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Preface/Introduction to AEP book

Preventing Occupational Exposures to Bloodborne Pathogens

Articles from Advances in Exposure Prevention, 1994-2003




 Advances in Exposure Prevention was launched by the International Healthcare Worker Safety Center in 1994 as a forum for rapidly communicating the latest findings from our EPINet multi-hospital database and for discussing government policy, legislative developments, and best practices and devices to prevent occupational exposures to bloodborne pathogens. We also intended AEP to be a resource for government policy-makers and legislators to support initiatives to protect healthcare workers from occupational infection. Over the past ten years AEP has been put to good use in many ways, fulfilling its original objectives. The numerous issues of AEP have been read and circulated, some filed, some scattered to the four winds. Because they represent a coherent body of work, we decided to gather them into a retrospective volume, which we are pleased to present here.

We introduce this volume with our first article published in the New England Journal of Medicine in 1988, “Rates of Needle-Stick Injury Caused By Various Devices in a University Hospital,” which set us on a national course to safer medical device design. We conclude the volume with an article published in the Journal in 2001, “Risks to Health Care Workers in Developing Countries,” which set forth our vision for the future: to bring effective protection to healthcare workers in the farthest reaches of the globe.

The cumulative body of work this book represents traces the history of a critical period when risks to healthcare workers had become more lethal than ever, while at the same time preventive technologies were becoming more effective than ever. It tells the story of the coordinated, and ultimately successful, efforts of researchers, government agencies, medical products manufacturers, professional associations, unions and individual healthcare workers to tip the balance in favor of workplace health and safety.

We thank all those who have contributed their ideas, energy and time to AEPespecially our editorial advisory board and our many colleagues who have written articles for AEP. We particularly want to recognize and thank our colleagues at what was once the Vascular Access unit of Johnson and Johnson—a unit that was first part of a division called Critikon, then Johnson & Johnson Medical, then Ethicon Endo-Surgery. More recently, the vascular access business was sold to Medex, Inc. Their generous financial support for AEP over the last nine years has been unwavering and crucial to our efforts.

BD and Medisystems, Inc., have also been long-time supporters of AEP and the Center, through bulk subscriptions and educational grants. In addition, Medisystems provided some funding for production of this book, for which we are grateful.

One of AEP’s most important roles has been providing a voice for healthcare workers who have experienced the consequences of an occupational blood exposure. Their courage in sharing their experiences in AEP gave names, faces and a heart to this issue, and a sense of urgency to legislators and government policy-makers. They have been a continuing inspiration to us, giving meaning and purpose to our efforts.

We would also like to recognize each hospital that contributed their EPINet surveillance data to our multi-hospital research database; their names are listed in the acknowledgements. The database now includes more than 25,000 blood exposure incidents—each one representing a healthcare worker who reported information on his or her exposure. The database as a whole is the source of much of what we know about the risk of blood exposures to healthcare workers; that knowledge rests on the foundation of individual reports diligently provided by thousands of workers. The surveillance coordinators at each participating hospital made a special contribution of their time and effort to compile, maintain, and transmit data to our center. We thank them and we hope that we have been good custodians of their information.

Our international collaborators have brought depth and perspective to our understanding of healthcare worker risks. In particular, we acknowledge our close collaborators at the SIROH group (Italy’s national program of surveillance and research on occupational risk of HIV and other bloodborne diseases among healthcare workers), directed by Dr. Giuseppe Ippolito; and also our Japanese colleagues, who developed an EPINet-Japan surveillance database on occupational exposures under the direction of Dr. Satoshi Kimura. We have benefited tremendously from the expertise of these colleagues, and the opportunities for comparative research that they have made possible.

We are particularly proud to document the history of healthcare worker protection in the United States. Nationally, we have accomplished something unique in the time interval represented in this volume. Working together, we have brought about a revolution in the safety of medical device design. Healthcare employers are now required by law to provide to workers sharp devices with engineered sharps injury protection. No other country has achieved the level of safety that has become a standard requirement for U.S. healthcare employers. This is an accomplishment we share. But there remains so much more to do beyond our borders. Let us learn from our experience and set our sights high in order to bring these beneficial changes to every healthcare worker around the globe.


                                         Janine Jagger, M.P.H., Ph.D., Editor-in-Chief, AEP

                                         Jane Perry, M.A., Managing Editor, AEP