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)
TL;DR
Substantial gaps exist in the occupational exposure management pathway at PSMMC, with prolonged reporting delays, suboptimal PEP initiation, and poor follow-up adherence needed to protect HCWs from preventable infections.
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.