35] interns, and resident doctors Nurse, laboratory Nwoga et al. Cross- 2018 2020 200 27.0 NA scientist/ Nigeria Developing Low [39] sectional technician, and others Canadian Journal of Infectious Diseases and Medical Microbiology 5 Table 1: Continued. Survey Pub. 12 Study Socioeco Risk of Author N Lifetime Participant Setting Country year year months design status bias Ebrahimi Laboratory Cross- 2010 2015 193 25.4 36.3 Hospital Iran Developing Moderate et al. [26] personnel sectional Doctors, clinical officers, nurses, laboratory Laisser and personnel, Health Cross- Ng’home 2015 2017 277 20.9 NA Tanzania Developing Low mortuary facilities sectional [32] attendants, and housekeeping staff Doctors, nurses, Chalya et al. 2013- laboratory staff, Cross- 2015 436 17.0 Hospital Tanzania Developing Low [33] 14 and auxiliary sectional health workers Butsashvili 2006- Physician and Cross- 2012 1386 46.0 Hospitals Georgia Transition Low et al. [46] 07 nurse sectional Physicians, nurses, lab Cvejanov- personnel, and Cross- Kezunovic 2011 2014 1043 49.6 NA other non- Hospital Croatia Developed Low sectional et al. [47] HCW (cleaning, delivery, and maintenance) Nurses, physician, lab Zaidi et al. Cross- United Arab 2008 2012 230 7.39 NA staff, and other Hospital Developing Low [36] sectional Emirates healthcare providers Sreedharan Cross- United Arab 2009 2010 101 NA 25.7 Nurses Hospital Developing Moderate et al. [37] sectional Emirates Karani et al. Cross- 2008 2011 64 55 NA Medical interns Hospital South Africa Moderate [21] sectional Medical residents, emergency Kessler et al. Not Cross- 2007 2011 455 NA 22.6 residents, USA Developed Low [48] specified sectional nursing, and dental professional Physician, Zhang et al. nurse, and Cross- 2003/4 2009 1144 66.34 NA Hospital China Developing Low [31] laboratory sectional technician articles, and studies not available in full texts were excluded (e articles were searched using a combination of from the current study. Boolean logic operators (AND, OR, and NOT), Medical Subject Headings, and keywords. (e following is a search term used in the initial search: “prevalence” [MeSH Terms] 2.3. Information Sources and Search Strategy. (e articles OR “prevalence” [All Fields]) AND ((“occupational” were searched using ten electronic databases (SCOPUS/ [MeSH Terms] OR “occupational” [All Fields], OR “work Science Direct, PubMed, Web of Science, Google Scholar, place” [All Fields] OR “work place” [MeSH]) AND CINAHL, MEDLINE, Cochrane Library, DOAJ, and ((“blood and body fluids” [MeSH Terms]] OR (“blood” [All MedNar) using a combination of Boolean logic operators Fields] AND “fluids” [All Fields]) OR “blood and splash” (AND, OR, and NOT), Medical Subject Headings (MeSH), [All Fields]) OR “healthcare workers” [MeSH Terms] OR and keywords, such as health professionals, healthcare “healthcare” [All Fields] AND “workers” [All Fields]) OR workers, healthcare system, developing country, developed “healthcare workers” [All Fields]) OR “health professional” country, blood, blood and body fluids, and occupational [All Fields]) OR “health professional” [All Fields]) OR exposure. “health professional” [All Fields])” OR (“health” [All 6 Canadian Journal of Infectious Diseases and Medical Microbiology Statistics for each study Authors Event Lower Upper Event rate and 95% CI Z-Value P-Value Rate Limit Limit <0.001 Kasatpibal et al 0.400 0.379 0.421 −8.952 Mbais et al 0.250 0.205 0.302 −8.308 <0.001 Yenesew & Fekadu 0.659 0.605 0.709 5.561 <0.001 Markovic-Denic et al 0.269 0.242 0.298 −13.899 <0.001 Mbah et al 0.255 0.217 0.298 −9.847 <0.001 Mandic et al 0.390 0.377 0.403 −15.804 <0.001 Sabbah et al 0.300 0.249 0.357 −6.462 <0.001 Abere et al 0.653 0.595 0.707 5.009 <0.001 Musa et al 0.357 0.293 0.426 −3.947 <0.001 Markovic-Denic et al 0.259 0.205 0.322 −6.768 <0.001 Yasin et al 0.390 0.335 0.448 −3.664 <0.001 Shitu et al 0.467 0.420 0.515 −1.358 0.174 Yang et al 0.245 0.240 0.250 −88.139 <0.001 Selladurai, & Shireen 0.545 0.482 0.607 1.392 0.164 Nwoga et al 0.270 0.213 0.336 −6.245 <0.001 Ebrahimi et al 0.254 0.198 0.320 −6.515 <0.001 Laisser & Ng'home 0.209 0.165 0.261 −9.007 <0.001 Chalya et al 0.170 0.138 0.208 −12.437 <0.001 −0.258 Cvejanov-Kezunovic et al 0.496 0.466 0.526 0.796 Zaidi et al 0.739 0.678 0.792 6.932 <0.001 Karani et al 0.550 0.428 0.667 0.799 0.424 10.844 Zhang et al 0.663 0.635 0.690 <0.001 0.390 0.327 0.457 −3.203 0.001 −1.00 −0.50 0.00 0.50 1.00 Heterogeneity I =90.06, p value=0.001 Figure 2: Pooled prevalence of occupational exposure to blood and body fluids in the last 12 months among healthcare workers. Fields] AND “provider” [All Fields]) OR “health provider” respect to the inclusion of studies were resolved by con- sensus after discussion. Finally, studies that met the inclu- [All Fields])) AND (“developing country” [MeSH Terms] OR (“developing” [All Fields] AND “countries” [All sion criteria were included in the systematic review and Fields]) OR “developing countries” [All Fields]) OR “de- meta-analysis. veloped countries” [MeSH Terms] OR (“developed” [All Fields] AND “countries” [All Fields]) OR “developed 2.5. Data Extraction. (e authors (DAM, GDG, EM, DMA, countries” [All Fields])). KB, WD, FKA, and YAA) independently extracted the data (en, all identified keywords and index terms were from the included articles. A predefined Microsoft Excel checked across the nine electronic databases included. Fi- 2016 format was used to extract information from selected nally, searching the reference list of all identified articles for studies under the following headings: author; publication further articles was conducted. year; country of study; study design; primary outcomes such as prevalence or magnitude of exposure to BBFs and possible 2.4. Study Selection. (e study selection process was per- confounding factors considered. In general, all data are formed using the PRISMA flowchart, indicating the number extracted from the eligible articles. of articles included in the review and articles excluded from the study with reasons. Following the search for articles through selected electronic databases, duplicate studies were 2.6. Quality Assessment. (e selected articles were subjected removed using the ENDNOTE software version X5 to a rigorous independent assessment using a standardized ((omson Reuters, USA). (e authors independently se- critical assessment tool, the Joanna Briggs Institute (JBI) lected the articles based on the titles and abstracts by ap- Critical Assessment Tools for prevalence studies [13]. (ese plying the inclusion criteria. Furthermore, the full text of the articles were then evaluated by the authors (DAM, GDG, relevant articles was further read in detail and independently YMD, YAA, and AG) to confirm their relevance to the study evaluated by the authors. Any disagreements made with and the quality of the work. Canadian Journal of Infectious Diseases and Medical Microbiology 7 Statistics for each study Group by Study name Event rate and 95% CI Event Lower Upper Publication year Z-Value p-Value rate limit limit 2004-2008 Zhang et al 0.663 0.635 0.690 10.844 <0.001 2004-2008 0.663 0.635 0.690 10.844 <0.001 2010-2015 Mbais et al 0.250 0.205 0.302 −8.308 <0.001 2010-2015 Yenesew & Fekadu 0.659 0.605 0.709 5.561 <0.001 2010-2015 Markovic-Denic et al 0.269 0.242 0.298 −13.899 <0.001 2010-2015 Sabbah et al 0.300 0.249 0.357 −6.462 <0.001 2010-2015 Musa et al 0.357 0.293 0.426 −3.947 <0.001 2010-2015 Markovic Denic et al 0.259 0.205 0.322 −6.768 <0.001 2010-2015 Ebrahimi et al 0.254 0.198 0.320 −6.515 <0.001 2010-2015 Chalya et al 0.170 0.138 0.208 −12.437 <0.001 2010-2015 Cvejanov-Kezunovic et al 0.496 0.466 0.526 −0.258 0.796 6.932 2010-2015 Zaidi et al 0.739 0.678 0.792 <0.001 2010-2015 Karani et al 0.550 0.428 0.667 0.799 0.424 2010-2015 0.380 0.279 0.492 −2.095 0.036 −8.952 2016-2021 Kasatpibal et al 0.400 0.379 0.421 <0.001 2016-2021 Mbah et al 0.255 0.217 0.298 −9.847 <0.001 2016-2021 Mandic et al 0.390 0.377 0.403 −15.804 <0.001 5.009 2016-2021 Abere et al 0.653 0.595 0.707 <0.001 2016-2021 Yasin et al 0.390 0.335 0.448 −3.664 <0.001 2016-2021 Shitu et al 0.467 0.420 0.515 −1.358 0.174 −88.139 2016-2021 Yang et al 0.245 0.240 0.250 <0.001 1.392 2016-2021 Selladurai & Shireen 0.545 0.482 0.607 0.164 2016-2021 Nwoga et al 0.270 0.213 0.336 −6.245 <0.001 −9.007 2016-2021 Laisser & Ng'home 0.209 0.165 0.261 <0.001 2016-2021 0.374 0.301 0.454 −3.068 0.002 Overall 0.616 0.589 0.642 8.306 <0.001 −1.00 −0.50 0.00 0.50 1.00 Figure 3: Pooled prevalence of occupational exposure to blood and body fluids in last 12 months among healthcare workers based on the publication year. (e evaluation tools have the following nine evaluation prevalence estimates due to genuine variation in prevalence criteria or parameters: (1) appropriate sampling frame; (2) [14, 15]. (e level of heterogeneity was classified into four proper sampling technique; (3) adequate sample size; (4) categories: no heterogeneity (0%), low (25–50%), moderate description of the study subject and setting description; (5) (50–75%), and high heterogeneity (greater than 75%) [16]. sufficient data analysis; (6) use of valid methods for iden- (e random-effects model was used to analyze the data. tified conditions; (7) valid measurement for all participants; Furthermore, subgroup analysis was conducted based on the (8) use of appropriate statistical analysis; and (9) adequate year of publication, survey period (when the study was response rate. Failure to satisfy each parameter was scored as conducted), and study areas. Publication bias among the 0, if not 1. (e score was then given across all studies and included studies was evaluated using funnel plots. A sen- graded as high (85% and above), moderate (60–85% score), sitivity analysis was done to determine differences in pooled or low quality (60% score). Disagreement made on what was effects by dropping studies that were found to influence the to be extracted was solved by discussion after repeating the summary estimates. same procedures. (e PRISMA guidelines protocol [12] was used to conduct the review. 3. Results 3.1. Study Selection. A total of 2912 studies were retrieved 2.7. Statistical Procedures and Data Analysis. (e pooled from searches in selected electronic databases. (en, 1430 prevalence of the BBFs was performed using Comprehensive duplicate articles were excluded. Out of 1610 non- Meta-Analysis (CMA) version 3.0 statistical software. A duplicated studies, 327 studies were excluded based on forest plot and a random-effects model were used to de- titles and abstracts. Furthermore, 1759 full-text studies termine and visualize the pooled prevalence of the BBFs. were further assessed to determine their eligibility, of (e Cochran Q test (Q) and I squared test (I statistics) which 1724 studies were excluded. (ese articles were were used to evaluate the heterogeneity between the in- excluded as a result of not reporting the prevalence of cluded articles. I statistics is the proportion of variation in blood and body fluids in their career time or last year; 8 Canadian Journal of Infectious Diseases and Medical Microbiology Statistics for each study Group by Event Lower Upper Authors Event rate and 95% CI survey period Z-Value p-Value rate limit limit 2003-2008 Zaidi et al 0.739 0.678 0.792 6.932 <0.001 2003-2008 Karani et al 0.550 0.428 0.667 0.799 0.424 2003-2008 Zhang et al 0.663 0.635 0.690 10.844 <0.001 2003-2008 0.666 0.584 0.738 3.869 <0.001 2010-2015 Kasatpibal et al 0.400 0.379 0.421 −8.952 <0.001 2010-2015 Mbais et al 0.250 0.205 0.302 −8.308 <0.001 2010-2015 Yenesew & Fekadu 0.659 0.605 0.709 5.561 <0.001 2010-2015 Markovic-Denic et al 0.269 0.242 0.298 −13.899 <0.001 2010-2015 Mbah et al 0.255 0.217 0.298 −9.847 <0.001 2010-2015 Mandic et al 0.390 0.377 0.403 −15.804 <0.001 2010-2015 Sabbah et al 0.300 0.249 0.357 −6.462 <0.001 2010-2015 Musa et al 0.357 0.293 0.426 −3.947 <0.001 2010-2015 Markovic-Denic et al 0.259 0.205 0.322 −6.768 <0.001 2010-2015 Selladurai, & Shireen 0.545 0.482 0.607 1.392 0.164 2010-2015 Ebrahimi et al 0.254 0.198 0.320 −6.515 <0.001 2010-2015 Laisser & Ng'home 0.209 0.165 0.261 −9.007 <0.001 2010-2015 Chalya et al 0.170 0.138 0.208 −12.437 <0.001 2010-2015 Cvejanov-Kezunovic et al 0.496 0.466 0.526 −0.258 0.796 2010-2015 0.336 0.284 0.392 −5.513 <0.001 2016-2021 Abere et al 0.653 0.595 0.707 5.009 <0.001 2016-2021 Yasin et al 0.390 0.335 0.448 −3.664 <0.001 2016-2021 Shitu et al 0.467 0.420 0.515 −1.358 0.174 2016-2021 Yang et al 0.245 0.240 0.250 −88.139 <0.001 2016-2021 Nwoga et al 0.270 0.213 0.336 −6.245 <0.001 2016-2021 0.398 0.251 0.566 −1.196 0.232 Overall 0.438 0.392 0.485 −2.555 0.011 −1.00 −0.50 0.00 0.50 1.00 Figure 4: Pooled prevalence of occupational exposure to blood and body fluids in last 12 months among healthcare workers based on the survey period. conducted in United Arab Emirate [36, 37], 2 were con- unclear objectives, unclear methods, not available in full text; nonhealthcare worker study participants; review ducted in Nigeria [38, 39],and 1 was conducted in each of articles; letters to the editor; brief reports; and written in a (ailand [40], Kenya [41], Turkey [42], Lebanon [43], non-English language. Finally, 33 studies that met the Bosnia and Herzegovina [44], Togo [45], Georgia [46], inclusion criteria were included in the review (Figure 1). Croatia [47], and USA [48]. About three-quarters were conducted in hospitals (Table 1). 3.2.StudyCharacteristics. (is systematic review and meta- analysis included a total of 33 studies conducted on 54328 3.3. Prevalence of Blood and Body Fluids. (is systematic HCWs in 18 countries from 2003 to 2021. (e sample size review and meta-analysis was conducted using the Com- prehensive Meta-Analysis (CMA) Version 3 statistical of included studies ranged from 64 to 33156 healthcare workers. Seventeen articles were conducted in developing package (software) to determine the pooled prevalence of countries. (e highest prevalence of exposure to BBFs in blood and body fluids among healthcare workers. the last year and career time was reported in China and Ethiopia, respectively. Among the included studies, 4 ar- 3.3.1. Previous Last Year Prevalence of Exposure to Blood and ticles were conducted in Ethiopia [2, 17–19], 3 were conducted in South Africa [20–22], 3 were conducted in Body Fluids. (e last year’s prevalence of occupational exposure to blood and body fluids among healthcare Serbia [23–25], 3 were conducted in Iran [26–28], 3 were conducted in China [29–31], 2 were conducted in Tanzania workers was found to be 39.0% (95% CI: 32.7, 45.7) with a P-value of<0.001 (Figure 2). [32, 33], 2 were conducted in India [34, 35], 2 were Canadian Journal of Infectious Diseases and Medical Microbiology 9 Statistics for each study Group by Event Lower Upper Authors Event rate and 95% CI WHO Region Z-Value p-Value rate limit limit Africa Mbais et al 0.250 0.205 0.302 −8.308 <0.001 Africa Yenesew & Fekadu 0.659 0.605 0.709 5.561 <0.001 Africa Mbah et al 0.255 0.217 0.298 −9.847 <0.001 Africa Abere et al 0.653 0.595 0.707 5.009 <0.001 Africa Yasin et al 0.390 0.335 0.448 −3.664 <0.001 Africa Shitu et al 0.467 0.420 0.515 −1.358 0.174 −6.245 <0.001 Africa Nwoga et al 0.270 0.213 0.336 Africa Laisser & Ng'home 0.209 0.165 0.261 −9.007 <0.001 Africa Chalya et al 0.170 0.138 0.208 −12.437 <0.001 Africa Karani et al 0.550 0.428 0.667 0.799 0.424 Africa 0.373 0.264 0.497 −2.008 0.045 Eastern Mediterranean Sabbah et al 0.300 0.249 0.357 −6.462 <0.001 Eastern Mediterranean Ebrahimi et al 0.254 0.198 0.320 −6.515 <0.001 Eastern Mediterranean Zaidi et al 0.739 0.678 0.792 6.932 <0.001 Eastern Mediterranean 0.427 0.169 0.731 −0.445 0.656 Europe Markovic-Denic et al 0.269 0.242 0.298 −13.899 <0.001 Europe Mandic et al 0.390 0.377 0.403 −15.804 <0.001 Europe Musa et al 0.357 0.293 0.426 −3.947 <0.001 Europe Markovic-Denic 0.259 0.205 0.322 −6.768 <0.001 Europe Cvejanov-Kezunovic et al 0.496 0.466 0.526 −0.258 0.796 Europe 0.352 0.279 0.433 −3.517 <0.001 South east Asia Kasatpibal et al 0.400 0.379 0.421 −8.952 <0.001 South east Asia Selladurai, & Shireen 0.545 0.482 0.607 1.392 0.164 South east Asia 0.469 0.332 0.610 −0.427 0.669 Western Pacific Yang et al 0.245 0.240 0.250 −88.139 <0.001 Western Pacific Zhang et al 0.663 0.635 0.690 10.844 <0.001 Western Pacific 0.444 0.120 0.824 −0.249 0.803 Overall 0.382 0.326 0.442 −3.826 <0.001 −1.00 −0.50 0.00 0.50 1.00 Figure 5: Prevalence of occupational exposure to blood and body fluids in the last 12 months among healthcare workers based on WHO regions. Based on a subgroup analysis by publication year, there was 3.3.2. Career Time Prevalence of Exposure to BBFs. (e a relatively equal prevalence of BBFs in the last 12 months that career time prevalence of occupational exposure to blood accounted for 38.0% (95% CI: 27.9, 49.2%) and 37.4% (95% CI: and body fluids among healthcare workers was found to be 30.1, 45.4%) for those articles published between 2010 and 2015 56.6% (95% CI: 47.3, 65.4) (Figure 6). and 2016 and 2021, respectively (Figure 3). Based on a subgroup analysis by publication year, the According to a subgroup analysis by survey year, studies highest career time pooled prevalence (60.6% (95% CI: 47.0, 72.7%)) was reported among the studies published from conducted between 2003 and 2008 had the highest pooled prevalence (66.6% (95% CI: 58.4, 73.8%)), while studies 2015 to 2020, while the lowest prevalence (51.1% (95% CI: conducted between 2010 and 2015 had the lowest (33.6% 39.0, 63.2%)) was reported among the studies published (95% CI: 28.4%, 39.2%)) (Figure 4). from 2010–2014 (Figure 7). Based on the WHO regions, the highest prevalence of Based on the survey period, the highest career time last year’s BBF was observed in the Southeast Asia Region pooled prevalence (71.0% (95% CI: 58.4, 81.1%)) was re- (46.9% (95% CI: 33.2, 61.0%)) followed by the Western ported in the study conducted from 2015 to 2019, while the Pacific (44.4% (95% CI: 12.0, 82.4%)). (e lowest prevalence lowest prevalence (30.8% (95% CI: 16.4, 50.3%)) was re- was reported from the European Region (35.2% (95% CI: ported among the study published from 2005 to 2009 27.9, 43.3%)) (Figure 5). (Figure 8). 10 Canadian Journal of Infectious Diseases and Medical Microbiology Statistics for each study Authors Event rate and 95% CI Event Lower Upper Z-Value p-Value rate limit limit Yenesew & Fekadu 0.760 0.710 0.804 8.765 <0.001 Markovic Denic et al 0.565 0.534 0.596 4.064 <0.001 Engin et al 0.583 0.526 0.638 2.862 0.004 Mandic et al 0.660 0.647 0.673 22.760 <0.001 Abere et al 0.870 0.825 0.905 10.640 <0.001 Musa et al 0.633 0.563 0.698 3.678 <0.001 Markovi Denic et al 0.606 0.539 0.669 3.092 0.002 Yasin et al 0.585 0.527 0.641 2.841 0.004 Shaghaghian et al 0.800 0.737 0.851 7.664 <0.001 Yi et al 0.659 0.618 0.698 7.311 <0.001 Rasweswe and Peu 0.430 0.334 0.532 −1.353 0.176 Nmadu et al 0.680 0.607 0.745 4.611 <0.001 Ditorguena et al 0.676 0.593 0.749 4.014 <0.001 Fazili et al 0.250 0.234 0.266 −25.005 <0.001 Farsi et al 0.575 0.505 0.642 2.113 0.035 Ebrahimi et al 0.363 0.298 0.433 −3.757 <0.001 Butsashvil et al 0.460 0.434 0.486 −2.975 0.003 Sreedharan et al 0.257 0.181 0.351 −4.662 <0.001 Kessler et al 0.226 0.190 0.267 −10.983 <0.001 0.566 0.473 0.654 1.399 0.162 Heterogeneity I =89.98, p value <0.001 −1.00 −0.50 0.00 0.50 1.00 Random effect model Figure 6: Overall pooled prevalence of occupational exposure to blood and body fluids in career time among healthcare workers. Based on the WHO regions, the African region had the occupational-related injuries or exposures, such as percu- highest prevalence (68.4% (95% CI: 56.1, 78.6%)) of oc- taneous injuries and needlestick injuries. cupational exposure to BBFs, followed by the Western In the workplace, blood and body fluids are a major risk Pacific (65.9% (95% CI: 61.8, 69.8%)). (e American Re- factor for the transmission of various blood-borne infec- tions to healthcare workers [49] such as hepatitis B virus, gion had the lowest prevalence (22.6% (95% CI: 19.0, 26.7%)) (Figure 9). hepatitis C virus, and human immunodeficiency virus, the three leading causes of occupationally related blood-borne infections among HCWs [50]. However, this study found 3.4. Sensitivity Analysis Results. (e sensitivity analysis was that the last year’s prevalence of occupational exposure to conducted by dropping small sample size and large sample blood and body fluids among healthcare workers accounted size. However, there was no significant change found in the for 39.0% (95% CI: 32.7, 45.7). (e current study found a prevalence of both career time and last year occupational lower prevalence of BBFs than another study conducted in exposure to blood and body fluids (Table 2). 21 African countries, which discovered 48.0% prevalence [6]. Other studies conducted in Africa reported a one-year 4. Discussion prevalence rate of blood exposure accounted for 84.0% A total of 3912 studies were retrieved from selected elec- [51], which was higher than the current finding. (e variation may be related to the scope of the study because tronic databases, of which 1430 duplicate articles were ex- cluded. A total of 33 studies conducted on 54328 HCWs the current study included studies conducted in both from 2003 to 2021 were included in the systematic review developing and developed countries. Occupational ex- and meta-analysis. Direct comparison of the current find- posure to hazards continues to be a public health concern ings with other findings was difficult because of a lack of globally. Another study found that about 36.4% (95% CI: similar systematic reviews and meta-analyses. (e authors 32.9–40.0) of HCWs were exposed to percutaneous in- found only one systematic review and meta-analysis con- juries in the previous year, which is lower than the current ducted to determine occupational exposure to BBFs among finding. (e variation could be due to differences in the HCWs in Africa. However, we considered other outcomes of these studies because HCWs can be exposed Canadian Journal of Infectious Diseases and Medical Microbiology 11 Statistics for each study Group by Event Lower Upper Authors Event rate and 95% CI Publication year Z-Value p-Value rate limit limit 2010-2014 Yenesew & Fekadu 0.760 0.710 0.804 8.765 <0.001 2010-2014 Engin et al 0.583 0.526 0.638 2.862 0.004 3.678 2010-2014 Musa et al 0.633 0.563 0.698 <0.001 2010-2014 Markovic-Denic et al 0.606 0.539 0.669 3.092 0.002 2010-2014 Farsi et al 0.575 0.505 0.642 2.113 0.035 −2.975 2010-2014 Butsashvil et al 0.460 0.434 0.486 0.003 2010-2014 Sreedharan et al 0.257 0.181 0.351 −4.662 <0.001 2010-2014 Kessler et al 0.226 0.190 0.267 −10.983 <0.001 2010-2014 0.511 0.390 0.632 0.178 0.858 0.565 0.534 0.596 4.064 <0.001 2015-2020 Markovic-Denic et al 2015-2020 Mandic et al 0.660 0.647 0.673 22.760 <0.001 2015-2020 Abere et al 0.870 0.825 0.905 10.640 <0.001 2.841 2015-2020 Yasin et al 0.585 0.527 0.641 0.004 2015-2020 Shaghaghian et al 0.800 0.737 0.851 7.664 <0.001 Yi et al 2015-2020 0.659 0.618 0.698 7.311 <0.001 2015-2020 Rasweswe & Peu 0.430 0.334 0.532 −1.353 0.176 2015-2020 Nmadu et al 0.680 0.607 0.745 4.611 <0.001 2015-2020 Ditorguena et al 0.676 0.593 0.749 4.014 <0.001 2015-2020 Fazili et al 0.250 0.234 0.266 −25.005 <0.001 −3.757 2015-2020 Ebrahimi et al 0.363 0.298 0.433 <0.001 2015-2020 0.606 0.470 0.727 1.530 0.126 Overall 0.554 0.462 0.642 1.156 0.247 −1.00 −0.50 0.00 0.50 1.00 Figure 7: Pooled prevalence of occupational exposure to blood and body fluids in career time among healthcare workers based on the publication year. to blood and other body fluids in different ways, such as the study because this study found the career time needlestick injuries or contact with contaminated objects prevalence of BBF exposure among HCWs in the African or mucous membranes. region accounted for 68.4% (95% CI: 56.1, 78.6), which Similarly, this study found that the prevalence of BBF was in line with the finding of another study, which found exposure in the last year in the Africa Region was 37.3% 65.7% [6]. Furthermore, more than half of the HCWs in the African (95% CI: 26.4, 49.7), which was in line with the finding of another study, which reported about 48.0% prevalence of Region, Western Pacific and Pacific, and European Region exposure [6]. Furthermore, this study found a variation in were exposed to BBFs. (e high prevalence could be due to the prevalence of BBFs among different regions of the world. inadequate healthcare systems and poor occupational health For example, the highest last 12-month prevalence of BBF and safety practices. Additionally, even though the highest exposure was reported from the Southeast Asia Region prevalence was observed in the African region, the study (46.9% (95% CI: 33.2, 61.0%)), while the lowest prevalence found an increase in the career time prevalence of BBF was observed in the study conducted in the European Region exposure from 2005 to 2020. (is indicates that there is a (22.6% (95% CI: 19.0, 26.7%). (e variation may be related to high risk of being to be exposed to blood-borne diseases the difference in implementation of health and safety among HCWs. guidelines or standard precautions or differences in the Overall, the study found a high prevalence of occupa- tional exposure to BBFs in the last year (more than one in healthcare system. On the other hand, this study found a career time three HCWs) and throughout the career time (more than prevalence of occupational exposure to blood and body two in three HCWs) among healthcare workers. However, fluids among healthcare workers accounted for 56.6% exposure to blood and body fluids has serious health im- (95% CI: 47.3, 65.4). (is finding was lower than the plications because exposure to blood and other body fluids is finding of another study conducted in African countries the potential source of blood-borne pathogens such as HBV that found 65.7% (95% CI: 59.7–71.6) prevalence of BBFs and HIV that need critical attention to protect the workers’ [6]. (e variation may be related to the included region in health. 12 Canadian Journal of Infectious Diseases and Medical Microbiology Statistics for each study Group by Study name Event Lower Upper Event rate and 95% CI Survey period Z-Value p-Value rate limit limit 2005-2009 Butsashvil et al 0.460 0.434 0.486 −2.975 0.003 2005-2009 Sreedharan et al 0.257 0.181 0.351 −4.662 <0.001 2005-2009 Kessler et al 0.226 0.190 0.267 −10.983 <0.001 2005-2009 0.308 0.164 0.503 −1.927 0.054 2010-2014 Yenesew & Fekadu 0.760 0.710 0.804 8.765 <0.001 2010-2014 Markovic-Denic et al 0.565 0.534 0.596 4.064 <0.001 2010-2014 Engine et al 0.583 0.526 0.638 2.862 0.004 2010-2014 Mandic et al 0.660 0.647 0.673 22.760 <0.001 2010-2014 Musa et al 0.633 0.563 0.698 3.678 <0.001 Markovic-deniic et al 0.606 0.539 0.669 3.092 0.002 2010-2014 2010-2014 Shaghaghian et al 0.800 0.737 0.851 7.664 <0.001 2010-2014 Rasweswe & peu 0.430 0.334 0.532 −1.353 0.176 2010-2014 Nmadu et al 0.680 0.607 0.745 4.611 <0.001 2010-2014 Fazili et al 0.250 0.234 0.266 −25.005 <0.001 Davood farsi 0.575 0.505 0.642 2.113 0.035 2010-2014 2010-2014 Ebrahimi et al 0.363 0.298 0.433 −3.757 <0.001 2010-2014 0.580 0.454 0.696 1.245 0.213 2015-2019 Abere et al 0.870 0.825 0.905 10.640 <0.001 2015-2019 Yasin et al 0.585 0.527 0.641 2.841 0.004 Yi et al 0.659 0.618 0.698 7.311 2015-2019 <0.001 2015-2019 Ditorguena et al 0.676 0.593 0.749 4.014 <0.001 2015-2019 0.710 0.584 0.811 3.143 0.002 Overall 0.584 0.500 0.664 1.956 0.050 −1.00 −0.50 0.00 0.50 1.00 Figure 8: Pooled prevalence of career time occupational exposure to blood and body fluids among healthcare workers based on the survey period. (erefore, applying standard precautions, occupational promotion of a healthy work environment, healthy work health and safety measures or services, regular training on practices, strengthening occupational health services, de- infection prevention, and proper implementation of velopment of occupational health standards, and strength- guidelines play a major role in reducing BBFs and pre- ening of research [53]. venting infectious diseases in the healthcare system. 4.1. Possible Prevention or Control Strategies. Integrated 4.2. Limitations of the Current Study. (ere was an unequal approaches to occupational health and safety, including distribution of occupations among the included articles that engineering measures, administrative policy, and the use of make the comparison of BBFs exposure among different personal protective equipment, should be implemented to occupations more difficult. On the other hand, the preva- control, eliminate, or reduce occupational exposure to lence of occupational exposure to BBFs in some regions was not covered due to the lack of studies in these regions. (ere hazards [52], including BBFs. Furthermore, there is a need to implement priority strategies, which include strengthening were a few studies from developed countries conducted on of international and national policies for health at work, the outcome of interests. Canadian Journal of Infectious Diseases and Medical Microbiology 13 Statistics for each study Group by Authors Event Lower Upper Event rate and 95% CI WHO region Z-Value p-Value rate limit limit Africa Yenesew & Eekadu 0.760 0.710 0.804 8.765 <0.001 Africa Abere et al 0.870 0.825 0.905 10.640 <0.001 Africa Yasin et al 0.585 0.527 0.641 2.841 0.004 Africa Rasweswe & Peu 0.430 0.334 0.532 −1.353 0.176 Africa Nmadu et al 0.680 0.607 0.745 4.611 <0.001 Africa Ditorguena et al 0.676 0.593 0.749 4.014 <0.001 Africa 0.684 0.561 0.786 2.864 0.004 America Kessler et al 0.226 0.190 0.267 −10.983 <0.001 America 0.226 0.190 0.267 −10.983 <0.001 Eastern Mediterranean Shaghaghian et al 0.800 0.737 0.851 7.664 <0.001 Eastern Mediterranean Farsi et al 0.575 0.505 0.642 2.113 0.035 Eastern Mediterranean Ebrahimi et al 0.363 0.298 0.433 −3.757 <0.001 Eastern Mediterranean Sreedharan et al 0.257 0.181 0.351 −4.662 <0.001 Eastern Mediterranean 0.505 0.282 0.726 0.043 0.966 Europe Markovic-Denic et al 0.565 0.534 0.596 4.064 <0.001 Europe Engine et al 0.583 0.526 0.638 2.862 0.004 Europe Mandic et al 0.660 0.647 0.673 22.760 <0.001 Europe Musa et al 0.633 0.563 0.698 3.678 <0.001 Europe Markovic-Denic et al 0.606 0.539 0.669 3.092 0.002 Europe Butsashvi et al 0.460 0.434 0.486 −2.975 0.003 Europe 0.585 0.501 0.663 1.991 0.046 South east Asia Fazili et al 0.250 0.234 0.266 −25.005 <0.001 South east Asia 0.250 0.234 0.266 −25.005 <0.001 Western Pacific Yi et al 0.659 0.618 0.698 7.311 <0.001 <0.001 Western Pacific 0.659 0.618 0.698 7.311 Overall 0.325 0.310 0.341 −20.278 <0.001 −1.00 −0.50 0.00 0.50 1.00 Figure 9: Prevalence of career time occupational exposure to blood and body fluids among healthcare workers based on WHO regions. Table 2: Sensitivity analysis by dropping small sample size and large sample size. Criteria Initial prevalence After analysis (%) Heterogeneity 95% CI Dropping 2 small sample size (career time) 56.6% [95% CI: 47.3, 65.4] 58.2 99.137 47.6, 68.1% Dropping one smallest sample size (career time) 56.6% [95% CI: 47.3, 65.4] 56.4 99.095 46.0, 66.2% Dropping large sample size (career time) 56.6% [95% CI: 47.3, 65.4] 55.1 98.649 44.7, 65.1% Dropping small sample size (last year) 39.0% (95% CI: 32.7, 45.7) 38.3 99.088 32.0, 45.1% Dropping large sample size (last year) 39.0% (95% CI: 32.7, 45.7) 39.8 97.843 33.9, 46.0% 5. Conclusions Abbreviations (is systematic review and meta-analysis found a higher BBF: Blood and body fluids percentage of career time and previous one-year global CMA: Comprehensive meta-analysis occupational exposures to blood and body fluids among HBV: Hepatitis B virus healthcare workers. 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Global Occupational Exposure to Blood and Body Fluids among Healthcare Workers: Systematic Review and Meta-Analysis

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Copyright © 2022 Dechasa Adare Mengistu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Canadian Journal of Infectious Diseases and Medical Microbiology Volume 2022, Article ID 5732046, 16 pages https://doi.org/10.1155/2022/5732046 Review Article Global Occupational Exposure to Blood and Body Fluids among Healthcare Workers: Systematic Review and Meta-Analysis Dechasa Adare Mengistu , Gebisa Dirirsa , Elsai Mati , Dinku Mekbib Ayele , Kefelegn Bayu , Wegene Deriba , Fekade Ketema Alemu , Yohannes Mulugeta Demmu , Yohanis Alemeshet Asefa , and Abraham Geremew Department of Environmental Health, College of Health and Medical Science, Haramaya University, P.O. Box 235, Harar, Ethiopia Correspondence should be addressed to Dechasa Adare Mengistu; dechasaadare@gmail.com Received 11 January 2022; Accepted 19 May 2022; Published 3 June 2022 Academic Editor: Vijay Singh Gondil Gondil Copyright © 2022 Dechasa Adare Mengistu et al. �is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Occupational exposure to blood and body „uids has become a serious public health problem for healthcare workers and is a major risk for the transmission of various infections such as human immune-de‡ciency virus, hepatitis B virus, and hepatitis C virus. �is systematic review and meta-analysis aims to determine the career time and previous one-year global pooled prevalence of occupational exposure to blood and body „uids among healthcare workers. Methods. For the review, the articles published in English were searched using the electronic databases (SCOPUS/Science Direct, PubMed, Web of Science, Google Scholar, CINAHL, MEDLINE, Cochrane Library, DOAJ, and MedNar) with a combination of Boolean logic operators (AND, OR, and NOT), Medical Subject Headings (MeSH), and keywords. A quality assessment was conducted to determine the relevance of the articles using JBI critical appraisal tools. Furthermore, several steps of assessment and evaluation were taken to select and analyze the relevant articles. Results. Of the 3912 articles identi‡ed through the electronic database search, 33 that met the inclusion criteria were included in the ‡nal analysis. �e current study found that the global pooled prevalence of blood and body „uids among healthcare workers during career time and in the previous one year accounted for 56.6% (95% CI: 47.3, 65.4) and 39.0% (95% CI: 32.7, 45.7), respectively. Based on subgroup analysis by publication year, survey year, and World Health Or- ganization regions, the highest prevalence of blood and body „uid exposure in the last 12 months was observed among articles published between 2004 and 2008 (66.3%), conducted between 2003 and 2008 (66.6%), and conducted in the Southeast Asia Region (46.9%). �e highest career time prevalence was 60.6%, 71.0%, and 68.4% for articles published between 2015 and 2020, conducted between 2015 and 2019, and reported in the African region, respectively. Conclusion. �e current study revealed a high prevalence of occupational exposure to blood and body „uids among healthcare workers and suggests the need to improve occupational health and safety services in healthcare systems globally. and other blood-borne pathogens, including cytomegalo- 1. Introduction virus, herpes simplex virus, and parvovirus B19 [4]. Occupational exposure to blood-borne pathogens as a result Healthcare workers are at high risk of being infected with of contact with human blood and body „uids has become a various occupational-related diseases as a result of exposure serious health concern for healthcare workers (HCWs) to blood-borne pathogens [1, 5, 6]. globally [1]. Occupational exposure to blood and body „uids �e risk of transmission of infection after exposure to (BBFs) constitutes a risk of transmission of blood-borne infected blood is 0.3% times greater for human immu- pathogens, such as human immune-de‡ciency virus (HIV), node‡ciency virus-infected blood than for uninfected hepatitis B virus (HBV), and hepatitis C virus (HCV) [2–5], blood, while it is estimated to be up to 100 times greater for 2 Canadian Journal of Infectious Diseases and Medical Microbiology Record identified through Record identified through additional database searches (N= 2714). search (N=198) Record identified Excluded articles (n =337) Review articles (n=112). Record aer duplication Editorial paper, reports, short removed (n=1482). communication, preprint (n=214]. Articles not published in English language (n=11). Record screened by title and abstract (n= 1145). Excluded articles (n=454) Non relevant articles (n= 217) Not available in full tests (n=198) Full-text articles assessed Not specified the country, period for Eligibility (n=691). and study, study participants Excluded articles (n=658) Studies included in a Not reported outcome of the systematic review (n=33). interest (n=378) Unclear objectives (n=89) Unclear methods (n=114) Unclear outcome (n=77) Studies included in Meta- analysis (n=33). Figure 1: Study selection process of included articles for systematic review and meta-analysis, 2021. the hepatitis B virus and from 3 to 10% for the hepatitis C 2. Materials and Methods virus [7, 8]. Among the above infections (HBV, HCV, and 2.1. Protocol Registration and Search Strategy. (e research HIV), only HBV had a vaccine until the time of this study protocol was registered in the PROSPERO international [7]. prospective register of systematic reviews According to the World Health Organization (WHO) (CRD42017077201). (e Preferred Reporting Items for report, about three million HCWs are exposed to blood- Systematic Reviews and Meta-Analysis (PRISMA) guideline borne pathogens each year, of which 170,000 are exposed to was used to perform this systematic review [12]. HIV infections, 2 million to HBV infections, and 0.9 million to HCV infections [9]. Most of the time, healthcare pro- viders get exposure through the splash of blood or other 2.2. Eligibility Criteria body fluids into the eyes, nose, or mouth or nonintact skin exposure, and percutaneous injury occurs as a result of a 2.2.1. Inclusion Criteria. (e studies that met the following break in the skin caused by a needlestick or sharps con- inclusion criteria were included in the systematic review and taminated with blood or body fluids [9]. meta-analysis: Several studies, including systematic reviews and meta- (i) Study population: healthcare workers regardless of analysis, have been conducted and published on the prev- their occupation alence of BBFs among HCWs in different settings, such as at country or region levels. And also, a few studies reported the (ii) Outcomes: study reporting quantitative outcomes global prevalence of occupational exposure to needlestick (magnitude, frequency, rate, or prevalence of BBFs injuries [10], the prevalence and device-related causes of in lifetime and/or last year) needlestick injuries [11], percutaneous injury [1], and the (iii) Language: studies written in English prevalence of exposure to blood and body fluids in Africa (iv) Types of articles: peer-reviewed full text, original, [6]. and published articles However, there is no evidence regarding the global prevalence of blood and body fluids among healthcare (v) Publication year: not specified (not limited) workers. (erefore, this is the only study that provides a (vi) Study region or country: not specified (not limited) global prevalence of blood and body fluid exposure among healthcare workers, which can be used as evidence and input to reduce the burden of BBF exposure and may prompt the 2.2.2. Exclusion Criteria. Studies that did not report 12 development of appropriate policies, systems, and processes. months or career time prevalence (such as 3 or/and 6 Furthermore, this systematic review and meta-analysis es- months) of BBFs, case reports, case series, review articles, timated the regional levels, last year, and career time surveillance data, reports, conference abstracts, personal prevalence of BBFs among HCWs. opinions, articles written in non-English, high risk of bias Eligibility Identification Included Screening Canadian Journal of Infectious Diseases and Medical Microbiology 3 Table 1: Overall characteristics of articles included in the systematic review and meta-analysis, 2021. Survey Pub. 12 Study Socioeco Risk of Author N Lifetime Participant Setting Country year year months design status bias Kasatpibal 2011- Cross- 2016 2031 40.0 NA Nurses Hospital (ailand Developing Low et al. [40] 2012 sectional Doctors, nurses, clinical officers, laboratory Mbaisi et al. Cross- 2010 2013 305 25.0 NA personnel, Hospital Kenya Developing Low [41] sectional dentists, supportive staff, and students Nurses, health officers, health assistants, Yenesew and medical Healthcare Cross- 2012 2014 317 65.9 76.0 Ethiopia Developing Low Fekadu [19] doctors, facilities sectional laboratory technicians, and dentists Markovic- Healthcare Cross- Denic et al. 2012 2015 983 26.9 56.5 Hospital Serbia Transition Moderate workers sectional [25] Health Mbah et al. Doctors and Cross- 2013 2020 444 25.5 NA center and South Africa Developing Low [20] nurses sectional hospital Nurses, physicians, Engin et al. cleaning staff, Cross- 2010 2014 300 58.3 Hospital Turkey Developing Moderate [42] student nurses, sectional and laboratory technicians Physician, nurses, laboratory technicians, and Mandic´ et al. Cross- 2013 2018 5247 39.0 66.0 support staff Hospital Serbia Transition Low [24] sectional such as cleaners and workers in laundry and sterilization Sabbah et al. 2011/ Physician and Cross- 2013 277 30.0 NA Hospital Lebanon Developing Low [43] 12 nurses sectional Nurse, medical doctor, laboratory Abere et al. Cross- 2018 2020 277 65.3 87.0 technology, Hospital Ethiopia Developing Low [17] sectional health officer, midwife, pharmacy Physicians and Musa et al. Cross- Bosnia and 2013 2014 196 35.7 63.3 nurses/ Hospital Transition Low [44] sectional Herzegovina technicians Markovic- ´ Nurses and Cross- Denic´ et al. 2011 2013 216 25.9 60.6 Hospital Serbia Transition Moderate doctors sectional [23] Nurse, laboratory, Yasin et al. Cross- 2017 2019 282 39.0 58.5 medical doctor, Hospital Ethiopia Developing Low [2] sectional midwife, and others 4 Canadian Journal of Infectious Diseases and Medical Microbiology Table 1: Continued. Survey Pub. 12 Study Socioeco Risk of Author N Lifetime Participant Setting Country year year months design status bias Dental Shaghaghian Cross- 2011 2015 191 80.0 Dental students school Iran Developing Low et al. [27] sectional department Cross- Yi et al. [29] 2015 2018 548 65.9 Nurses Hospital China Developing Low sectional Rasweswe Cross- 2014 2020 94 43.0 Nurses Hospital South Africa Developing Moderate and Peu [22] sectional Nurses, midwives, CHOs, CHEWs, Primary Nmadu et al. laboratory Cross- 2011 2016 172 68.0 healthcare Nigeria Developing Low [38] technicians, sectional centers pharmacy technicians, and ward attendants Hospitals Shitu et al. Cross- 2020 2021 424 46.7 NA Midwives and health Ethiopia Developing Low [18] sectional centers Doctors, nurses, anesthetists, Yang et al. midwives, Cross- 2019 2021 33,156 24.5 NA Hospital China Developing Moderate [30] laboratory sectional personnel, and others Doctors, surgeons, nurses, Ditorguena midwives, Cross- 2018 2019 136 67.6 Hospital Togo Developing Moderate et al. [45] laboratory sectional technicians, and nursing assistants Doctors, nursing staff, lab staff, Tertiary Fazili et al. Cross- 2014 2017 2763 25.0 sanitation staff, care India Developing Moderate [34] sectional administration, institute laundry, and linen Physicians, residents, medical interns, nurses, Farsi et al. Cross- 2010 2012 200 57.5 laboratory Hospital Iran Developing Low [28] sectional personnel, housekeepers, cleaners, and others Nurses, Selladurai laboratory, Cross- and Shireen 2014 2019 240 54.5 NA technicians, Hospital India Developing Moderate sectional [35] interns, and resident doctors Nurse, laboratory Nwoga et al. Cross- 2018 2020 200 27.0 NA scientist/ Nigeria Developing Low [39] sectional technician, and others Canadian Journal of Infectious Diseases and Medical Microbiology 5 Table 1: Continued. Survey Pub. 12 Study Socioeco Risk of Author N Lifetime Participant Setting Country year year months design status bias Ebrahimi Laboratory Cross- 2010 2015 193 25.4 36.3 Hospital Iran Developing Moderate et al. [26] personnel sectional Doctors, clinical officers, nurses, laboratory Laisser and personnel, Health Cross- Ng’home 2015 2017 277 20.9 NA Tanzania Developing Low mortuary facilities sectional [32] attendants, and housekeeping staff Doctors, nurses, Chalya et al. 2013- laboratory staff, Cross- 2015 436 17.0 Hospital Tanzania Developing Low [33] 14 and auxiliary sectional health workers Butsashvili 2006- Physician and Cross- 2012 1386 46.0 Hospitals Georgia Transition Low et al. [46] 07 nurse sectional Physicians, nurses, lab Cvejanov- personnel, and Cross- Kezunovic 2011 2014 1043 49.6 NA other non- Hospital Croatia Developed Low sectional et al. [47] HCW (cleaning, delivery, and maintenance) Nurses, physician, lab Zaidi et al. Cross- United Arab 2008 2012 230 7.39 NA staff, and other Hospital Developing Low [36] sectional Emirates healthcare providers Sreedharan Cross- United Arab 2009 2010 101 NA 25.7 Nurses Hospital Developing Moderate et al. [37] sectional Emirates Karani et al. Cross- 2008 2011 64 55 NA Medical interns Hospital South Africa Moderate [21] sectional Medical residents, emergency Kessler et al. Not Cross- 2007 2011 455 NA 22.6 residents, USA Developed Low [48] specified sectional nursing, and dental professional Physician, Zhang et al. nurse, and Cross- 2003/4 2009 1144 66.34 NA Hospital China Developing Low [31] laboratory sectional technician articles, and studies not available in full texts were excluded (e articles were searched using a combination of from the current study. Boolean logic operators (AND, OR, and NOT), Medical Subject Headings, and keywords. (e following is a search term used in the initial search: “prevalence” [MeSH Terms] 2.3. Information Sources and Search Strategy. (e articles OR “prevalence” [All Fields]) AND ((“occupational” were searched using ten electronic databases (SCOPUS/ [MeSH Terms] OR “occupational” [All Fields], OR “work Science Direct, PubMed, Web of Science, Google Scholar, place” [All Fields] OR “work place” [MeSH]) AND CINAHL, MEDLINE, Cochrane Library, DOAJ, and ((“blood and body fluids” [MeSH Terms]] OR (“blood” [All MedNar) using a combination of Boolean logic operators Fields] AND “fluids” [All Fields]) OR “blood and splash” (AND, OR, and NOT), Medical Subject Headings (MeSH), [All Fields]) OR “healthcare workers” [MeSH Terms] OR and keywords, such as health professionals, healthcare “healthcare” [All Fields] AND “workers” [All Fields]) OR workers, healthcare system, developing country, developed “healthcare workers” [All Fields]) OR “health professional” country, blood, blood and body fluids, and occupational [All Fields]) OR “health professional” [All Fields]) OR exposure. “health professional” [All Fields])” OR (“health” [All 6 Canadian Journal of Infectious Diseases and Medical Microbiology Statistics for each study Authors Event Lower Upper Event rate and 95% CI Z-Value P-Value Rate Limit Limit <0.001 Kasatpibal et al 0.400 0.379 0.421 −8.952 Mbais et al 0.250 0.205 0.302 −8.308 <0.001 Yenesew & Fekadu 0.659 0.605 0.709 5.561 <0.001 Markovic-Denic et al 0.269 0.242 0.298 −13.899 <0.001 Mbah et al 0.255 0.217 0.298 −9.847 <0.001 Mandic et al 0.390 0.377 0.403 −15.804 <0.001 Sabbah et al 0.300 0.249 0.357 −6.462 <0.001 Abere et al 0.653 0.595 0.707 5.009 <0.001 Musa et al 0.357 0.293 0.426 −3.947 <0.001 Markovic-Denic et al 0.259 0.205 0.322 −6.768 <0.001 Yasin et al 0.390 0.335 0.448 −3.664 <0.001 Shitu et al 0.467 0.420 0.515 −1.358 0.174 Yang et al 0.245 0.240 0.250 −88.139 <0.001 Selladurai, & Shireen 0.545 0.482 0.607 1.392 0.164 Nwoga et al 0.270 0.213 0.336 −6.245 <0.001 Ebrahimi et al 0.254 0.198 0.320 −6.515 <0.001 Laisser & Ng'home 0.209 0.165 0.261 −9.007 <0.001 Chalya et al 0.170 0.138 0.208 −12.437 <0.001 −0.258 Cvejanov-Kezunovic et al 0.496 0.466 0.526 0.796 Zaidi et al 0.739 0.678 0.792 6.932 <0.001 Karani et al 0.550 0.428 0.667 0.799 0.424 10.844 Zhang et al 0.663 0.635 0.690 <0.001 0.390 0.327 0.457 −3.203 0.001 −1.00 −0.50 0.00 0.50 1.00 Heterogeneity I =90.06, p value=0.001 Figure 2: Pooled prevalence of occupational exposure to blood and body fluids in the last 12 months among healthcare workers. Fields] AND “provider” [All Fields]) OR “health provider” respect to the inclusion of studies were resolved by con- sensus after discussion. Finally, studies that met the inclu- [All Fields])) AND (“developing country” [MeSH Terms] OR (“developing” [All Fields] AND “countries” [All sion criteria were included in the systematic review and Fields]) OR “developing countries” [All Fields]) OR “de- meta-analysis. veloped countries” [MeSH Terms] OR (“developed” [All Fields] AND “countries” [All Fields]) OR “developed 2.5. Data Extraction. (e authors (DAM, GDG, EM, DMA, countries” [All Fields])). KB, WD, FKA, and YAA) independently extracted the data (en, all identified keywords and index terms were from the included articles. A predefined Microsoft Excel checked across the nine electronic databases included. Fi- 2016 format was used to extract information from selected nally, searching the reference list of all identified articles for studies under the following headings: author; publication further articles was conducted. year; country of study; study design; primary outcomes such as prevalence or magnitude of exposure to BBFs and possible 2.4. Study Selection. (e study selection process was per- confounding factors considered. In general, all data are formed using the PRISMA flowchart, indicating the number extracted from the eligible articles. of articles included in the review and articles excluded from the study with reasons. Following the search for articles through selected electronic databases, duplicate studies were 2.6. Quality Assessment. (e selected articles were subjected removed using the ENDNOTE software version X5 to a rigorous independent assessment using a standardized ((omson Reuters, USA). (e authors independently se- critical assessment tool, the Joanna Briggs Institute (JBI) lected the articles based on the titles and abstracts by ap- Critical Assessment Tools for prevalence studies [13]. (ese plying the inclusion criteria. Furthermore, the full text of the articles were then evaluated by the authors (DAM, GDG, relevant articles was further read in detail and independently YMD, YAA, and AG) to confirm their relevance to the study evaluated by the authors. Any disagreements made with and the quality of the work. Canadian Journal of Infectious Diseases and Medical Microbiology 7 Statistics for each study Group by Study name Event rate and 95% CI Event Lower Upper Publication year Z-Value p-Value rate limit limit 2004-2008 Zhang et al 0.663 0.635 0.690 10.844 <0.001 2004-2008 0.663 0.635 0.690 10.844 <0.001 2010-2015 Mbais et al 0.250 0.205 0.302 −8.308 <0.001 2010-2015 Yenesew & Fekadu 0.659 0.605 0.709 5.561 <0.001 2010-2015 Markovic-Denic et al 0.269 0.242 0.298 −13.899 <0.001 2010-2015 Sabbah et al 0.300 0.249 0.357 −6.462 <0.001 2010-2015 Musa et al 0.357 0.293 0.426 −3.947 <0.001 2010-2015 Markovic Denic et al 0.259 0.205 0.322 −6.768 <0.001 2010-2015 Ebrahimi et al 0.254 0.198 0.320 −6.515 <0.001 2010-2015 Chalya et al 0.170 0.138 0.208 −12.437 <0.001 2010-2015 Cvejanov-Kezunovic et al 0.496 0.466 0.526 −0.258 0.796 6.932 2010-2015 Zaidi et al 0.739 0.678 0.792 <0.001 2010-2015 Karani et al 0.550 0.428 0.667 0.799 0.424 2010-2015 0.380 0.279 0.492 −2.095 0.036 −8.952 2016-2021 Kasatpibal et al 0.400 0.379 0.421 <0.001 2016-2021 Mbah et al 0.255 0.217 0.298 −9.847 <0.001 2016-2021 Mandic et al 0.390 0.377 0.403 −15.804 <0.001 5.009 2016-2021 Abere et al 0.653 0.595 0.707 <0.001 2016-2021 Yasin et al 0.390 0.335 0.448 −3.664 <0.001 2016-2021 Shitu et al 0.467 0.420 0.515 −1.358 0.174 −88.139 2016-2021 Yang et al 0.245 0.240 0.250 <0.001 1.392 2016-2021 Selladurai & Shireen 0.545 0.482 0.607 0.164 2016-2021 Nwoga et al 0.270 0.213 0.336 −6.245 <0.001 −9.007 2016-2021 Laisser & Ng'home 0.209 0.165 0.261 <0.001 2016-2021 0.374 0.301 0.454 −3.068 0.002 Overall 0.616 0.589 0.642 8.306 <0.001 −1.00 −0.50 0.00 0.50 1.00 Figure 3: Pooled prevalence of occupational exposure to blood and body fluids in last 12 months among healthcare workers based on the publication year. (e evaluation tools have the following nine evaluation prevalence estimates due to genuine variation in prevalence criteria or parameters: (1) appropriate sampling frame; (2) [14, 15]. (e level of heterogeneity was classified into four proper sampling technique; (3) adequate sample size; (4) categories: no heterogeneity (0%), low (25–50%), moderate description of the study subject and setting description; (5) (50–75%), and high heterogeneity (greater than 75%) [16]. sufficient data analysis; (6) use of valid methods for iden- (e random-effects model was used to analyze the data. tified conditions; (7) valid measurement for all participants; Furthermore, subgroup analysis was conducted based on the (8) use of appropriate statistical analysis; and (9) adequate year of publication, survey period (when the study was response rate. Failure to satisfy each parameter was scored as conducted), and study areas. Publication bias among the 0, if not 1. (e score was then given across all studies and included studies was evaluated using funnel plots. A sen- graded as high (85% and above), moderate (60–85% score), sitivity analysis was done to determine differences in pooled or low quality (60% score). Disagreement made on what was effects by dropping studies that were found to influence the to be extracted was solved by discussion after repeating the summary estimates. same procedures. (e PRISMA guidelines protocol [12] was used to conduct the review. 3. Results 3.1. Study Selection. A total of 2912 studies were retrieved 2.7. Statistical Procedures and Data Analysis. (e pooled from searches in selected electronic databases. (en, 1430 prevalence of the BBFs was performed using Comprehensive duplicate articles were excluded. Out of 1610 non- Meta-Analysis (CMA) version 3.0 statistical software. A duplicated studies, 327 studies were excluded based on forest plot and a random-effects model were used to de- titles and abstracts. Furthermore, 1759 full-text studies termine and visualize the pooled prevalence of the BBFs. were further assessed to determine their eligibility, of (e Cochran Q test (Q) and I squared test (I statistics) which 1724 studies were excluded. (ese articles were were used to evaluate the heterogeneity between the in- excluded as a result of not reporting the prevalence of cluded articles. I statistics is the proportion of variation in blood and body fluids in their career time or last year; 8 Canadian Journal of Infectious Diseases and Medical Microbiology Statistics for each study Group by Event Lower Upper Authors Event rate and 95% CI survey period Z-Value p-Value rate limit limit 2003-2008 Zaidi et al 0.739 0.678 0.792 6.932 <0.001 2003-2008 Karani et al 0.550 0.428 0.667 0.799 0.424 2003-2008 Zhang et al 0.663 0.635 0.690 10.844 <0.001 2003-2008 0.666 0.584 0.738 3.869 <0.001 2010-2015 Kasatpibal et al 0.400 0.379 0.421 −8.952 <0.001 2010-2015 Mbais et al 0.250 0.205 0.302 −8.308 <0.001 2010-2015 Yenesew & Fekadu 0.659 0.605 0.709 5.561 <0.001 2010-2015 Markovic-Denic et al 0.269 0.242 0.298 −13.899 <0.001 2010-2015 Mbah et al 0.255 0.217 0.298 −9.847 <0.001 2010-2015 Mandic et al 0.390 0.377 0.403 −15.804 <0.001 2010-2015 Sabbah et al 0.300 0.249 0.357 −6.462 <0.001 2010-2015 Musa et al 0.357 0.293 0.426 −3.947 <0.001 2010-2015 Markovic-Denic et al 0.259 0.205 0.322 −6.768 <0.001 2010-2015 Selladurai, & Shireen 0.545 0.482 0.607 1.392 0.164 2010-2015 Ebrahimi et al 0.254 0.198 0.320 −6.515 <0.001 2010-2015 Laisser & Ng'home 0.209 0.165 0.261 −9.007 <0.001 2010-2015 Chalya et al 0.170 0.138 0.208 −12.437 <0.001 2010-2015 Cvejanov-Kezunovic et al 0.496 0.466 0.526 −0.258 0.796 2010-2015 0.336 0.284 0.392 −5.513 <0.001 2016-2021 Abere et al 0.653 0.595 0.707 5.009 <0.001 2016-2021 Yasin et al 0.390 0.335 0.448 −3.664 <0.001 2016-2021 Shitu et al 0.467 0.420 0.515 −1.358 0.174 2016-2021 Yang et al 0.245 0.240 0.250 −88.139 <0.001 2016-2021 Nwoga et al 0.270 0.213 0.336 −6.245 <0.001 2016-2021 0.398 0.251 0.566 −1.196 0.232 Overall 0.438 0.392 0.485 −2.555 0.011 −1.00 −0.50 0.00 0.50 1.00 Figure 4: Pooled prevalence of occupational exposure to blood and body fluids in last 12 months among healthcare workers based on the survey period. conducted in United Arab Emirate [36, 37], 2 were con- unclear objectives, unclear methods, not available in full text; nonhealthcare worker study participants; review ducted in Nigeria [38, 39],and 1 was conducted in each of articles; letters to the editor; brief reports; and written in a (ailand [40], Kenya [41], Turkey [42], Lebanon [43], non-English language. Finally, 33 studies that met the Bosnia and Herzegovina [44], Togo [45], Georgia [46], inclusion criteria were included in the review (Figure 1). Croatia [47], and USA [48]. About three-quarters were conducted in hospitals (Table 1). 3.2.StudyCharacteristics. (is systematic review and meta- analysis included a total of 33 studies conducted on 54328 3.3. Prevalence of Blood and Body Fluids. (is systematic HCWs in 18 countries from 2003 to 2021. (e sample size review and meta-analysis was conducted using the Com- prehensive Meta-Analysis (CMA) Version 3 statistical of included studies ranged from 64 to 33156 healthcare workers. Seventeen articles were conducted in developing package (software) to determine the pooled prevalence of countries. (e highest prevalence of exposure to BBFs in blood and body fluids among healthcare workers. the last year and career time was reported in China and Ethiopia, respectively. Among the included studies, 4 ar- 3.3.1. Previous Last Year Prevalence of Exposure to Blood and ticles were conducted in Ethiopia [2, 17–19], 3 were conducted in South Africa [20–22], 3 were conducted in Body Fluids. (e last year’s prevalence of occupational exposure to blood and body fluids among healthcare Serbia [23–25], 3 were conducted in Iran [26–28], 3 were conducted in China [29–31], 2 were conducted in Tanzania workers was found to be 39.0% (95% CI: 32.7, 45.7) with a P-value of<0.001 (Figure 2). [32, 33], 2 were conducted in India [34, 35], 2 were Canadian Journal of Infectious Diseases and Medical Microbiology 9 Statistics for each study Group by Event Lower Upper Authors Event rate and 95% CI WHO Region Z-Value p-Value rate limit limit Africa Mbais et al 0.250 0.205 0.302 −8.308 <0.001 Africa Yenesew & Fekadu 0.659 0.605 0.709 5.561 <0.001 Africa Mbah et al 0.255 0.217 0.298 −9.847 <0.001 Africa Abere et al 0.653 0.595 0.707 5.009 <0.001 Africa Yasin et al 0.390 0.335 0.448 −3.664 <0.001 Africa Shitu et al 0.467 0.420 0.515 −1.358 0.174 −6.245 <0.001 Africa Nwoga et al 0.270 0.213 0.336 Africa Laisser & Ng'home 0.209 0.165 0.261 −9.007 <0.001 Africa Chalya et al 0.170 0.138 0.208 −12.437 <0.001 Africa Karani et al 0.550 0.428 0.667 0.799 0.424 Africa 0.373 0.264 0.497 −2.008 0.045 Eastern Mediterranean Sabbah et al 0.300 0.249 0.357 −6.462 <0.001 Eastern Mediterranean Ebrahimi et al 0.254 0.198 0.320 −6.515 <0.001 Eastern Mediterranean Zaidi et al 0.739 0.678 0.792 6.932 <0.001 Eastern Mediterranean 0.427 0.169 0.731 −0.445 0.656 Europe Markovic-Denic et al 0.269 0.242 0.298 −13.899 <0.001 Europe Mandic et al 0.390 0.377 0.403 −15.804 <0.001 Europe Musa et al 0.357 0.293 0.426 −3.947 <0.001 Europe Markovic-Denic 0.259 0.205 0.322 −6.768 <0.001 Europe Cvejanov-Kezunovic et al 0.496 0.466 0.526 −0.258 0.796 Europe 0.352 0.279 0.433 −3.517 <0.001 South east Asia Kasatpibal et al 0.400 0.379 0.421 −8.952 <0.001 South east Asia Selladurai, & Shireen 0.545 0.482 0.607 1.392 0.164 South east Asia 0.469 0.332 0.610 −0.427 0.669 Western Pacific Yang et al 0.245 0.240 0.250 −88.139 <0.001 Western Pacific Zhang et al 0.663 0.635 0.690 10.844 <0.001 Western Pacific 0.444 0.120 0.824 −0.249 0.803 Overall 0.382 0.326 0.442 −3.826 <0.001 −1.00 −0.50 0.00 0.50 1.00 Figure 5: Prevalence of occupational exposure to blood and body fluids in the last 12 months among healthcare workers based on WHO regions. Based on a subgroup analysis by publication year, there was 3.3.2. Career Time Prevalence of Exposure to BBFs. (e a relatively equal prevalence of BBFs in the last 12 months that career time prevalence of occupational exposure to blood accounted for 38.0% (95% CI: 27.9, 49.2%) and 37.4% (95% CI: and body fluids among healthcare workers was found to be 30.1, 45.4%) for those articles published between 2010 and 2015 56.6% (95% CI: 47.3, 65.4) (Figure 6). and 2016 and 2021, respectively (Figure 3). Based on a subgroup analysis by publication year, the According to a subgroup analysis by survey year, studies highest career time pooled prevalence (60.6% (95% CI: 47.0, 72.7%)) was reported among the studies published from conducted between 2003 and 2008 had the highest pooled prevalence (66.6% (95% CI: 58.4, 73.8%)), while studies 2015 to 2020, while the lowest prevalence (51.1% (95% CI: conducted between 2010 and 2015 had the lowest (33.6% 39.0, 63.2%)) was reported among the studies published (95% CI: 28.4%, 39.2%)) (Figure 4). from 2010–2014 (Figure 7). Based on the WHO regions, the highest prevalence of Based on the survey period, the highest career time last year’s BBF was observed in the Southeast Asia Region pooled prevalence (71.0% (95% CI: 58.4, 81.1%)) was re- (46.9% (95% CI: 33.2, 61.0%)) followed by the Western ported in the study conducted from 2015 to 2019, while the Pacific (44.4% (95% CI: 12.0, 82.4%)). (e lowest prevalence lowest prevalence (30.8% (95% CI: 16.4, 50.3%)) was re- was reported from the European Region (35.2% (95% CI: ported among the study published from 2005 to 2009 27.9, 43.3%)) (Figure 5). (Figure 8). 10 Canadian Journal of Infectious Diseases and Medical Microbiology Statistics for each study Authors Event rate and 95% CI Event Lower Upper Z-Value p-Value rate limit limit Yenesew & Fekadu 0.760 0.710 0.804 8.765 <0.001 Markovic Denic et al 0.565 0.534 0.596 4.064 <0.001 Engin et al 0.583 0.526 0.638 2.862 0.004 Mandic et al 0.660 0.647 0.673 22.760 <0.001 Abere et al 0.870 0.825 0.905 10.640 <0.001 Musa et al 0.633 0.563 0.698 3.678 <0.001 Markovi Denic et al 0.606 0.539 0.669 3.092 0.002 Yasin et al 0.585 0.527 0.641 2.841 0.004 Shaghaghian et al 0.800 0.737 0.851 7.664 <0.001 Yi et al 0.659 0.618 0.698 7.311 <0.001 Rasweswe and Peu 0.430 0.334 0.532 −1.353 0.176 Nmadu et al 0.680 0.607 0.745 4.611 <0.001 Ditorguena et al 0.676 0.593 0.749 4.014 <0.001 Fazili et al 0.250 0.234 0.266 −25.005 <0.001 Farsi et al 0.575 0.505 0.642 2.113 0.035 Ebrahimi et al 0.363 0.298 0.433 −3.757 <0.001 Butsashvil et al 0.460 0.434 0.486 −2.975 0.003 Sreedharan et al 0.257 0.181 0.351 −4.662 <0.001 Kessler et al 0.226 0.190 0.267 −10.983 <0.001 0.566 0.473 0.654 1.399 0.162 Heterogeneity I =89.98, p value <0.001 −1.00 −0.50 0.00 0.50 1.00 Random effect model Figure 6: Overall pooled prevalence of occupational exposure to blood and body fluids in career time among healthcare workers. Based on the WHO regions, the African region had the occupational-related injuries or exposures, such as percu- highest prevalence (68.4% (95% CI: 56.1, 78.6%)) of oc- taneous injuries and needlestick injuries. cupational exposure to BBFs, followed by the Western In the workplace, blood and body fluids are a major risk Pacific (65.9% (95% CI: 61.8, 69.8%)). (e American Re- factor for the transmission of various blood-borne infec- tions to healthcare workers [49] such as hepatitis B virus, gion had the lowest prevalence (22.6% (95% CI: 19.0, 26.7%)) (Figure 9). hepatitis C virus, and human immunodeficiency virus, the three leading causes of occupationally related blood-borne infections among HCWs [50]. However, this study found 3.4. Sensitivity Analysis Results. (e sensitivity analysis was that the last year’s prevalence of occupational exposure to conducted by dropping small sample size and large sample blood and body fluids among healthcare workers accounted size. However, there was no significant change found in the for 39.0% (95% CI: 32.7, 45.7). (e current study found a prevalence of both career time and last year occupational lower prevalence of BBFs than another study conducted in exposure to blood and body fluids (Table 2). 21 African countries, which discovered 48.0% prevalence [6]. Other studies conducted in Africa reported a one-year 4. Discussion prevalence rate of blood exposure accounted for 84.0% A total of 3912 studies were retrieved from selected elec- [51], which was higher than the current finding. (e variation may be related to the scope of the study because tronic databases, of which 1430 duplicate articles were ex- cluded. A total of 33 studies conducted on 54328 HCWs the current study included studies conducted in both from 2003 to 2021 were included in the systematic review developing and developed countries. Occupational ex- and meta-analysis. Direct comparison of the current find- posure to hazards continues to be a public health concern ings with other findings was difficult because of a lack of globally. Another study found that about 36.4% (95% CI: similar systematic reviews and meta-analyses. (e authors 32.9–40.0) of HCWs were exposed to percutaneous in- found only one systematic review and meta-analysis con- juries in the previous year, which is lower than the current ducted to determine occupational exposure to BBFs among finding. (e variation could be due to differences in the HCWs in Africa. However, we considered other outcomes of these studies because HCWs can be exposed Canadian Journal of Infectious Diseases and Medical Microbiology 11 Statistics for each study Group by Event Lower Upper Authors Event rate and 95% CI Publication year Z-Value p-Value rate limit limit 2010-2014 Yenesew & Fekadu 0.760 0.710 0.804 8.765 <0.001 2010-2014 Engin et al 0.583 0.526 0.638 2.862 0.004 3.678 2010-2014 Musa et al 0.633 0.563 0.698 <0.001 2010-2014 Markovic-Denic et al 0.606 0.539 0.669 3.092 0.002 2010-2014 Farsi et al 0.575 0.505 0.642 2.113 0.035 −2.975 2010-2014 Butsashvil et al 0.460 0.434 0.486 0.003 2010-2014 Sreedharan et al 0.257 0.181 0.351 −4.662 <0.001 2010-2014 Kessler et al 0.226 0.190 0.267 −10.983 <0.001 2010-2014 0.511 0.390 0.632 0.178 0.858 0.565 0.534 0.596 4.064 <0.001 2015-2020 Markovic-Denic et al 2015-2020 Mandic et al 0.660 0.647 0.673 22.760 <0.001 2015-2020 Abere et al 0.870 0.825 0.905 10.640 <0.001 2.841 2015-2020 Yasin et al 0.585 0.527 0.641 0.004 2015-2020 Shaghaghian et al 0.800 0.737 0.851 7.664 <0.001 Yi et al 2015-2020 0.659 0.618 0.698 7.311 <0.001 2015-2020 Rasweswe & Peu 0.430 0.334 0.532 −1.353 0.176 2015-2020 Nmadu et al 0.680 0.607 0.745 4.611 <0.001 2015-2020 Ditorguena et al 0.676 0.593 0.749 4.014 <0.001 2015-2020 Fazili et al 0.250 0.234 0.266 −25.005 <0.001 −3.757 2015-2020 Ebrahimi et al 0.363 0.298 0.433 <0.001 2015-2020 0.606 0.470 0.727 1.530 0.126 Overall 0.554 0.462 0.642 1.156 0.247 −1.00 −0.50 0.00 0.50 1.00 Figure 7: Pooled prevalence of occupational exposure to blood and body fluids in career time among healthcare workers based on the publication year. to blood and other body fluids in different ways, such as the study because this study found the career time needlestick injuries or contact with contaminated objects prevalence of BBF exposure among HCWs in the African or mucous membranes. region accounted for 68.4% (95% CI: 56.1, 78.6), which Similarly, this study found that the prevalence of BBF was in line with the finding of another study, which found exposure in the last year in the Africa Region was 37.3% 65.7% [6]. Furthermore, more than half of the HCWs in the African (95% CI: 26.4, 49.7), which was in line with the finding of another study, which reported about 48.0% prevalence of Region, Western Pacific and Pacific, and European Region exposure [6]. Furthermore, this study found a variation in were exposed to BBFs. (e high prevalence could be due to the prevalence of BBFs among different regions of the world. inadequate healthcare systems and poor occupational health For example, the highest last 12-month prevalence of BBF and safety practices. Additionally, even though the highest exposure was reported from the Southeast Asia Region prevalence was observed in the African region, the study (46.9% (95% CI: 33.2, 61.0%)), while the lowest prevalence found an increase in the career time prevalence of BBF was observed in the study conducted in the European Region exposure from 2005 to 2020. (is indicates that there is a (22.6% (95% CI: 19.0, 26.7%). (e variation may be related to high risk of being to be exposed to blood-borne diseases the difference in implementation of health and safety among HCWs. guidelines or standard precautions or differences in the Overall, the study found a high prevalence of occupa- tional exposure to BBFs in the last year (more than one in healthcare system. On the other hand, this study found a career time three HCWs) and throughout the career time (more than prevalence of occupational exposure to blood and body two in three HCWs) among healthcare workers. However, fluids among healthcare workers accounted for 56.6% exposure to blood and body fluids has serious health im- (95% CI: 47.3, 65.4). (is finding was lower than the plications because exposure to blood and other body fluids is finding of another study conducted in African countries the potential source of blood-borne pathogens such as HBV that found 65.7% (95% CI: 59.7–71.6) prevalence of BBFs and HIV that need critical attention to protect the workers’ [6]. (e variation may be related to the included region in health. 12 Canadian Journal of Infectious Diseases and Medical Microbiology Statistics for each study Group by Study name Event Lower Upper Event rate and 95% CI Survey period Z-Value p-Value rate limit limit 2005-2009 Butsashvil et al 0.460 0.434 0.486 −2.975 0.003 2005-2009 Sreedharan et al 0.257 0.181 0.351 −4.662 <0.001 2005-2009 Kessler et al 0.226 0.190 0.267 −10.983 <0.001 2005-2009 0.308 0.164 0.503 −1.927 0.054 2010-2014 Yenesew & Fekadu 0.760 0.710 0.804 8.765 <0.001 2010-2014 Markovic-Denic et al 0.565 0.534 0.596 4.064 <0.001 2010-2014 Engine et al 0.583 0.526 0.638 2.862 0.004 2010-2014 Mandic et al 0.660 0.647 0.673 22.760 <0.001 2010-2014 Musa et al 0.633 0.563 0.698 3.678 <0.001 Markovic-deniic et al 0.606 0.539 0.669 3.092 0.002 2010-2014 2010-2014 Shaghaghian et al 0.800 0.737 0.851 7.664 <0.001 2010-2014 Rasweswe & peu 0.430 0.334 0.532 −1.353 0.176 2010-2014 Nmadu et al 0.680 0.607 0.745 4.611 <0.001 2010-2014 Fazili et al 0.250 0.234 0.266 −25.005 <0.001 Davood farsi 0.575 0.505 0.642 2.113 0.035 2010-2014 2010-2014 Ebrahimi et al 0.363 0.298 0.433 −3.757 <0.001 2010-2014 0.580 0.454 0.696 1.245 0.213 2015-2019 Abere et al 0.870 0.825 0.905 10.640 <0.001 2015-2019 Yasin et al 0.585 0.527 0.641 2.841 0.004 Yi et al 0.659 0.618 0.698 7.311 2015-2019 <0.001 2015-2019 Ditorguena et al 0.676 0.593 0.749 4.014 <0.001 2015-2019 0.710 0.584 0.811 3.143 0.002 Overall 0.584 0.500 0.664 1.956 0.050 −1.00 −0.50 0.00 0.50 1.00 Figure 8: Pooled prevalence of career time occupational exposure to blood and body fluids among healthcare workers based on the survey period. (erefore, applying standard precautions, occupational promotion of a healthy work environment, healthy work health and safety measures or services, regular training on practices, strengthening occupational health services, de- infection prevention, and proper implementation of velopment of occupational health standards, and strength- guidelines play a major role in reducing BBFs and pre- ening of research [53]. venting infectious diseases in the healthcare system. 4.1. Possible Prevention or Control Strategies. Integrated 4.2. Limitations of the Current Study. (ere was an unequal approaches to occupational health and safety, including distribution of occupations among the included articles that engineering measures, administrative policy, and the use of make the comparison of BBFs exposure among different personal protective equipment, should be implemented to occupations more difficult. On the other hand, the preva- control, eliminate, or reduce occupational exposure to lence of occupational exposure to BBFs in some regions was not covered due to the lack of studies in these regions. (ere hazards [52], including BBFs. Furthermore, there is a need to implement priority strategies, which include strengthening were a few studies from developed countries conducted on of international and national policies for health at work, the outcome of interests. Canadian Journal of Infectious Diseases and Medical Microbiology 13 Statistics for each study Group by Authors Event Lower Upper Event rate and 95% CI WHO region Z-Value p-Value rate limit limit Africa Yenesew & Eekadu 0.760 0.710 0.804 8.765 <0.001 Africa Abere et al 0.870 0.825 0.905 10.640 <0.001 Africa Yasin et al 0.585 0.527 0.641 2.841 0.004 Africa Rasweswe & Peu 0.430 0.334 0.532 −1.353 0.176 Africa Nmadu et al 0.680 0.607 0.745 4.611 <0.001 Africa Ditorguena et al 0.676 0.593 0.749 4.014 <0.001 Africa 0.684 0.561 0.786 2.864 0.004 America Kessler et al 0.226 0.190 0.267 −10.983 <0.001 America 0.226 0.190 0.267 −10.983 <0.001 Eastern Mediterranean Shaghaghian et al 0.800 0.737 0.851 7.664 <0.001 Eastern Mediterranean Farsi et al 0.575 0.505 0.642 2.113 0.035 Eastern Mediterranean Ebrahimi et al 0.363 0.298 0.433 −3.757 <0.001 Eastern Mediterranean Sreedharan et al 0.257 0.181 0.351 −4.662 <0.001 Eastern Mediterranean 0.505 0.282 0.726 0.043 0.966 Europe Markovic-Denic et al 0.565 0.534 0.596 4.064 <0.001 Europe Engine et al 0.583 0.526 0.638 2.862 0.004 Europe Mandic et al 0.660 0.647 0.673 22.760 <0.001 Europe Musa et al 0.633 0.563 0.698 3.678 <0.001 Europe Markovic-Denic et al 0.606 0.539 0.669 3.092 0.002 Europe Butsashvi et al 0.460 0.434 0.486 −2.975 0.003 Europe 0.585 0.501 0.663 1.991 0.046 South east Asia Fazili et al 0.250 0.234 0.266 −25.005 <0.001 South east Asia 0.250 0.234 0.266 −25.005 <0.001 Western Pacific Yi et al 0.659 0.618 0.698 7.311 <0.001 <0.001 Western Pacific 0.659 0.618 0.698 7.311 Overall 0.325 0.310 0.341 −20.278 <0.001 −1.00 −0.50 0.00 0.50 1.00 Figure 9: Prevalence of career time occupational exposure to blood and body fluids among healthcare workers based on WHO regions. Table 2: Sensitivity analysis by dropping small sample size and large sample size. Criteria Initial prevalence After analysis (%) Heterogeneity 95% CI Dropping 2 small sample size (career time) 56.6% [95% CI: 47.3, 65.4] 58.2 99.137 47.6, 68.1% Dropping one smallest sample size (career time) 56.6% [95% CI: 47.3, 65.4] 56.4 99.095 46.0, 66.2% Dropping large sample size (career time) 56.6% [95% CI: 47.3, 65.4] 55.1 98.649 44.7, 65.1% Dropping small sample size (last year) 39.0% (95% CI: 32.7, 45.7) 38.3 99.088 32.0, 45.1% Dropping large sample size (last year) 39.0% (95% CI: 32.7, 45.7) 39.8 97.843 33.9, 46.0% 5. Conclusions Abbreviations (is systematic review and meta-analysis found a higher BBF: Blood and body fluids percentage of career time and previous one-year global CMA: Comprehensive meta-analysis occupational exposures to blood and body fluids among HBV: Hepatitis B virus healthcare workers. (e study suggests that more than one HCV: Hepatitis C virus in three and two in three healthcare workers were exposed HIV: Human immune-deficiency virus to BBFs annually and in their career time, respectively. HCW: Healthcare workers (erefore, efforts should be made to reduce the high JBI: Joanna Briggs Institute burden of occupational blood and body fluid exposures PRISMA: Preferred Reporting Items for Systematic Review through effective implementation of standard precaution and Meta-Analysis measures along with occupational health and safety WHO: World Health Organization measures. MeSH: Medical Subject Heading. 14 Canadian Journal of Infectious Diseases and Medical Microbiology [7] J. L. Gerberding, “Management of occupational exposures to Data Availability blood-borne viruses,” New England Journal of Medicine, vol. 332, no. 7, pp. 444–451, 1995. Almost all data are included in this study. Some additional [8] V. Puro, N. Petrosillo, and G. 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