Profile of victims of occupational accidents involving exposure to biological material notified in the city of Palmas, state of Tocantins, Brazil

Introduction An occupational accident involving exposure to biological material is characterized by worker’s contact with organic fluids during the working day and in Brazil it is considered a condition of compulsory declaration. Objectives To analyze the profile of victims of occupational accident involving exposure to biological material in the city of Palmas, state of Tocantins, from 2010 to 2020. Methods Descriptive cross-sectional study using the Notifiable Diseases Information System. Results During the study period, there were 1,173 notifications, most of which were female (80.10%), aged from 20 to 49 years (90.20%), and worked as statutory civil servants (44.50%). Percutaneous exposure was the most common type of accident, and blood was the main route of contamination (81.59%). Most victims evolved with discharge without serological conversion (66.92%), and 18.5% withdrew follow-up. The most frequent circumstance was improper disposal on the floor (12.45%). Health care professionals were the most involved in occupational accidents with biological material (79.02%) compared with professionals from other areas, with a predominance of nursing professionals (60.35%). Conclusions The findings of this study reiterate training in the prevention of occupational accidents involving exposure to biological material is necessary for all jobs involving exposure to this type of material, regardless of the area, as well as changes in work organization so as to reduce the presence of risk factors for this type of injury.


INTRODUCTION
An occupational accident (OA) involving exposure to biological material (BM) occurs when workers have contact with blood and/or other body fluids during their working day.The most frequent exposures result from percutaneous inoculation and direct contact with skin and/or mucosas.¹The risk of accidents varies according to the type of exposure, severity, size of injury, presence and volume of blood involved, clinical conditions of the source, and the prophylactic measures applied.² The nursing staff is especially more susceptible to the occurrence of these exposures, due to the great number of workers in this professional category, to the constant handling of sharp objects, and to the constant provision of direct care to patients with several diseases. 3fter an OA with BM, individuals should receive assistance appropriate to the type of occurrence, and the institution is responsible for referring them to care.Furthermore, workers need to receive prophylactic measures as briefly as possible, in order to minimize the risk for transmission of diseases such as HIV and hepatitis B. 4 Hepatitis A vaccine is available for free through the public health network and confers immunity from 90 to 95% in immunocompetent adults, being the main pre-exposure prevention measure.However, nearly 25% of professionals are not vaccinated and are at increased risk of acquiring the disease in case of direct contact with contaminated BM. 5 Therefore, isolated actions to prevent accidents are considered ineffective; thus, a combination of several strategies is necessary, namely: improvement of working conditions, especially work organization, in order to prevent fatigue; provision of personal protective equipment (PPE) and material of safety devices; and training sessions to promote changes in professionals' behavior. 6n Brazil, Ordinance no.1,271, of June 6 th , 2014, which established the national list of diseases, injuries, and public health events of compulsory notification in public and private health services throughout the entire national territory, defined OA involving exposure to BM as a condition of compulsory notification. 7owledge of the profile of victims of OA involving exposure to BM allows for previous identification of main risk factors and enables to improve preventive actions, targeting mainly at the most susceptible groups.Therefore, this study aimed to analyze the profile of victims of OAs involving exposure to BM in the city of Palmas, state of Tocantins, Brazil, so as to quantify data available on the forms of the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação, SINAN), delineate the profile of victims of these accidents, and evaluate the possible risk factors for OAs with BM.

METHODS
This is a descriptive, cross-sectional study 8 that used notifications forms available on the SINAN reporting OAs involving exposure to BM that occurred from 2010 to 2020, collected in June 2021.The reference population was all workers with notified cases living in the city of Palmas, state of Tocantins, Brazil.The characterization of victims of OAs involving exposure to BM included variables such as: age, sex, schooling, municipality of residence, occupation, working situation, type of exposure, organic material, circumstance of the accident, agent, use of PPE, and number of deaths.
This study was approved by the Research Ethics Committee of Fundação Escola de Saúde Pública de Palmas, through opinion number 4,677,466.
Inclusion criteria were all professionals who suffered an OA involving exposure to BM in the city of Palmas, Tocantins, reported to the SINAN from 2010 and 2020.Exclusion criteria were notification records with insufficient information for the study.

RESULTS
Over the time interval analyzed, 1,173 cases of OAs involving exposure to BM were notified to the SINAN, of which 940 (80.10%) occurred in women.The most affected age group was from 20 to 49 years, accounting for 1,058 (90.20%) cases.With regard to the year of notification, there were no relevant variations, with the lowest number of cases being observed in 2013 (85; 7.20%), and the highest in 2017 (132; 11.30%) (Table 1).
Finally, administrative/executive/office professionals (information analyst, administrative assistant, office assistant, receptionist, executive secretary, administrative supervisor, staff assistant, hotel manager, responsible for mechanical maintenance of operating systems) (41; 3.52%) and laboratory professionals (clinical analysis laboratory assistant, pharmacy laboratory technical assistant, biomedical doctor, physico-chemical analysis laboratory technician, industrial laboratory technician, pharmacy laboratory technician, biotechnologist, clinical pathology technical assistant, biochemical pharmacist, and clinical pathology technician) (49; 4.20%) were also involved in OAs (Table 4).

DISCUSSION
The present study observed that most OAs involving exposure to BM occurred in women (80.10%), a fact that results from the great participation of women in the health workforce, more specifically in the nursing area, which accounts for the highest number of professionals in hospitals and is one of the professional categories that has direct contact with patients on a more frequent basis.These findings are similar to those of a study conducted in the macroregion of Florianópolis, state of Santa Catarina, Brazil, which also found a predominance of females in notifications of OAs involving exposure to BM. 9 Moreover, there was a predominance of individuals aged from 20 to 59 years (90.2%),covering the period when people enter the labor market up to their retirement.
Blood was the most commonly identified material in accidents (81.59%), since it is handled for a variety of tests.The risk for contamination with diseases such as hepatitis B, hepatitis C, and HIV is considered low, 10 a fact that can be confirmed by the percentage of victims who evolved to discharge without serological conversion (66.92%).However, a considerable number (18.50%) of patients withdrew follow-up and, since these highly severe diseases can result in professional's death or impair their capacity, it is necessary to show the importance of monitoring the case until its resolution, making proper use of PPE, and providing courses and accessible information on disposal and handling of materials.
Accidents with sharp materials were the most reported type of OA, and improper disposal, D-glucose test, and administration of intravenous medication accounted for 46.91% of circumstances of accidents.This percentage suggests a possible lack of professionals' training and health responsibility, since previous studies showed that many professionals are not aware of health regulations for disposal and capacity of containers.
Furthermore, routine work in environments with poor structure may contribute to reduce professionals' perception of risk. 11Use of inadequate collectors and inadequate use of PPE as factors influencing these numbers, as well as organizational factors such as teams with a limited number of workers, demand disproportionate to the size of the team, stressful work environment, lack of appropriate rest at the workplace, since all these factors make workers more vulnerable to an OA involving exposure to BM.It is known that professionals who handle BM are more often in the nursing area, thus justifying the fact that 79.02% of accidents involved nursing professionals. 12,13ith regard to occupation, health care professionals account for the vast majority of the cases.This result was expected, since the main type of exposure was percutaneous, the most common route was blood, and the most frequent circumstance was improper disposal of sharps.Considering that other professionals do not have, or have minimum contact with these factors, the number of accidents involving exposure to BM becomes small compared with that observed among nursing professionals, for example, who handle sharps on a routine and common basis. 14urthermore, individuals who are not health care professionals, especially garbage collector, work in unhealthy environments.In most cases, there is no distribution of PPE, work has few rest intervals, there is constant noise, work rhythm is fast, hygiene is poor, and many workers are not concerned about proper discard of materials that may cut or cause perforations. 15onsidering the data shown in this study, measures should be adopted to prevent accidents.In Brazil, Ordinance no.485, of November 11 th , 2005, which defines the standards for regulating occupational safety and health, sets for the distribution of PPE in sufficient number and its proper use by professionals. 16It is also crucial to value professional training, focused on knowledge of techniques for proper and safe handling of sharps, in addition to proper disposal; other measures include promotion of hepatitis B vaccination to all health care professionals, since it available for free and often confers sufficient immunity; inspection of compliance with the agreed working hours and with rest intervals, thus preventing workers' burnout; and adequacy of work environments, providing proper infrastructure and hygiene.

CONCLUSIONS
Most workers involved in OA with exposure to BM were health care professionals working as statutory civil servants.This position provides them with job stability, but with fewer wage changes, which may lead servants to work in more than one job, to take long work hours, and to work in night shifts, thus influencing in their risk of accidents.It is necessary to reduce the cases of OA involving exposure to BM, to reduce the number of invasive procedures (as much as possible), and to promote a safe work environment and an adequate ratio between health personnel and the population of patients assisted.
Prevention measures should include joint actions, established between workers and service managers, so as to improve working conditions, especially work organization, to supply materials with safety devices, to repeat serological tests for HIV and hepatitis B and C viruses, and to raise awareness with the purpose of promoting behavioral changes among workers and managers, because isolated actions are considered ineffective to minimize these problems.Moreover, it is necessary to improve the structure of the services responsible for care provision to injured individuals, and also provide full support from exposure to discharge.
Outcomes were favorable, with no notifications of deaths or serological conversion.However, it is worth highlighting the significant percentage of followup withdrawal, evidencing the need of searching for new strategies among the involved sectors in order to reduce these percentages, with the understanding that withdrawal is a multifactorial event.It is also worth observing the need of qualifying the staff responsible for registering information, because it has an impact on investigation, monitoring, and follow-up of worker's health.

2023
Associação Nacional de Medicina do Trabalho This is an open access article distributed under the terms of the Creative Commons license.

Table 2 .
Occupational data of professionals who suffered an occupational accident involving exposure to biological material in Palmas, state of Tocantins, Brazil, notified to the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação, SINAN) from 2010 to 2020 Source: SINAN.

Table 1 .
Socio-demographic characteristics of professionals who suffered occupational accidents involving exposure to biological material in Palmas, state of Tocantins, Brazil, notified to the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação, SINAN) from 2010 to 2020 Source: SINAN

Table 3 .
Characteristics of occupational accidents involving exposure to biological material in Palmas, state of Tocantins, Brazil, notified to the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação, SINAN) from 2010 to 2020 of cases, followed by dentists and other dental professionals (dental office assistant, denturist, oral health assistant in the family health strategy, and dental hygiene technician) (62; 5.31%) and physicians (59; 5.06%). number

Table 4 .
Victims of occupational accidents involving exposure to biological material in Palmas, state of Tocantins, Brazil, notified to the Notifiable Diseases Information System (Sistema de Informação de Agravos de Notificação, SINAN) from 2010 to 2020, according to occupation/professional category