Exposições ocupacionais a HIV e HBV em ambientes odontológicos: revisão sistemática, avaliação da qualidade dos registros de acidentes biológicos e análise descritiva com modelagem por clusters

Abstract

Occupational accidents involving exposure to biological materials constitute an important public health problem, particularly in dental practice, where the intensive use of sharp instruments, close proximity to the oral cavity, and the dynamics of clinical procedures increase the risk of contact with potentially infectious fluids. Among the most relevant hazards are the human immunodeficiency virus (HIV) and the hepatitis B virus (HBV), whose potential for seroconversion underscores the need for continuous surveillance and evidence-based prevention strategies. This doctoral thesis was structured around three complementary methodological approaches, which resulted in independent and interconnected scientific products. The first approach consisted of a global systematic review with meta-analysis aimed at estimating the incidence of occupational HIV seroconversion among healthcare workers exposed to biological materials. The search was conducted in six international bibliographic databases and grey literature, with the protocol registered on the PROSPERO platform. Observational studies were included, and quantitative syntheses were performed using random-effects models, stratified according to type of exposure, use of post-exposure prophylaxis (PEP), and completeness of clinical follow-up, in addition to assessments of risk of bias and certainty of evidence. The results indicated a low incidence of occupational HIV seroconversion, with rare events even following percutaneous exposures, high consistency across studies, and no seroconversion among individuals who used PEP, in contrast to higher, although still rare, rates among those with indication but without PEP use. The second approach corresponded to an evaluation of the quality of information recorded in notification forms for accidents involving exposure to biological material in the Sistema de Informação de Agravos de Notificação (Sinan), referring to dental settings in the municipality of Belo Horizonte between 2006 and 2019. The attributes of completeness, internal consistency, and duplicity were analyzed according to guidelines of the Ministério da Saúde. The analysis showed no duplicate records and high completeness of mandatory variables. However, essential clinical and care-related variables, such as laboratory testing, post-exposure management, and case evolution, exhibited predominantly poor or very poor completeness, as well as relevant inconsistencies, particularly in the “Evolução do caso” field, indicating limitations of the system for infection risk assessment and adequate follow-up of exposed workers. The third approach involved a descriptive observational study based on the same dataset, with characterization of reported exposures and application of the TwoStep Cluster method to identify risk profiles. Exposures occurred predominantly via the percutaneous route during clinical procedures, with incomplete use of personal protective equipment and frequent gaps in the documentation of laboratory tests and post-exposure follow-up. Cluster analysis identified two distinct profiles, one characterized by lower biological risk and another associated with mucosal and non-intact skin exposures, a higher proportion of positive or unknown sources, and less adequate protective barriers, with no recorded seroconversions to HIV, HBV, or HCV. The study was approved by the Comitês de Ética em Pesquisa da Universidade Federal de Minas Gerais (approval no. 6.097.439) and the Secretaria Municipal de Saúde de Belo Horizonte (approval no. 6.161.565).