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Current status and high-risk factors of blood-borne occupational exposure among midwives in China: A cross-sectional survey

  • Author Footnotes
    # These authors contributed equally to this work.
    Jing Li
    Correspondence
    Corresponding author: Jing Li, Delivery ward, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China. Tel: +8618613833206
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Delivery ward, Beijing Ditan Hospital Capital Medical University, Beijing, 100015, China
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    # These authors contributed equally to this work.
    Haixia Zhang
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Nursing Department, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
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  • Author Footnotes
    # These authors contributed equally to this work.
    Yanhua Zhang
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Intensive care unit, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
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    # These authors contributed equally to this work.
    Lijuan Wang
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    # These authors contributed equally to this work.
    Affiliations
    Emergency Room, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
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  • Author Footnotes
    # These authors contributed equally to this work.
    Li Li
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Obstetrics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
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  • Meiling Chen
    Affiliations
    Medical Record Statistics Department, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
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    # These authors contributed equally to this work.
Open AccessPublished:June 12, 2022DOI:https://doi.org/10.1016/j.ajic.2022.06.009

      Highlights

      • Blood-borne occupational exposure among midwives in China: A cross-sectional survey
      • A total of 2743 midwives were investigated in this study; the incidence rate of blood-borne occupational exposure was 46.77%
      • Midwives are at high risk of blood-borne occupational exposure, and midwives with ≤ 5 years of service had the highest risk
      • The treatment after occupational exposure is not standardized

      Abstract

      Background

      To identify the problems and high-risk factors of blood-borne occupational exposure among midwives in China.

      Methods

      Midwives from the obstetrics department and delivery room of hospitals in institutions. The self-compiled questionnaire on the current status of blood-borne occupational exposure of Chinese midwives was used for data collection.

      Results

      The incidence rate of blood-borne occupational exposure was 46.77%. The independen risk factors were working years≤ 5 years (p=0.001), unable to take standard prevention at work (p=0.000), unaware of HIV treatment procedures (p=0.000), and average daily working hours of 8 hours (p=0.002), the high risk of blood-borne occupational exposure at work (p=0.000), and contact with patient fluids, blood without gloves (p=0.000).

      Discussion

      Midwives are at high risk of blood-borne occupational exposure, and midwives with ≤ 5 years of service are the focus group.Failure to achieve standard prevention,the length of working hours and the ignorance of the treatment process of AIDS have a certain impact on the occurrence of blood-borne occupational exposure.

      Conclusion

      It is necessary to focus on cultivating high-level midwifery talents to overcome the shortage of midwives and rationally use midwifery resources, as well as to strengthen standard prevention and improve the occupational protection and guarantee system for midwives.

      Keywords

      Background

      Blood-borne occupational exposure of medical personnel refers to the harm caused by the exposure of medical and health workers to blood, body fluids, and laboratory culture fluids in the process of diagnosing, treating, nursing, preventing, testing and managing diseases
      • Subramanian GC
      • Arip M
      • Saraswathy Subramaniam TS.
      Knowledge and Risk Perceptions of Occupational Infections Among Health-care Workers in Malaysia.
      . Nurses are especially at high risk for blood-borne occupational exposure. According to a previous one-year cross-sectional study, the incidence of occupational exposure of nurses after exposure to blood and body fluids is as high as 65.3%
      • Abere G
      • Yenealem DG
      • Wami SD.
      Occupational Exposure to Blood and Body Fluids among Health Care Workers in Gondar Town, Northwest Ethiopia: A Result from Cross-Sectional Study.
      . Due to the specific nature of their work, midwives are more frequently exposed to patients' blood, bodily fluids, secretions, amniotic fluid, and sharps than general ward nurses, and their risk of blood-borne occupational exposure is greater
      • Han Y
      • Jin GC
      • Sun JW
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      A longitudinal study of predictors of psychological stress after blood-borne occupational exposure in medical staff.
      . Once midwives are exposed to blood, it increases their perceived stress and may even lead to psychological stress disorders such as post-traumatic stress disorder, anxiety, and depression, which can seriously affect work and quality of life
      • Mashoto KO
      • Mubyazi GM
      • Mushi AK.
      Knowledge of occupational exposure to HIV: a cross sectional study of healthcare workers in Tumbi and Dodoma hospitals, Tanzania.
      . The occupational safety of midwives has attracted increasing attention. Considering these midwives are facing occupational hazards, researching practical measures to ensure the occupational safety of midwives is of great importance. Therefore, in order to understand the current situation of blood-borne occupational exposure of midwives in China and to identify the problems and risk factors of blood-borne occupational exposure of midwives, we investigated the blood-borne occupational exposure of midwives across 29 provinces, municipalities, and autonomous regions so as to provide a relevant reference for the education, training and security system of occupational protection of midwives in the future.

      Material and methods

      Subjects

      This study adopted the judgment sampling method. Between February 2019 and February 2021, experts from the Infectious Diseases Nursing Professional Committee of the Chinese Nursing Association decided to investigate the provinces, autonomous regions, and municipalities directly under the Central Government according to the research purposes. The survey units were selected from the institutions where some members of the Nursing Professional Committee belonged(they tended to skew more towards academic centers, cities, etc.). A questionnaire survey was conducted covering obstetric departments and delivery rooms of hospitals across 29 provinces, municipalities, and autonomous regions in China. Inclusion criteria were the following: (i) registered nurse midwives employed in hospitals; (ii) informed of the scope of the survey and volunteered to participate. Exclusion criteria were: (i) long-term sick leave (> 6 months), leaving the post of midwives; (ii) training midwives and trainee midwives.
      This study complied with the requirements of the Declaration of Helsinki. Human research ethics approval was obtained from XXX Hospital. Consent was implied through the completion of the survey. The anonymity of participants was assured no identifying information were collected.

      Measures

      After consulting domestic and foreign policies, regulations, guidelines, and other relevant books and literature
      • Mashoto KO
      • Mubyazi GM
      • Mushi AK.
      Knowledge of occupational exposure to HIV: a cross sectional study of healthcare workers in Tumbi and Dodoma hospitals, Tanzania.
      ,
      • Scaggiante R
      • Chemello L
      • Rinaldi R
      • et al.
      Acute hepatitis C virus infection in a nurse trainee following a needlestick injury[J].
      ,
      • Varghese G M
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      Post—exposure prophylaxis for blood borne viral infections in healthcare workers[J].
      ,
      Ministry of health of the people's Republic of China
      Guidelines for occupational exposure protection against blood borne pathogens [s].
      , the researchers made the first draft of the questionnaire and consulted 5 experts in related fields of the Infectious Disease Nursing Professional Committee of the Chinese Nursing Association through the Delphi method, including 2 with intermediate titles, 2 with senior deputy titles, and 1 with senior titles so as to design a questionnaire on the current situation of blood-borne occupational exposure of midwives in China. In the form of on-site answers, 200 questionnaires were distributed for pre investigation. After collecting and sorting out the data, they were revised again according to the feedback content, and finally a formal occupational exposure management questionnaire was formed, a questionnaire on the current situation of blood-borne occupational exposure of Chinese midwives was formed. The content included: (i) the general information of the midwives, including the title, working years, nature of the hospital, etc.; (ii) basic knowledge of blood-borne occupational exposure: knowledge of standard precautions, blood-borne occupational exposure treatment procedures, HIV post-exposure prophylaxis medication time, needle stick injury Wound treatment, post-treatment of mucosal exposure; (iii) the risk assessment status of blood-borne occupational exposure: the number of people who were exposed to blood-borne occupational exposure, the location of blood-borne occupational exposure, the method of blood-borne occupational exposure, the route of blood-borne occupational exposure, cause of exposure and whether to report it. The Content validity index (CVI) and Cronbach′sαof the questionnaire were 0.87 and 0.82, respectively.

      Data collection

      The heads of the infectious disease nursing committee of the Chinese Nursing Association, who underwent unified training, distributed and collected the questionnaire online. The questionnaire was filled out by the midwife in the delivery room/obstetrics department, who were asked to carefully read the purpose of the study and the precautions for filling in the questionnaire before completing the questionnaire. If they had any questions, they could consult the person in charge by e-mail or telephone. All of the online questionnaire questions were set as mandatory questions, and the questionnaire could only be submitted after all the filling was completed. The questionnaires were screened for logic after they were completed, and the questionnaires with obvious errors were eliminated. Among a total of 2850 distributed questionnaires, 2743 valid questionnaires were obtained, resulting in an effective rate of 96.24%.

      Statistical analyses

      A database was established using Epidata. SPSS 22.0 was used for all statistical analyses. Qualitative were described by frequency and rate, and the Chi-square test was used for comparison between groups. Significant factors in univariate analysis were analyzed by binary logistic regression method, and p < 0.05 was considered statistically significant.

      Results

      The basic situation of blood borne occupational exposure of midwives

      A total of 2743 midwives were investigated in this study; the incidence rate of blood-borne occupational exposure was 46.77% (1283/2743). There were 305 (23.77%) people with working years ≤5 years, 444 (34.60%) people with 5-10 years of experience, 336 (26.19%) people in 10-20 years, 198 (15.43%) people in >20 years.The main body parts affected by blood-borne exposure and respective incidence rates were as follows: hands, 97.66% (1253/1283). The main reasons for the occurrence of blood-borne occupational exposure among midwives were improper handling of sharp instruments (60.80% (780/1283)) . The main methods of blood-borne occupational exposure of midwives were: discarded sharps in 55.73% cases (715/1283), needles in 52.14% cases (669/1283). The routes of blood-borne occupational exposure of midwives were skin exposure in 96.80% (1242/1283) cases. The main reasons why midwives did not report blood-borne exposure in a timely manner were the fact that patients were clearly without infectious diseases in 69.47% of cases (339/1283) (Table 1).
      Table 1Investigation of blood-borne occupational exposure
      VariableNumberProportion (%)VariableNumberProportion (%)
      Reason for not wearing glovesCause of occupational exposure
      Busy, too late7659.84%Operational inattention52741.08%
      Unconscious gloving1511.81%No safe injection device

      in hospital
      25419.80%
      Inconvenient operation8768.50%Safe injection device

      in hospital but not used
      14511.30%
      Departmental

      cost control
      3124.41%Operation environment disorder

      or insufficient light
      35927.98%
      Other53.94%Improper sharps handling78060.80%
      Occupational exposure siteNon-standard operation41432.27%
      Hand125397.66%Uncooperative patient71055.34%
      Foot1058.18%Other685.30%
      Eye27621.51%Mode of Occupational Exposure
      Forearm14411.22%Needle Double Cap53942.01%
      Other171.33%When disposing of waste sharps71555.73%
      Reasons for not timely reportingUpon Needle Removal66952.14%
      Not aware of an escalation process336.76%At suture35827.90%
      Cumbersome procedure17335.45%When passing sharps21716.91%
      Definitely not an infectious disease33969.47%Accidental injury by others35227.44%
      Patient fluke psychology, will not infect12826.23%Secretion/blood splashing66051.44%
      Fear of being criticized306.15%Patient scratch36128.14%
      Fear of discrimination81.64%Other272.10%
      Other336.76%Routes of Occupational Exposure
      Dermal Exposure124296.80%
      Mucosal exposure66251.60%
      Other201.56%

      A one-factor analysis of blood-borne occupational exposure in midwives

      The general data of midwives with blood-borne occupational exposure and midwives without blood-borne occupational exposure were analyzed for influencing factors. The results showed that midwives' professional title, working years, whether they could do standard prevention at work, whether they knew about the treatment process of AIDS, the duration of prophylactic drug use after HIV blood-borne occupational exposure and the longest duration of prophylactic use after HIV blood-borne occupational exposure, the average daily working hours, risk of blood-borne occupational exposure at work, exposure to patient body fluids, and whether midwives wore gloves when coming in contact with blood were nine single factors affecting the occurrence of blood-borne occupational exposure of midwives; the observed difference was statistically significant (p<0.05) (Table 2).
      Table 2Univariate analysis of blood-borne occupational exposure in midwives
      VariableYesNoχ2pVariableYesNoχ2p
      n=1283 (%)n=1460 (%)n=1283 (%)n=1460 (%)
      TitleFor how long the prophylactic medication should be given after HIV blood-borne occupational exposure
      Primary825 (42.6)1110 (57.4)46.4590.0002 hours554 (44.2)669 (55.8)22.5080.000
      Intermediate402 (56.0)316 (44.0)4 hours160(41.6)225(58.4)
      Sub-high and above56 (62.25.5)34 (37.8)24 hours452(50.4)444(49.6)
      Years of workThe maximum duration of prophylaxis after blood-borne occupational exposure to HIV
      ≤5305 (35.9)544 (64.1)70.5710.0002 hours72 (46.2)84 (53.8)23.7120.000
      5-10444 (48.4)473 (51.6)4 hours26 (40.0)39 (60.0)
      10-20336 (52.3)307 (47.7)24 hours603 (43.6)779 (56.4)
      >20198 (59.3)136 (40.7)72 hours435 (48.8)457 (51.2)
      Hospital natureUnknown147 (59.3)101 (40.7)
      Public hospital1240 (46.8)1412(53.2)0.0130.994Correct handling of wounds after needle stick exposure
      Private Hospital32 (47.1)36(52.9)Unknown338 (52.0)312 (48.0)0.5140.473
      Other11 (47.8)12 (52.2)Aware1122 (53.6)971 (46.4)
      Awareness Standard PreventionCorrect handling of wounds after mucosal exposure
      No94 (48.5)100 (51.1)0.2360.627Unknown643(45.4)773(54.6)2.187O.139
      Yes1189 (46.6)1360 (53.4)Aware640(48.2)687(51.8)
      Standard prevention can be achievedWorking hours per day
      No284 (59.2)196 (40.8)35.8990.0008 hours608 (42.5)824 (57.5)3.0000.000
      Yes999 (44.1)1264 (55.9)8-10 hours555 (52.1)511 (47.9)
      Process for Handling Occupational Exposure to AIDS10-12 hours85 (51.5)80 (48.5)
      Unknown188 (57.0)142 (43.0)15.6420.000More than 12 hours35 (43.8)45 (56.3)
      Aware1095 (45.4)1318 (54.6)Job Hazard Level
      Process for Handling Occupational Exposure to HBVLow29 (35.4)53 (64.6)42.4860.000
      Unknown54 (39.1)84 (60.9)3.4440.067General289 (37.8)476 (62.2)
      Aware1229 (47.2)1376 (52.8)High965 (50.9)931 (49.1)
      Process for Handling Occupational Exposure to HCVWearing gloves when contacting patient's body fluid and blood
      Unknown399 (49.1)414 (50.9)2.4610.117No78(61.4)49(38.6)78.9290.000
      Aware884 (45.8)1046 (54.2)Occasionally370(60.6)241(39.4)
      Process for Handling Occupational Exposure to RPRYes835(41.6)1170(58.4)
      Unknown251 (52.6)226(47.4)7.9120.005
      Aware1032 (45.5)1234(54.5)

      Multifactorial analysis of blood-borne occupational exposure in midwives

      Binary Logistic model was used for regression analysis, with the occurrence of blood-borne occupational exposure of midwives as the dependent variable and the variables with statistical significance in the χ2 test as independent variables. The pseudo R2 of this regression model was 0.175, and the overall correct percentage of the model is 65%. It was comprehensively judged that the model fitting effect was good. Regression analysis revealed that 6 factors, i.e., working years ≤ 5 years, failure to achieve standard prevention at work, lack of awareness of the treatment process of AIDS, average daily working hours of 8 hours, high risk of blood-borne occupational exposure at work, contact with patients' bodily fluids and blood without gloves, were independent risk factors affecting the occurrence of hematogenic occupational exposure in midwives (Table 3).
      Table 3Logistic regression analysis of hematogenous occupational exposure in midwives
      VariableβSEWaldpOR95%CI
      constants-0.0480.4380.0120.9120.953
      TitlePrimary3.8840.143
      Intermediate-0.4140.2782.2130.1370.6610.383-1.140
      Sub-high and above-0.1900.2570.5500.4580.8270.500-1.367
      Years of work≤515.9410.001
      5-10-0.6630.3753.1250.0770.5150.247-1.075
      10-20-0.1830.3540.2680.6050.8330.416-1.666
      >200.0180.3280.0030.9571.0180.535-1.935
      Awareness Standard PreventionNo25.2590.000
      Yes0.7490.14128.1830.0002.1151.604-2.788
      Process for Handling Occupational Exposure to AIDSUnknown11.1350.000
      Aware0.3790.1298.7050.0031.4611.136-1.880
      Working hours per day8 hours14.3930.002
      8-10 hours-0.1480.2470.3560.5510.8630.531-1.401
      10-12 hours0.1390.2490.3120.5771.1490.705-1.873
      More than 12 hours0.3000.2901.0710.3011.3490.765-2.380
      Job Hazard LevelLow34.9680.000
      General-0.5820.2485.5280.0190.5590.344-0.908
      High-0.5240.09331.8790.0000.5920.494-0.710
      Wearing gloves when contacting patient's body fluid and bloodNo50.3780.000
      Occasionally0.6560.19711.1090.0011.9281.310-2.836
      Yes0.6710.10044.5500.0001.9561.606-2.381

      Discussion

      Midwives are at high risk of blood-borne occupational exposure, and midwives with ≤ 5 years of service are the focus group

      The results showed that midwives were a high-risk group of blood-borne occupational exposure, and the incidence of bloodborne occupational exposure among midwives was 46.77%. The regression analysis revealed that working years ≤ 5 years was an independent risk factor for blood-borne occupational exposure in midwives, which was associated with insufficient awareness of the severity of blood-borne diseases, lack of experience, irregular operation, unskilled technique, unstable psychological quality, lack of awareness of occupational protection, and lack of relevant knowledge in junior midwives. In addition, needle stick injuries and skin injuries were more likely to occur among midwives with ≤ 5 years of working experience. Among the departments with higher occupational hazards, the delivery room ranks second
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      Safety culture and exposure to blood and body fluids among paramedics.
      . Our results showed that 97.66% of blood-borne occupational exposure sites in midwives were on hands (including fingers, wrists, and palms), 96.80% on the skin, while 55.73% occurred when sharp waste was handled, which was basically consistent with previous studies
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      found that 93% of occupational injuries could be reduced by operational training. Therefore, occupational protection training should be used as one of the essential courses for midwives' pre-employment training to strengthen their knowledge and skills related to blood-borne occupational exposure. The midwives should be regularly assessed on their occupational protection knowledge, processing procedures, and infectious disease prevention and control so as to ensure that occupational safety and health protection education is always at the highest levels throughout the career of the midwives
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      Failure to achieve standard prevention at work and contact with patient's body fluids and blood without wearing gloves is a high-risk behavior during which blood-borne occupational exposure occurs

      Our results showed that the failure to achieve standard prevention at work, and contact with patients' bodily fluids and blood without gloves, were independent risk factors for midwives to develop blood-borne occupational exposure. It was found that 34.91% of midwives were exposed to bodily fluids and blood without or occasionally wearing gloves, which is basically consistent with Olubyide's findings
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      WHO Guidelines Approved by the Guidelines Review Committee. WHO Guideline on the Use of Safety-Engineered Syringes for Intramuscular, Intradermal and Subcutaneous Injections in Health-Care Settings. Geneva: World Health Organization Copyright © World Health Organization 2015.; 2015.

      showed that the incidence of sharps injury was related to compliance with standard prophylaxis. Standard precautions are recognized worldwide as the most basic and effective method for preventing and controlling nosocomial infections, protecting health care workers, patients, and public safety

      Departments RJDoH, Richmond House, 79 Whitehall, London SW1A 2NJ, UK, [email protected] Guidance for clinical health care workers: protection against infection with blood-borne viruses. 2000.

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      From the Centers for Disease Control and Prevention
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      . Previous studies have shown that double gloves can reduce exposure to 95% of the blood on the surface of sharp instruments, and wearing protective glasses can prevent pollutants such as blood and amniotic fluid from directly splashing into the eyes
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      The length of working hours in midwifery and the high degree of job risk have a certain impact on the occurrence of blood-borne occupational exposure

      Our regression analysis revealed that working some 8 hours per day (47.38%) and high job risk level were independent risk factors for blood-borne occupational exposure (p<0.05). In addition, the number of midwives with blood-borne occupational exposure was higher than that without blood-borne occupational exposure during the working hours at each time period, which was related to the shortage of human resources of midwives. According to the 2014 report on the status of midwifery in the world

      Organization WH. The state of the world's midwifery 2014: A universal pathway - a woman's right to health. 2014.

      , providing professional midwifery services for every pregnant woman is the most effective measure to reduce maternal and neonatal mortality. According to World Health Organization (WHO) recommendations, six midwives are needed for every 1000 births. The ratio of midwives to births in China is only 1/4 000, and there is a serious shortage of midwifery human resources

      Lei HU, Jiang M, Xinfen XU, Yang W, Luo B. Investigation on the current situation of midwives human resources in China.

      . Currently, the problem of "imbalance of midwifery human resources" is widespread in many countries around the world, and the human resources crisis has become an urgent global health problem
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      . When there is unbalanced resource allocation of midwives and insufficient capital chain allocation, in order to save human resource costs, midwives are forced to sacrifice their rest time to improve work efficiency. The results showed that the number of blood-borne occupational exposures in midwifery posts with high risk was 33 (965/29) times higher compared to posts with low risk, which may be related to the different work categories of midwives. The International Confederation of Midwives (ICM) defines midwives as trusted professionals who, through partnerships with women, provide women with essential support, care, and counseling during pregnancy and during and after delivery. They also provide midwifery, newborn care, and continuous services for pregnant women within the scope of their responsibilities

      Nurse-Midwifery NJJo. INTERNATIONAL DEFINITION OF MIDWIFE. 1973;18:29-34.

      . The risk degree of midwives responsible for counseling and education during pregnancy is relatively low, while the risk degree of midwives responsible for delivery and postpartum delivery and caring for newborns is relatively high, as they have more contact with blood-borne occupational exposure sources such as blood, body fluids and amniotic fluid, and a higher proportion of blood-borne occupational exposure. Accordingly, midwifery institutions should establish cooperative relations with universities to cultivate midwifery talents in a targeted manner. At the same time, nursing managers should adopt a dynamic, flexible scheduling system according to the maternal situation so as to achieve a rational use of midwifery resources and further optimize the allocation of human resources for midwives.

      The treatment after occupational exposure is not standardized, and the ignorance of the treatment process of AIDS has a certain impact on the occurrence of blood-borne occupational exposure

      Our results revealed that the reporting rate of midwives after occupational exposure was 45.05%, which was lower than the reported 75.62% of medical staff in 101 hospitals in Shanghai, China, in 2018
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      . The main reasons for failure in timely reporting were that 69.47% of patients with infectious diseases could not be identified, and 35.45% were cumbersome procedures. Midwifery institutions should strengthen perinatal health care and standardize the results of prenatal infectious disease screening and blood tests for pregnant and lying-in women. For those with infectious diseases, isolated and clearly marked delivery rooms should be arranged. The information-based occupational exposure reporting process is adopted to increase the timeliness of reporting and achieve refined management after occupational exposure
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      . Unawareness of HIV management (14.63%) resulted as an independent risk factor for blood-borne occupational exposure, which is slightly higher than that reported by Sin et al (10.4%)
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      found that 24.59% of the medical staff in Tianjin, China, did not have the relevant knowledge on AIDS prevention and treatment. HIV accounts for 4.90% of blood-borne exposure sources, and midwives are a high-risk group for human immunodeficiency virus (HIV) infection
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      • Elkarim MA.
      Hazards analysis, within departments and occupations, for hepatitis B virus among health care workers in Public Teaching Hospitals in Khartoum State; Sudan.
      . Since there is no effective vaccine for the prevention of AIDS, the current specific treatment methods for prevention of HIV infection are routine topical treatment within 24 hours and post-exposure prophylaxis (PEP) medication. UNAIDS Annual World AIDS Day Report clearly states that the global epidemic of AIDS needs to be ended in 2030 to maximize the detection of infected individuals and reduce transmission. The increasing number of visits to HIV-infected people increases the risk of hematogenous occupational exposure to HIV. HIV-infected people are still largely discriminated in society, which causes serious physical and mental damage and a great psychological burden. Therefore, midwives who have potential HIV occupational infection risk may be under much stress. It is particularly important for midwives to timely self-assess and correct treatment after HIV blood-borne occupational exposure. Accordingly, it is necessary to combine simulation technology and information software to deliver diversified and multi-form knowledge training, thus improving the awareness rate of occupational exposure protection knowledge such as AIDS treatment processes.
      This study has also a few limitations. The mental health of midwives was not investigated, so future prospective high-quality studies are needed to examine the effect of psychosocial factors on occupational protection of midwives. Currently, there is no multi-center cross-sectional study on midwives' personality traits, psychological resilience levels, and social support effects. Future studies should use psychological techniques to reduce the group pressure of midwives. Also, the psychological capital construction of midwives should be longitudinally studied to reduce blood-borne occupational exposure and strengthen the effectiveness of occupational protection, thus achieving the best occupational protection effect at reasonable socioeconomic costs.

      Conclusion

      Our results revealed that the incidence of blood-borne occupational exposure among midwives was high, and the occupational protection level of midwives working ≤ 5 years needs to be improved. At the same time, it is necessary to cultivate high-level midwifery talents to overcome the shortage of midwives, rationalize the use of midwifery resources, strengthen standard protection, and improve the occupational protection guarantee system for midwives. It is especially important to establish the protection system and focus on the effective use and innovation of protective equipment and the development of the protection knowledge system and perfection.

      Funding

      None.

      Availability of data and materials

      The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

      Ethical statement

      This study complied with the requirements of the Declaration of Helsinki. Human research ethics approval was obtained from Beijing Ditan Hospital affiliated with Capital Medical University. Consent was implied through the completion of the survey. The anonymity of participants was assured as no name-related data were collected.

      Authors' contributions

      Jing Li and Haixia Zhang carried out the studies, participated in collecting data, and drafted the manuscript. Meiling Chen and Li Li performed the statistical analysis and participated in its design. Yanhua Zhang and Lijuan Wang participated in acquisition, analysis, or interpretation of data and draft the manuscript. All authors read and approved the final manuscript.

      Declaration of Competing Interest

      The authors declare that they have no competing interests.

      Acknowledgements

      None.

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