Timeliness and guideline concordance of post-exposure prophylaxis following occupational blood and body fluid exposures at Prince Sultan Military Medical City: a retrospective timestamp-based cohort study (2024-2025)

Sultan Meshal Alruqi; Ammar Hamid Abbas

doi:10.18203/2320-6012.ijrms20263271

Authors

Sultan Meshal Alruqi Department of Infection Prevention and Control, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
Ammar Hamid Abbas Department of Infection Prevention and Control, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263271

Keywords:

Occupational exposure, Needlestick injuries, Post-exposure prophylaxis, Healthcare workers, Guideline adherence, Saudi Arabia

Abstract

Background: Healthcare workers (HCWs) are at increased risk of acquiring bloodborne infections through occupational exposure to blood and body fluids (BBFEs). Prompt post-exposure prophylaxis (PEP) is essential to reduce the risk of transmission yet delays and inconsistent adherence to institutional protocols remain significant concerns. To determine the median exposure-to-reporting delay, the proportion of HCWs reporting within the institutional target of ≤24 hours, assess adherence to PEP guidelines, and identify predictors of delayed reporting.

Methods: A retrospective cohort study was conducted at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia, from January 2024 to December 2025. All HCWs who reported occupational BBFEs with complete exposure and reporting timestamps were included. Data were extracted from occupational health and electronic health records. The primary outcome was exposure-to-reporting delay in hours. Logistic regression identified predictors of delayed reporting (>24 hours).

Results: Among 145 HCWs (mean age 32.6±7.1 years; 74.5% female), the median exposure-to-reporting delay was 504.30 hours (IQR: 1463.88), with only 39.3% reporting within ≤24 hours. Needlestick injuries comprised 88.3% of exposures. HIV PEP was indicated in 47 cases (32.4%), of which 26 (55.3%) were initiated. HBIG was administered in 4 cases (2.8%). Follow-up attendance declined from 37.9% in 6 weeks to 4.1% in 12 months. Delayed reporting was significantly associated with initiation of HIV PEP (p=0.003), HBIG administration (p<0.001), and infectious disease consultation (p<0.001). No demographic or occupational factors predicted delayed reporting.

Conclusions: Substantial gaps exist in the occupational exposure management pathway at PSMMC, with prolonged reporting delays, suboptimal PEP initiation, and poor follow-up adherence. Reporting delays appear systemic rather than attributable to individual HCW characteristics. Urgent improvements in reporting systems, documentation, and follow-up reminders are needed to protect HCWs from preventable infections.

References

Feng H, Mao X, Li M, Mao H. Analysis of characteristic and postexposure practices of occupational blood and body fluid exposures among health care workers in Chinese tertiary hospitals: a retrospective ten-year study. BMC Infect Dis. 2024;24(1):256.

Cheuyem FZ, Mouangue C, Ajong BN, Edzamba MF, Hamadama DC, Achangwa C, Mohamadou A, Sonfack P, Amani A. Occupational Exposures to Blood and other Body Fluids among Healthcare Workers in Cameroon: A Systematic Review and Meta-analysis. medRxiv. 2024;2024-12.

World Health Organization. Occupational exposure to HIV: post-exposure prophylaxis. Geneva: WHO; 2021.

Lu PJ. Surveillance of vaccination coverage among adult populations-United States, 2018. MMWR. Surveillance Summaries. 2021;70.

Zhang L, Collins S, Fox J, von Kleist M. Modelling the impact of initiation delay, duration and prior PrEP usage on the prophylactic efficacy of FTC/TDF-containing post-exposure prophylaxis. medRxiv. 2024;2024-07.

Liu Y, Li Y, Yuan S, Ma W, Chen S, Wang LY. Risk factors for occupational blood exposure, compliance with policies of infection prevention and control, and costs associated with post exposure management among nursing staff. Infection Drug Resist. 2024;1215-28.

Shulakova NI, Tutelyan AV, Akimkin VG. Occupational Risks of Hemocontact Viral Infections for Healthcare Workers: A Systematic Literature Review. Health. 2025(1):172.

Takougang I, Lekeumo Cheuyem FZ, Ze BRS, Tsamoh FF, Moneboulou HM. Awareness of standard precautions, circumstances of occurrence and management of occupational exposures to body fluids among healthcare workers in a regional level referral hospital (Bertoua, Cameroon). BMC Health Services Res. 2024;24(1):424.

Oh HS, Chung HW, Kim JS, Cho SI. National survey of the status of infection surveillance and control programs in acute care hospitals with more than 300 beds in the Republic of Korea. Am J Infect Cont. 2006;34(4):223-33.

Romero-Mora KA, Gómez-Palacio-Schjetnan M, Jiménez-Sánchez LL, Alvarado-de la Barrera C, Murakami-Ogasawara A, Schulz-Medina SE, et al. Increased Occupational Exposure to Body Fluids in Healthcare Workers During the COVID-19 Pandemic: A Retrospective study from 2013 to 2022. Revista Invest Clín. 2025;77(2):55-66.

Changraksa N, Pannapoch L, Phatharodom P, Werarak P, Ratanasuwan W, Navanukroh O. Occupational post-exposure prophylaxis after blood and body fluids exposure among healthcare workers in Siriraj Hospital. Siriraj Med J. 2022;74(11):787-91.

Singh N, Mohapatra I, Pattnaik D, Panda SS, Pradhan R, Mund K, et al. Factors associated with needle stick injuries among healthcare workers: a retrospective study in a tertiary care hospital of Eastern India. Cureus. 2024;16(10):1.

Al-Zahrani MA, Berekaa MM, Al-Warthan M, AlMulla AA. Occupational Exposure to Sharp Object Injuries Among Healthcare Workers in Dammam and Jeddah Hospitals, Saudi Arabia‏. J Multidiscipl Healthcare. 2024;5199-210.

Sula I, Saquib J, Almazrou A, Farhat A, Djoudjou T, Zakaria A, et al. Work-related injuries and compliance with personal protective equipment among migrant workers in Al-Qassim, Saudi Arabia. Industrial Health. 2025;63(3):309-17.

Deva A, Kamarthi P, Hepzibai J, AV J, Madappa BP. Occupational Blood Exposures in Health Care Workers at a Tertiary Teaching Hospital: Incidence, Characteristics and Transmission of Blood Borne Pathogens. J Pure Applied Microbiol. 2020;14(1):1.

Lahuerta M, Selenic D, Kassa G, Mwakitosha G, Hokororo J, Ngonyani H, et al. Reporting and case management of occupational exposures to blood-borne pathogens among healthcare workers in three healthcare facilities in Tanzania. J Infect Prevent. 2016;17(4):153-60.

Alshehri S, Kayal M, Alahmad Almshhad H, Dirar Q, AlKattan W, Shibl A, et al. The Incidence of Needlestick and Sharps Injuries Among Healthcare Workers in a Tertiary Care Hospital: A Cross-Sectional Study. Cureus. 2023;15(4):e38097.

Alshammari FS, Alhaiti A, Alruwaili MM, Mohammed OE, Argungu ZM, Jibreel EA. Needlestick and Sharp Object Injuries among Healthcare Workers in Saudi Arabia. Adv Health Sci Technol J. 2025;1(2):71-8.

Senoo-Dogbey VE, Ohene LA, Wuaku DA. Occupational exposure to Hepatitis B virus, disease burden and pathways for postexposure prophylaxis management: recommendations for healthcare workers in highly endemic settings. Infect Prevent Pract. 2024;6(2):100354.

Avnisha I, Garg P, Malhotra S, Bhatia N, Kaur A, Anand A. Prevalence of needle stick injuries among health care workers in a tertiary care hospital in Delhi, India. Indian J Microbiol Res. 2025;12(1):125-9.