Bibliography
April 2008
1. Aisaka K, Itabashi K, Nagasaka K., Kuroda K, Arita S, Takane
V. Influence of Novel Blunt Needles (Ethiguard) on Safety for Gynecologic
Operations. Obstetrics & Gynecology 2008; 109(4 (supplement)):25S.
ABSTRACT: OBJECTIVE: The present study was performed to evaluate the safety
of the Ethiguard (a new type of blunt needle) by measurement of the resistance
to puncture using a surgical rubber glove and chicken breast meat.
METHODS: The resistance of a
surgical glove and chicken breast meat (5 mm and 10 mm thick) to being
punctured by three needles, a conventional round needle (J-765D), Ethiguard
CTXB (circle taper extra large blunt), and a usual type of blunt needle (BP-1)
was measured by the computer control system autograph (AGS-100B; Shimadzu
Company, Tokyo, Japan). This procedure was repeated 10 times on each material.
RESULTS: The values measured for
the resistance of the surgical glove to being pierced by the three needles were
27.110.1, 17515.4, and 352.421.7 g, respectively (P.001). In contrast,
the resistance of the 5-mm and 10-mm chicken breast meat test pieces to being
pierced by the blunt needle was found to be significantly greater than their
resistance to being pierced by the other two needles (5 mm: 13.82.7, 18.64.2,
45.95.5 g, P.001; 10 mm: 32.44.2, 37.85.8, 77.96.8 g, P.001).
These results demonstrated that the Ethiguard was less likely than the
conventional round needle to puncture a surgical glove, but it had the same capacity
as the conventional round needle to penetrate tissue.
CONCLUSION: The use of the
Ethiguard is effective in preventing needle-stick accidents but still
penetrates tissues satisfactorily, and also it is effective in protecting
against such infections as human immunodeficiency virus (HIV) and hepatitis C
virus (HCV).
2. Alamgir H, Cvitkovich Y, Astrakianakis G, Yu S, Yassi A.
Needlestick and other potential blood and body fluid exposures among health
care workers in British Columbia, Canada. Am J Infect Control 2008;
36(1):12-21.
ABSTRACT: BACKGROUND: Health care
workers have high risk of exposure to human blood and body fluids (BBF) from
patients in acute care and residents in nursing homes or personal homes.
METHODS: This analysis examined the epidemiology for BBF exposure across health
care settings (acute care, nursing homes, and community care). Detailed
analysis of BBF exposure among the health care workforce in 3 British Columbian
health regions was conducted by Poisson regression modeling, with generalized
estimating equations to determine the relative risk associated with various
occupations. RESULTS: Acute care had the majority of needlestick, sharps, and
splash events with the BBF exposure rate in acute care 2 to 3 times higher
compared with nursing home and community care settings. Registered nurses had
the highest frequency of needlestick, sharps, and splash events. Laboratory
assistants had the highest exposure rates from needlestick injuries and
splashes, whereas licensed practical nurses had the highest exposure rate from
sharps. Most needlestick injuries (51.3%) occurred at the patient's bedside.
Sharps incidents occurred primarily in operating rooms (26.9%) and at the
patient's bedside (20.9%). Splashes occurred most frequently at the patient's
bedside (46.1%) and predominantly affected the eyes or face/mouth. The majority
of needlestick/sharps injuries occurred during use for registered nurses,
during disposal for licensed practical nurses, and after disposal for care
aides. CONCLUSION: The high risk of BBF exposure for some occupations indicates
there is room for improvement to reduce BBF exposure by targeting high-risk
groups for prevention strategies
3. Apisarnthanarak A, Babcock HM, Fraser VJ. The effect of
nondevice interventions to reduce needlestick injuries among health care
workers in a Thai tertiary care center. Am J Infect Control 2008; 36(1):74-75.
ABSTRACT: To the Editor: It
is estimated that more than 380,000 needlestick injuries (NSIs) are reported by
hospital staff members each year in the United States.1 In
developing countries, health care workers (HCWs) face even greater risks
because of the higher prevalence of bloodborne pathogens and the use of certain
medical equipments, such as nonretracting finger-stick lancets and glass
capillary tubes to test for common tropical diseases.[2]
and [3] Although safety-engineered devices have been incorporated
to help reduce NSIs in the United States, the role of such devices in
developing countries remains controversial.
4. Boal WL, Leiss JK, Sousa S, Lyden JT, Li J, Jagger J. The
National study to prevent blood exposure in paramedics: Exposure reporting. Am
J
ABSTRACT: BACKGROUND: This survey
was conducted to provide national incidence rates and risk factors for exposure
to blood among paramedics. The present analysis assesses reporting of exposures
to employers. METHODS: A questionnaire was mailed in 2002-2003 to a national
sample of paramedics selected using a two-stage design. Information on exposure
reporting was obtained on the two most recent exposures for each of five routes
of exposure. RESULTS: Forty-nine percent of all exposures to blood and 72% of
needlesticks were reported to employers. The main reason for under-reporting
was not considering the exposure a "significant risk." Females
reported significantly more total exposures than males. Reporting of
needlesticks was significantly less common among respondents who believed most
needlesticks were due to circumstances under the worker's control. Reporting
was non-significantly more common among workers who believed reporting
exposures helps management prevent future exposures. Reporting may have been
positively associated with workplace safety culture. CONCLUSIONS: This survey
indicates there is need to improve the reporting of blood exposures by
paramedics to their employers, and more work is needed to understand the
reasons for under-reporting. Gender, safety culture, perception of risk, and
other personal attitudes may all affect reporting behavior. Am. J. Ind. Med.
51:213-222, 2008. (c) 2008 Wiley-Liss, Inc
5. Byass P, D'Ambruoso L. Cellular telephone networks in
developing countries. The Lancet 2008; 371(9613):650-642.
ABSTRACT: While undertaking
community-based follow-ups of maternal deaths in Burkina Faso and Indonesia, we
were struck by the irony of sitting in some of the world's poorest households,
wherein many mothers had died after failing to access health services, and yet
where good cellular telephone signals were available (figure). From such
households it is possible to call anywhere in the world-but there is generally
no designated emergency number nor means of getting medical advice or
assistance via a portable telephone
6. Chopra M, Munro S, Lavis JN, Vist G, Bennett S. Effects of
policy options for human resources for health: an analysis of systematic
reviews. The Lancet 2008; 371(9613):668-674.
ABSTRACT: Background: Policy makers face challenges to ensure an appropriate
supply and distribution of trained health workers and to manage their
performance in delivery of services, especially in countries with low and
middle incomes. We aimed to identify all available policy options to address
human resources for health in such countries, and to assess the effectiveness
of these policy options.
Methods: We searched Medline and
Embase from 1979 to September, 2006, the Cochrane Library, and the Human
Resources for
Findings: 28 of the 759
systematic reviews of effects that we identified were eligible according to our
criteria. Of these, only a few included studies from countries with low and
middle incomes, and some reviews were of low quality. Most evidence focused on
organisational mechanisms for human resources, such as substitution or shifting
tasks between different types of health workers, or extension of their roles;
performance-enhancing strategies such as quality improvement or continuing
education strategies; promotion of teamwork; and changes to workflow. Of all
policy options, the use of lay health workers had the greatest proportion of
reviews in countries with a range of incomes, from high to low.
Interpretation: We have
identified a need for more systematic reviews on the effects of policy options
to improve human resources for health in countries with low and middle incomes,
for assessments of any interventions that policy makers introduce to plan and
manage human resources for health, and for other research to aid policy makers
in these countries
7. Crisp N, Gawanas B, Sharp I. Training the health workforce:
scaling up, saving lives. The Lancet 2008; 371(9613):689-691.
ABSTRACT: Over a billion people
worldwide have little or no access to health services and the help and advice
of health workers. There is good evidence that health workers affect health
outcomes. The density of health workers is significant in accounting for rates
of maternal mortality, infant mortality, under-5 mortality, and immunisation
rates across countries. Similarly,
assessments of disease-oriented country programmes have found that the lack of
health workers is one of the major bottlenecks in implementing evidence-based
interventions to improve maternal and child health, and to address HIV/AIDS,
malaria, and tuberculosis. There is also evidence for the effectiveness of
specific cadres of health workers, including community and mid-level
workers. But, as the 2006 World Health
Report, Working Together for Health,highlighted, there is a global
shortage of some 4·3 million health workers, with the greatest shortages in the
poorest countries.
The causes of the crisis are many, from a global rise in chronic disease and an
ageing population, to poor local working conditions and international
migration.6 But the massive shortfall in production of
trained health workers underpins all other problems. To take one example,
8. Doull L, Campbell F. Human resources for health in fragile
states. The Lancet 2008; 371(9613):626-627.
ABSTRACT: Human resources are
crucial for a functioning health system. The global shortage of health workers
is evident in many developing countries, especially in. fragile states-countries whose governments,
for various reasons, cannot or will not deliver core functions to most of the
population. Building and retaining a
skilled and motivated health workforce is particularly challenging in settings
where staff might be under extreme pressure (eg, during conflicts, long-term
underinvestment in the health sector, and the HIV/AIDS epidemic). Furthermore,
for health professionals, there are growing opportunities that encourage movement
from fragile states to search for better professional and economic
environments. The results are shortages of health staff and an inability to
provide even basic health care.
9. Gershon RR, Pogorzelska M, Qureshi KA, Sherman M. Home health
care registered nurses and the risk of percutaneous injuries: a pilot study. Am
J Infect Control 2008; 36(3):165-172.
ABSTRACT: BACKGROUND: Home health
care is the fastest-growing sector in the health care industry, expected to
grow 66% over the next 10 years. Yet data on occupational health hazards,
including the potential risk of exposure to blood and body fluids, associated
with the home care setting remain very limited. As part of a larger study of
bloodborne pathogen risk in non-hospital-based registered nurses (RNs), data
from 72 home health care nurses were separately analyzed to identify risk of
blood/body fluid exposure. METHODS: A 152-item self-administered mailed risk
assessment questionnaire was completed by RNs employed in home health care
agencies in
10. Glassman A, Becker L, Makinen M, de
Ferranti D. Planning and costing human resources for health. The Lancet 2008;
371(9613):693-695.
ABSTRACT: Human resources are
crucial for the provision of health care and represent the largest single use
of public spending on health in developing countries. Yet countries face an ongoing challenge when
it comes to financing human resources for health (HRH) sufficiently to sustain
an adequate supply of health workers and stimulate greater productivity and
more effective health care.
Several papers prepared for the 2006 World Health Report and the Global Health
Workforce Alliance describe the HRH financing gap and the variables such as
economic growth, government revenues, aid, fiscal sustainability targets, and
priority-setting practices that affect the ability of governments and donors to
increase spending on this input.
Inspired by the global HRH movement, some countries, mostly in
11. Hagopian A, Micek MA, Vio F, Gimbel-Sherr
K, Montoyo P. What if we decided to take care of everyone who needed treatment?
Workforce planning in
ABSTRACT: ABSTRACT: BACKGROUND: The growing AIDS epidemic in southern
ABSTRACT: BACKGROUND: Acquiring a
blood-borne disease is a risk of performing operations. Most data about
seroconversion are based on hollow-bore needlesticks. Some studies have
examined the inoculation volumes of pure blood delivered by suture needles.
There is a lack of data about the effect of double-gloving on contaminant
transmission in less viscous fluids that are not prone to coagulation. STUDY
DESIGN: We used enzymatic colorimetry to quantify the volume of inoculation
delivered by a suture needle that was coated with an aqueous contaminant.
Substrate color change was measured using a microplate reader. Both cutting and
tapered suture needles were tested against five different glove types and
differing numbers of glove layers (from zero to three). RESULTS: One glove
layer removed 97% of contaminant from tapered needles and 65% from cutting
needles, compared with the no-glove control data. Additional glove layers did
not significantly improve contaminant removal from tapered needles (p >
0.05). For the cutting needle, 2 glove layers removed 91% of contaminant, which
was significantly better than a single glove (p = 0.002). Three glove layers
did not afford statistically significant additional protection (p = 0.122).
There were no statistically significant differences between glove types (p =
0.41). CONCLUSIONS: With an aqueous needle contaminant, a single glove layer
removes contaminant from tapered needles as effectively as multiple glove
layers. For cutting needles, double-glove layering offers superior protection.
There is no advantage to triple-glove layering. A surgeon should double-glove
for maximum safety. Additionally, a surgeon should take advantage of other
risk-reduction strategies, such as sharps safety, risk management, and use of
sharpless instrumentation when possible
13. Mbongwe B, Mmereki BT, Magashula A.
Healthcare waste management: current practices in selected healthcare
facilities,
ABSTRACT: Healthcare waste
management continues to present an array of challenges for developing
countries, and
14. McCoy D, Bennett S, Witter S et al.
Salaries and incomes of health workers in sub-Saharan Africa. The Lancet 2008;
371(9613):675-681.
ABSTRACT: Summary: Public-sector health workers are vital to the functioning
of health systems. We aimed to investigate pay structures for health workers in
the public sector in sub-Saharan
15. Merli R. CDC Probes Needlesticks, Possible
HIV Infection Among Laundry Workers. American Laundry News 2008; 3/21/08.
ABSTRACT: The Centers for Disease
Control and Prevention (CDC) is investigating as many as four more potential
cases of laundry and housekeeping workers infected with HIV, the virus that
causes AIDS, as a result of needlestick injuries they suffered at work.
16. Mills EJ,
ABSTRACT: Shortages of health-care
staff are endemic in sub-Saharan
17. Mornar SJ, Perlow JH. Blunt suture needle
use in laceration and episiotomy repair at vaginal delivery. Am J Obstet
Gynecol 2008.
ABSTRACT: OBJECTIVE: By surveying
obstetricians regarding the use of blunt suture needles for laceration and
episiotomy repair, the purpose of this study was to determine whether blunt
suture needles represent a safe and effective alternative to sharp needles.
STUDY DESIGN: Blunt suture needles were made available at our institution for
repairs at vaginal delivery. Participating physicians indicated their personal
history of needlestick injuries and rated the blunt suture needle after
completing the repair. Categorical variables were analyzed using Fisher's exact
test and a 2-tailed P < .05 was considered significant. RESULTS: Attending
and resident physicians completed 80 surveys, and 83% reported previous
needlestick injuries. Blunt suture needles were rated as excellent or good by
92.5% (95% confidence interval 84.6 to 96.5%). No needlestick injuries
occurred. CONCLUSION: In an effort to reduce needlestick injuries, the use of
blunt suture needles is safe and effective for repairs at vaginal delivery
18. Musharrafieh UM, Bizri AR, Nassar NT et
al. Health care workers' exposure to blood-borne pathogens in Lebanon. Occup
Med (Lond) 2008; 58(2):94-98.
ABSTRACT: BACKGROUND: Accidental
exposure to blood-borne pathogens (BBPs) is a risk for health care workers
(HCWs). AIM: To study the pattern of occupational exposure to blood and body
fluids (BBFs) at a tertiary care hospital. METHODS: This study reports a
17-year experience (1985-2001) of ongoing surveillance of HCW exposure to BBFs
at a 420-bed academic tertiary care hospital. RESULTS: A total of 1590 BBF
exposure-related accidents were reported to the Infection Control Office. The
trend showed a decrease in these exposures over the years with an average +/-
standard error of 96 +/- 8.6 incidents per year. In the last 6 years, the
average rate of BBF exposures was 0.57 per 100 admissions per year (average of
needlestick injuries alone was 0.46 per 100 admissions). For 2001, the rates of
exposure were found to be 13% for house officers, 9% for medical student, 8%
for attending physicians, 5% for nurses, 4% for housekeeping, 4% for
technicians and 2% for auxiliary services employees. The reason for the
incident, when stated, was attributed to a procedural intervention (29%),
improper disposal of sharps (18%), to recapping (11%) and to other causes (5%).
CONCLUSIONS: The current study in
19. Nsubuga P, White M, Fontaine R, Simone P.
Training programmes for field epidemiology. The Lancet 2008; 371(9613):630-631.
ABSTRACT: Public-health systems are
an important subset of the health systems that are needed to meet the
Millennium Development Goals (MDGs). How many public-health workers will be
needed to achieve the MDGs is unknown, but there is an urgent unmet need. Moreover, even as the MDGs are being
implemented, the newly revised International Health Regulations call for the
establishment of a group of experts in public-health surveillance and response in
all countries.
One strategy that has worked in the building of public-health surveillance and
response systems and the workforce to operate the systems is the implementation
of training programmes in field epidemiology.3 Over the past
27 years, 29 countries have created these programmes in partnership with the US
Centers for Disease Control and Prevention (CDC) and WHO to directly build and
strengthen public-health systems, while simultaneously training future
public-health leaders. The programmes are based on CDC's Epidemic Intelligence
Service which is a 2-year public-health leadership-training programme. More
than 1000 public-health leaders have graduated from the training programmes in
field epidemiology, and many more have completed short courses. Many graduates
of training programmes in field epidemiology have moved into leadership
positions within the ministries of health of their own countries
20. Omaswa F. Human resources for global
health: time for action is now. The Lancet 2008; 371(9613):625-626.
ABSTRACT: Over several decades, a
global health-workforce crisis has developed before our eyes. The crisis is
characterised by widespread global shortages, maldistribution of personnel
within and between countries, migration of local health workers, and poor
working conditions.
The factors that led to this crisis include increased demand for care in
developed countries with ageing populations, an upsurge of new and old
pandemics in low-income countries with poorly performing economies, and
neglect. Counterproductive and poorly administered solutions, such as bans and
across-the-board ceilings on recruitment, have aggravated these factors.
21. Ozgediz D, Galukande M, Mabweijano J et
al. The Neglect of the Global Surgical Workforce: Experience and Evidence from
ABSTRACT: BACKGROUND:
22. Ozgediz D, Kijjambu S, Galukande M et al.
Africa's neglected surgical workforce crisis. The Lancet 2008;
371(9613):627-628.
ABSTRACT: Funding priorities in
Few surgical procedures are done in
23. Peng B, Tully PJ, Boss K, Hiller JE.
Sharps Injury and Body Fluid Exposure Among Health Care Workers in an
ABSTRACT: To examine sharps injury
and body fluid exposure among health care workers, a descriptive
epidemiological study was conducted in a 1000-bed tertiary hospital between
2000 and 2003 using surveillance data of all reported sharps injuries and body
fluid exposures. A total of 640 sharps injuries and body fluid exposures were
reported from hospital and nonhospital staff, although no seroconversions to
HIV, hepatitis B virus, or hepatitis C virus were observed during the study
period. Nurses reported 47% of sharps injuries and 68% of body fluid exposures,
medical staff reported 38% and 16%, and other nonmedical staff notified 5% and
4%, respectively, while nonhospital staff reported the rest. Hollow-bore
needles accounted for 56% of sharps injuries, while 11% of the incidents were
sustained during recapping and inappropriate disposal. Further research into
Australian work practices, disposal systems, education strategies, and the use
of safety sharps should be emphasized to implement strategies to reduce
work-related injuries among health care workers
24. Pick W. Lack of evidence hampers
human-resources policy making. The Lancet 2008; 371(9613):629-630.
ABSTRACT: In today's Lancet,
Mickey Chopra and colleagues describe the dearth of evidence for policy making
on human resources for health. Despite their study being a systematic review of
systematic reviews over a set period, albeit of reports in English, they make a
compelling case for more research to inform policy makers. At a time when there
is a resurgence of interest in this field, Chopra and colleagues' overview
serves as a timely reminder to researchers that much more information is needed
if we are to persuade those responsible for health services, and especially
human resources for health, to take decisions that will contribute to the
solution of the global crisis in the staffing of health systems
25. Pillay Y, Mahlati P. Health-worker
salaries and incomes in sub-Saharan
ABSTRACT: There is global focus on
the need to strengthen health systems to achieve the Millennium Development
Goals by 2015, especially in sub-Saharan
According to the Global Health Workforce Alliance in 2006, sub-Saharan Africa
faces the most chronic shortage of health workers.2 The
Alliance noted that this region has 11% of the world's population and a quarter
of the global burden of disease, but has only 3% of the world's health
workforce and spends less than 1% of the global health expenditure. According
to Physicians for Human Rights, more than 80% of sub-Saharan countries do not
meet WHO's minimum recommendations for the numbers of doctors and nurses.3
And about 65 000 physicians and 70 000 nurses born in Africa were working in
developed countries in 2000
26. Poz MRD. Understanding women's
contribution to the health workforce. The Lancet 2008; 371(9613):641-642.
ABSTRACT: One of my first activities
after my appointment as Director of Human Resources for Health for the State of
Rio de Janeiro, Brazil, in 1987, was to assess and appraise the health
workforce at that time. To me, if the government had a better understanding of
its human resources in the health system, it could better plan and adopt
adequate options to improve the health of the population, while ameliorating
the working conditions of its more than 20 000 employees.
Globally, it is estimated that health workers account for some 2·5-10·0% of the
total labour force in a country (Hum Resour Health 2003; 1 : 5). In
27. Robinson M, Clark P. Forging solutions to
health worker migration. The Lancet 2008; 371(9613):691-693.
ABSTRACT: All over the world,
increased demand from wealthier countries resulting from ageing populations and
medical advances has pulled large numbers of health workers from some of the
world's poorest countries-many of whom are left with acute shortages of health
workers of their own.
28. Schatz JJ.
ABSTRACT:
Just past the entrance to the sprawling University Teaching Hospital (UTH) in
29. Schatz JJ. Francis Omaswa: tackling the
shortage of health workers. The Lancet 2008; 371(9613):643-642.
ABSTRACT: Francis Omaswa was working
as head of cardiothoracic surgery at
More than two decades later, Omaswa looks back on his time in Ngora as a
pivotal training ground for his current role as Executive Director of WHO's
Global Health Workforce Alliance (GHWA). The group, which holds a major
conference in
30. Taegtmeyer M, Suckling RM, Nguku PM et al.
Working with risk: Occupational safety issues among healthcare workers in
ABSTRACT: The objective of this
study was to explore knowledge of, attitudes towards and practice of
post-exposure prophylaxis (PEP) among healthcare workers (HCWs) in the Thika
district,
31. The L. Finding solutions to the human
resources for health crisis. The Lancet 2008; 371(9613):623.
ABSTRACT: Earlier this month,
medical workers at
32. Wada K, Sakata Y, Fujino Y et al. The
Association of Needlestick Injury with Depressive Symptoms among First-year
Medical Residents in
ABSTRACT: Depressive symptoms among
medical residents are common. The objective of this study was to determine the
association of depressive symptoms with needlestick injury among first-year
medical residents (so-called "intern"). We conducted a prospective
cohort study among 107 medical residents in 14 training hospitals. The baseline
survey was conducted in August 2005 and the follow-up survey was conducted in
March 2006. Depressive symptoms were based on the Center for Epidemiological
Study of Depression. Factors associated with depressive symptoms were examined
using logistic regression analysis. For medical residents without depressive
symptoms at the baseline survey, needlestick injury events were associated with
depressive symptoms at the follow-up survey (corrected odds ratio [cOR]=2.98;
95% confidence interval [CI], 1.16-3.70). Because it was not possible to
determine when the medical residents developed depressive symptoms, it is not
possible to definitely determine causality between needlestick injury and
depressive symptoms, although these findings are suggestive. Therefore, it
would seem prudent to suggest the provision of mental health services to
medical residents sustaining a needlestick injury since this may be helpful in
identifying and treating depression
33. Whitby M, McLaws ML, Slater K. Needlestick
injuries in a major teaching hospital: the worthwhile effect of hospital-wide
replacement of conventional hollow-bore needles. Am J Infect Control 2008;
36(3):180-186.
ABSTRACT: BACKGROUND: Needlestick
injury (NSI) with hollow-bore needles remains a significant risk of bloodborne
virus acquisition in health care workers. The impact on NSI rates after
substantial replacement of conventional hollow-bore needles with the
simultaneous introduction of safety-engineered devices (SEDs) including
retractable syringes, needle-free intravenous (IV) systems, and safety winged
butterfly needles was examined in an 800-bed Australian university hospital.
METHODS: NSIs were prospectively monitored for 2 years (2005-2006) after the
introduction of SEDs and compared with prospectively collected preintervention
NSI data (2000-2004). RESULTS: Preintervention hollow-bore NSI rates over 10
years persisted at a constant rate between 3.01 and 3.77 per 100 full-time
equivalent employees (FTE) (P = .31). Rates for 2005 (1.93; 95% CI: 1.48-2.47
per 100 FTE) and 2006 (1.50; 95% CI: 1.11-1.97 per 100 FTE) were significantly
lower than the average rate for the preintervention years (3.39; 95% CI:
2.7-4.24 per 100 FTE, P = .00004). This represents a fall of 49% (43.1%-55.7%)
in hollow-bore NSI, contributed to by the virtual elimination of NSI related to
accessing IV lines. More importantly, high-risk injuries were also reduced 57%
by retractable syringe use with an overall budgetary increase of approximately
US $90,000 per annum. CONCLUSION: Introduction of SEDs results in an impressive
fall in NSI with minimal cost outlay
34. White SM. Needlestick injuries - a testing
time. Nurs Crit Care 2008; 13(1):1-2.
35. White SM. Needlestick injuries - a testing
time. Nurs Crit Care 2008; 13(1):1-2.
ABSTRACT: Critical care staff need
to be aware of recent changes in the law. Using the example of human
immunodeficiency virus (HIV) and hepatitis screening after needlestick injuries
involving unconscious patients, this editorial will examine the implications of
the Human Tissue Act 2004 (HTA) and the Mental Capacity Act 2005 (MCA) for
critical care practice and explore potential solutions to the problem.
In response to high-profile public concerns over unethical organ retention at
36. Wicker S, Jung J, Allwinn R, Gottschalk R,
Rabenau HF. Prevalence and prevention of needlestick injuries among health care
workers in a German university hospital. Int Arch Occup Environ Health 2008;
81(3):347-354.
ABSTRACT: OBJECTIVE: Health care
workers (HCWs) are exposed to bloodborne pathogens, especially hepatitis B
(HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) through
job-related risk factors like needlestick, stab, scratch, cut, or other bloody
injuries. Needlestick injuries can be prevented by safer devices. METHODS: The
purpose of this study was to investigate the frequency and causes of
needlestick injuries in a German university hospital. Data were obtained by an
anonymous, self-reporting questionnaire. We calculated the share of reported
needlestick injuries, which could have been prevented by using safety devices.
RESULTS: 31.4% (n = 226) of participant HCWs had sustained at least one
needlestick injury in the last 12 months. A wide variation in the number of
reported needlestick injuries was evident across disciplines, ranging from
46.9% (n = 91/194) among medical staff in surgery and 18.7% (n = 53/283) among
HCWs in pediatrics. Of all occupational groups, physicians have the highest
risk to experience needlestick injuries (55.1%-n = 129/234). Evaluating the
kind of activity under which the needlestick injury occurred, on average 34% (n
= 191/561) of all needlestick injuries could have been avoided by the use of
safety devices. Taking all medical disciplines and procedures into
consideration, safety devices are available for 35.1% (n = 197/561) of
needlestick injuries sustained. However, there was a significant difference
across various medical disciplines in the share of needlestick injuries which
might have been avoidable: Pediatrics (83.7%), gynecology (83.7%), anesthesia
(59.3%), dermatology (33.3%), and surgery (11.9%). In our study, only 13.2% (n
= 74/561) of needlestick injuries could have been prevented by organizational
measures. CONCLUSION: There is a high rate of needlestick injuries in the daily
routine of a hospital. The rate of such injuries depends on the medical
discipline. Implementation of safety devices will lead to an improvement in
medical staff's health and safety
37. Hospital's liability affirmed over nurse's
needlestick injury. AIDS Policy & Law 2007; 22(12).
ABSTRACT: An appeals court affirmed
a ruling that a nurse contracted HIV from a needlestick injury that occurred
four years before she tested positive for the virus.
On June 30, 1994, Anglea Price was working as a certified nursing assistant for
Christus Health/St. Joseph Hospital.
While drawing blood from a patient with HIV who had developed AIDS,
Price accidently stuck her finger with a needle that she used on the
patient. Price immediately reported the
needlestick to her supervisors and went to the hospital's emergency room. She tested negative for HIV on the date of
the incident.
38. Study: Gaps persist in HBV immunizations.
Hospital Employee Health 2007; 26(2):21-22.
ABSTRACT: About one in four health
care workers who are offered the hepatitis B vaccine decline to take it,
according to a study by the Centers for Disease Control and Prevention. Although the occupational risk of acquiring
hepatitis B has declined dramatically since the 1980s, health care workers
still need to be vigilant about vaccinations, says Ian Williams, PhD, MS, chief
of the Epidemiologic Research and Field Investigations Team in the Division of
Viral Hepatitis at the CDC.
39. Rapid response lowers HIV needlestick
risk: Rural hospitals may not have PEP on stock. Hospital Employee Health 2007;
26(1):6-8.
ABSTRACT: AIDS has forever altered
the way health care workers fiew the threat of infectious disease. Although HCWs had long been at risk of
contracting tuberculosis, hepatitis B, and other serious diseases, the AIDS
epidemic in the 1980s brought a new level of fear -- and a focous on the need
for workplace protections.
40. Statement on sharps safety. Bull Am Coll
Surg 2007; 92(10):34-37.
ABSTRACT: Sharps injuries and
surgical glove tears continue to expose surgeons and operating room (OR)
personnel to the risk of human immunodeficiency virus, viral hepatitis B, viral
hepatitis C, and bacterial infections from patients. Patients' blood makes
contact with the skin or mucous membranes of OR personnel in as many as 50
percent of operations, with cuts or needlesticks occurring in as many as 15
percent of operations. Surgeons and first assistants are at highest risk for
injury, sustaining up to 59 percent of the injuries in the operating room.
Scrub personnel have the second highest frequency of injuries in the OR (19%),
followed by anesthesiologists (6%) and circulating nurses (6%). For surgeons,
suture needles are the most frequent source of sharps injuries.
41. Nonhospital health-care workers at
substantial risk of exposure to bloodbornepathogens. 12-20-2007.
ABSTRACT: In one of the largest
studies of its kind, researchers from the Columbia University Mailman School of
Public Health assessed the risk of exposure to bloodborne pathogens among
non-hospital based registered nurses (RNs), and found that nearly one out of 10
of the more than 1100 nurse participants reported at least one needlestick
injury in the previous 12 months.
42. Computer-based training not up to OSHA
bloodborne pathogen standard: Program must allow for real-time Q&A.
Hospital Employee Health 2007; 26(3):25-27.
ABSTRACT: Technology has opened new
avenues for health and safety training, but it comes with a caveat:
Computer-based modules may not meet the requirements of the bloodborne pathogen
standard.
The U.S. Occupational Safety and Health Administration (OSHA) requires
employers provide "direct access to a qualified trainer during
training," which can include e-mail only if the trainer is available to
respond to the e-mail immediately.
43. Al-Dwairi ZN. Infection Control Procedures
in Commercial Dental Laboratories in
ABSTRACT: The risk of
cross-infection in dental clinics and laboratories has attracted the attention
of practitioners for the past few years, yet several medical centers have
discarded compliance with infection control guidelines, resulting in a non-safe
environment for research and medical care. In
44. Allegranzi B, Pittet D.
Healthcare-associated infection in developing countries: simple solutions to
meet complex challenges. Infection Control & Hospital Epidemiology 2007;
28(12):1323-1327.
45. Allos BM, Schaffner W. Transmission of
hepatitis B in the health care setting: the elephant in the room ... or the
mouse? J Infect Dis 2007; 195(9):1245-1247.
ABSTRACT: Most infections with
hepatitis B virus in the
46. American Nurses Association. Medication
errors and syringe safety are top concerns for nurses according to new national
study. New Jersey Nurse 2007; 37(4):4-5.
ABSTRACT:
47. Argentero PA, Zotti CM, Abbona F et al.
[Regional surveillance of occupational percutaneous and mucocutaneous exposure
to blood-borne pathogens in health care workers: strategies for prevention].
[Italian]. Medicina
ABSTRACT: BACKGROUND: Several
studies have investigated both the frequency and modality of occurrence of
occupational exposure of health-care workers to blood-borne pathogens. At the
moment no complete epidemiological data are available covering the hospitals of
an entire Region. OBJECTIVES ANd METHODS: To describe the characteristics of
mucocutaneous and percutaneous exposure to body fluids of the healthcare
workers in 47 out of the 56 public hospitals (90% of a total 15,000 beds,
28,000 health-care workers full time equivalent) in Piedmont, Northern Italy
(4.5 million inhabitants) over a three-year period (1999-2002), using SIROH
(Studio Italiano Rischio Occupazionale da HIV) model to collect the data.
RESULTS AND CONCLUSIONS: 5174 percutaneous injuries (12.7/100 beds) and 1724
mucocutaneous exposure (4.1/100 beds) were recorded. Surveillance data were
similar to those collected in other multi-hospital studies. The variability of
rates between hospitals was high, most likely due to the amount of underreporting.
The categories most at risk of percutaneous and mucocutaneous exposure were,
respectively, surgeons (9.3/100 surgeons) and midwives (2.9/100 midwives).
Needles (syringe, winged steel, suture) were the medical devices most
frequently involved in percutaneous injuries, 60% of which occurred after the
use of such devices. Eighty-three per cent of healthcare workers had been
HBV-vaccinated versus only 45% of cleaning staff. After percutaneous injuries
with exposure to an HIV positive source only 40% of those exposed received
post-exposure prophylaxis; in the case of mucocutaneous exposure the rate was
11%. We recorded 2 seroconversions following occupational exposure to an HCV
positive source (risk of seroconversion: 0,2%). In order to implement
preventive programmes the use of safety devices, an increase in the number of
HBV-vaccinated contract workers, the use of chemoprophylaxis for HIV exposure,
and the use of protective equipment are deemed necessary
48. Arora A, Hakim I, Baxter J et al.
Needle-free delivery of macromolecules across the skin by nanoliter-volume
pulsed microjets. Proc Natl Acad Sci U S A 2007; 104(11):4255-4260.
ABSTRACT: Needle-free liquid jet
injectors were invented >50 years ago for the delivery of proteins and
vaccines. Despite their long history, needle-free liquid jet injectors are not
commonly used as a result of frequent pain and bruising. We hypothesized that
pain and bruising originate from the deep penetration of the jets and can
potentially be addressed by minimizing the penetration depth of jets into the
skin. However, current jet injectors are not designed to maintain shallow
dermal penetration depths. Using a new strategy of jet injection, pulsed
microjets, we report on delivery of protein drugs into the skin without deep
penetration. The high velocity (v >100 m/s) of microjets allows their entry
into the skin, whereas the small jet diameters (50-100 mum) and extremely small
volumes (2-15 nanoliters) limit the penetration depth ( approximately 200 mum).
In vitro experiments confirmed quantitative delivery of molecules into human
skin and in vivo experiments with rats confirmed the ability of pulsed
microjets to deliver therapeutic doses of insulin across the skin. Pulsed
microjet injectors could be used to deliver drugs for local as well as systemic
applications without using needles
49. Askarian M, Memish ZA, Khan AA. Knowledge,
practice, and attitude among Iranian nurses, midwives, and students regarding
standard isolation precautions. Infection Control & Hospital Epidemiology 2007;
28(2):241-244.
ABSTRACT: Our goal was to assess the
knowledge, attitudes, and practices regarding infection control and standard
precautions among a group of nursing and midwifery instructors and students in
50. Askarian M, Shaghaghian S, McLaws ML. Needlestick
Injuries Among Nurses of
ABSTRACT: PURPOSE: A prevalence
survey was performed to estimate the magnitude and predictors for needlestick
injury (NSI) in nurses of
51. Askew SM. Occupational exposures to blood
and body fluid: a study of medical students and health professions students in
ABSTRACT: Medical students and
health professions students may be at high risk for occupational exposures to
blood-borne pathogens. This retrospective chart review explored the rates and types
of self-reported blood and body fluid exposures among medical students and
health professions students at Eastern Virginia Medical School (EVMS), the
University of Virginia School of Medicine, and Virginia Commonwealth University
School of Medicine between January 1, 2001, and December 31, 2005, to determine
an average rate of exposure reported by the student population at EVMS and in
Virginia. Students at EVMS reported 126 exposures: 105 were needlestick and
sharps injuries and 21 were blood and body fluid exposures. Fifty-one percent
of the EVMS students reported not being the original user of the device causing
their exposure. Students in
52. Azar-Cavanagh M, Burdt P, Green-McKenzie
J. Effect of the introduction of an engineered sharps injury prevention device
on the percutaneous injury rate in healthcare workers. Infection Control &
Hospital Epidemiology 2007; 28(2):165-170.
ABSTRACT: Objective. To evaluate the
effect of introducing an engineered device for preventing injuries from sharp
instruments (engineered sharps injury prevention device [ESIPD]) on the
percutaneous injury rate in healthcare workers (HCWs).Methods. We undertook a
controlled, interventional, before-after study during a period of 3 years (from
January 1998 through December 2000) at a major medical center. The study
population was HCWs with potential exposure to bloodborne pathogens. HCWs who
sustain a needlestick injury are required by hospital policy to report the
exposure. A confidential log of these injuries is maintained that includes
information on the date and time of the incident, the type and brand of sharp
device involved, and whether an ESIPD was used.Intervention. Introduction of an
intravenous (IV) catheter stylet with a safety-engineered feature (a retractable
protection shield), which was placed in clinics and hospital wards in lieu of
other IV catheter devices that did not have safety features. No protective
devices were present on suture needles during any of the periods. The incidence
of percutaneous needlestick injury by IV catheter and suture needles was
evaluated for 18 months before and 18 months after the intervention.Results.
After the intervention, the incidence of percutaneous injuries resulting from
IV catheters decreased significantly (P<.01), whereas the incidence of
injuries resulting from suture needle injuries increased significantly
(P<.008).Conclusion. ESIPDs lead to a reduction in percutaneous injuries in
HCWs, helping to decrease HCWs' risk of exposure to bloodborne pathogens
53. Bdour A, Altrabsheh B, Hadadin N,
Al-Shareif M. Assessment of medical wastes management practice: a case study of
the northern part of
ABSTRACT: This study includes a
survey of the procedures available, techniques, and methods of handling and
disposing of medical waste at medium (between 100 and 200 beds) to large (over
200 beds) size healthcare facilities located in Irbid city (a major city in the
northern part of Jordan). A total of 14 healthcare facilities, including four
hospitals and 10 clinical laboratories, serving a total population of about 1.5
million, were surveyed during the course of this research. This study took into
consideration both the quantity and quality of the generated wastes to
determine generation rates and physical properties. Results of the survey
showed that healthcare facilities in Irbid city have less appropriate practices
when it comes to the handling, storage, and disposal of wastes generated in
comparison to the developed world. There are no defined methods for handling
and disposal of these wastes, starting from the personnel responsible for
collection through those who transport the wastes to the disposal site.
Moreover, there are no specific regulations or guidelines for segregation or
classification of these wastes. This means that wastes are mixed, for example,
wastes coming from the kitchen with those generated by different departments.
Also, more importantly, none of the sites surveyed could provide estimated
quantities of waste generated by each department, based upon the known
variables within the departments. Average generation rates of total medical
wastes in the hospitals were estimated to be 6.10 kg/patient/day (3.49
kg/bed/day), 5.62 kg/patient/day (3.14 kg/bed/day), and 4.02 kg/patient/day
(1.88 kg/bed/day) for public, maternity, and private hospitals, respectively.
For medical laboratories, rates were found to be in the range of 0.053-0.065
kg/test-day for governmental laboratories, and 0.034-0.102 kg/test-day for
private laboratories. Although, based on the type of waste, domestic or general
waste makes up a large proportion of the waste volume, so that if such waste is
not mixed with patient derived waste, it can be easily handled. However, based
on infections, it is important for healthcare staff to take precautions in
handling sharps and pathological wastes, which comprises only about 26% of the
total infectious wastes. Statistical analysis was conducted to develop
mathematical models to aid in the prediction of waste quantities generated by
the hospitals studied, or similar sites in the city that are not included in
this study. In these models, the number of patients, number of beds, and
hospital type were determined to be significant factors on waste generation.
Such models provide decision makers with tools to better manage their medical
waste, given the dynamic conditions of their healthcare facilities
54. Bennett NJ, Bull AL, Dunt DR et al.
Occupational exposures to bloodborne pathogens in smaller hospitals. Infection Control
& Hospital Epidemiology 2007; 28(7):896-898.
55. Bohannon J. The Freeing of the
ABSTRACT: I was in
56. Bowen S. Safety Sharp Solutions.
Outpatient Surgery Magazine 2007; VIII Supplement(10):S40-S42.
ABSTRACT: Here's how and why you
need to convinceyour staff to make the switch.
Have you incorporated the use of safety scalpels and blunt-tip suture
needles: If you have, is it properly
documented in your Exposure Control Plan?
If you haven't, what's stopping you?
Your staff's safety is on the line.
57. Brasel KJ, Mol C, Kolker A, Weigelt JA. Needlesticks
and surgical residents: who is most at risk? J Surg Educ 2007; 64(6):395-398.
ABSTRACT: OBJECTIVE: Exposure to
blood-borne diseases remains an occupational risk. Mandates have improved
training in how to report exposures for all health-care workers. How exposure
rates of surgical residents correlate with experience and mandatory training to
reduce risk is not known. It was hypothesized that enhanced training would
result in an increased reporting of exposures by surgical trainees and that risk
would be greater in the first years of training. DESIGN: Retrospective review
of occupational health records and operative case logs, prospective survey.
METHODS: Occupational Health Services provides both initial and annual training
to General Surgery house staff at the Medical College of Wisconsin. Initial
training consists of a blood-borne pathogen review and a detailed explanation
of exposure reporting. Mandatory annual training is provided during Surgical
Grand Rounds. Training was enhanced beginning June 2005 using a videotape
outlining surgical risks and specific countermeasures. The numbers of reported
exposures per year before and after enhanced training were compared. Exposures
were self-reported. As most exposures occurred in the operating room, rate of
exposure was calculated for each year of training using the total number of
cases done each year reported by the general surgical residents. RESULTS:
Surgical residents reported 118 needlestick injuries over 6 years. Senior and
chief residents demonstrated a significantly lower exposure rate than junior
residents (nonparametric Mood's median test, p < 0.0001). No significant
difference in the injury rate was found per 1000 cases after enhanced training.
CONCLUSIONS: Increasing surgical experience lowered the needlestick injury
rate. Assuming no change in self-reporting rates by year, enhanced training and
reporting guidelines did not seem to change risk. More specific training for
junior residents, as well as passive prevention solutions, may be necessary to
positively impact their exposure risk
58. Casey AL, Elliott TS. The usability and
acceptability of a needleless connector system. Br J Nurs 2007; 16(5):267-271.
ABSTRACT: Needleless connectors were
introduced into clinical practice to reduce the rate of needlestick injuries to
healthcare workers (HCWs). There have, however, been limited reports of user
acceptability of these devices. The usability and acceptability of the
Clearlink needleless connector (Baxter Healthcare,
59. Catanzarite V, Byrd K, McNamara M, Bombard
A. Preventing needlestick injuries in obstetrics and gynecology: how can we
improve the use of blunt tip needles in practice? Obstet Gynecol 2007;
110(6):1399-1403.
ABSTRACT: Surgical needlestick
injuries are common in obstetrics and gynecology and can cause transmission of
viral diseases including hepatitis and acquired immunodeficiency syndrome
(AIDS). Strategies to reduce the rate of needlestick injuries include using
instruments rather than fingers to retract tissue and grasp needles, double
gloving, using surgical staplers for skin closure, and substituting blunt tip
surgical needles for sharp tip needles where applicable. Studies have shown the
use of blunt tip surgical needles to be remarkably effective in reducing
needlestick injuries. Despite recommendations by the American College of
Surgeons that blunt tip surgical needles be used routinely, at least for
fascial closure, and by the Occupational Safety and Health Administration and
the National Institute for Occupational Health and Safety that these devices be
used whenever medically appropriate, use in obstetrics and gynecology appears
to be limited. Potential barriers to use include availability, the
"feel" of the needle as it penetrates tissue, and habit. We suggest
that blunt tip surgical needles have the potential to replace traditional
needles for many obstetric and gynecologic applications. If their use is to become
more widespread, we must focus on availability, evaluation for specific
applications, and physician education
60. Charles Morse and Stuart Colburn
(Defendant). Christus Health/
ABSTRACT: Appellant, Christus
Health/St. Joseph Hospital, appeals a judgement infavor of appellee, Angela
Price, that was entered in accordance with the jury's verdict. The hospital sued Priced to attempt to
reverse a determination by the Texas Workers' Compensation Commission (TWCC),
which had found that Price sustained a compensable injury in the course and
scope of her employment with the hospital.
The sole issue submitted to the jury was whether Price had received a
compensable injury. The jury agreed with
the determination by the TWCC. The trial
court rendered judgement that the hospital take nothing in its suit against
Price and awarded Price her attorney's fees and costs before the trail court
and appellate attorney's fees in the event of an unsuccessful appeal by the
hospital. In three issues, the hospital
contends that (1) the trail court erred by excluding medical records obtained
by a deposition on written questions, (2) the trail court erred by allowing
Price's expert witness to tesitfy, and (3) the evidence was legally and
factually insufficent to support the jury's verdict that Price sustained a
compensable injury. We affirm the
judgement of the trial court.
61. Charney W, Schirmer J. Nursing injury
rates and negative patient outcomes--connecting the dots. AAOHN J 2007;
55(11):470-475.
ABSTRACT: The connection between
nursing injury rates and patient outcomes has not been totally grasped in the
health care occupational health setting. This article concludes that nursing
injury rates are linked to the nursing shortage and less nursing time at the
bedside, both of which have been scientifically linked to negative patient
outcomes. Because nurses' working conditions affect patients' outcomes, more
funding and changes are needed to improve these conditions
62. Chen GX, Jenkins EL. Potential
work-related bloodborne pathogen exposures by industry and occupation in the
ABSTRACT: BACKGROUND: Since the
early 1990s, researchers have attempted to assess the magnitude of potential
work-related bloodborne pathogen (BBP) exposures in the
63. Chen GX, Jenkins EL. Potential
work-related exposures to bloodborne pathogens by industry and occupation in
the United States Part II: A telephone interview study. American Journal of
Industrial Medicine 2007; 50(4):285-292.
ABSTRACT: BACKGROUND: The companion
surveillance portion of this study [Chen and Jenkins, 2007] reported the
frequency and rate of potential work-related exposures to bloodborne pathogens
(BBP) treated in emergency departments (EDs) by industry and occupation, but it
lacks details on the circumstances of the exposure and other relevant issues
such as BBP safety training, use of personal protective equipment (PPE) or
safety needles, or reasons for seeking treatment in a hospital ED. METHODS:
Telephone interviews were conducted with workers who had been treated in EDs
for potential work-related exposures to BBP in 2000-2002. Respondents were
drawn from the National Electronic Injury Surveillance System. RESULTS: Of the
593 interviews, 382 were from hospitals, 51 were from emergency medical
service/firefighting (EMS/FF), 86 were from non-hospital healthcare settings
(e.g., nursing homes, doctors' offices, home healthcare providers, etc.), 22
were from law enforcement (including police and correctional facilities), and
52 were from other non-healthcare settings (i.e., schools, hotels, and
restaurants). Needlestick/sharps injuries were the primary source of exposure
in hospitals and non-hospital healthcare settings. Skin and mucous membrane was
the primary route of exposure in EMS/FF. Human bites accounted for a
significant portion of the exposures in law enforcement and other
non-healthcare settings. In general, workers from non-hospital settings were
less likely to use PPE, to have BBP safety training, to be aware of the BBP
standards and exposure treatment procedures, and to report or seek treatment
for a work-related exposure compared to hospital workers. CONCLUSIONS: This
study suggests that each industry group has unique needs that should be
addressed
64. Clarke SP. Hospital work environments,
nurse characteristics, and sharps injuries. Am J Infect Control 2007;
35(5):302-309.
ABSTRACT: BACKGROUND: A growing body
of research links working conditions, such as staffing levels and work
environment characteristics, with safety for both patients and workers in
health care settings, including sharps injuries in hospital staff nurses.
METHODS: Surveys of 11,516 staff nurses from 188
65. Clarke SP, Schubert M, Korner T.
Sharp-device injuries to hospital staff nurses in 4 countries. Infect Control
Hosp Epidemiol 2007; 28(4):473-478.
ABSTRACT: OBJECTIVE: To compare
sharp-device injury rates among hospital staff nurses in 4 Western countries.
DESIGN: Cross-sectional survey. SETTING: Acute-care hospital nurses in the
66.
ABSTRACT: BACKGROUND: The
Occupational Safety and Health Administration and the Centers for Disease
Control and Prevention (CDC) recommend that health care personnel (HCP) adopt
safer work practices and consider using medical devices with safety features.
This article describes the circumstances of percutaneous injuries among a
sample of hospital-based dental HCP and estimates the preventability of a
subset of these injuries: needlesticks. METHODS: The authors analyzed
percutaneous injuries reported by dental HCP in the CDC's National Surveillance
System for Health Care Workers (NaSH) from December 1995 through August 2004 to
describe the circumstances. RESULTS: Of 360 percutaneous injuries, 36 percent
were reported by dentists, 34 percent by oral surgeons, 22 percent by dental
assistants, and 4 percent each by hygienists and students. Almost 25 percent
involved anesthetic syringe needles. Of 87 needlestick injuries, 53 percent
occurred after needle use and during activities in which a safety feature could
have been activated (such as during passing and handling) or a safer work
practice used. CONCLUSIONS: NaSH data show that needlestick injuries still
occur and that a majority occur at a point in the workflow at which safety
syringes--in addition to safe work practices and recapping systems--could
contribute to injury prevention. CLINICAL IMPLICATIONS: All dental practices
should have a comprehensive written program for preventing needlestick injuries
that describes procedures for identifying, screening and, when appropriate,
adopting safety devices; mechanisms for reporting and providing medical
follow-up for percutaneous injuries; and a system for training staff members in
safe work practices and the proper use of safety devices
67. Cleveland JL, Barker LK, Cuny EJ, Panlilio
AL. Preventing percutaneous injuries among dental health care personnel. J Am
Dent Assoc 2007; 138(2):169-178.
ABSTRACT: BACKGROUND: The
Occupational Safety and Health Administration and the Centers for Disease
Control and Prevention (CDC) recommend that health care personnel (HCP) adopt
safer work practices and consider using medical devices with safety features.
This article describes the circumstances of percutaneous injuries among a
sample of hospital-based dental HCP and estimates the preventability of a
subset of these injuries: needlesticks. METHODS: The authors analyzed
percutaneous injuries reported by dental HCP in the CDC's National Surveillance
System for Health Care Workers (NaSH) from December 1995 through August 2004 to
describe the circumstances. RESULTS: Of 360 percutaneous injuries, 36 percent
were reported by dentists, 34 percent by oral surgeons, 22 percent by dental
assistants, and 4 percent each by hygienists and students. Almost 25 percent
involved anesthetic syringe needles. Of 87 needlestick injuries, 53 percent
occurred after needle use and during activities in which a safety feature could
have been activated (such as during passing and handling) or a safer work
practice used. CONCLUSIONS: NaSH data show that needlestick injuries still
occur and that a majority occur at a point in the workflow at which safety
syringes--in addition to safe work practices and recapping systems--could
contribute to injury prevention. CLINICAL IMPLICATIONS: All dental practices
should have a comprehensive written program for preventing needlestick injuries
that describes procedures for identifying, screening and, when appropriate,
adopting safety devices; mechanisms for reporting and providing medical
follow-up for percutaneous injuries; and a system for training staff members in
safe work practices and the proper use of safety devices
68. Connell J, Zurn P, Stilwell B, Awases M,
Braichet JM. Sub-Saharan
ABSTRACT: Migration of skilled
health workers from sub-Saharan African countries has significantly increased
in this century, with most countries becoming sources of migrants. Despite the
growing problem of health worker migration for the effective functioning of
health care systems there is a remarkable paucity and incompleteness of data.
Hence, it is difficult to determine the real extent of migration from, and
within,
69. Cutter J, Gammon J. Review of standard
precautions and sharps management in the community. Br J Community Nurs 2007;
12(2):54-60.
ABSTRACT: Standard precautions are
imperative for staff and patient safety and provide a basis for sound infection
control practice in all health-care settings. One key element of these
precautions relates to the safe handling and management of sharps to prevent
occupational acquisition of blood-borne viral infection. Many inoculation
injuries could be avoided by following standard precautions whenever contact
with blood or body fluids is anticipated. However, evidence suggests that
compliance with standard precautions is inadequate. With the modernization of
the health service in the
70. Damani N. Simple measures save lives: an
approach to infection control in countries with limited resources. [Review] [19
refs]. Journal of Hospital Infection 2007; 65(S2):151-154.
ABSTRACT: It has been estimated that
in developed countries up to 10% of hospitalized patients develop infections
every year. The risk of
healthcare-associated infections (HAI) in developing countries is 2-20 times
higher than in developed countries and it has been estimated that more than 40%
of these infections are preventable.
71. David HT, Aminzadeh KK, Kae AH, Radomsky
SC. Instrument retraction to avoid needle-stick injuries during intraoral local
anesthesia. Oral Surgery Oral Medicine Oral Pathology Oral Radiology &
Endodontics 2007; 103(3):e11-e13.
ABSTRACT: We present a new
retraction technique for the intraoral injection of a local anesthetic. This
approach eliminates the hazards associated with needle-stick injuries during
the injection procedure
72. Davies CG,
ABSTRACT: INTRODUCTION: While most
surgeons make an effort to avoid needlestick injury, some can pay little
attention to reduce the potential route of infection occurring when body fluids
splash into the eye. It has been shown that transmission of HIV, hepatitis B or
C can occur across any mucous membrane. This study aims to quantify how
frequently body fluids splash the mask and lens of wrap around protective
glasses thus potentially exposing the surgeon to infection. PATIENTS AND
METHODS: A prospective study was carried out by a single surgeon on all cases
performed over a 1-year period. Protective mask and glasses were examined
before and after operations. RESULTS: A total of 384 operations were performed
with 174 (45%) showing blood or body fluid splash on the lens. A high incidence
of splashes was found in vascular surgical procedures (79%). All amputations
showed splash on the protective lens. Interestingly, 50% of laparoscopic cases
resulted in blood or body fluid splash on the protective lens. CONCLUSIONS:
This study has shown a high incidence (45%) of blood and body fluid splashes
found on protective glasses and masks. There was a very high incidence (79%)
during vascular surgical procedures. With the prevalence of HIV and hepatitis
increasing, it seems prudent to protect oneself against possible routes of
transmission
73.
ABSTRACT: Executive Summary: Health care worker exposures to bloodborne
pathogens as a result of injuries caused by needles and other sharp devices are
a significant public health concern. The
U.S. Centers for Disease Control and Prevention (CDC) estimate that,
nationwide, between 600,000 and 800,000 percutaneous injuries from contaminated
sharp devices occur each year in health care; approximately half are sustained
by hospital workers.
Sharps injuries are preventable, and health care facilities are required by
state and federal regulations to implement comprehensive plans to reduce these
injuries. Elements of a successful
sharps injury prevention program (as outlined by the CDC) include: promoting an
overall cuulture of safety in the workplace, eliminating the unnecessary use of
needles and other sharp devices, using devices with sharps injury prevention
features (safety devices), employing safe workplace practices, and training
health care personnel. Sharps injury
surveillance is also a key component of a comprehensive program.
74. Doi SA, Amigo MF. Nurses' intentions to
wear gloves during venipuncture procedures: a behavioral psychology
perspective. Infection Control & Hospital Epidemiology 2007; 28(6):747-750.
ABSTRACT: Registered nurses working
at a teaching hospital in
75. Falagas ME, Karydis I, Kostogiannou I.
Percutaneous exposure incidents of the health care personnel in a newly founded
tertiary hospital: a prospective study. PLoS ONE 2007; 2:e194.
ABSTRACT: BACKGROUND: Percutaneous
exposure incidents (PEIs) and blood splashes on the skin of health care workers
are a major concern, since they expose susceptible employees to the risk of
infectious diseases. We undertook this study in order to estimate the overall
incidence of such injuries in a newly founded tertiary hospital, and to
evaluate possible changes in their incidence over time. METHODOLOGY/PRINCIPAL
FINDINGS: We prospectively studied the PEIs and blood splashes on the skin of
employees in a newly founded (October 2000) tertiary hospital in Athens,
Greece, while a vaccination program against hepatitis B virus, as well as
educational activities for avoidance of injuries, were taking place. The study
period ranged from October 1, 2002 to February 28, 2005. Serologic studies for
hepatitis B (HBV) and C virus (HCV) as well as human immunodeficiency virus
(HIV) were performed in all injured employees and the source patients, when
known. High-titer immunoglobulin (250 IU anti-HBs intramuscularly) and HBV vaccination
were given to non-vaccinated or previously vaccinated but serologically
non-responders after exposure. Statistical analysis of the data was performed
using Mc Nemar's and Fisher's tests. 60 needlestick, 11 sharp injuries, and two
splashes leading to exposure of the skin or mucosa to blood were reported
during the study period in 71 nurses and two members of the cleaning staff. The
overall incidence (percutaneous injuries and splashes) per 100 full-time
employment-years (100 FTEYs) for high-risk personnel (nursing, medical, and
cleaning staff) was 3.48, whereas the incidence of percutaneous injuries
(needlestick and sharp injuries) alone per 100 FTEYs was 3.38. A higher
incidence of injuries was noted during the first than in the second half of the
study period (4.67 versus 2.29 per 100 FTEYs, p = 0.005). No source patient was
found positive for HCV or HIV. The use of high-titer immunoglobulin after
adjustment for the incidence of injuries was higher in the first than in the
second half of the study period, although the difference was not statistically
significant [9/49 (18.37%) vs 1/24 (4.17%), p = 0.15].
CONCLUSIONS/SIGNIFICANCE: Our data show that nurses are the healthcare worker
group that reports most of PEIs. Doctors did not report such injuries during
the study period in our setting. However, the possibility of even relatively
frequent PEIs in doctors cannot be excluded. This is due to underreporting of
such events that has been previously described for physicians and surgeons. A
decrease of the incidence of PEIs occurred during the operation of this newly
founded hospital
76. Fisman DN, Harris AD, Rubin M, Sorock GS,
Mittleman MA. Fatigue increases the risk of injury from sharp devices in
medical trainees: results from a case-crossover study. Infection Control &
Hospital Epidemiology 2007; 28(1):10-17.
ABSTRACT: Background. Extreme
fatigue in medical trainees likely compromises patient safety, but regulations
that limit trainee work hours have been controversial. It is not known whether
extreme fatigue compromises trainee safety in the healthcare workplace, but
evidence of such a relationship would inform the current debate on trainee work
practices. Our objective was to evaluate the relationship between fatigue and
workplace injury risk among medical trainees and nontrainee healthcare
workers.Design. Case-crossover study.Setting. Five academic medical centers in
the
77. Ganczak M, Barss P, Al-Marashda A,
Al-Marzouqi A, Al-Kuwaiti N. Use of the Haddon matrix as a tool for assessing
risk factors for sharps injury in emergency departments in the United Arab
Emirates. Infection Control & Hospital Epidemiology 2007; 28(6):751-754.
ABSTRACT: We investigated the
epidemiology and prevention of sharps injuries in the
78. Gershon RR, Sherman M, Mitchell C et al.
Prevalence and risk factors for bloodborne exposure and infection in
correctional healthcare workers. Infection Control & Hospital Epidemiology
2007; 28(1):24-30.
ABSTRACT: Objective. To determine
the prevalence and risk factors for bloodborne exposure and infection in
correctional healthcare workers (CHCWs).Design. Cross-sectional risk assessment
study with a confidential questionnaire and serological testing performed
during 1999-2000.Setting. Correctional systems in 3 states.Results. Among 310 participating
CHCWs, the rate of percutaneous injury (PI) was 32 PIs per 100 person-years
overall and 42 PIs per 100 person-years for CHCWs with clinical job duties.
Underreporting was common, with only 25 (49%) of 51 PIs formally reported to
the administration. Independent risk factors for experiencing PI included being
age 45 or older (adjusted odds ratio [aOR], 2.41 [95% confidence interval (CI),
1.31-4.46]) and having job duties that involved needle contact (aOR, 3.70 [95%
CI, 1.28-10.63]) or blood contact (aOR, 5.05 [95% CI, 1.45-17.54]). Overall,
222 CHCWs (72%) reported having received a primary hepatitis B vaccination
series; of these, 150 (68%) tested positive for anti-hepatitis B surface
antigen, with negative results significantly associated with receipt of last
dose more than 5 years previously. Serologic markers of hepatitis B virus
infection were identified in 31 individuals (10%), and the prevalence of
hepatitis C virus infection was 2% (n=7). The high hepatitis B vaccination rate
limited the ability to identify risk factors for infection, but hepatitis C
virus infection correlated with community risk factors only.Conclusion.
Although the wide coverage with hepatitis B vaccination and the decreasing rate
of hepatitis C virus infection in the general population are encouraging, the
high rate of exposure in CHCWs and the lack of exposure documentation are
concerns. Continued efforts to develop interventions to reduce exposures and
encourage reporting should be implemented and evaluated in correctional
healthcare settings. These interventions should address infection control
barriers unique to the correctional setting
79. Gershon RR, Qureshi KA,
ABSTRACT: The aim of this study was
to assess the risk of blood and body fluid exposure among non-hospital based
registered nurses (RNs) employed in
80. Gisselquist D. How much do blood exposures
contribute to HIV prevalence in female sex workers in sub-Saharan Africa,
ABSTRACT: Female sex workers (FSWs)
are subject to frequent invasive procedures in health care and cosmetic services.
When infection control is deficient, these procedures not only put FSWs at risk
to acquire HIV, but are also risks for FSWs to transmit HIV to the general
population. Direct information about blood exposures other than injection drug
use as risks for HIV infection in FSWs has been too limited to test the
hypothesis that unsterile health-care procedures have infected large numbers of
FSWs in sub-Saharan Africa and
81. Gold K, Schumann J. Dangers of used sharps
in household trash: implications for home care. Home Healthc Nurse 2007;
25(9):602-607.
ABSTRACT: Between 8 and 9 million
Americans are self-injecting medication at home, and the majority of the
needles used are being thrown into the household trash. It is up to all
stakeholders, including healthcare professionals, to help change the way these
dangerous needles and other sharps are discarded. Are you giving your patients
the correct information?
82. Green-McKenzie J, Shofer FS. Duration of
time on shift before accidental blood or body fluid exposure for housestaff,
nurses, and technicians. Infection Control & Hospital Epidemiology 2007;
28(1):5-9.
ABSTRACT: Background. Shift work has
been found to be associated with an increased rate of errors and accidents
among healthcare workers (HCWs), but the effect of shift work on accidental
blood and body fluid exposure sustained by HCWs has not been well
characterized.Objectives. To determine the duration of time on shift before
accidental blood and body fluid exposure in housestaff, nurses, and technicians
and the proportion of housestaff who sustain a blood and body fluid exposure
after 12 hours on duty.Methods. This retrospective, descriptive study was
conducted during a 24-month period at a large urban teaching hospital.
Participants were HCWs who sustained an accidental blood and body fluid
exposure.Results. Housestaff were on duty significantly longer than both
nursing staff (P=.02) and technicians (P<.0001) before accidental blood and
body fluid exposure. Half of the blood and body fluid exposures sustained by
housestaff occurred after being on duty 8 hours or more, and 24% were sustained
after being on duty 12 hours or more. Of all HCWs, 3% reported an accidental
blood and body fluid exposure, with specific rates of 7.9% among nurses, 9.4%
among housestaff, and 3% among phlebotomists.Conclusions. Housestaff were
significantly more likely to have longer duration of time on shift before blood
and body fluid exposure than were the other groups. Almost one-quarter of
accidental blood and body fluid exposures to housestaff were incurred after
they had been on duty for 12 hours or more. Housestaff sustained a higher rate
of accidental blood and body fluid exposures than did nursing staff and
technicians
83. Gurley ES, Montgomery JM, Hossain MJ et
al. Risk of nosocomial transmission of nipah virus in a
ABSTRACT: We conducted a
seroprevalence study and exposure survey of healthcare workers to assess the
risk of nosocomial transmission of Nipah virus during an outbreak in
84. Hecht N, Wettan S. Percutaneous injuries.
J Am Dent Assoc 2007; 138(5):574.
85. Heneghan C, Perera R. Prevention of
hepatitis C in
86. Hu T, Li G, Zuo Y, Zhou X. Risk of
Hepatitis B Virus Transmission via Dental Handpieces and Evaluation of an
Antisuction Device for Prevention of Transmission. Infection Control &
Hospital Epidemiology 2007; 28(1):80-82.
ABSTRACT: We evaluated the risk of
hepatitis B virus (HBV) transmission via dental handpieces and the effects of
an antisuction device in preventing HBV contamination. The results of our study
show that under certain conditions, HBV transmission can occur when an
antisuction device is used during dental procedures. We conclude that such
devices may decrease contamination, but do not eliminate it
87. Huber MA, Terezhalmy GT. HIV: infection
control issues for oral healthcare personnel. [Review] [55 refs]. Journal of
Contemporary Dental Practice [Electronic Resource] 2007; 8(3):1-12.
ABSTRACT: AIM: To present the
essential elements of an infection control/exposure control plan in the oral
healthcare setting with emphasis on HIV infection. METHODS AND MATERIALS: A
comprehensive review of the literature was conducted with special emphasis on
HIV-related infection control issues in the oral healthcare setting. RESULTS:
Currently available knowledge related to HIV-related infection control issues
is supported by data derived from well-conducted trials or extensive,
controlled observations, or, in the absence of such data, by best-informed,
most authoritative opinion available. CONCLUSION: Essential elements of an
effective HIV-related infection control plan include: (1) education and
training related to the etiology and epidemiology of HIV infection and exposure
prevention; (2) plans for the management of oral healthcare personnel
potentially exposed to HIV and for the follow-up of oral healthcare personnel
exposed to HIV; and (3) a policy for work restriction of HIV-positive oral
healthcare personnel. CLINICAL SIGNIFICANCE: While exposure prevention remains
the primary strategy for reducing occupational exposure to HIV, knowledge about
potential risks and concise written procedures that promote a seamless response
following occupational exposure can greatly reduce the emotional impact of an
accidental needlestick injury. [References: 55]
88. Ismail NA, boul Ftouh AM, El-Shoubary WH,
Mahaba H. Safe injection practice among health-care workers in
ABSTRACT: We assessed safe injection
practices among 1100 health-care workers in 25 health-care facilities in
Gharbiya Governorate. Questionnaires were used to collect information and 278
injections were observed using a standardized checklist. There was a lack of
infection control policies in all the facilities and a lack of many supplies
needed for safe injection. Proper needle manipulation before disposal was
observed in only 41% of injections, safe needle disposal in 47.5% and safe
syringe disposal in 0%. Reuse of used syringes and needles was reported by
13.2% of the health-care workers and 66.2% had experienced a needle-stick
injury. Only 11.3% had received a full course of hepatitis B vaccination
89. Jagger J. Caring for Heathcare Workers: A
Global Perspective. Infection Control & Hospital Epidemiology 2007;
28(1):-4.
ABSTRACT: This issue of the journal
reflects broadly upon the risks of bloodborne pathogen exposure--risks faced by
healthcare workers (HCWs) everywhere.
The article covers an array of issues, including the impact of work
schedules, healthcare settings, culture-specific practices, and the
implementation of safety-engineered sharp devices on the occupational risk of
injuries from sharp devices and blood contact.
It is a fitting occasion to reflect on the state of the art in providing
a safe working environment for HCWs and to consider a future path towards
equitable access to its basic element.
90. Janjua NZ, Razaq M, Chandir S, Rozi S,
Mahmood B. Poor knowledge--predictor of nonadherence to universal precautions
for blood borne pathogens at first level care facilities in Pakistan. BMC
Infectious Diseases 2007; 7:81.
ABSTRACT: BACKGROUND: We conducted
an assessment of knowledge about blood borne pathogens (BBP) and use of
universal precautions at first level care facilities (FLCF) in two districts of
Pakistan. METHODS: We conducted a cross-sectional survey and selected three
different types of FLCFs ; public, general practitioners and unqualified
practitioners through stratified random sampling technique. At each facility,
we interviewed a prescriber, a dispenser, and a housekeeper for knowledge of
BBPs transmission and preventive practices, risk perception, and use of
universal precautions. We performed multiple linear regression to assess the
effect of knowledge score (11 items) on the practice of universal precautions
score (4 items- use of gloves, gown, needle recapping, and HBV vaccination).
RESULTS: We interviewed 239 subjects. Most of the participants 128 (53%) were
recruited from general practitioners clinics and 166 (69.5%) of them were
dispensers. Mean (SD) knowledge score was 3.8 (2.3) with median of 4. MBBS
prescribers had the highest knowledge score while the housekeepers had the
lowest. Mean universal precautions use score was 2.7 +/- 2.1. Knowledge about
mode of transmission and the work experience alone, significantly predicted
universal precaution use in multiple linear regression model (adR2 = 0.093).
CONCLUSION: Knowledge about mode of transmission of blood borne pathogens is
very low. Use of universal precautions can improve with increase in knowledge
91. Javadi AA, Mobasherizadeh S, Memarzadeh M,
Mostafavizadeh K, Yazdani R, Tavakoli A. Evaluation of needle-stick injuries
among health care workers in Isfahan province, Islamic Republic of Iran.
ABSTRACT: Sir, Health care workers
(HCWs) are at-risk for infections with blood-borne pathogens such as human
immunodeficiency virus, hepatitis b virus and hepatitis C virus from
occupational blood-exposure through injuries with sharp instruments and
needlesticks. In the
92. Karkar A. Hepatitis C in dialysis units:
the Saudi experience. Hemodialysis International 2007; 11(3):354-367.
ABSTRACT: Hepatitis C virus (HCV)
infection is a significant health problem, as it can lead to chronic active
hepatitis, liver cirrhosis, and hepatic carcinoma. Patients undergoing
hemodialysis treatment are at increased risk of contracting HCV and other viral
infections. This is primarily due to their impaired cellular immunity,
underlying diseases, and blood exposure for a prolonged period. Transmission of
viral hepatitis, and in particular HCV in dialysis units, has been showing a
progressive increase worldwide, ranging between 5% in some western countries
and up to 70% in some developing countries. The annual rate of HCV
seroconversion in
93. Krikorian R, Lozach-Perlant A,
Ferrier-Rembert A et al. Standardization of needlestick injury and evaluation
of a novel virus-inhibiting protective glove. Journal of Hospital Infection
2007; 66(4):339-345.
ABSTRACT: Rubber surgical gloves
worn as a barrier to prevent contamination from body fluids offer relative
protection against contamination through direct percutaneous injuries involving
needles, scalpel blades or bone fragments. To determine the main experimental
parameters influencing the volume of blood transmitted by a hollow-bore needle
(worst case scenario) during an accidental puncture, we designed an automatic
puncture apparatus. Herpes simplex type 1 virus (HSV1), a model for enveloped
viruses, was used as a 'marker' in an in-vitro gelatine model. Of the
experimental parameters studied, the most critical influences were found to be
needle diameter and puncture depth, whereas puncture speed, puncture angle and
glove-stretching feature appeared to be less influential. A single glove
reduced the volume of blood transferred by 52% compared with no glove, but
double gloving offered no additional protection against hollow-bore needle
punctures. Using 'standardized' puncture conditions, the virus-inhibiting
surgical glove G-VIR((R)) elicited an 81% reduction in the amount of HSV1
transmitted as compared with single or double latex glove systems
94. Krishnan P, Dick F, Murphy E. The impact
of educational interventions on primary health care workers' knowledge of
occupational exposure to blood or body fluids. Occupational Medicine (
ABSTRACT: AIM: To assess the impact
of educational interventions on primary health care workers' knowledge of
management of occupational exposure to blood or body fluids. METHODS:
Cluster-randomized trial of educational interventions in two National Health
Service board areas in
95. Kubitschke A, Bahr MJ, Aslan N et al.
Induction of hepatitis C virus (HCV)-specific T cells by needle stick injury in
the absence of HCV-viraemia. European Journal of Clinical Investigation 2007;
37(1):54-64.
ABSTRACT: BACKGROUND: The risk of
hepatitis C virus (HCV) infection after occupational exposure is low with
seroconversion rates between 0 and 5%. However, factors associated with natural
resistance against HCV after needle stick injury are poorly defined.
HCV-specific T-cell responses have been described in cross-sectional studies of
exposed HCV-seronegative individuals. MATERIALS AND METHODS: In this study, we
prospectively followed 10 healthcare professionals who experienced an injury
with an HCV-contaminated needle. Blood samples were taken on the day or the day
after the event and at different time points during follow-up for up to 32
months. HCV-specific T-cell responses were investigated directly ex vivo and in
T-cell lines. RESULTS: None of the individuals became positive for HCV-RNA in
serum tested with the highly sensitive transcription-mediated amplification
(TMA)-assay or in peripheral blood mononuclear cells (PBMC). All of them
remained anti-HCV negative throughout follow-up. At the time of injury,
HCV-specific CD4+ T-cell responses were already detectable in two individuals
and became detectable thereafter in three additional persons. Transient HCV-specific
CD8+ T-cell responses developed in two HLA-A2 positive patients, which became
negative until the most recent follow-up after 5 and 17 months, respectively.
CONCLUSION: We demonstrate the development of HCV-specific T cells in
HCV-exposed individuals after needle stick injury indicating subinfectious
exposure to HCV. T-cell immunity against HCV may contribute to the low
prevalence of HCV in medical healthcare professionals in Western countries
96. Lamontagne F, Abiteboul D, Lolom I et al.
Role of safety-engineered devices in preventing needlestick injuries in 32
French hospitals. Infection Control & Hospital Epidemiology 2007;
28(1):18-23.
ABSTRACT: Objectives. To evaluate
safety-engineered devices (SEDs) with respect to their effectiveness in preventing
needlestick injuries (NSIs) in healthcare settings and their importance among
other preventive measures.Design. Multicenter prospective survey with a 1-year
follow-up period during which all incident NSIs and their circumstances were
reported. Data were prospectively collected during a 12-month period from April
1999 through March 2000. The procedures for which the risk of NSI was high were
also reported 1 week per quarter to estimate procedure-specific NSI rates.
Device types were documented. Because SEDs were not in use when a similar
survey was conducted in 1990, their impact was also evaluated by comparing
findings from the recent and previous surveys.Setting. A total of 102 medical
units from 32 hospitals in France.Participants. A total of 1,506 nurses in
medical or intensive care units.Results. A total of 110 NSIs occurring during
at-risk procedures performed by nurses were documented. According to data from
the 2000 survey, use of SEDs during phlebotomy procedures was associated with a
74% lower risk (P<.01). The mean NSI rate for all relevant nursing
procedures was estimated to be 4.72 cases per 100,000 procedures, for a 75%
decrease since 1990 (P<.01); however, the decrease in NSI rates varied
considerably according to procedure type. Between 1990 and 2000, decreases in
the NSI rates for each procedure were strongly correlated with increases in the
frequency of SED use (r=0.88; P<.02).Conclusion. In this French hospital
network, the use of SEDs was associated with a significantly lower NSI rate and
was probably the most important preventive factor
97. Leigh JP, Gillen M, Franks P et al. Costs
of needlestick injuries and subsequent hepatitis and HIV infection. Curr Med
Res Opin 2007; 23(9):2093-2105.
ABSTRACT: BACKGROUND: Physicians,
nurses and other healthcare workers (HCWs) are at risk of bloodborne pathogens
infection from needlestick injuries, but costs of needlesticks are little
studied. METHODS: We used the cost-of-illness and incidence approaches. We used
the perspective of the medical provider (medical costs) and the individual
(lost productivity). Data on needlesticks, infections from hepatitis B and C
(HBV, HCV) and human immune-deficiency (HIV) among HCWs, as well as data on
per-unit costs were culled from research literature, Centers for Disease
Control and Prevention reports, and Bureau of Labor Statistics reports. We also
generated estimates based upon industry employment and scenarios for
source-patients. These data and estimates were combined with assumptions to
produce a model that generated base-case estimates as well as one-way and
multi-way probabilistic sensitivity analyses. Future costs were discounted by
3%. RESULTS: We estimated 644,963 needlesticks in the healthcare industry for
2004 of which 49% generated costs. Medical costs were $107.3 million of which
96% resulted from testing and prophylaxis and 4% from treating long-term
infections (34 persons with chronic HBV, 143 with chronic HCV, and 1 with HIV).
Lost-work productivity generated $81.2 million, for which 59% involved testing
and prophylaxis and 41% involved long-term infections. Combined medical and
work productivity costs summed to $188.5 million. Multi-way sensitivity
analysis suggested a range on combined costs from $100.7 million to $405.9
million. CONCLUSION: Detailed methodology was developed to estimate costs of
needlesticks and subsequent infections for hospital-based and
non-hospital-based health care workers. The combined medical and lost
productivity costs comprised roughly 0.1% of all occupational injury and
illness costs for all jobs in the economy. We did not account for lost home
production or pain and suffering costs, however, nor did we estimate
benefit/cost ratios of specific interventions to reduce needlesticks
98. Lot F, Delarocque-Astagneau E, Thiers V et
al. Hepatitis C virus transmission from a healthcare worker to a patient.
Infection Control & Hospital Epidemiology 2007; 28(2):227-229.
ABSTRACT: We investigated the source
of infection in a patient who developed acute hepatitis C virus infection after
cardiothoracic surgery. A healthcare worker was found to be infected with
hepatitis C virus, and molecular analysis indicated the strain was similar to
that found in the patient. The exact mode of transmission was not identified;
however, atopic eczema on the healthcare worker's hands may have contributed to
the transmission
99. Lynch P, Pittet D, Borg MA, Mehtar S.
Infection control in countries with limited resources. Journal of Hospital
Infection 2007; 65(S2):148-150.
ABSTRACT: Infection control (IC) in
countries with limited resources potentially affects healthcare in all
countries; infectious diseases have spread around the globe very efficiently
but infection prevention has lagged behind.
Control of healthcare-associated infections (HAIs) is one of the great
successes: it reduces illness andmortality and saves money for patients and
hospitals. Yet, today only 57 of 192
countries have national IC societies and there is still no global planning for
managing this plague which is largely preventable, and which spawns a host of
related problems including multidrug-resistant organisms and bloodborne
infections among patients and healthcare workers (HCWs). In fact, infection problems continue to be
amplified in hosptials rather than reduced.
For example, the Severe Acute Respiratory Syndrome (SARS) began as a
community-acquired, severe respiratory disease but ultimately, almost half of
cases were due to hospital transmission.
100. M'ikanatha NM, Imunya SG, Fisman DN, Julian
KG. Sharp-device injuries and perceived risk of infection with bloodborne
pathogens among healthcare workers in rural
ABSTRACT: To the Editor-Healthcare
workers (HCWs) worldwide face the risk of occupational
infection by bloodborne pathogens, including human immunodeficiency
virus (HIV), hepatitis B virus (HBV), and hepatitis C
virus (HCV). Guidelines exist
for preventing injuries from sharp devices (hereafter, sharps),
as well as for postexposure evaluation and prophylaxis,
but HCWs working in limited-resource settings may not
have adequate access to these recommended safety measures.
This is especially of concern where the prevalence of
bloodborne pathogens in the patient population may be
relatively high.
101. Makary MA, Al-Attar A, Holzmueller CG et al.
Needlestick injuries among surgeons in training.
ABSTRACT: BACKGROUND: Surgeons in
training are at high risk for needlestick injuries. The reporting of such
injuries is a critical step in initiating early prophylaxis or treatment.
METHODS: We surveyed surgeons in training at 17 medical centers about previous
needlestick injuries. Survey items inquired about whether the most recent
injury was reported to an employee health service or involved a
"high-risk" patient (i.e., one with a history of infection with human
immunodeficiency virus, hepatitis B or hepatitis C, or injection-drug use); we
also asked about the perceived cause of the injury and the surrounding circumstances.
RESULTS: The overall response rate was 95%. Of 699 respondents, 582 (83%) had
had a needlestick injury during training; the mean number of needlestick
injuries during residency increased according to the postgraduate year (PGY):
PGY-1, 1.5 injuries; PGY-2, 3.7; PGY-3, 4.1; PGY-4, 5.3; and PGY-5, 7.7. By
their final year of training, 99% of residents had had a needlestick injury;
for 53%, the injury had involved a high-risk patient. Of the most recent
injuries, 297 of 578 (51%) were not reported to an employee health service, and
15 of 91 of those involving high-risk patients (16%) were not reported. Lack of
time was the most common reason given for not reporting such injuries among 126
of 297 respondents (42%). If someone other than the respondent knew about an
unreported injury, that person was most frequently the attending physician
(51%) and least frequently a "significant other" (13%). CONCLUSIONS:
Needlestick injuries are common among surgeons in training and are often not
reported. Improved prevention and reporting strategies are needed to increase
occupational safety for surgical providers
102. Manian FA, Ponzillo JJ. Compliance with
routine use of gowns by healthcare workers (HCWs) and non-HCW visitors on entry
into the rooms of patients under contact precautions. Infection Control &
Hospital Epidemiology 2007; 28(3):337-340.
ABSTRACT: BACKGROUND: Modified
contact precautions (MCP), defined as routine donning of isolation gowns (along
with routine gloving) on entry into the rooms of patients under contact
precautions, regardless of the likelihood of direct exposure to the patient or
their immediate environment, were instituted at our medical center to reduce
nosocomial transmission of common hospital pathogens. OBJECTIVES: To study
compliance with MCP policy regarding routine gowning in intensive care units
(ICUs) and general wards and to determine the relationship between gown and
glove use in the care of patients under MCP in ICUs. DESIGN: Prospective
observational study from February 20, 2004, through January 8, 2005, involving
2,110 persons (1,504 healthcare workers [HCWs] and 606 non-HCW visitors).
SETTING: A 900-bed tertiary care teaching community hospital. RESULTS: Overall
compliance with routine gown use was observed for 1,542 persons (73%), including
1,150 HCWs (76%) and 392 visitors (65%) (odds ratio [OR], 1.8 [95% confidence
interval {CI}, 1.4-2.2]; P<.001). Visitors in the ICUs (186 [91%] of 204)
were more likely than visitors in the general wards (202 [51%] of 398) to
comply with gown use (OR, 10 [95% CI, 6.0-17.0]; P<.001). In logistic
regression analysis, independent predictors of gown compliance among HCWs were
female sex (OR, 2.3 [95% CI, 1.8-3.0]; P<.001) and ICU setting (OR, 2.2 [95%
CI, 1.7-2.9]; P<.001). In the ICUs, gown use was highly predictive of glove
use among HCWs (positive predictive value, 95%). CONCLUSION: Improvement in
compliance with gown use at our medical center will require more-intensive
educational efforts targeted at male HCWs and at HCWs and visitors on general
wards. In the care of ICU patients under MCP, HCW compliance with gown use may
be used as a proxy for their compliance with glove use
103. Mantel C, Khamassi S, Baradei K, Nasri H,
Mohsni E, Duclos P. Improved injection safety after targeted interventions in the
Syrian Arab Republic. Tropical Medicine & International Health 2007;
12(3):422-430.
ABSTRACT: OBJECTIVES: Concerns about
unsafe injection practices and possible infections with blood-borne pathogens
in the
104. Mattner F, Henke-Gendo C, Martens A et al.
Risk of rabies infection and adverse effects of postexposure prophylaxis in
healthcare workers and other patient contacts exposed to a rabies
virus-infected lung transplant recipient. Infection Control & Hospital
Epidemiology 2007; 28(5):513-518.
ABSTRACT: BACKGROUND: Rabies virus
was inadvertently transmitted to a lung transplant recipient through donor
lungs. The patient was given ventilatory assistance and cared for
postoperatively for 6 weeks before a diagnosis of rabies virus infection was
made. Postexposure prophylaxis (PEP) was offered to potentially exposed
healthcare workers (HCWs). METHODS: Only HCWs classified as belonging to
possible and/or proven contact groups (according to a standardized interview)
received PEP. The risk of individual HCWs being exposed to rabies virus was
reassessed on the basis of viral concentrations measured in the patient's
excretions and body fluids. HCWs who were vaccinated as part of PEP were
followed up prospectively according to a standardized procedure. RESULTS: Of
179 HCWs and other patient contacts, 132 met the eligibility criteria for PEP
(118 [89.4%] with possible contact and 14 [10.6%] with proven contact with the
patient's excretions and/or body fluids). One hundred thirty-one individuals
started PEP, and 126 met the inclusion criteria for analysis. Of these, 48
(38%) developed at least 1 adverse effect (8 [6.3%] had fever, 37 [29.4%] had
headache, 3 [2.4%] had lymphadenopathy, 17 [13.5%] had dizziness, and 6 [4.8%]
had paresthesia). No HCW or other patient contact developed rabies or serious
PEP-related adverse effects. Reassessment of the individual's risk of infection
as a function of the viral concentration in the patient's excretions and/or
body fluids (up to 5.12 x 10(7) copies/mL) revealed that 103 HCWs (78.0%) had
contact with high-risk substances (89 [67.40%] had possible contact and 14
[10.7%] had proven contact). CONCLUSION: HCWs can be exposed to significant
viral concentrations in excretions and/or body fluids from rabies
virus-infected lung transplant recipients. Because widespread use of PEP
entails the possibility of significant health problems for HCWs considered to
be at risk of contracting rabies, applying a rational indication for PEP is
crucial
105. Mijai Grinberg. Doctor convicted of
deliberately infecting patients with Hepatitis C. Haaretz 2007 Jul 10.
ABSTRACT: The Be'er Sheve Distrct
Court on Tuesday convicted Dr. Sergel Puntos of 25 counts of causing grievous
bodily h arm, intentionally spreading a disease, and posession and use of
narcotics.
Puntos, who wored as an anesthesiologist at Be'er Sheva's
ABSTRACT: BACKGROUND: Contaminated
sharps, such as needles, lancets, scalpels, broken glass, specimen tubes, and
other instruments, can transmit bloodborne pathogens such as HIV, hepatitis B
(HBV), and hepatitis C viruses (HCV). METHODS: Observation of facilities and
injections and questionnaire-guided interviews were conducted in 2005 among
health care workers (HCWs) in 2 public hospitals in
107. Mullan F, Frehywot S. Non-physician
clinicians in 47 sub-Saharan African countries. Lancet 2007;
370(9605):2158-2163.
ABSTRACT: Many countries have
health-care providers who are not trained as physicians but who take on many of
the diagnostic and clinical functions of medical doctors. We identified
non-physician clinicians (NPCs) in 25 of 47 countries in sub-Saharan
108. Nagao Y, Baba H, Torii K et al. A long-term
study of sharps injuries among health care workers in
ABSTRACT: BACKGROUND: The risk of
transmission of occupational blood-borne infection is a serious problem for
health care workers (HCWs) in
109. O'Malley EM, Scott RD, Gayle J et al. Costs
of management of occupational exposures to blood and body fluids. Infection
Control & Hospital Epidemiology 2007; 28(7):774-782.
ABSTRACT: OBJECTIVE: To determine
the cost of management of occupational exposures to blood and body fluids.
DESIGN: A convenience sample of 4 healthcare facilities provided information on
the cost of management of occupational exposures that varied in type, severity,
and exposure source infection status. Detailed information was collected on
time spent reporting, managing, and following up the exposures; salaries
(including benefits) for representative staff who sustained and who managed
exposures; and costs (not charges) for laboratory testing of exposure sources
and exposed healthcare personnel, as well as any postexposure prophylaxis taken
by the exposed personnel. Resources used were stratified by the phase of exposure
management: exposure reporting, initial management, and follow-up. Data for 31
exposure scenarios were analyzed. Costs were given in 2003 US dollars. SETTING:
The 4 facilities providing data were a 600-bed public hospital, a 244-bed
Veterans Affairs medical center, a 437-bed rural tertiary care hospital, and a
3,500-bed healthcare system. RESULTS: The overall range of costs to manage
reported exposures was $71-$4,838. Mean total costs varied greatly by the
infection status of the source patient. The overall mean cost for exposures to
human immunodeficiency virus (HIV)-infected source patients (n=19, including
those coinfected with hepatitis B or C virus) was $2,456 (range, $907-$4,838),
whereas the overall mean cost for exposures to source patients with unknown or
negative infection status (n=8) was $376 (range, $71-$860). Lastly, the overall
mean cost of management of reported exposures for source patients infected with
hepatitis C virus (n=4) was $650 (range, $186-$856). CONCLUSIONS: Management of
occupational exposures to blood and body fluids is costly; the best way to
avoid these costs is by prevention of exposures
110. Odusanya OO, Meurice FP, Hoet B. Nigerian
medical students are at risk for hepatitis B infection. Transactions of the
Royal Society of Tropical Medicine & Hygiene 2007; 101(5):465-468.
ABSTRACT: Medical students are
exposed to blood and body fluids. This study was conducted to estimate the
prevalence of hepatitis B virus (HBV) infection amongst medical students of the
Lagos State University College of Medicine,
111. Pan A, Mondello P., Posfay-Barbe K. et al.
Hand Hygiene and Glove Use Behavior in an
ABSTRACT: In an Italian hospital,
we observed that hand hygiene was performed in 638
(19.6%) of 3,253 opportunities, whereas gloves were worn
in 538 (44.2%) 1,218 of opportunities. We observed an
inverse correlation between the intensity of care and the
rate of hand hygiene compliance (R2 = 0.057; P
< .001), but no such association was observed for
the rate of glove use compliance (R2 = 0.014; P =
.078). Rates of compliance with hand hygiene and glove
use recommendations follow different behavioral patterns.
112. Phillips EK, Owusu-Ofori A, Jagger J.
Bloodborne pathogen exposure risk among surgeons in sub-saharan
ABSTRACT: To document the frequency
and circumstances of bloodborne pathogen exposures among surgeons in sub-Saharan
113. Rabin R. When the Surgeon is Infected, How
Safe is the Surgery? The New York Times 2007 Jul 3.
ABSTRACT: A few years ago, two Long
Islanders with hepatitis C met in a support group and soon discovered they had
something in common: both had become infected witht he virus after open-heart
surgery - by the same surgeon.
Public health investigators, who were looking into one of the two cases, had
not asked members of the patient's surgical team whether one of them might be
infected. Now they did. Eventually they determined that the surgeon,
Dr. Michael Hall, was infected and dthat he was the inadvertent source of both
patients' infections -- and that of at least one other patient.
114. Roden A. Needles less of sore point after
safety syringes cut down injuries.
ABSTRACT: Needle injuries among
Lothians health workers are down by a quarter after a landmark legal ruling
forced hospitals to introduce safety syringes.
Thousands of health service staff are accidently priced by syringes every year,
leaving them in fear of infection from HIV or hepatitis.
115. Runner JC. Bacterial and viral contamination
of reusable sharps containers in a community hospital setting. Am J Infect
Control 2007; 35(8):527-530.
ABSTRACT: BACKGROUND: Proper
disposal of sharps in the clinical setting is a key factor in infection
control. Previous research studies suggest that reprocessed, reusable medical
devices and infectious waste containers are potential sources of microorganisms
capable of causing infection in immunocompromised patients. This pilot study
was a single-center, prospective, hospital-based, microbiologic evaluation of
reusable sharps disposal containers returned to the hospital from a
reprocessing company. METHODS: A
116. Rupp ME, Sholtz LA, Jourdan DR et al.
Outbreak of bloodstream infection temporally associated with the use of an
intravascular needleless valve. Clinical Infectious Diseases 2007;
44(11):1408-1414.
ABSTRACT: BACKGROUND: Needleless
intravascular catheter connector valves have been introduced into clinical
practice to minimize the risk of needlestick injury. However, infection-control
risks associated with these valves may be underappreciated. In March 2005, a
dramatic increase in bloodstream infections was noted in multiple patient care
units of a hospital in temporal association with the introduction of a
needleless valve into use. METHODS: Surveillance for primary bloodstream
infection was conducted using standard methods throughout the hospital. Blood
culture contamination rates were monitored. Cultures were performed using
samples obtained from intravascular catheter connector valves. RESULTS: The
relative risk of bloodstream infection for the time period in which the suspect
connector valve was in use, compared with baseline, was 2.79 (95% confidence
interval, 2.27-3.43). In critical care units, the rate of primary bloodstream
infection increased with the introduction of the valve from 3.87 infections per
1000 catheter-days to 10.64 infections per 1000 catheter-days (P<.001), and
it decreased to 5.59 infections per 1000 catheter-days (P=.02) in the 6 months
following removal of the device from use. Similarly, in inpatient nursing
units, the rate of bloodstream infection increased from 3.47 infections per
1000 catheter-days to 7.3 infections per 1000 catheter-days (P=.02) following introduction
of the device, and it decreased to 2.88 infections per 1000 catheter-days
(P=.57) following removal of the device from use. Similar events occurred in
the cooperative care units. The rate of blood culture contamination did not
substantially change over the course of the study. Of 37 valves that were
subjected to microbiological sample testing, 24.3% yielded microbes,
predominantly coagulase-negative staphylococci. CONCLUSION: A significant
association between primary bloodstream infection and a needleless connector
valve was observed. Evaluation of needleless connector valves should include a
thorough assessment of infection risks in prospective randomized trials prior
to their introduction to the market
117. Sacchi M, Daglio M, Feletti T, Lanave M,
Candura SM, Strosselli M. [Accidents with risk of blood-borne infections in
obstetricians: analysis of a hospital case records]. Med Lav 2007; 98(1):64-72.
ABSTRACT: BACKGROUND: Health care
workers (HCW) are at high risk of accidental contact with biological fluids. In
spite of extensive recom mendations concerning HCW accidents continue to be
frequent and seem to be related to specific factors. OBJECTIVES: To evaluate
the factors influencing risk of blood-borne infections in a particular category
of HCW--obstetricians, and obtain information useful for prevention guidelines.
METHODS: Data were obtained from the exposure registers of nursing and of the
Emergency Ward staff where HCWfirst report after accidental contact with
biological fluids. RESULTS: Accidents with risk of blood-borne diseases were
more frequent in obstetricians with lower job seniority. They usually occurred
between 8 a.m. and 4p. m., in the patient's room. The hands and face
(particularly the eyes) were the body parts more often involved In almost half
of the accidents, the worker was not wearing any personal protective device.
Although some contacts were with infected blood, no seroconversion occurred.
CONCLUSIONS: Obstetricians are at high risk of contact with biologicalfluids.
Prevention requires a global strategy including the availability of protective
and safety devices, as well as worker education, especially concerning the use
of such devices, the application of the universal rules of prevention and the
improvement of risk awareness. An adequate post-exposure management of
accidents in also required
118. Salamut W,
ABSTRACT: We believe current
practice for securing central lines is outdated and inherently unsafe. Central
line insertion is a core skill for anaesthetists. During placement they are
usually secured with a hand-held silk suture on a straight needle, a practice
prone to promoting needle-stick injuries.
119. Salgado CD, Chinnes L, Paczesny TH, Cantey
JR. Increased rate of catheter-related bloodstream infection associated with
use of a needleless mechanical valve device at a long-term acute care hospital.
Infect Control Hosp Epidemiol 2007; 28(6):684-688.
ABSTRACT: OBJECTIVE: To determine
whether introduction of a needleless mechanical valve device (NMVD) at a
long-term acute care hospital was associated with an increased frequency of
catheter-related bloodstream infection (BSI). DESIGN: For patients with a
central venous catheter in place, the catheter-related BSI rate during the
24-month period before introduction of the NMVD, a period in which a needleless
split-septum device (NSSD) was being used (hereafter, the NSSD period), was
compared with the catheter-related BSI rate during the 24-month period after
introduction of the NMVD (hereafter, the NMVD period). The microbiological
characteristics of catheter-related BSIs during each period were also compared.
Comparisons and calculations of relative risks (RRs) with 95% confidence intervals
(CIs) were performed using chi (2) analysis. RESULTS: Eighty-six
catheter-related BSIs (3.86 infections per 1,000 catheter-days) occurred during
the study period. The rate of catheter-related BSI during the NMVD period was
significantly higher than that during the NSSD period (5.95 vs 1.79 infections
per 1,000 catheter-days; RR, 3.32 [95% CI, 2.88-3.83]; P<.001). A
significantly greater percentage of catheter-related BSIs during the NMVD
period were caused by gram-negative organisms, compared with the percentage
recorded during the NSSD period (39.5% vs 8%; P=.007). Among catheter-related
BSIs due to gram-positive organisms, the percentage caused by enterococci was
significantly greater during the NMVD period, compared with the NSSD period
(54.8% vs 13.6%; P=.004). The catheter-related BSI rate remained high during
the NMVD period despite several educational sessions regarding proper use of
the NMVD. CONCLUSIONS: An increased catheter-related BSI rate was temporally
associated with use of a NMVD at the study hospital, despite several
educational sessions regarding proper NMVD use. The current design of the NMVD
may be unsafe for use in certain patient populations
120. Scardino PT. A hazard surgeons need to
address. Nat Clin Pract Urol 2007; 4(7):347.
121. Schraag J. Sharps Safety Extends Beyond
Hospital Walls. Infection Control Today 2007.
ABSTRACT: My son had a special
friend in kindergarten whom neither of us will ever forget. Little D was the sweetest boy -- so cute and
full of life. He was the baby of the
three children in his family, and named after his daddy, Big D.
The reason I will always remember Little D isn't because the boys -- at the rip
old age of 5 --got themselves locked out on the balcony at 4 a.m. during a
sleepover. It is because Little D, at
the end of kidergarten, was told that his momma wouldn't make it to see him
begin first grade.
122. Shariati B, Shahidzadeh-Mahani A, Oveysi T,
Akhlaghi H. Accidental exposure to blood in medical interns of Tehran
University of Medical Sciences. J Occup Health 2007; 49(4):317-321.
ABSTRACT: Healthcare workers and
medical students are at risk of exposure to blood-borne viruses such as HBV,
HCV HIV, etc. Here we report the results of a survey of the frequency and
causes of cutaneous blood exposure accidents (CBEA) among medical students.
Anonymous questionnaires were randomly distributed to 200 interns in their
second year of internship in hospitals affiliated to Tehran University of
Medical Sciences. A definite exposure was defined as injury by a sharp object
causing obvious bleeding, whereas a possible exposure was defined as subtle or
superficial injury due to contact with a contaminated instrument or needle but
without bleeding, or contamination of an existing wound with blood or other
body fluids. One hundred eighty-four subjects (92% of the original sample)
responded to the questionnaire. We recorded 121 definite exposures and 259
possible exposures over a mean time interval of 14 months. Needles were the
most common objects (41% of exposure episodes) causing CBEAs, while phlebotomy
and suturing were the hospital procedures that accounted for the highest
percentage of exposure episodes (30 and 28 percent, respectively). Only a
minority of students regularly observed basic safety measures (wearing gloves,
not recapping used needles and proper disposal of sharp objects). Considering
the high incidence of blood exposure in medical interns at Tehran University of
Medical Sciences and the ensuing risk of blood-borne infections, the subjects
are likely to develop such infections during their internship period
123. Simard EP, Miller JT, George PA et al.
Hepatitis B vaccination coverage levels among healthcare workers in the United
States, 2002-2003. Infection Control & Hospital Epidemiology 2007; 28(7):783-790.
ABSTRACT: Background. Hepatitis B
virus (HBV) infection is a well recognized risk for healthcare workers (HCWs),
and routine vaccination of HCWs has been recommended since 1982. By 1995, the
level of vaccination coverage among HCWs was only 67%.Objective. To obtain an
accurate estimate of hepatitis B vaccination coverage levels among HCWs and to
describe the hospital characteristics and hepatitis B vaccination policies
associated with various coverage levels.Design. Cross-sectional survey.Methods.
A representative sample of 425 of 6,116 American Hospital Association member
hospitals was selected to participate, using probability-proportional-to-size
methods during 2002-2003. The data collected included information regarding
each hospital's hepatitis B vaccination policies. Vaccination coverage levels
were estimated from a systematic sample of 25 HCWs from each hospital whose
medical records were reviewed for demographic and vaccination data. The main
outcome measure was hepatitis B vaccination coverage levels.Results. Among
at-risk HCWs, 75% had received 3 or more doses of the hepatitis B vaccine,
corresponding to an estimated 2.5 million vaccinated hospital-based HCWs. The
coverage level was 81% among staff physicians and nurses. Compared with nurses,
coverage was significantly lower among phlebotomists (71.1%) and nurses' aides
and/or other patient care staff (70.9%; P<.05). Hepatitis B vaccination
coverage was highest among white HCWs (79.5%) and lowest among black HCWs
(67.6%; P<.05). Compared with HCWs who worked in hospitals that required
vaccination only of HCWs with identified risk for exposure to blood or other
potentially infectious material, hepatitis B vaccination coverage was
significantly lower among HCWs who worked in hospitals that required
vaccination of HCWs without identified risk for exposure to blood or other
potentially infectious material (76.6% vs 62.4%; P<.05).Conclusions. In the
124. Slater K, Whitby M, McLaws ML. Prevention of
needlestick injuries: the need for strategic marketing to address health care
worker misperceptions. Am J Infect Control 2007; 35(8):560-562.
ABSTRACT: The occupational
transmission of blood borne viruses (BBV) through needlestick injury (NSI) has
been widely recognized over the past 20 years. While focused interventions have
decreased the risk of NSI, little reduction has been reported in the prevalence
of NSI due to hollow bore needles-an injury that poses the highest risk to
health care workers (HCW). We have
previously reported2 the trends of NSI between 1990 and 1999
in the 800-bed university teaching
The two-year trial of retractable syringes commenced in October 2004. The trial
was widely promoted and an extensive education program took place prior to
implementation. The education focused not only on how to use the new devices,
but also on the risks associated with various devices.
125. Sofola OO, Folayan MO, Denloye OO, Okeigbemen
SA. Occupational exposure to bloodborne pathogens and management of exposure
incidents in Nigerian dental schools. J Dent Educ 2007; 71(6):832-837.
ABSTRACT: The goal of this study was
to determine the frequency of occupational exposures to bloodborne pathogens
amongst Nigerian clinical dental students, their HBV vaccination status, and
reporting practices. A cross-sectional study of all clinical dental students in
the four Nigerian dental schools was carried out by means of an anonymous
self-administered questionnaire that asked questions on demography, number and
type of exposure, management of the exposures, personal protection against
cross infection, and the reporting of such exposures. One hundred and
fifty-three students responded (response rate of 84.5 percent). Only
thirty-three (37.9 percent) were fully vaccinated against HBV. Ninety (58.8
percent) of the students have had at least one occupational exposure. There was
no significantly associated difference between sex, age, location of school,
and exposure. Most of the exposures (44.4 percent) occurred in association with
manual tooth cleaning. There was inadequate protection of the eyes. None of the
exposures were formally reported. It is the responsibility of training
institutions to ensure the safety of the students by mandatory HBV vaccination
prior to exposure and adequate training in work safety. Written policies and
procedures should be developed and made easily accessible to all workers to
facilitate prompt reporting and management of all occupational exposures
126. Talashek ML, Kaponda CP, Jere DL et al.
Identifying what rural health workers in
ABSTRACT: Health workers have high
potential as HIV prevention leaders, but health system and individual barriers
limit their impact. This descriptive qualitative study identified the HIV
prevention needs of rural health workers to use as a basis for tailoring an
HIV/AIDS risk-reduction intervention. Data included interviews with 9 health
administrators, 22 focus groups with 200 health workers, and 12 observations of
caregivers in two rural districts. Health system barriers identified included
lack of essential supplies, staff shortages, overcrowded facilities, and lack
of training. Individual barriers included hopelessness, stigmatizing attitudes,
knowledge gaps, and risky personal behaviors. Health workers also expressed
willingness to be HIV prevention leaders and role models. Most results agree
with previous African studies. Personal risky behaviors and willingness to be
HIV prevention leaders have not been previously reported. Results provide
insights for developing effective interventions and health policies to address
health workers' HIV prevention needs
127. Tanne JH. Most
ABSTRACT: By the end of their five
years of trainingin general surgery almost every
128. Tosti ME, Mariano A, Spada E et al. Incidence
of parenterally transmitted acute viral hepatitis among healthcare workers in
ABSTRACT: In
129. Trinkoff AM, Le R, Geiger-Brown J, Lipscomb
J. Work schedule, needle use, and needlestick injuries among registered nurses.
Infection Control & Hospital Epidemiology 2007; 28(2):156-164.
ABSTRACT: Objective. To examine the
association between working conditions and needlestick injury among registered
nurses. We also describe needle use and needlestick injuries according to
nursing position, workplace, and specialty.Design. Three-wave longitudinal
survey conducted between November 2002 and April 2004.Setting and participants.
A probability sample of 2,624 actively licensed registered nurses from 2 states
in the
130. Valls V, Lozano MS, Yanez R et al. Use of
safety devices and the prevention of percutaneous injuries among healthcare
workers. Infect Control Hosp Epidemiol 2007; 28(12):1352-1360.
ABSTRACT: OBJECTIVE: To study the
effectiveness of safety devices intended to prevent percutaneous
injuries.Design. Quasi-experimental trial with before-and-after intervention
evaluation. SETTING: A 350-bed general hospital that has had an ongoing
educational program for the prevention of percutaneous injuries since January
2002. METHODS: In October 2005, we implemented a program for the use of
engineered devices to prevent percutaneous injury in the emergency department
and half of the hospital wards during the following procedures: intravascular
catheterization, vacuum phlebotomy, blood-gas sampling, finger-stick blood
sampling, and intramuscular and subcutaneous injections. The nurses in the
wards that participated in the intervention received a 3-hour course on
occupationally acquired bloodborne infections, and they had a 2-hour
"hands-on" training session with the devices. We studied the
percutaneous injury rate and the direct cost during the preintervention period
(October 2004 through March 2005) and the intervention period (October 2005
through March 2006). RESULTS: We observed a 93% reduction in the relative risk
of percutaneous injuries in areas where safety devices were used (14 vs 1
percutaneous injury). Specifically, rates decreased from 18.3 injuries (95%
confidence interval [CI], 5.9-43.2 injuries) to 0 injuries per 100,000 patients
in the emergency department (P=.002) and from 44.0 injuries (95% CI, 20.1-83.6
injuries) to 5.2 injuries (95% CI, 0.1-28.8 injuries) per 100,000 patient-days
in hospital wards (P=.007). In the control wards of the hospital (ie, those
where the intervention was not implemented), rates remained stable. The direct
cost increase was 0.558 euros (US$0.753) per patient in the emergency
department and 0.636 euros (US$0.858) per patient-day in the hospital wards.
CONCLUSION: Proper use of engineered devices to prevent percutaneous injury is
a highly effective measure to prevent these injuries among healthcare workers.
However, education and training are the keys to achieving the greatest
preventative effect
131. Valls V, Lozano MS, Yanez R et al. Use of
safety devices and the prevention of percutaneous injuries among healthcare
workers. Infect Control Hosp Epidemiol 2007; 28(12):1352-1360.
ABSTRACT: Objective. To study the
effectiveness of safety devices intended to prevent percutaneous
injuries.Design. Quasi-experimental trial with before-and-after intervention
evaluation.Setting. A 350-bed general hospital that has had an ongoing
educational program for the prevention of percutaneous injuries since January
2002.Methods. In October 2005, we implemented a program for the use of
engineered devices to prevent percutaneous injury in the emergency department
and half of the hospital wards during the following procedures: intravascular
catheterization, vacuum phlebotomy, blood-gas sampling, finger-stick blood
sampling, and intramuscular and subcutaneous injections. The nurses in the
wards that participated in the intervention received a 3-hour course on
occupationally acquired bloodborne infections, and they had a 2-hour
"hands-on" training session with the devices. We studied the
percutaneous injury rate and the direct cost during the preintervention period
(October 2004 through March 2005) and the intervention period (October 2005
through March 2006).Results. We observed a 93% reduction in the relative risk
of percutaneous injuries in areas where safety devices were used (14 vs 1
percutaneous injury). Specifically, rates decreased from 18.3 injuries (95%
confidence interval [CI], 5.9-43.2 injuries) to 0 injuries per 100,000 patients
in the emergency department (P=.002) and from 44.0 injuries (95% CI, 20.1-83.6
injuries) to 5.2 injuries (95% CI, 0.1-28.8 injuries) per 100,000 patient-days
in hospital wards (P=.007). In the control wards of the hospital (ie, those
where the intervention was not implemented), rates remained stable. The direct
cost increase was euro0.558 (US$0.753) per patient in the emergency department
and euro0.636 (US$0.858) per patient-day in the hospital wards.Conclusion.
Proper use of engineered devices to prevent percutaneous injury is a highly
effective measure to prevent these injuries among healthcare workers. However,
education and training are the keys to achieving the greatest preventative
effect
132. Venier AG, Vincent A, L'Heriteau F et al.
Surveillance of occupational blood and body fluid exposures among French
healthcare workers in 2004. Infection Control & Hospital Epidemiology 2007;
28(10):1196-1201.
ABSTRACT: Objective. To estimate the
incidence rate of reported occupational blood and body fluid exposures among
French healthcare workers (HCWs).Design. Prospective national follow-up of HCWs
from January 1 to December 31, 2004.Setting. University hospitals, hospitals,
clinics, local medical centers, and specialized psychiatric centers were
included in the study on a voluntary basis.Participants. At participating
medical centers, every reported blood and body fluid exposure was documented by
the occupational practitioner in charge of the exposed HCW by use of an
anonymous, standardized questionnaire.Results. A total of 375 medical centers
(15% of French medical centers, accounting for 29% of hospital beds) reported
13,041 blood and body fluid exposures; of these, 9,396 (72.0%) were needlestick
injuries. Blood and body fluid exposures were avoidable in 39.1% of cases
(5,091 of 13,020), and 52.2% of percutaneous injuries (4,986 of 9,552) were
avoidable (5.9% due to needle recapping). Of 10,656 percutaneous injuries,
22.6% occurred during an injection, 17.9% during blood sampling, and 16.6%
during surgery. Of 2,065 splashes, 22.6% occurred during nursing activities,
19.1% during surgery, 14.1% during placement or removal of an intravenous line,
and 12.0% during manipulation of a tracheotomy tube. The incidence rates of
exposures were 8.9 per 100 hospital beds (95% confidence interval [CI], 8.7-9.0
exposures), 2.2 per 100 full-time-equivalent physicians (95% CI, 2.4-2.6
exposures), and 7.0 per 100 full-time-equivalent nurses (95% CI, 6.8-7.2
exposures). Human immunodeficiency virus serological status was unknown for
2,789 (21.4%) of 13,041 patients who were the source of the blood and body
fluid exposures.Conclusion. National surveillance networks for blood and body
fluid exposures help to better document their characteristics and risk factors
and can enhance prevention at participating medical centers
133. Wada K, Narai R, Sakata Y et al. Occupational
exposure to blood or body fluids as a result of needlestick injuries and other
sharp device injuries among medical residents in Japan. Infection Control &
Hospital Epidemiology 2007; 28(4):507-509.
ABSTRACT: To the Editor-Medical
residents are vulnerable to needlestick injuries and/or injuries
from other sharp devices (hereafter referred to as needlestick and/or sharps
injuries) because they lack experience and skill. In the
134. Wallis GC, Kim WY, Chaudhary BR, Henderson
JJ. Perceptions of orthopaedic surgeons regarding hepatitis C viral
transmission: a questionnaire survey. Ann R Coll Surg Engl 2007; 89(3):276-280.
ABSTRACT: INTRODUCTION:
Occupationally acquired hepatitis C viral infection is an important issue in
surgery since there are no known vaccines or effective prophylaxis. MATERIALS
AND METHODS: An anonymous questionnaire survey was performed to determine the
attitudes and perception of risks of occupational acquired hepatitis C viral
transmission in orthopaedic surgeons. RESULTS: A total of 763 questionnaires
were posted to orthopaedic surgeons with various subspecialty interests and 261
surgeons responded (34.2%). Of respondents, 117 (47%) had sustained sharps
injuries in the previous 12 months. Only 82 surgeons (33%) always reported such
injuries, although 208 (84%) expressed concerns of occupationally acquired
hepatitis C viral transmission. Orthopaedic surgeons were mostly unaware of the
true prevalence of hepatitis C in high-risk groups, such as intravenous drug
abusers. CONCLUSIONS: Greater awareness of all aspects of hepatitis C infection
and its risks to the practice of surgery is required. Further debate is
necessary on the role of routine testing of surgeons and patients
135. White RG, Ben SC, Kedhar A et al. Quantifying
HIV-1 transmission due to contaminated injections. Proceedings of the
ABSTRACT: Assessments of the
importance of different routes of HIV-1 (HIV) transmission are vital for
prioritization of control efforts. Lack of consistent direct data and large
uncertainty in the risk of HIV transmission from HIV-contaminated injections
has made quantifying the proportion of transmission caused by contaminated
injections in sub-Saharan
136. Yang YH, Liou SH, Chen CJ et al. The
effectiveness of a training program on reducing needlestick injuries/sharp
object injuries among soon graduate vocational nursing school students in
southern
ABSTRACT: Needlestick/sharp injuries
(NSIs/SIs) are a serious threat to medical/nursing students in hospital
internships. Education for preventing NSIs/SIs is important for healthcare
workers but is rarely conducted and evaluated among vocational school nursing
students. We conducted an educational intervention for such students after
their internship rotations before graduation. This program consisted of a
lecture to the students after the internship training and a self-study brochure
for them to study before their graduation. This study used the pre-test
questionnaires completed by all students and the post-test questionnaires
completed by 107 graduates after work experience as licensed nurses to assess
the effectiveness of the intervention. After educational intervention, the
incidence of NSIs/SIs decreased significantly from 50.5% pre-test to 25.2%
post-test, and the report rate increased from 37.0% to 55.6%, respectively. In
conclusion, this intervention significantly reduced the incidence of NSIs/SIs
and increased the report rate of such events
137. Yang YH, Liou SH, Chen CJ et al. The
effectiveness of a training program on reducing needlestick injuries/sharp
object injuries among soon graduate vocational nursing school students in
southern
ABSTRACT: Needlestick/sharp injuries
(NSIs/SIs) are a serious threat to medical/nursing students in hospital
internships. Education for preventing NSIs/SIs is important for healthcare
workers but is rarely conducted and evaluated among vocational school nursing
students. We conducted an educational intervention for such students after
their internship rotations before graduation. This program consisted of a
lecture to the students after the internship training and a self-study brochure
for them to study before their graduation. This study used the pre-test
questionnaires completed by all students and the post-test questionnaires
completed by 107 graduates after work experience as licensed nurses to assess
the effectiveness of the intervention. After educational intervention, the
incidence of NSIs/SIs decreased significantly from 50.5% pre-test to 25.2%
post-test, and the report rate increased from 37.0% to 55.6%, respectively. In
conclusion, this intervention significantly reduced the incidence of NSIs/SIs and
increased the report rate of such events
138. Yasunaga H. Risk of authoritarianism:
fibrinogen-transmitted hepatitis C in
ABSTRACT: In 1977, the US Food and
Drug Administration revoked all licences for fibrinogen concentrate because of
the risk for hepatitis infection and suspected lack of effectiveness. However,
in
139. Yoshikawa T, Kidouchi K, Kimura S, Okubo T,
Perry J, Jagger J. Needlestick injuries to the feet of Japanese healthcare
workers: a culture-specific exposure risk. Infection Control & Hospital
Epidemiology 2007; 28(2):215-218.
ABSTRACT: A comparison of
needlestick injury surveillance data from Japan and the United States revealed
a higher proportion of foot injuries to Japanese healthcare workers (HCWs),
compared with US HCWs. This study investigates the underlying factors that
contribute to this difference and proposes evidence-based prevention strategies
to address the risk, including the use of safety-engineered needle devices,
point-of-use disposal containers for sharp instruments and devices, and
closed-toe footwear
140. Zanni GR, Wick JY. Preventing needlestick
injuries. Consult Pharm 2007; 22(5):400-6, 409.
ABSTRACT: Inadvertent puncture
during use, disassembly, or disposal of needles or sharp devices (called
collectively, "sharps") creates risk beyond a simple puncture. Sharps
injury has always been a risk for health care workers, but emergence of certain
blood-borne pathogens has intensified the need to act. Three- hepatitis B,
hepatitis C, and HIV-are of utmost concern because they can cause significant
morbidity or death. The incidence of sharps injury remains unacceptably high.
Injury analysis at long-term care facilities and at the national level reveals
several trends that can be used to shape policy and select interventions.
Policy, practice, and training need to address new devices engineered to
prevent sharps injuries, sharps disposal containers, and prophylaxis after percutaneous
injury
141. Adams D, Elliott TS. Impact of safety needle
devices on occupationally acquired needlestick injuries: a four-year
prospective study. J Hosp Infect 2006; 64(1):E pub.
ABSTRACT: A four-year prospective
study was undertaken at the University Hospital Birmingham National Health
Service Foundation Trust to evaluate the effect of the introduction of a range
of safety hypodermic needle devices on the number of reported needlestick
injuries (NSIs). Data on the number of reported NSIs for four clinical areas
began in 2001. Following an enhanced sharps awareness strategy in 2002, the
number of NSIs reduced from 16.9/100 000 devices used in 2001 to 13.9/100 000
devices (P=0.813). In 2003, when only standard training was provided, the
number of NSIs increased to 20/100 000 devices. However, the subsequent
introduction of three safety needle devices with concomitant training resulted
in a significant reduction in the number of reported NSIs to 6/100 000 devices
in 2004 (P=0.045). User satisfaction and acceptance of the safety needles was
also very favourable. These results suggest that when safety needle devices are
introduced into the clinical setting and appropriate training is given, a
significant reduction in the number of occupationally acquired NSIs may ensue
142. Al Habdan I, Corea JR, Sadat-Ali M. Double or
single gloves: which is safer in pediatric orthopedic surgery. Journal of
Pediatric Orthopedics 2006; 26(3):409-411.
ABSTRACT: BACKGROUND AND AIM::
Surgical gloves should form an efficient barrier between surgeons and patients
to prevent cross infection. Single gloves (SGs) have long been reported unsafe,
and usage of double gloves (DGs) is still not universal. No study has reported
the usage of DGs in pediatric orthopedic operations. The aim of this study was
to assess the efficacy of DGs versus SGs in prevention of body fluid contact
between patients and surgeons during pediatric orthopedic surgery.
METHODOLOGY:: After 150 pediatric orthopedic operations, DGs and SGs were
collected and tested for perforations. Gloves were tested for size, site, and
number of perforations among principal surgeons, assistant surgeons, and scrub
nurses. Gloves were not changed during long surgical procedures and were
changed only if perforations were identified and recorded. The DGs used were
Maxitex Duplex, powder-free indicator gloves and the SGs were of Gammex-Ansell.
One hundred unused gloves of each group were tested as controls. Medical
records of the patients were reviewed for age, sex, type of operation, duration
of operation, and any postoperative wound infection. The data were entered in
database and analyzed using SPSS package. The data were compared between double
and SGs using t test with a level of statistical significance at P less than
0.05. RESULTS:: Five hundred twenty-six DGs and 316 SGs were tested.
Forty-three perforations were detected in DGs (8.1%). Outer gloves were
breached in 7.8% and inner in 0.3% as compared with SGs in which 28 (8.7%) were
perforated. In DGs, 4% had multiple perforations compared with 11.9% in SGs.
There was a statistical significance (P < 0.001) when the perforations of
inner gloves were compared with the SGs. None of the inner perforations were
recognized during surgery, but the outer gloves of the DGs were recognized in
71% as compared with 9% in SGs (P < 0.001). The majority of perforations
were seen in the nondominant hand in surgeons and assistants hands, whereas
scrub nurses had 85% of perforations in the dominant hand. The index finger was
the site of perforations in DGs (53.4%; SGs, 43%). The inner gloves were
breached only when the outer glove was found to be perforated. The duration of
surgery had a direct impact on the number of perforations. There were no
perforations in DGs in less than 60 minutes as compared with 3 (10.7%) in SGs.
Between 60 and 120 minutes, the perforations in the DGs were 11, and in SGs,
21. During the study period, 4 patients had surgical site infection. Three were
superficial and one deep-seated infection. In 3 patients with infection, the
gloves were found to be perforated, and 1 patient with infection had no
perforations in the gloves. CONCLUSION:: Our study confirms that DGs are safer
than SGs during pediatric orthopedic operations. In the event of
nonavailability of DGs, SGs should be changed on an hourly basis during long
procedures. Lastly, there exists a relationship between surgical site infection
and glove perforations
143. Al AS, Bawikar S, Duclos P. Safe injection
practices in a primary health care setting in Oman.
ABSTRACT: We conducted a national
survey of injection practices in 78 government health facilities in
144. Apisarnthanarak A, Babcock HM, Fraser VJ.
Compliance with universal precautions among medical students in a tertiary care
center in
ABSTRACT: To the Editor-Occupational
exposure to bloodborne pathogens poses a serious threat
to healthcare workers (HCWs). Transmission of at least 20
different pathogens by injuries due to sharp instruments
and devices ("sharps") and needlesticks has been
reported. HCWs in
developing countries face an even higher risk because of
the elevated prevalence of hepatitis B virus (HBV),
hepatitis C virus (HCV), and human immunodeficiency virus
(HIV). In addition, certain
medical equipment used in developing countries, such as
nonretracting finger-stick lancets and glass capillary tubes used
to test for common tropical diseases, enhances the risk
of transmission of bloodborne pathogens. At
145. Armadans GL, Fernandez Cano MI, Albero A, I
et al. [Safety-engineered devices to prevent percutaneous injuries:
cost-effectiveness analysis on prevention of high-risk exposure]. [Spanish].
Gaceta Sanitaria 2006; 20(5):374-381.
ABSTRACT: OBJECTIVE: To assess the
efficiency of the replacement of several medical devices by engineered sharp
injury (SI) prevention devices (ESIPDs). METHODS: The cost-effectiveness ratios
of the replacement of medical devices in use by ESIPDs were estimated: their
purchasing costs and the direct costs of sharp injury care were taken into
account; the number of SI avoidable by each ESIPD was estimated from the 252
occupational SI notified by healthcare workers at a 1,300 bed hospital from
March 2002 to February 2003. The relationship between ESIPD additional costs
and the number of high-risk SI was estimated (SI were classified as high-risk
if they met two or more of the following criteria: moderately-deep or deep
injury, injury with a device previously inserted in an artery or vein, or with
a device exposed to blood). RESULTS: ESIPDs order according to cost-effectiveness
ratio: safety needle for implanted ports (-2.65 euro/SI avoided), followed by
syringes with protective shield (869.79 euro/SI), resheathable winged steel
needles, needleless administration sets, and short catheters with protective
encasement. ESIPDs order according to relationship between additional costs and
number of high-risk sharp injuries avoided: safety needles for implanted ports,
followed by winged steel needles, hypodermic syringes, short catheter and
needleless administration sets. CONCLUSIONS: Savings in SI care outweigh
additional costs of certain ESIPDs. Cost-effectiveness analysis is useful in
assigning priorities; however the risks of SI by every device must be taken
into account
146. Ayas NT, Barger LK, Cade BE et al. Extended
work duration and the risk of self-reported percutaneous injuries in interns.
JAMA 2006; 296(9):1055-1062.
ABSTRACT: CONTEXT: In their first
year of postgraduate training, interns commonly work shifts that are longer
than 24 hours. Extended-duration work shifts are associated with increased
risks of automobile crash, particularly during a commute from work. Interns may
be at risk for other occupation-related injuries. OBJECTIVE: To assess the
relationship between extended work duration and rates of percutaneous injuries
in a diverse population of interns in the
147. Baggaley RF, Boily MC, White RG, Alary M.
Risk of HIV-1 transmission for parenteral exposure and blood transfusion: a
systematic review and meta-analysis. AIDS 2006; 20(6):805-812.
ABSTRACT: BACKGROUND: The role of
iatrogenic transmission within the HIV/AIDS pandemic remains contentious.
Estimates of the risk of HIV transmission from injections and blood
transfusions are required to inform appropriate prevention policy. OBJECTIVES:
Systematic review and meta-analysis of the literature on HIV-1 infectivity for
parenteral transmission and blood transfusion. REVIEW METHODS: All identified
studies with relevant transmission probability estimates up to May 2005 were
included. STATISTICAL METHODS: When appropriate, summary estimates for
accidental percutaneous and blood product exposures were derived. RESULTS:
Infectivity estimates following a needlestick exposure ranged from 0.00 to
2.38% [weighted mean, 0.23%; 95% confidence interval (CI), 0.00-0.46%; n = 21].
Three estimates of infectivity per intravenous drug injection ranged from 0.63
to 2.4% (median, 0.8%); a summary estimate could not be calculated. The quality
of the only estimate of infectivity per contaminated medical injection (1.9-6.9%)
was assessed. Instead we propose a range of 0.24-0.65%. Infectivity estimates
for confirmed contaminated blood transfusions range from 88.3 to 100.0%
(weighted mean, 92.5%; 95% CI, 89.0-96.1%; n = 6). CONCLUSIONS: Infectivity
estimates for infected blood transfusions are larger than for other modes of
HIV transmission. Few studies on transmission risk per contaminated injection
were found. However, transmission risk per needlestick injury, where needles
are more likely to be rinsed or disinfected between recipients (especially for
medical injections), may be representative of non-intravenous medical
injections and lower than the risk from intravenous injections, which are
likely to be deeper and to involve more fluids. Further work is needed to
better estimate transmission probability related to contaminated injections and
its likely contribution to overall HIV transmission
148. Bakaeen F, Awad S, Albo D et al. Epidemiology
of exposure to blood borne pathogens on a surgical service. Am J Surg 2006;
192(5):e18-e21.
ABSTRACT: BACKGROUND: The goal of
this study was to analyze the type and mechanism of blood exposure injuries on
the surgical service in order to develop appropriate preventative strategies.
METHODS: A retrospective review of all exposure injuries affecting members of
the operative care line at a single teaching institution between December 2002
and December 2005 was performed. RESULTS: Of 98 exposure injuries on the
surgical service, only 17 (17%) were inflicted by hollow-bore needles. Seventy-four
(76%) of these reported injuries occurred in the operating room (OR) and 24
(24%) occurred in other clinical areas. Sharps injuries accounted for 69 (93%)
of OR injuries and were inflicted by suture needles (n = 37, 50%), hollow-bore
needles (n = 7, 9%), and sharp instruments (n = 25, 34%). Mucocutaneous
contamination accounted for 5 (7%) of the OR exposures. Professionals most
frequently injured were residents (n = 43, 44%), followed by nurses (n = 28,
29%), students (n = 17, 17%) and other healthcare workers (n = 10, 10%).
CONCLUSIONS: Blood exposure prevention strategies should be directed at safety
within the surgical field and focused beyond hollow-bore needle stick injuries
to include education, mentoring, and competency training
149. Bellissimo-Rodrigues WT, Bellissimo-Rodrigues
F, Machado AA. Occupational exposure to biological fluids among a cohort of
Brazilian dentists. Int Dent J 2006; 56(6):332-337.
ABSTRACT: OBJECTIVE: To evaluate the
epidemiology of percutaneous occupational exposure to biologic fluids and the
level of compliance with some recommendations contained in the 'Standard
Precautions' among dentists. SETTING: Sertaozinho city,
150. Bi P, Tully PJ, Pearce S, Hiller JE.
Occupational blood and body fluid exposure in an Australian teaching hospital.
Epidemiol Infect 2006; 134(3):465-471.
ABSTRACT: To examine work-related
blood and body fluid exposure (BBFE) among health-care workers (HCWs), to
explore potential risk factors and to provide policy suggestions, a 6-year
retrospective study of all reported BBFE among HCWs (1998-2003) was conducted
in a 430-bed teaching hospital in
151. Bilski B, Kostiukow A, Ptak D. [Risk
bloodborne infections in health care workers]. Med Pr 2006; 57(4):375-379.
ABSTRACT: The paper presents current
data on epidemiology and risk factors responsible for incidents leading to
blood-borne infections among health care workers. In many countries, the number
of this type of incidents has markedly decreased, whereas in
152. Bilski B, Kostiukow A, Ptak D. [Risk
bloodborne infections in health care workers]. [Polish]. Medycyna Pracy 2006;
57(4):375-379.
ABSTRACT: The paper presents current
data on epidemiology and risk factors responsible for incidents leading to
blood-borne infections among health care workers. In many countries, the number
of this type of incidents has markedly decreased, whereas in
153. Bouchard F. Les dispositifs sécuritaires pour
réduire les expositions au sang. Objectif Prévention 2006; 29(4):22-25.
ABSTRACT: Le risque d'EAS est très
présent dans les milieux de soins et difficile à éliminer totalement. Le moyen le plus efficace pour éliminer à la
source ou pour contrôler le risque d'EAS consiste à utiliser les DS. Des études démontrent que l'utilisation de
DS, lorsqu'ils font partie d'un programme global de réduction des EAS, peut
être très efficace. Des taux
d'efficacité allant jusqu'à 88% ont été mesurés.
154. Calfee DP. Prevention and management of
occupational exposures to human immunodeficiency virus (HIV). Mt Sinai J Med
2006; 73(6):852-856.
ABSTRACT: Occupational exposure to
blood and other potentially infectious body fluids places health care workers
at risk for acquisition of bloodborne pathogens, including the human
immunodeficiency virus (HIV). Utilizing appropriate techniques, personal
protective equipment, and safer "sharp" technology can minimize the
risk of these exposures. When exposure does occur, immediate evaluation and
initiation of post-exposure prophylaxis, when indicated. can substantially
reduce the risk of transmission of HIV. In this article, the basic concepts of
exposure prevention and management are reviewed
155.
ABSTRACT: BACKGROUND: Nosocomial
transmission of group A Streptococcus (GAS) has been well described. A recent
report of an outbreak investigation suggested that transmission can be
extensive and that standard infection control measures may not be adequate to
prevent transmission from patients with severe, invasive disease to healthcare
workers (HCWs). OBJECTIVE: A case of pharyngitis in an HCW caring for a patient
with GAS pharyngitis and necrotizing fasciitis prompted an investigation of the
extent and risk factors for nosocomial transmission of GAS. SETTING: A 509-bed,
tertiary care center in
156. Coleman C. Jury Backs HIV-Positive Cleaning
Woman.
ABSTRACT: A cleaning woman who
became HIV-positive after pricking her finger on dirty needles while working at
an upscale
The woman, whose name was withheld by the court, sued the Madison Medical
Cener, which treats AIDS patients.
According to her attorney, George Pfluger, the woman pricked with a
needle on Dec. 11, 1998, and again on Feb. 1, 1999, while emptying the trash.
Pfluger said this was one of the saddest cases he's ever experienced.
"My client is pleased with the verdict, but she is severely
depressed," he said. "She
doesn't have full-blown AIDS, but she's living with a deadly, ticking time
bomb."
157. Cullen BL, Genasi F, Symington I et al.
Potential for reported needlestick injury prevention among healthcare workers
through safety device usage and improvement of guideline adherence: expert
panel assessment. J Hosp Infect 2006; 63(4):445-451.
ABSTRACT: A prospective survey was
conducted over six months in order to estimate the proportion of reported
occupational needlestick injuries sustained by National Health Service (NHS)
Scotland staff that could have been prevented through either safety device
introduction, improved guideline adherence, guideline revision or a combination
of these. This survey involved the administration of a standard proforma to
healthcare workers followed by an expert panel assessment. All acute and
primary care NHS Scotland trusts, the Scottish Ambulance Service and the
Scottish National Blood Transfusion Service were included. Proforma and expert
panel assessment data were available for 64% of injuries (952/1497) reported by
healthcare staff. These injuries were all percutaneous. The expert panel
concluded that: 56% of all injuries and 80% of venepuncture/injection
administration injuries would probably/definitely have been prevented through
safety device usage, 52% of all injuries and 56% of venepuncture/injection
administration injuries would probably/definitely have been prevented through
guideline adherence and 72% of all injuries and 88% of venepuncture/injection
administration injuries would probably/definitely have been prevented through
either intervention. Multi-factorial analysis indicated that injuries sustained
through venepuncture/injection administration were significantly more likely to
be prevented through safety device usage [adjusted odds ratio (OR) 5.09, 95%
confidence intervals (CI) 3.11-8.31 and adjusted OR 2.70, 95% CI 1.64-4.45,
respectively], and significantly less likely to be prevented through guideline
adherence (adjusted OR 0.26, 95% CI 0.11-0.60 and adjusted OR 0.31, 95% CI
0.12-0.78, respectively). Injuries sustained after completing procedures were
significantly more likely to be prevented through safety device usage and guideline
adherence. The study's findings support the need for improvements to staff's
adherence to needlestick injury guidelines and appropriate implementation of
safety devices for venepuncture and injection administration
158. Dannetun E, Tegnell A, Torner A, Giesecke J.
Coverage of hepatitis B vaccination in Swedish healthcare workers. J Hosp
Infect 2006; 63(2):201-204.
ABSTRACT: The aim of this study was
to assess how well the guidelines on vaccination against hepatitis B had been
implemented among healthcare workers (HCWs) at risk for blood exposure. A
point-prevalence survey was conducted in six departments of a university
hospital in
159. de Souza RA, Namen FM, Galan J, Jr., Vieira
C, Sedano HO. Infection control measures among senior dental students in Rio de
Janeiro State, Brazil. Journal of Public Health Dentistry 2006; 66(4):282-284.
ABSTRACT: OBJECTIVE: The aim of this
study was to verify the practices and attitudes of senior dental students about
infection control procedures. METHODS: A cross-sectional survey was performed
during the 1st semester of 2003. Open- and close-ended questions were given to
196 students in 6 universities. RESULTS: Overall, 90.8% of students had been
vaccinated for hepatitis B. Only 25.0% have been assessed for anti-HBs. A total
of 99.5% students reported always using gloves for all procedures. Eye
protection were always used by 84.2% of students, and all the students used
face masks for all procedures. Caps or hair covers were used by 92.3% of
students and 87.8% reported no objection to treating patients with infectious
diseases. Among instructors, the students observed that 60.2% of them did not
use gloves for all procedures, 43.4% of those didn't change gloves between
patients. CONCLUSIONS: These results address the need for an improved quality
assurance, in order for the students and faculty to improve their practices and
attitudes on infection control measures
160. de Waal N, Rabie H, Bester R, Cotton MF. Mass
needle stick injury in children from the
ABSTRACT: Illegal dumping of
contaminated medical waste occurs commonly in
161. de OT, Pybus OG, Rambaut A et al. Molecular
epidemiology: HIV-1 and HCV sequences from Libyan outbreak. Nature 2006;
444(7121):836-837.
ABSTRACT: In 1998, outbreaks of
human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV)
infection were reported in children attending
162. Deisenhammer S, Radon K, Nowak D, Reichert J.
Needlestick injuries during medical training. J Hosp Infect 2006;
63(3):263-267.
ABSTRACT: Medical students are at
risk of acquiring infections caused by needlestick injuries, although it is
unknown when needlestick injuries are most likely to occur during medical
training. The aim of this study was to define high-risk periods over the course
of medical training. A cross-sectional study was conducted among medical
students in the first, third, fourth and fifth years of training at two medical
schools in
163. Deuchert E, Brody S. The role of health care
in the spread of HIV/AIDS in Africa: evidence from
ABSTRACT: It is commonly asserted
that the sub-Saharan African HIV/AIDS epidemic is predominantly due to
heterosexual transmission. However, recent re-examination of the available
evidence strongly suggests that unsafe health care is the more likely vector.
The present report adds to the evidence for health-care transmission by showing
that Kenyan women who received prophylactic tetanus toxoid injections during
pregnancy are 1.89 times (95% confidence interval [CI]:1.03-3.47) more likely to
be HIV-1 seropositive than women who did not receive this vaccination. In
contrast, recent sexual behaviour (condom use, number of partners) was not
related to HIV status. The findings are unconfounded by reverse causality (all
injections were purely prophylactic rather than for treatment of any
HIV-related illnesses, and none of the women reported knowing that she was HIV
seropositive). Focus on a specific injection may have improved participant
recall. The results are consistent with health care being a very important
vector for HIV in sub-Saharan
164. Elder A, Paterson C. Sharps injuries in
ABSTRACT: AIMS: To review the
literature on sharps injuries and occupational bloodborne virus transmission in
health care in the
165. Erdem Y, Talas MS. Blunt and penetrating
object injuries in housekeepers working in a
ABSTRACT: BACKGROUND: Hospitals have
been described as hazardous work environments with an increase in job-related
injuries. This situation creates great risks and hazards for housekeepers while
carrying out their job. METHODS: This descriptive study was performed on 402
housekeepers working in patient-care services in
166. Gabriel J. Needle stick injuries: How can we
minimise our risk? J Vasc Access 2006; 7(1):3-6.
ABSTRACT: In the United Kingdom (UK)
there is inequity in health care workers access to safer sharps and needle free
systems. The availability of safer sharps and needle free systems is dependent
on the budget manager authorising the purchase of these devices within
individual hospitals. This can mean that within the same organisation one
de-partment can be using safer sharps and needle free systems, while another
department is denied access to such equipment. This is partly due to competing
priorities for scarce health care resources, which is becoming more acute, and
lack of national guidance to employers to provide such safety equipment for
their employees. At the current time the
167. Ganczak M, Milona M, Szych Z. Nurses and occupational
exposures to bloodborne viruses in
ABSTRACT: STUDY OBJECTIVE: To record
descriptions of occupational exposures to blood, determine factors predictive
of exposure, and identify interventions that might reduce the frequency of
exposure. DESIGN: An analytic, cross-sectional survey. STUDY POPULATION: A
total of 601 nurses from surgical wards, operating rooms, and emergency
departments. STUDY INSTRUMENT: An anonymous questionnaire developed by the
authors on the basis of previously published guidelines was distributed between
January and March 2003. SAMPLING: Random, with 18 hospitals selected from 2
urban and rural locations. RESULTS: Almost half of respondents reported having
had at least 1 puncture injury during the preceding year, 1 in 5 had exposure
via mucous membranes, and more than half had worked at least once with a recent
abrasion or cut on their hands. The number of injuries was independent of age
(P=.26), duration of practice (P=.21), and workplace setting (P=.78). The
percentage of nurses without percutaneous exposure during the preceding year
was significantly higher in the group that received special HIV/AIDS training
than in the group that did not (95% confidence interval, 5.8-24.1%; P<.002).
The most recent exposure was primarily caused by hollow-bore needles, involved
the palm and fingers II-V, was self-inflicted, took place during an elective
procedure, and was not reported to the hospital's infection control center by
74% of respondents. The most common reason for not reporting the exposure (38%
of cases) was the conviction that the source patient was not infected.
CONCLUSIONS: Because of the large number of occupational exposures to blood,
especially those due to injuries with hollow-bore needles, nurses should adopt
more adequate behavioral strategies to prevent the transmission of blood-borne
pathogens. Policies for providing adequate education programs tailored to
encourage nurses to report all exposures are urgently required
168. Ganczak M. [HIV infection under laboratory
conditions]. Med Pr 2006; 57(4):353-358.
ABSTRACT: Laboratory workers are at
a particularly high risk of acquiring HIV. Based on the medical literature,
selected cases of occupational HIV infections among laboratory workers are
presented. Having analyzed specific circumstances connected with occupational
exposures, risk factors of such incidents are discussed. The importance of
continuing education in the areas of infection control procedures and
compliance with universal precautions as well as reporting on occupational
exposures to any infectious material in the context of post-exposure
prophylaxis are pointed as the best ways to achieve a successful outcome in the
HIV infection prevention under laboratory conditions. The lack of efficient,
multifaceted legislation covering all aspects of occupational exposure to
blood-borne pathogens, still observed in
169. Garmaise D. Health care workers push for use
of safer hypodermic needles. HIV AIDS Policy Law Rev 2006; 11(1):18-19.
ABSTRACT: Unions in
In
170. Gisselquist D, Upham G, Potterat JJ.
Efficiency of human immunodeficiency virus transmission through injections and
other medical procedures: evidence, estimates, and unfinished business. Infect
Control Hosp Epidemiol 2006; 27(9):944-952.
ABSTRACT: Objective. To estimate the
transmission efficiency of human immunodeficiency virus (HIV) through medical
injections and other invasive procedures.Design. We searched our own files and
Medline (from 1966-2004, using the keywords ["iatrogenic" or
"nosocomial" or "injections"] and "HIV") for
reports of iatrogenic outbreaks worldwide, except outbreaks traced to receipt
of contaminated blood or blood products. We also analyzed information from a
case-control study of percutaneous exposures to healthcare workers.Setting.
Worldwide healthcare settings.Events. We identified 8 iatrogenic outbreaks that
met our study criteria; published information from 4 outbreaks was sufficient
to estimate transmission efficiency.Results. From the 4 documented iatrogenic
outbreaks, we estimated that 1 iatrogenic infection occurred after 8-52
procedures involving HIV-infected persons. Although only 0.3% of healthcare
workers seroconvert after percutaneous exposure, a case-control study reported
that deep injuries and other risk factors collectively increased seroconversion
risk by as much as 50 times. Laboratory investigations demonstrate HIV survival
through time and various rinsing regimens. We estimate that the transmission
efficiency in medical settings with no or grossly insufficient efforts to clean
equipment ranges from 0.5% to 3% for lower risk procedures (eg, intramuscular
injections) and from 10% to 20% or more for high-risk procedures. Efforts to
clean equipment, short of sterilization, may cut the transmission efficiency by
0%-100%. Procedures that contaminate multidose vials may accelerate
transmission efficiency.Conclusion. To achieve better estimates of the
transmission efficiency for a range of medical procedures and settings,
investigations of iatrogenic outbreaks should be accorded high priority
171. Gomaa A, Sinclair R, Alarcon W. Occupational
blood-borne diseases in surgery.[comment]. American Journal of Surgery 2006;
192(3):408-409.
ABSTRACT: To the Editor: We read
with great interest Dr. Fry's article "Occupational Blood-borne Diseases
in Surgery" recently published by the American Journal of Surgery. The article draws the conclusion that it is
unlikely that we know all of the potential blood-borne pathogens that may pose
an occupational risk for surgeons, that blood exposure in the operating room is
tolerated with the same lassitude that chacterized the pre-HIV era, and that
prevention of blood exposure is a desirable goal.
172. Hagstrom AM. Perceived barriers to
implementation of a successful sharps safety program. AORN J 2006; 83(2):391,
393-391, 397.
ABSTRACT: IN RESPONSE TO INCREASING
needle sticks and sharps injuries at a large, urban trauma center in the
northeastern
173. Haiduven D, Applegarth S, DiSalvo H,
Mangipudy S, Konopack J, Fisher J. A pilot study to measure the compressive and
tensile forces required to use retractable intramuscular safety syringes. Am J
Infect Control 2006; 34(10):661-668.
ABSTRACT: BACKGROUND: A pilot study
was conducted at the
174. Health Protection Agency Centre for
Infections. Eye of the Needle:
ABSTRACT: This report provides
information on the risks for occupational exposure and seroconversion to
bloodborne viruses in healthcare workers. In conjunction with monitoring and
informing related policies, it provides recommendations for prevention and
improving clinical management of significant occupational exposures to
bloodborne viruses.
175. Henry LB, Pellowski DM, Davis DA. Combination
forceps fuse both safety and efficiency. Dermatol Surg 2006; 32(5):717-720.
ABSTRACT: BACKGROUND:
Instrumentation prevents needle stick injury. OBJECTIVE: To review forceps that
insure safety and facilitate tissue-handling and knot-tying efficiency. METHOD:
Medical literature reports were reviewed using Ovid. Commercially available
instruments were qualitatively tested. RESULTS: Suture platforms securely hold
suture needles and can be used during knot tying. A wide range of combination
forceps have been invented and can be broadly categorized as either skin hook
or toothed combination forceps. CONCLUSIONS: Combination forceps fuse both
efficiency and safety. Skin hook forceps may eventually be the optimal
combination instrument, but toothed combination forceps are recommended
176. Herida M, Larsen C, Lot F et al.
Cost-effectiveness of HIV post-exposure prophylaxis in France.[see comment].
AIDS 2006; 20(13):1753-1761.
ABSTRACT: OBJECTIVE: To assess the
cost-effectiveness of HIV post-exposure prophylaxis (PEP) in
177. Hoofnagle JH, Seeff LB. Peginterferon and
ribavirin for chronic hepatitis C. [Review] [50 refs].
ABSTRACT: A 44-year-old woman with
chronic hepatitis C has intermittent fatigue and persistent
elevations in serum alanine aminotransferase levels. She has had
hepatitis C for 10 years. The diagnosis was made after she attempted
to donate blood and was found to have antibodies against the
hepatitis C virus (HCV). On questioning, she reports having used
illicit injection drugs in her early 20s.
The physical examination is normal except for obesity. The results of laboratory tests show an alanine
aminotransferase level of 86 U per liter (normal value, <42); the
alkaline phosphatase level, direct and total bilirubin levels,
albumin level, prothrombin time, and complete blood count are
normal. The serum HCV RNA level is 3.5 million IU per milliliter
(genotype 1), and a liver biopsy specimen shows bridging fibrosis.
The patient is evaluated by a hepatologist, who recommends treatment
with pegylated interferon and ribavirin.
178. Hsieh WB,
ABSTRACT: BACKGROUND AND PURPOSE:
Blood and infectious body fluid (BBF) exposures are common safety problems for
health care workers (HCWs). We analyzed reported BBF exposures during a 3-year
period at a teaching hospital. METHODS: We collected reports of BBF exposures
among HCWs occurring from January 2001 to December 2003 at a 2000-bed tertiary
care medical center in northern
179. Ibekwe RC, Ibeziako N. Hepatitis B
vaccination status among health workers in
ABSTRACT: BACKGROUND: Health workers
in
180. Ilhan MN, Durukan E, Aras E, Turkcuoglu S,
Aygun R. Long working hours increase the risk of sharp and needlestick injury
in nurses: the need for new policy implication. J Adv Nurs 2006; 56(5):563-568.
ABSTRACT: AIM: This paper reports a
study to determine the sharp and needlestick injury incidence in nurses working
at a university hospital and the contributing factors. BACKGROUND: Although it
is generally felt that working in the healthcare sector is clean and without
risk, healthcare staff and especially physicians and nurses who generally work
very long hours are actually exposed to various occupational risks. Sharps and
needlestick injuries are important problems for healthcare workers as they
increase the risk of spread of infection. METHOD: A self-administered
questionnaire was completed in October 2005 by 449 of the 516 nurses working at
a Turkish hospital (response rate 87.0%). RESULTS: The percentage of nurses
experiencing a sharp or needlestick injury during their professional life was
79.7%. The incidence of exposure to sharp or needlestick injury in the last
year was 68.4%. The factors increasing the rate of sharp and needlestick injury
were: age 24 years and less, <or=4 years of nursing experience, working in
surgical or intensive care units and working for more than 8 hours per day (P
< 0.05). CONCLUSION: The findings indicate which groups of staff should be
targeted for educational programmes. Consideration also needs to be given to
the unwanted effects of working long shifts, where tiredness may contribute to
the number of needlestick injuries
181. Ilhan MN, Durukan E, Aras E, Turkcuoglu S,
Aygun R. Long working hours increase the risk of sharp and needlestick injury
in nurses: the need for new policy implication. J Adv Nurs 2006; 56(5):563-568.
ABSTRACT: AIM: This paper reports a
study to determine the sharp and needlestick injury incidence in nurses working
at a university hospital and the contributing factors. BACKGROUND: Although it
is generally felt that working in the healthcare sector is clean and without
risk, healthcare staff and especially physicians and nurses who generally work
very long hours are actually exposed to various occupational risks. Sharps and
needlestick injuries are important problems for healthcare workers as they
increase the risk of spread of infection. METHOD: A self-administered
questionnaire was completed in October 2005 by 449 of the 516 nurses working at
a Turkish hospital (response rate 87.0%). RESULTS: The percentage of nurses
experiencing a sharp or needlestick injury during their professional life was
79.7%. The incidence of exposure to sharp or needlestick injury in the last
year was 68.4%. The factors increasing the rate of sharp and needlestick injury
were: age 24 years and less, <or=4 years of nursing experience, working in
surgical or intensive care units and working for more than 8 hours per day (P
< 0.05). CONCLUSION: The findings indicate which groups of staff should be
targeted for educational programmes. Consideration also needs to be given to
the unwanted effects of working long shifts, where tiredness may contribute to
the number of needlestick injuries
182.
ABSTRACT: Chestlist for Sharps
Injury Prevention
183. Jagger J, Perry JL. Response to Mallolas et
al. "Obstetrician-to-patient HIV transmission". AIDS 2006;
20(13):1785-1786.
ABSTRACT: The report of Mallolas et
al. is an important confirmation that, although uncommon, HIV can be
transmitted from an infected healthcare worker (HCW) to a patient via a
needlestick injury during an exposure-prone procedure. The actions of the
obstetrician in this case raise some important issues.
First, although the obstetrician was in a known risk group for HIV infection,
he declined to know his HIV status before infecting a patient, in contradiction
to recommendations cited by the authors. By knowing his HIV status he could
have eliminated or reduced his risk of infecting a patient by refraining from
performing invasive procedures or by eliminating the use of sharp-tip suture
needles from caesarean and other obstetric procedures (substituting blunt
suture needles instead), and also by receiving antiretroviral therapy, which
can reduce the viral load in the blood of an infected individual.
184. Jagger J, Perry JL. Response to Mallolas et
al. "Obstetrician-to-patient HIV transmission". AIDS 2006;
20(13):1785-1786.
ABSTRACT: The report of Mallolas et
al. [1] is an important confirmation that, although uncommon, HIV can be
transmitted from an infected healthcare worker (HCW) to a patient via a
needlestick injury during an exposure-prone procedure. The actions of the
obstetrician in this case raise some important issues.
185. Jovic-Vranes A, Jankovic S, Vranes B. Safety
practice and professional exposure to blood and blood-containing materials in
serbian health care workers. Journal of Occupational Health 2006;
48(5):377-382.
ABSTRACT: Safety practice is an
important element of workplace safety and quality of health care. To
investigate the safety practice and professional exposure to blood and
blood-containing materials during a one-year period among Health Care Workers
(HCWs) in
186. Kanter L. Accidental needle stick prevention:
an important, costly, unsafe policy revisited. Ann Allergy Asthma Immunol 2006;
97(1):7-9.
ABSTRACT: The article by Wolf et al
in this issue of the Annals addresses important medicoeconomic and
disease transmission and safety issues. Because of the number of injections
administered at an allergy practice, sharp object containers are usually kept
within immediate reach of the employee giving shots. Activating a needle guard
mechanism after giving the injection adds an additional action, thereby
potentially increasing the opportunity for accidental needle sticks (ANSs).
In 1984, the first case of needle stick-transmitted human immunodeficiency
virus (HIV) was reported. In 1986, the
Occupational Safety and Health Administration (OSHA) was petitioned by various
unions representing health care employees to develop a standard that protects
employees from occupational exposure to bloodborne diseases. The US Congress subsequently passed the
Needlestick Safety and Prevention Act. This act, which passed on January 18,
2001, and became effective on April 18, 2001, directed OSHA to revise the
bloodborne pathogens standard. This
revision specifies that "safer medical devices, such as sharps with
engineered sharps injury protections and needle-less systems" constitute
"an effective" engineering control and must be used where
feasible. There was no definition of "effective" or "safer"
or the need to validate before use.
187. Keeler N, Schonberger LB, Belay ED, Sehulster
L, Turabelidze G, Sejvar JJ. Investigation of a possible iatrogenic case of
Creutzfeldt-Jakob disease after a neurosurgical procedure. [Review] [15 refs].
Infection Control & Hospital Epidemiology 2006; 27(12):1352-1357.
ABSTRACT: OBJECTIVE: To investigate
a case of Creutzfeldt-Jakob disease (CJD) possibly acquired from contaminated
neurosurgical instruments. DESIGN: Retrospective review of medical records,
hospital databases, service log books, and state vital statistics. SETTING: A
tertiary care hospital (hospital A) in
188. Krishnan P, Dick F, Murphy E. The impact of
educational interventions on primary health care workers' knowledge of
occupational exposure to blood or body fluids. Occup Med (Lond) 2006; Advance
Access.
ABSTRACT: Aim To assess the impact
of educational interventions on primary health care workers' knowledge of
management of occupational exposure to blood or body fluids. Methods
Cluster-randomized trial of educational interventions in two National Health
Service board areas in
189. Kubiczek P, Langona M, Mellen PF.
Occupational injuries in a pathology residency program.[comment]. Archives of
Pathology & Laboratory Medicine 2006; 130(2):146-147.
ABSTRACT: To the Editor: We read
with interest the article "Cutting Injuries in an Academic Pathology
Department," by Pritt and Waters, and wish to share our observations and
experiences on this topic. We reviewed
reports of occupational injuries from May 2000 through May 2003 occurring at
the Ball Memorial Hospital Pathology Residency program. This 400-bed community hospital with academic
residency programs in multiple specialities processed 857 autopsies (mostly
forensic) and 80,000 surgical pathology cases during this period.
190. L'Heriteau F, Tarantola A, Olivier M et al.
Variation in blood and body fluids exposure when small-gauge needles or
peripheral venous catheters were implicated: results of a 4-year surveillance
in
ABSTRACT: The blood and body fluids
exposure (BBFE) risk for health care workers varies according to numerous
factors. Based on a needlestick surveillance in 13 French hospitals from 1997
to 2000, we evaluated incidence and temporal trends of BBFE according to
medical devices causing needlestick injuries. We observed that the BBFE
incidence per 100,000 peripheral venous catheters purchased decreased from 12.9
to 4.9, whereas incidence per 100,000 subcutaneous needles purchased increased
from 8.7 to 14.3
191. Leens E, Van Laer F. Accidents exposant au
sang au bloc opératoire. NOSO 2006; 10(3):4-9.
ABSTRACT: 'Sur la base des résultats
du réseau de surveillance national des AES, cet article vise à offrir une
meilleure compréhension du risque encouru par le personnel du bloc opératoire.
Nous nous intéresserons de plus près au nombre et au type d' AES, aux
circonstances des infections, au type de matériel utilisé lors de l'incident et
aux mesures de prévention à prendre pour minimiser le risque dans le contexte
spécifique du bloc opératoire.'
192. Leiss J, Ratcliff JM, Lyden JT et al. Blood
Exposure Among Paramedics: Incidence Rates From the National Study to Prevent
Blood Exposure in Paramedics. Annals of Epidemiology 2006; 16(9):720-725.
ABSTRACT: Purpose The aim of the study is to estimate incidence rates of
occupational blood exposure by route of exposure (needlesticks; cuts from sharp
objects; mucous membrane exposures to the eyes, nose, or mouth; bites; and
blood contact with nonintact skin) in US and
Methods A mail survey was
conducted in a national probability sample of certified paramedics.
Results Proportions of
paramedics who reported an exposure in the previous year were 21.6% (95%
confidence interval [CI], 17.8–25.3) for the national sample and 14.8% (95% CI,
12.2–17.4) for
Conclusion Paramedics continue
to be at substantial risk for blood exposure. More attention should be given to
reducing mucocutaneous exposures. The impact of legislation on reducing
exposures and the importance of nonintact skin exposures need to be better
understood.
193. Liu CH, Chen BF,
ABSTRACT: BACKGROUND: Little is
known about the transmission of variant hepatitis C virus (HCV) genome through
needlestick injuries. METHODS: To demonstrate how HCV quasi species are
transmitted and adapt to the new host in acute resolving infection, we analyzed
the nucleotide and deduced amino acid sequences of the hypervariable region 1
(HVR-1) in the E2 domain of HCV in both the source of the virus
("donor") and the person who received the virus through a needlestick
accident ("recipient"). In addition, we also performed phylogenetic
analysis of HCV quasi species in these patients to document the viral
transmission. RESULTS: We obtained a total of 33 clones at different time
points by using polymerase chain reaction amplification and cloning and
sequencing of HVR-1. A predominant HVR-1 variant (in 4 of 10 isolates) in the
donor was not present in the recipient 6 and 14 weeks after the accident. In
contrast, a minor variant (in 1 of 10 isolates) in the donor became the
predominant strain in the recipient 6 weeks (in 10 of 12 isolates) and 14 weeks
(in 6 of 11 isolates) after the accident. Additional phylogenetic analysis
showed high homology of nucleotide sequences between isolates obtained from the
donor and isolates obtained from the recipient. In addition, the variants in
the recipient's virus showed substantial genetic preservation in the course of
acute resolving hepatitis. CONCLUSIONS: These data suggested that a minor HCV
variant from a donor was transmitted to the recipient through a needlestick
injury and that it prevailed as the dominant species. The preserved genetic
homogeneity of the transmitted viral variants in patients with acute HCV
infection may account for their clinical outcomes of resolving hepatitis
194. Makary MA, Pronovost PJ, Weiss ES et al.
Sharpless surgery: a prospective study of the feasibility of performing
operations using non-sharp techniques in an urban, university-based surgical
practice. World Journal of Surgery 2006; 30(7):1224-1229.
ABSTRACT: CONTEXT: Percutaneous
injuries occur frequently during surgical procedures and represent a
significant occupational hazard to operating room personnel. OBJECTIVES: To
evaluate the feasibility of performing select general surgical procedures using
a combination of non-sharp devices and techniques to replace the conventional
use of scalpels and needles. DESIGN, SETTING, AND PARTICIPANTS: Candidate
procedures for which sharpless techniques could replace conventional scalpels
and suture needles were identified preoperatively in an urban, university-based
general surgical practice over a 1-year period (June 2003-June 2004). Non-sharp
techniques included monomeric 2-octyl cyanoacrylate adhesive, electrocautery,
tissue stapler, and minimally invasive instrumentation. Conventional scalpels
and suture needles were readily available and used whenever necessary. MAIN
OUTCOME MEASURES: We rated the feasibility of performing specific procedures
without sharps. We also documented the rate of overall reversion to sharps
during operations on patients that had been identified preoperatively as candidates
for sharpless surgery. RESULTS: Of 358 procedures performed in the general
surgery university practice, 91 were identified preoperatively as appropriate
for sharpless surgery. Of these, 86.8% (79/91) were completed without the use
of sharps, including 13/22 (59.1%) open laparotomy procedures, 20/22 (90.9%)
laparoscopic procedures, and 46/47 (97.8%) soft tissue procedures.
Intraoperative reversion to sharps occurred in 12 cases when deemed necessary
by the surgeon. CONCLUSIONS: Select common procedures can be performed entirely
with sharpless techniques, eliminating the risk to surgical personnel
associated with intraoperative percutaneous injuries
195. Mallolas J, Arnedo M, Pumarola T et al.
Transmission of HIV-1 from an obstetrician to a patient during a caesarean
section. AIDS 2006; 20(2):285-299.
ABSTRACT: We describe a probable
case of HIV-1 transmission from a healthcare worker (HCW) to a patient during a
caesarean section. Genetic distance comparisons of the viral sequence of the
C2V4 region of the viruses from the patient and the obstetrician showed an
average nucleotide sequence divergence of 3% (2.8-3.1). HIV can be transmitted
from an infected HCW to a patient when percutaneous injuries with subsequent
exposure of the patient to the blood of the HCW can occur.
196. Mallolas J, Arnedo M, Pumarola T et al.
Transmission of HIV-1 from an obstetrician to a patient during a caesarean
section. AIDS 2006; 20(2):285-287.
ABSTRACT: We describe a probable
case of HIV-1 transmission from a healthcare worker (HCW) to a patient during a
caesarean section. Genetic distance comparisons of the viral sequence of the
C2V4 region of the viruses from the patient and the obstetrician showed an
average nucleotide sequence divergence of 3% (2.8-3.1). HIV can be transmitted
from an infected HCW to a patient when percutaneous injuries with subsequent
exposure of the patient to the blood of the HCW can occur
197. Mallolas J, Gatell JM, Bruguera M.
Transmission of HIV-1 from an obstetrician to a patient during a caesarean section.
AIDS 2006; 20(13):1785.
ABSTRACT: We have recently reported
[1] a probable case of the transmission of HIV-1 from an obstetrician to a
patient during a caesarean section. In response to a request from the editors
for clarification of the HIV testing that took place and in response to a
reader's query, so that others are aware of the details available on this
report of HIV transmission between a healthcare professional and a patient, we
would like to underline and or reinforce the following points: (i) The
HIV-negative test during pregnancy was reported by the patient only, and any
results for screening for HIV-1 antibodies and viral load could not be directly
verified.
198. Menna-Barreto M. HTLV-II transmission to a
health care worker. Am J Infect Control 2006; 34(3):158-160.
ABSTRACT: Health care workers,
mainly in emergency and forensic services, are at risk of exposure to
bloodborne pathogens. Human T-cell lymphotropic virus type I and type II
(HTLV-I and HTLV-II) are cosmopolitan human delta retroviruses causing endemic
infection in Japan, the Caribbean basin, South America, and sub-Saharan Africa,
and in clusters among intravenous drug users in Europe and the United States.
The seroprevalence of HTLV-I and HTLV-II among Brazilian blood donors ranges
from 0.08% to 1.35%. HTLV-I transmission to a Japanese researcher has already
been reported. We describe the transmission of HTLV-II infection to a Brazilian
laboratory worker caused by a needlestick injury when she was recapping a
syringe after collecting material for arterial blood gas analysis. To our
knowledge, this is the first report of an occupational transmission of HTLV-II
to a health care worker
199. Motamed N, BabaMahmoodi F, Khalilian A,
Peykanheirati M, Nozari M. Knowledge and practices of health care workers and
medical students towards universal precautions in hospitals in Mazandaran
Province.
ABSTRACT: This study investigated
knowledge of and practices towards universal precautions among 540 health care
workers and medical students in 2 university hospitals in
200. Pan A, Signorini L, Magri S, De Carli G.
Scalp needlestick injury during fine-needle aspiration cytologic evaluation without
needle manipulation: William tell in the laboratory, not quite. Infect Control
Hosp Epidemiol 2006; 27(9):996.
ABSTRACT: To The
Editor--Galed-Placed et al. suggest using a modified method of fine-needle
aspiration cytologic evaluation (FNAC) that eliminates manipulation of the
contaminated needle to reduce the risk of occupational infection in healthcare
personnel while retaining diagnostic accuracy.
The modified method of FNAC eliminates excess needle manipulation by
aspirating 2 ml. of air into the syringe so that, subsequent to the procedure,
the residual air can be used to empty the material in the needle. We describe a case of scalp injury in a
cytopathologist who used this modified method of FNAC.
201. Pellissier G, Migueres B, Tarantola A, Abiteboul
D, Lolom I, Bouvet E. Risk of needlestick injuries by injection pens. J Hosp
Infect 2006; 63(1):60-64.
ABSTRACT: Injection pens are used by
patients when auto-administering medication (insulin, interferon, apokinon
etc.) by the subcutaneous route. The objective of this study was to evaluate
the rate of injection pen use by healthcare workers (HCWs) and the associated
risk of needlestick injuries to document and compare injury rates between
injection pens and subcutaneous syringes. A one-year retrospective study was
conducted in 24 sentinel French public hospitals. All needlestick injuries
linked to subcutaneous injection procedures, which were voluntarily reported to
occupational medicine departments by HCWs between October 1999 and September
2000, were documented using a standardized questionnaire. Additional data
(total number of needlestick injuries reported, number of subcutaneous
injection devices purchased) were collected over the same period. A total of
144 needlestick injuries associated with subcutaneous injection were reported.
The needlestick injury rate for injection pens was six times the rate for
disposable syringes. Needlestick injuries with injection pens accounted for 39%
of needlestick injuries linked with subcutaneous injection. In all, 60% of
needlestick injuries with injection pens were related to disassembly. Injection
pens are associated with needlestick injuries six times more often than
syringes. Nevertheless, injection pens have been shown to improve the quality
of treatment for patients and may improve treatment observance. This study
points to the need for safety-engineered injection pens
202. Perry J, Jagger J. Waking up to the benefits
of safety I.V. catheters. Nursing2006 2006; 36(2):68.
ABSTRACT: Injuries to nurses from
conventinal I.V. catheters declined by 55% from 1993 to 2001. The most recent data from the Exposure
Prevention Information Network (EPINet) shown an even bigger drop: From 2001 to
2004, injuries decreased by another 63%.
This can be directly correlated to the implementation of I.V. safety
catheters, which had captured 94% of the U.S. I.V. catheter acute care market
as of 2004. Implementation of safety
I.V. catheters has become a priority in most
203. Perry JL,
ABSTRACT:
204. Prati D, Prati D. Transmission of hepatitis C
virus by blood transfusions and other medical procedures: a global review.
[Review] [112 refs]. Journal of Hepatology 2006; 45(4):607-616.
ABSTRACT: Hepatitis C virus (HCV) is
a leading cause of chronic blood-borne infection and chronic liver disease. The
global epidemic of HCV infection emerged in the second half of the 20th
century, and several lines of evidence indicate that it was primarily triggered
and fed iatrogenically by the increasing use of parenteral therapies and blood
transfusion. In developed countries, the rapid improvement of healthcare
conditions and the introduction of anti-HCV screening for blood donors have led
to a sharp decrease in the incidence of iatrogenic hepatitis C, but the
epidemic continues to spread in developing countries, where the virus is still
transmitted through unscreened blood transfusions and non-sterile injections.
This article reviews the published literature concerning HCV transmission
through blood transfusions and other unsafe medical procedures. Given the
substantial difference in current disease transmission patterns between the northern
and southern hemispheres, the situation in developed and developing countries
is separately analysed. [References: 112]
205. Raghavendran S, Bagry HS,
ABSTRACT: Hospital staff are at risk
from occupational exposure to blood-borne viruses due to needle stick injuries.
Occupational health departments have invested considerable resources in the
prevention of these injuries, which can be very distressing to the affected
individuals. We surveyed health care workers, i.e. doctors, nurses and
operating department practitioners, in the operating theatre and critical care
units of two
206. Rapparini C. Occupational HIV infection among
health care workers exposed to blood and body fluids in
ABSTRACT: BACKGROUND: Exposure to
bloodborne pathogens poses a serious risk to health care workers (HCWs).
Surveillance systems of occupationally acquired human immunodeficiency virus
(HIV) infection have been developed in several countries, mainly in the
developed world. The purpose of this study was to identify cases of
occupationally acquired HIV infection among HCWs in
207. Rogers DE, Brent AC. Small-scale medical
waste incinerators--experiences and trials in
ABSTRACT: Formal waste management
services are not accessible for the majority of primary healthcare clinics on
the African continent, and affordable and practicable technology solutions are
required in the developing country context. In response, a protocol was
established for the first quantitative and qualitative evaluation of relatively
low cost small-scale incinerators for use at rural primary healthcare clinics.
The protocol comprised the first phase of four, which defined the comprehensive
trials of three incineration units. The trials showed that all of the units
could be used to render medical waste non-infectious, and to destroy syringes
or render needles unsuitable for reuse. Emission loads from the incinerators
are higher than large-scale commercial incinerators, but a panel of experts
considered the incinerators to be more acceptable compared to the other waste
treatment and disposal options available in under-serviced rural areas.
However, the incinerators must be used within a safe waste management programme
that provides the necessary resources in the form of collection containers,
maintenance support, acceptable energy sources, and understandable operational
instructions for the incinerators, whilst minimising the exposure risks to
emissions through the correct placement of the units in relation to the clinic
and the surrounding communities. On-going training and awareness building are
essential in order to ensure that the incinerators are correctly used as a
sustainable waste treatment option
208. Rogers DE, Brent AC. Small-scale medical
waste incinerators--experiences and trials in
ABSTRACT: Formal waste management
services are not accessible for the majority of primary healthcare clinics on
the African continent, and affordable and practicable technology solutions are
required in the developing country context. In response, a protocol was
established for the first quantitative and qualitative evaluation of relatively
low cost small-scale incinerators for use at rural primary healthcare clinics.
The protocol comprised the first phase of four, which defined the comprehensive
trials of three incineration units. The trials showed that all of the units
could be used to render medical waste non-infectious, and to destroy syringes
or render needles unsuitable for reuse. Emission loads from the incinerators
are higher than large-scale commercial incinerators, but a panel of experts
considered the incinerators to be more acceptable compared to the other waste
treatment and disposal options available in under-serviced rural areas.
However, the incinerators must be used within a safe waste management programme
that provides the necessary resources in the form of collection containers,
maintenance support, acceptable energy sources, and understandable operational
instructions for the incinerators, whilst minimising the exposure risks to
emissions through the correct placement of the units in relation to the clinic
and the surrounding communities. On-going training and awareness building are
essential in order to ensure that the incinerators are correctly used as a
sustainable waste treatment option
209. Sadoh WE, Fawole AO, Sadoh AE, Oladimeji AO,
Sotiloye OS. Practice of universal precautions among healthcare workers. J Natl
Med Assoc 2006; 98(5):722-726.
ABSTRACT: INTRODUCTION: Healthcare
workers (HCWs) are exposed to bloodborne infections by pathogens, such as HIV,
and hepatitis B and C viruses, as they perform their clinical activities in the
hospital. Compliance with universal precautions has been shown to reduce the
risk of exposure to blood and body fluids. This study was aimed at assessing
the observance of universal precautions by HCWs in
210. Scully C, Greenspan JS. Human Immunodeficiency
Virus (HIV) Transmission in Dentistry. J Dent Res 2006; 85(9):794-800.
ABSTRACT: HIV transmission in the
health-care setting is of concern. To assess the current position in dentistry,
we have reviewed the evidence to November 1, 2005. Transmission is evidently
rare in the industrialized nations and can be significantly reduced or
prevented by the use of standard infection control measures, appropriate
clinical and instrument-handling procedures, and the use of safety equipment
and safety needles. We hope that breaches in standard infection control will
become vanishingly small. When occupational exposure to HIV is suspected, the
application of post-exposure protocols for investigating the incident and
protecting those involved from possible HIV infection further reduces the
likelihood of HIV disease, and also stress and anxiety
211. Shah SM, Merchant AT, Dosman JA. Percutaneous
injuries among dental professionals in
ABSTRACT: BACKGROUND: Percutaneous
exposure incidents facilitate transmission of bloodborne pathogens such as
human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B
virus (HBV). This study was conducted to identify the circumstances and
equipment related to percutaneous injuries among dental professionals. METHODS:
We used workers' compensation claims submitted to the Department of Labor and
Industries State Fund during a 7-year period (1995 through 2001) in
212. Shepard CW, Simard EP, Finelli L, Fiore AE,
Bell BP. Hepatitis B Virus Infection: Epidemiology and Vaccination. Epidemiol
Rev 2006.
ABSTRACT: Worldwide, two billion
people have been infected with hepatitis B virus (HBV), 360 million have
chronic infection, and 600,000 die each year from HBV-related liver disease or
hepatocellular carcinoma. This comprehensive review of hepatitis B epidemiology
and vaccines focuses on definitive and influential studies and highlights
current trends, policies, and directions. HBV can be transmitted vertically,
through sexual or household contact, or by unsafe injections, but chronic
infections acquired during infancy or childhood account for a
disproportionately large share of worldwide morbidity and mortality.
Vaccination against HBV infection can be started at birth and provides
long-term protection against infection in more than 90% of healthy people. In
the 1990s, many industrialized countries and a few less-developed countries
implemented universal hepatitis B immunization and experienced measurable
reductions in HBV-related disease. For example, in
ABSTRACT: Although needlestick and
sharps injuries (NSI) are known to affect professional nurses at high rates,
most studies depend on officially reported data and few have been undertaken in
ABSTRACT: BACKGROUND: Although
needlestick and sharps injuries (NSI) represent a significant occupational
hazard for physicians worldwide, their epidemiology has not been previously
examined in Mainland
215. Smith DR, Mihashi M, Adachi Y, Nakashima Y,
Ishitake T. Epidemiology of needlestick and sharps injuries among nurses in a
Japanese teaching hospital. Journal of Hospital Infection 2006; 64(1):44-49.
ABSTRACT: The epidemiology of
needlestick and sharps injuries (NSIs) was investigated among a complete
cross-section of 1,162 nurses from a large hospital in southern
ABSTRACT: Although needlestick and
sharps injuries (NSI) represent a major hazard in nursing practice, most
studies rely on officially reported data and none have yet been undertaken in
tropical environments. Therefore, we conducted a cross-sectional NSI survey
targeting all nurses within a tropical Australian hospital, regardless of
whether they had experienced an NSI or not. Our overall response rate was
76.7%. A total of 39 nurses reported 43 NSI events in the previous 12 months.
The most common causative device was a normal syringe needle, followed by
insulin syringe needles, i.v. needles or kits and blood collection needles.
Half of the nurses' NSI events occurred beside the patient's bed: drawing up
medication was the most common reason. Nurses working in the maternity/neonatal
wards were only 0.3 times as likely to have experienced an NSI as their counterparts
in the medical or surgical wards. Overall, our study has shown that NSI events
represent an important workplace issue for tropical Australian nurses. Their
actual rate might also be higher than official reports suggest
217. Sohn JW, Kim BG, Kim SH, Han C. Mental health
of healthcare workers who experience needlestick and sharps injuries. Journal
of Occupational Health 2006; 48(6):474-479.
ABSTRACT: Healthcare workers (HCWs)
are exposed daily to the risk of injury by needlesticks and other medical
instruments. However, the psychiatric impacts of such injuries have not been
evaluated. The aim of this study was to evaluate the mental health status of
HCWs with experiences of needlestick and sharps injuries. A cross-sectional
written survey was performed. The psychological symptoms before injury and
current status were measured using the Beck Depression Inventory (BDI),
Hamilton Anxiety Scale (HAM-A) and Perceived Stress Scale (PSS). The
proportions of HCWs with and without needlestick and sharps injuries were 71.1%
(n=263) and 28.9% (n=107), respectively. HAM-A and BDI scores were
significantly higher among HCWs with injury experiences (p<0.01). HCWs with
injury experiences exhibited higher PSS and BDI scores after the injury and
higher levels of anxiety and depression. Particular attention should be
directed towards the psychological consequences of needlestick and sharps
injuries in HCWs
218. St Lawrence JS, Klaskala W, Kankasa C, West
JT, Mitchell CD, Wood C. Factors associated with HIV prevalence in a pre-partum
cohort of Zambian women. Int J STD AIDS 2006; 17(9):607-613.
ABSTRACT: An ongoing study of
mother-to-child human herpes virus-8 (HHV-8) transmission in Zambian women (n =
3160) allowed us to examine the association of medical injections with HIV
serostatus while simultaneously accounting for other factors known to be
correlated with HIV prevalence. Multi-method data collection included
structured interviews, medical record ABSTRACTion,
clinical examinations, and biological measures. Medically administered
intramuscular or intravenous injections in the past five years (but not blood
transfusions) were overwhelmingly correlated with HIV prevalence, exceeding the
contribution of sexual behaviours in a multivariable logistic regression.
Statistically significant associations with HIV also were found for some
demographic variables, sexual behaviours, alcohol use, and sexually transmitted
diseases (STD). The results confirmed that iatrogenic needle exposure, sexual
behaviour, demographic factors, substance use, and STD history are all
implicated in Zambian women's HIV+ status. However, the disproportionate
association of medical injection history with HIV highlights the need to
investigate further and prospectively the role of health-care injection in
sub-Saharan
219. Sterling TR, Haas DW. Transmission of
Mycobacterium tuberculosis from health care workers.
ABSTRACT: The Centers for Disease
Control and Prevention (CDC) recently reported the transmission of Mycobacterium
tuberculosis from a health care worker to patients in New York
City.1 Several aspects of the episode were notable: the
health care worker was foreign-born; latent tuberculosis infection
had previously been diagnosed by tuberculin skin testing, but the
health care worker had declined treatment; and after active disease
developed in the health care worker, 1500 persons were exposed,
which necessitated a large-scale contact investigation to determine
the extent of transmission and prevent further spread.
220. Stringer B, Haines T, Goldsmith CH et al.
Perioperative use of the hands-free technique: a semistructured interview
study. AORN Journal 2006; 84(2):233-235.
ABSTRACT: OCCUPATIONALLY CONTRACTED
bloodborne infections are preventable, but the use of many protective measures
remains limited. THERE IS GROWING EVIDENCE that the use of the hands-free
technique (HFT) to pass sharp items during surgical procedures is effective in
protecting against sharps injury and bloody contamination. RESEARCHERS
CONDUCTED in-depth telephone interviews to explore 20 health care providers'
knowledge and use of the HFT. MOST OF THE INTERVIEWEES did not regularly use
the HFT, and some were resistant to its use
221. Stringer B, Haines T. Hands-free technique:
preventing occupational exposure during surgery. Journal of Perioperative
Practice 2006; 16(10):495-500.
ABSTRACT: Occupational exposure to
blood borne pathogens has led to HBV, HCV and HIV infections among surgeons,
nurses and other operating room (OR) personnel and, to a lesser degree,
patients (Ross et al 2000, The incident investigation teams and others 1997).
Of seven OR studies in which an observer or circulating nurse recorded
exposures, there was a percuataneous injury in 1.7-15% of all surgeries, and a
mucocutaneous contamination in 6.2-50% of all surgeries. (Gerberding et al
1990, Panlilio et al 1991, Popejoy & Fry 1991, Quebbeman et al 1991, Tokars
et al 1992, Lynch & White 1993, Stringer, Infante-Rivard & Hanley
2002). Surgeons and residents usually sustained the greatest number of
percutaneous and other exposures during surgery. [References: 26]
222. Suzuki R, Kimura S, Shintani Y et al. [The
efficacy of safety winged steel needles on needlestick injuries]. [Japanese]. Kansenshogaku
Zasshi - Journal of the Japanese Association for Infectious Diseases 2006;
80(1):39-45.
ABSTRACT: Safety winged steel
needles were introduced at the University of Tokyo Hospital in January 2001. We
studied their effect in needlestick injuries. A total of 952 'needlestick and
sharp-object injuries were reported. From January 1999 to December 2004, Cases
of injury with winged steel needles decreased dramatically soon after safety
devices were introduced, from 19.8% in Apr.-Dec.2000 to 6.7% in 2001 and 5.5%
in 2002 (p < .01). They began to increase, however, in July 2002, decreased
again after medical staff members mere given lectures and notices by e-mail.
Due to the introduction of safety devices, cases classified as a "while
recapping a used needle" and "when puncturing rubber stoppers"
decreased. Among 17 injuries with safety winged steel needles, the most common
cases were "safety mechanism not activated". We estimated that 76.5%
of cases with safety winged steel needles could be prevented if they were used
properly. In conclusion, the introduction of safety winged steel needles
effectively reduced cases of injury with such needles. It is thus important to
regularly remind hospital staff of safety device techniques and information
reduce the such injuries
223. Tabak N, Shiaabana AM, Shasha S. The health
beliefs of hospital staff and the reporting of needlestick injury. J Clin Nurs
2006; 15(10):1228-1239.
ABSTRACT: AIM: The aim of this study
is to examine the connection between the health beliefs of hospital staff
(doctors, nurses and auxiliary staff) and their failure to report needlestick
injuries. BACKGROUND: Needlestick injury to hospital staff is quite frequent
and can result in infections and disease, but staff frequently do not report
the injury despite their awareness of the risk of blood-borne pathogens.
METHODS: Five questionnaires were constructed based on three existing research
tools and were tested for validity and reliability. Two hundred and forty
questionnaires were distributed to eight randomly chosen departments of a
single Israeli hospital. Seventy-six percent of the questionnaires were
anonymously completed and returned. RESULTS: Nurses had the highest rate of
needlestick injury, followed by auxiliary staff and doctors. Auxiliary staff
showed the highest rate of compliance with the duty to report such injuries,
while doctors showed the lowest. Perceived severity of contractable disease,
the perceived efficacy of reporting injuries and overall motivation to maintain
health were the best predictors of reporting compliance. Non-compliers
emphasized the negative aspects of reporting the injuries, primarily that it
took up too much time. CONCLUSIONS: The solution to non-compliance with the
duty to report must be a targeted investment in training and education.
Relevance to clinical practice. Finding the reasons for compliance and
non-compliance with the duty to report needlestick injuries will help in
designing educational programmes for hospital staff and in determining a
strategy for improving health behaviour
224. Tao XG, Bernacki EJ, Jankosky C, Means C. An
assessment of universal versus risk-based hepatitis C virus testing of source
patients postexposure to blood and body fluids among healthcare workers.
Journal of Occupational & Environmental Medicine 2006; 48(5):470-477.
ABSTRACT: OBJECTIVE: The objective
of this study was to assess the impact of universal versus risk-based hepatitis
C (HCV) testing of source patients' (SPs) postexposure to blood and body fluids
on the HCV exposure rates among healthcare workers. METHODS: Exposure and test
result information between 1993 and 2004 was ABSTRACTed from the Johns Hopkins Bloodborne Pathogen Database. A
Poisson regression model estimating HCV infection among underlying SPs based on
partial testing was developed and applied. RESULTS: After adjusting for the
effect of partial testing of SPs, the estimated underlying prevalence of
HCV-positive SPs increased slightly during the study period, from 11.9% to
15.1%, but the trend was not statistically significant. Yield curve of
HCV-positive SPs rose quickly when SPs' testing rates were low but became flat
when SPs' testing rates were high. CONCLUSION: Reliance on HCV risk factors to
screen SPs resulted in an underestimation of the prevalence of HCV in SPs
before 1997 when the testing rates were between 15.4% and 25.6%. When SPs'
testing rates were above 65%, our model predicted no additional yield of
HCV-positive SPs
225. Tarantola A, Golliot F, L'Heriteau F et al.
Assessment of preventive measures for accidental blood exposure in operating
theaters: A survey of 20 hospitals in
ABSTRACT: BACKGROUND: Accidental
exposures to blood of body fluids (ABE) expose health care workers (HCW) to the
risk of occupational infection. OBJECTIVES: Our aim was to assess the
prevention equipment available in the operating theater (OT) with reference to
guidelines or recommendations and its use by the staff in that OT on that day
and past history of ABE. METHODS: Correspondents of the Centre de Coordination
de la Lutte contre les Infections Nosocomiales (CCLIN) Paris-Nord ABE
Surveillance Taskforce carried out an observational multicenter survey in 20
volunteer French hospitals. RESULTS: In total, 260 operating staff (including
151 surgeons) were investigated. Forty-nine of the 260 (18.8%) staff said they
double-gloved for all patients and procedures, changing gloves hourly.
Blunt-tipped suture needles were available in 49.1% of OT; 42 of 76 (55.3%) of
the surgeons in these OT said they never used them. Overall, 60% and 64% of
surgeons had never self-tested for HIV and hepatitis C virus (HCV),
respectively. Fifty-five surgeons said they had sustained a total of 96
needlestick injuries during the month preceding the survey. Ten of these
surgeons had notified of 1 needlestick injury each to the occupational health
department of their hospital (notification rate, 10.4%). CONCLUSION: The
occurrence of needlestick injury remained high in operating personnel in
226. Tarantola A, Abiteboul D, Rachline A.
Infection risks following accidental exposure to blood or body fluids in health
care workers: a review of pathogens transmitted in published cases. Am J Infect
Control 2006; 34(6):367-375.
ABSTRACT: Hospital staff and all
other human or veterinary health care workers, including laboratory, research,
emergency service, or cleaning personnel are exposed to the risk of
occupational infection following accidental exposure to blood or body fluids (BBF)
contaminated with a virus, a bacteria, a parasite, or a yeast. The human
immunodeficiency virus (HIV) or those of hepatitis B (HBV) or C (HCV) account
for most of this risk in France and worldwide. Many other pathogens, however,
have been responsible for occupational infections in health care workers
following exposure to BBF, some with unfavorable prognosis. In developed
countries, a growing number of workers are referred to clinicians responsible
for the evaluation of occupational infection risks following accidental
exposure. Although their principal task remains the evaluation of the risks of
HIV, HBV, or HCV transmission and the possible usefulness of postexposure
prophylaxis, these experts are also responsible for evaluating risks of
occupational infection with other emergent or more rare pathogens and their
possible timely prevention. The determinants of the risks of infection and the
characteristics of described cases are discussed in this article
227.
ABSTRACT: Contracting a disease from
bloodborne pathogens has been identified as an occupational hazard for
perioperative personnel for more than two decades. Perioperative staff members
are particularly vulnerable to percutaneous exposure. Despite known hazards,
research has shown that perioperative staff members continue to take risks by
not consistently complying with standard precautions and not reporting all
percutaneous injuries. Health care workers (HCWs) and their employers need to
work together to ensure that workplaces are safe. This article discusses
mechanisms of bloodborne pathogen transmission, compliance with standard guidelines,
and the social and economic costs of contracting a bloodborne illness. Steps to
ensure that HCWs are protected also are outlined. [References: 29]
228. Tuma S, Sepkowitz KA. Efficacy of
safety-engineered device implementation in the prevention of percutaneous
injuries: a review of published studies. Clinical Infectious Diseases 2006;
42(8):1159-1170.
ABSTRACT: Nearly 6 years have passed
since the Needlestick Safety and Prevention Act of 2000 was signed into law. We
reviewed studies published since 1995 that evaluated the effect of
safety-engineered device implementation on rates of percutaneous injury (PI)
among health care workers. Criteria for inclusion of studies in the review were
as follows: the intervention used to reduce PIs was a needleless system or a
device with engineered sharps-injury protection, the outcome measurements
included a PI rate, the intervention was evaluated in a defined population with
clear comparison groups in clinical settings, and outcomes and denominators
used for rate calculations were objectively measured using consistent
methodology. All 17 studies reported substantial decreases in device-associated
or overall PI rates after device implementation (range of reduction, 22%-100%).
The majority of studies (n=12) were uncontrolled before-after trials with
limited ability to control for confounding variables. In addition,
implementation of safety-engineered devices was often accompanied by other
interventions, and direct measurement of outcomes was not performed.
Nevertheless, safety-engineered devices are an important component in PI
prevention
229. Utkan A, Dayican A, Toyran A, Tumoz MA.
[Seroprevalences of hepatitis B, hepatitis C, and HIV in patients admitted to
orthopedic and traumatology department]. [Turkish]. Acta Orthopaedica et
Traumatologica Turcica 2006; 40(5):367-370.
ABSTRACT: OBJECTIVES: Orthopedic
surgeons are at a higher occupational risk for blood-borne infections because
of frequent handling of sharp instruments and bone fragments. We investigated
the seroprevalences of hepatitis B, hepatitis C, and human immunodeficiency
virus (HIV) among patients treated at orthopedic and traumatology department.
METHODS: Data on age, sex, diagnoses, and the seroprevalences of HBsAg,
anti-HCV and anti-HIV were reviewed in 1,040 patients hospitalized between
September 2003 and December 2004. The patients were divided into two groups as
orthopedics (n=646; mean age 37.8 years) or trauma (n=394; mean age 38.3 years)
according to the initial cause of presentation. The results were compared with
those of 28,642 blood donations during the same period. RESULTS: HBsAg
positivity was similar in the patients (2.3%) and the controls (2.1%). HBsAg
was detected in 16 patients (2.5%) in the orthopedics group and eight patients
(2%) in the trauma group (p>0.05), three of whom were younger than one year.
Similarly, the prevalences of anti-HCV antibodies were similar in the patient
(0.6%) and control (0.3%) groups. Four patients (0.6%) in the orthopedics group
and two patients (0.5%) in the trauma group were positive for anti-HCV
(p>0.05), and all had a past history of operations. Anti-HIV positivity was
not detected in the patient group, whereas it was 0.2% in the control group.
CONCLUSION: The similarities between patients admitted to orthopedic and
traumatology department and blood donors in the prevalences of HBsAg, and
anti-HCV and anti-HIV antibodies suggest that data obtained from blood banks
can be used for risk calculations
230. Utomi IL. Occupational exposures and
infection control among students in Nigerian dental schools.
Odonto-Stomatologie Tropicale 2006; 29(116):35-40.
ABSTRACT: OBJECTIVE: To assess the
incidence of occupational exposures to body fluids and infection control
practices among students in Nigerian dental schools. MATERIALS AND METHODS: A
self-administered questionnaire survey of 112 students from three Nigerian
dental schools. RESULTS: 57 (50.9%) of the students had experienced one or more
occupational exposures in the previous six months. There was no statistically significant
association between year group and reported number of exposures (p > 0,05).
There was also no statistically significant association between sex and
reported number of exposures (p > 0.05). 50.7% of the exposures were
percutaneous injuries, 26.1% splatter of saliva and 23.2% splatter of aerosol.
Percutaneous injuries were most frequently caused by scalers (42.9%) and
needlesticks (37.1%) Most incidents occurred during scaling (37.7%),use of
dental handpiece (21.7%) and cleaning of instruments (18.8%). 96.4% of the
exposures were not reported. Only 36.6% of the students were immunized against
Hepatitis B. None of those immunized had been post-screened for seroconversion.
The routine use of gloves, masks and protective eyewear was reported by 87.5%, 65.5%
and 17% of students respectively. CONCLUSIONS: This study indicates a high rate
of exposure to body fluids and low compliance with infection control
guidelines. There is a need for interventions to improve safe work practices,
hepatitis B vaccination, HBV post-immunization serology and use of protective
barriers. Also appropriate policies and procedures are needed for reporting and
managing exposures
231. van Gemert-Pijnen J, Hendrix MG, Van der PJ,
Schellens PJ. Effectiveness of protocols for preventing occupational exposure
to blood and body fluids in Dutch hospitals. J Hosp Infect 2006; 62(2):166-173.
ABSTRACT: Compliance of different
healthcare workers (HCWs) (nurses, physicians, laboratory technicians and
cleaners) with protocols to prevent exposure to blood and body fluids (BBF) was
studied. Questionnaires were used to assess perception of risks, familiarity
with protocols, motivation and actual behaviour. Performance of the protocols
in practice was also tested. The practical test provided more reliable results
than the questionnaire. HCWs overestimated their knowledge and skills, and
compliance was influenced by risk perception. HCWs encountered problems with
comprehension, acceptability and applicability of protocols, especially for
post-exposure precautions. Protocols are not tailored to the differences in
knowledge, risk perception and practical needs of different professional
groups, probably because HCWs have rarely been involved in writing them and
they are governed more by legal considerations than applicability. Most HCWs
experienced a lack of organizational support to aid compliance. To improve
compliance, we recommend information and training on risk management and
individual responsibilities regarding the safety of coworkers and patients,
participation of HCWs in protocol development, and support of management to
avoid reversion to previous habitual behaviour
232. van Wijk PT, Pelk-Jongen M, de BE, Voss A,
Wijkmans C, Schneeberger PM. Differences between hospital- and
community-acquired blood exposure incidents revealed by a regional expert
counseling center. Infection 2006; 34(1):17-21.
ABSTRACT: OBJECTIVE: One year (2003)
regional analysis of all blood exposure incidents from hospitals as well as
from the community. DESIGN: Establishment of an easily accessible regional
expert counseling center, operating 24 h a day, for all accidental blood
exposures. Tasks of the center were to register incoming calls, to inform and
counsel the victim, to assess the risk of the incident, and to provide a plan
of further actions, including prophylactic measures. SETTING: A Dutch region (
233. van Wijk PT, Pelk-Jongen M, Wijkmans C, Voss
A, Schneeberger PM. Quality control for handling of accidental blood exposures.
J Hosp Infect 2006; 63(3):268-274.
ABSTRACT: A regional counselling
service was established to handle all accidental blood exposures using a
standardized protocol. Levels of risk were assessed using an algorithm.
Accidents that posed a risk for the transmission of hepatitis B (HBV),
hepatitis C (HCV) and human immunodeficiency virus (HIV) were classified as
'high risk', whereas accidents that posed a risk for HBV alone were classified
as 'low risk'. Medical interventions were implemented according to the level of
risk. During a one-year period, all accidents were registered and analysed for
adherence to the standard protocol. In 2003, the centre handled 454 incidents.
Of these, 36 (7.9%) incidents were assessed as no risk, 329 (72.5%) were
assessed as low risk, and 67 (14.8%) were assessed as high risk. Due to
incomplete registration, 22 (4.8%) incidents could not be analysed further. In
total, 36% of the incidents with risk for HBV transmission and 40% of the
incidents with risk for HCV and HIV transmission were not handled according to
the proposed protocol. Breaches consisted of over-reaction (25/396) as well as
insufficient response (123/396). Potentially inadequate treatment occurred for
HIV postexposure prophylaxis in 12 of 63 incidents. Incomplete follow-up for
HCV occurred in 11 of 63 incidents, and lack of HBV immunoglobulin
administration occurred in five of 396 incidents, including three high-risk
incidents. In 21 of 396 low-risk exposures, the breaches in protocol resulted
from late reporting. It remains difficult to achieve an acceptable level of
standardized care when using standard operational procedures. Documentation and
evaluation of flaws are essential to improve the system
234. Visser L. Toronto hospital reduces sharps
injuries by 80%, eliminates blood collection injuries. A case study:
ABSTRACT: Needlestick and other
sharps injuries are a key Canadian public health issue, affecting 70,000 people
per year and costing some dollar 140 million. A safety program at Toronto East
General Hospital--focusing on blood collection and patient injection--achieved
an 80% reduction in injuries within one year (from 41 in 2003 to eight in
2004), with blood collection injuries eliminated entirely
235. Vos D, Gotz HM, Richardus JH. Needlestick
injury and accidental exposure to blood: the need for improving the hepatitis B
vaccination grade among health care workers outside the hospital. Am J Infect
Control 2006; 34(9):610-612.
ABSTRACT: To describe the
characteristics of needlestick injuries occurring to health care workers
outside the hospital, a new case report form was implemented and analyzed after
12 months. A total of 144 incidents were reported. Of the needlestick injuries
in nursing assistants, 84% involved an insulin needle or pen. Thirty-five
percent of all health care workers and 47% of the nursing assistants were not
vaccinated against hepatitis B. Hepatitis B vaccination grade in health care
workers outside the hospital should be improved, in particular among nursing
assistants
236. Wanchu A, Singh S, Bambery P, Varma S.
Possible occupationally acquired HIV infection in two Indian healthcare
workers. MedGenMed 2006; 8(2):56.
237. Wolf BL, Marks A, Fahrenholz JM. Accidental
needle sticks, the Occupational Safety and Health Administration, and the
fallacy of public policy. Ann Allergy Asthma Immunol 2006; 97(1):52-54.
ABSTRACT: BACKGROUND: Current
Occupational Safety and Health Administration (OSHA) guidelines mandate the use
of safety needles when allergy injections are given. Safety needles for
intradermal testing remain optional. Whether safety needles reduce the number
of accidental needle sticks (ANSs) in the outpatient setting has yet to be
proven. OBJECTIVE: To determine the rate of ANSs with new (safety) needles vs
old needles used in allergy immunotherapy and intradermal testing. METHODS:
Allergy practices from 22 states were surveyed by e-mail. RESULTS: Seventy
practices (28%) responded to the survey. Twice as many ANSs occurred in
practices giving immunotherapy when using new needles vs old needles (P <
.01). The rate of ANSs was roughly the same for intradermal testing with new
needles vs old needles. CONCLUSIONS: These findings further question whether
OSHA's guidelines for safety needle use in outpatient practice need revision
and if allergy practices might be excluded from the requirement to use safety
needles
238. Yazdanpanah Y, De Carli G, Migueres B et al.
[Risk factors for hepatitis C virus transmission to Health Care Workers after
occupational exposure: a European case-control study]. Rev Epidemiol Sante
Publique 2006; 54:Spec-1S31.
ABSTRACT: BACKGROUND: Factors that
influence the risk for HCV infection after occupational exposure to hepatitis C
virus (HCV) have not yet been determined. The objective of this study was to
assess potential risk factors for Hepatitis C seroconversion after occupational
exposure to HCV. METHODS: We conducted a European matched case-control study
from 01/01/1991 through 31/12/ 2002. Cases were Health Care Workers (HCWs) who
were HCV seronegative at the time of exposure, sustained a documented exposure
to HCV, and present documented HCV seroconversion temporally associated with
the exposure. Controls-HCWs had a documented exposure to HCV, were HCV
seronegative at the time of exposure, and remained so at least 6 months later.
Controls were matched to cases for the center and the time period of the
exposure occurrence. RESULTS: 60 cases and 204 controls were included. All
cases were exposed to HCV-infected materials through percutaneous injuries.
Those for whom information was available (61.6%) were exposed to viremic source
patients. Multivariate conditional logistic regression analysis, in which HCV
viral load was not introduced because of missing values, identified needle
placed in the source patient's vein or artery (Odds Ratio [OR]=100.1; 95% Confidence
Interval [CI]=7.3-1365.7), deep injury (OR=155.2; 95%CI=7.1-3417.2), and HCW's
gender (M vs. F: OR=3.1; 95%CI=1.0-10.0) as risk factors for HCV infection. In
univariate unmatched analysis the risk of HCV transmission was increased
11-fold (C195%=1.1-114.1) in HCWs exposed to sources with a viral load>6
log10 copies/mL when compared to sources with a HCV viral load<4 log10
copies/mL. CONCLUSION: The risk of HCV transmission after percutaneous exposure
increases with a larger volume of blood, and, a higher titer of HCV in the
source patient's blood. The role of HCW's gender need to be further
investigated. The results of this study have important implications for
counselling and follow-up of HCWs after exposure
239. Zafar A. Blood and body fluid exposure and
risk to health care workers. JPMA - Journal of the
ABSTRACT: Blood and body fluid (BBF)
exposure to health care workers (HCWs) and the infectious complications
associated with it, is a global issue. It affects all categories of staff
including clinicians, dental professionals and students both medical and
nursing, laboratory workers, paramedics, domestics, porters, hospital
volunteers and administrative staff. Exposure includes splash of BBF to the eyes,
nasal and oral cavities, or contact with damaged skin and needle stick
injuries.
240. Nadelstichverletzungen: Der bagatellisierte
„Massenunfall" [Needlestick injuries: the trivialized mass accident].
Deutsches Arzteblatt 2005; 102:110-114.
ABSTRACT: Injuries of the medical
personnel with sharp objects are among the most frequent working accidents; in
at least every second, the offensive objects contaminated through patient blood
(1). Independently of, whether such
sting injuries, cut injuries or scraper injuries the skin through needles,
knife or similar objects causes became (2), speaks one for reasons the
Praktikabilität usually about needle sting injuries (NSTV). Alone at the occupation union for health service
and welfare cultivated (BGW) are in 2002,170 hepatitis-B-, 254 hepatitis-C- and
nine HIV-Infektionen1 after NSTV indicated become. In the
241. How Safety Became the Norm, Not Needlesticks:
Why not make 'airbags' for needles? Hospital Employee Health 2005;
24(12):155-157.
ABSTRACT: Janine Jagger was working onintegrating
airbags in cars when her colleagues at the
To her, the answer was obvious. Create the equivalent of an airbag for a
needle.
242. Surveillance of significant occupational
exposure to bloodborne viruses in healthcare workers: 1 July 1996 to 30 June
2004. Communicable Disease Report 2005; 15(4):3-4.
ABSTRACT: The Health Protection
Agency's Centre for Infections (CFI) has this week published Eye of the Needle,
the latest report from the surveillance of significant occupational exposure to
bloodborne viruses (BBVs) in healthcare workers (HCWs) (1). This report
includes significant occupational exposure incidents reported to the CFI
between 1 July 1996 and 30 June 2004 from reporting centres. There are
currently 150 reporting centres scattered throughout
243. Nadelstichverletzung ist kein Bagatellunfall
[A needlestick injury is not a trivial accident]. Arzte Zeitung 2005.
ABSTRACT: Pflegekräfte, Arzthelferinnen
und Ärzte haben ein erhöhtes Risiko, sich durch Nadelstichverletzungen mit
Hepatitis oder HIV zu infizieren. Dagegen können sich Arbeitgeber und
Mitarbeiter schützen, in dem sie Spritzen, Kanülen und Skalpelle mit
Schutzvorrichtungen gegen solche Verletzungen benutzen.
[Care powers, physician helper and physicians have an increased risk to infect
itself through needle sting injuries with hepatitis or HIV. On the other hand employer and colleague can
protect themselves, in whom they use syringes, cannulae and scalpel with
protection devices against such injuries]
244. Anonymous. OR becomes last frontier for move
to sharps safety. Hospital Employee Health 2005; 24(12):149-155.
ABSTRACT: ACS endorses blunt
needles, spurring change. American
operating rooms may finally be ready to move toward sharps safety.
The
245. Association of periOperative Registered
Nurses. AORN guidance statement: sharps injury prevention in the perioperative
setting. AORN Journal 2005; 81(3):662-666.
ABSTRACT: Occupational exposure to
bloodborne pathogens via percutaneous injuries is one of the most serious
dangers perioperative team members face on a daily basis. The risk of
sustaining a percutaneous injury can be decreased through employee education,
clear communication, device engineering, and focused work practice controls.
Risk reduction strategies should include specific practices aimed at reducing
the unique risks of percutaneous injuries encountered in the perioperative environment.
AORN recognizes the various settings in which perioperative RNs practice, and
the suggested risk reduction strategies in this guidance statement are intended
to be adaptable to any setting where surgical or other invasive procedures are
performed
246. Azap A, Ergonul O, Memikolu KO et al.
Occupational exposure to blood and body fluids among health care workers in
Ankara, Turkey. Am J Infect Control 2005; 33(1):48-52.
ABSTRACT: BACKGROUND: The risk of
occupational acquisition of bloodborne pathogens via exposure to blood and body
fluids is a serious problem for health care workers in
247. Beekmann SE, Henderson DK. Protection of
healthcare workers from bloodborne pathogens. [Review] [50 refs]. Current
Opinion in Infectious Diseases 2005; 18(4):331-336.
ABSTRACT: PURPOSE OF REVIEW: For
decades, healthcare workers have been known to be at risk from acquiring a
variety of bloodborne pathogen infections as a result of occupational exposure.
Primary prevention of exposures, as recommended by universal precautions
guidelines, remains the cornerstone of protecting healthcare workers.
Nonetheless, a substantial number of parenteral exposures continue to occur.
Updated developments are summarized here, and recommendations for the
protection of healthcare workers from bloodborne pathogens are provided. RECENT
FINDINGS: The predominant evidence suggests that total percutaneous injuries
have decreased over the last decade. Thoughtful adherence to universal
precautions remains the primary means of preventing occupational exposures and
thus of reducing occupational risk of infection with bloodborne pathogens. A
number of studies have provided additional evidence for the efficacy of safety
devices in reducing specific subsets of injuries when combined with education
and administrative interventions. Barriers to and positive predictors of
universal precautions compliance have been identified. Postexposure prophylaxis
remains the second line of defense; several authorities have now recommended
three antiretroviral agents in this setting. SUMMARY: In summary, almost two
decades of experience with universal/standard precautions has resulted in a
decrease in parenteral injuries, but much work remains to be done. Vaccines,
effective infection control procedures, safer procedures, and safer devices
will all be necessary, along with a better understanding of factors that
influence healthcare worker behaviors that result in injury. In addition, a
number of issues relating to the postexposure management of occupational
exposures with bloodborne pathogens need to be better understood. [References:
50]
248. Berguer R, Heller PJ. Strategies for
preventing sharps injuries in the operating room. Surgical Clinics of North
America 2005; 85(6):1299-1305.
ABSTRACT: With the discovery of AIDS
and HIV, the medical community began to widely recognize the dangers of serious
illnesses spread-ing through contact with contaminated blood and body fluids.
In response, the Centers for Disease Control and other groups have developed
guidelines for the operating room to prevent the spread of infection from, for
example, accidental needle sticks. Unfortunately, those guidelines are not
always strictly followed. This article reviews studies that have examined
precautionary practices, including such practices as double gloving, the use of
blunt suture needles, and the use of neutral zones for passing sharps. The
article also provides related sources for further information. [References: 42]
249. Proceedings of the National Sharps Injury
Prevention Meeting. 05 Sep 12; 2005.
ABSTRACT: Occupational exposures to
bloodborne pathogens as a result of injuries from needles and other sharp
objects are an important public health concern. It is estimated that
hospital-based healthcare personnel sustain 385,000 sharps injuries annually in
the
The U.S. Centers for Disease Control and Prevention (CDC) convened a National
Sharps Injury Prevention Meeting on September 12, 2005, in
250. Cervini P, Bell C. Brief report: needlestick
injury and inadequate post-exposure practice in medical students. Journal of
General Internal Medicine 2005; 20(5):419-421.
ABSTRACT: BACKGROUND: Medical
students are at a particularly high risk for needlestick injury and its
consequences because of their relative inexperience and lack of disability
insurance. OBJECTIVE: To determine the risk of needlestick injury and the use
of post-exposure prophylaxis among medical students. DESIGN: Internet-based
survey. PARTICIPANTS: The 2003 graduating medical school class at the
251. Cervini P, Bell C. Brief report: needlestick
injury and inadequate post-exposure practice in medical students. J Gen Intern
Med 2005; 20(5):419-421.
ABSTRACT: BACKGROUND: Medical
students are at a particularly high risk for needlestick injury and its
consequences because of their relative inexperience and lack of disability
insurance. OBJECTIVE: To determine the risk of needlestick injury and the use
of post-exposure prophylaxis among medical students. DESIGN: Internet-based
survey. PARTICIPANTS: The 2003 graduating medical school class at the
252. Chen LH, Wilson ME. Nosocomial dengue by
mucocutaneous transmission.[comment]. Emerging Infectious Diseases 2005;
11(5):775.
ABSTRACT: To the Editor: Wagner and
colleagues report nosocomial dengue transmitted by needlestick and note that it
is the fourth case of nosocomial dengue to their knowledge (1). In the same
issue of Emerging Infectious Diseases, Nemes and colleagues report a separate
case of nosocomial dengue also transmitted by needle-stick (2). Three other
cases of nosocomial dengue transmission by needlestick have previously been
published (3-5).
253. Dix K. Best Practices for Purchasing
Managers. Infection Control Today 2005; 9(7):34-38.
ABSTRACT: Purchasing managers for
the healthcare community face a unique challenge--obtaining the best vales
possible for the healthcare facility while ensuring that patient safety and
infection control issues are kept at the forefront.
254. edo de OA, White KL, Leschinsky DP et al. An
outbreak of hepatitis C virus infections among outpatients at a
hematology/oncology clinic.[see comment][summary for patients in Ann Intern
Med. 2005 Jun 7;142(11):I38; PMID: 15941692]. Annals of Internal Medicine 2005;
142(11):898-902.
ABSTRACT: BACKGROUND: Approximately
2.7 million persons in the
255. Eikelboom JW. RE: Bain B.J. (2004) Bone
marrow biopsy morbidity and mortality: 2002 data. Clinical and Laboratory
Haematology 26, 315-318.[comment]. Clinical & Laboratory Haematology 2005;
27(3):209-210.
ABSTRACT: Sir, the report by Bain (2004) documenting a 0.12% incidence of
adverse events, including major bleeding, among more than 13k000 bone marrow
biopsy procedures performed by members of the British Society of Haematology
during 2002 is an important reminder for clinicians who perform t hese
procedures: while complications are rare, they may be serious.
256. Ellis K. Sharp Thinking: The Role of
Technology and Education in Promoting Sharps Safety. Infection Control Today
2005; 9(7):20-24.
ABSTRACT: Infection control
practitioners (ICPs) are intimately aware of the potential danger to healthcare
workers (HCWs) posed by bloodborne pathogens via accidental needlestick
accidental injuries. While the exact
prevalence of such injuries is unknown, the National Institute for Occupational
Safety and Health (NIOSH) estimates put the number somewhere between 600,000
and 800,000 per year. Furthermore, about
half of these are not reported. Other
studies actively seeking to monitor the rate of needlestick injuries have
reported as many as 839 injuries per 1,000 HCWs. The cost that facilities must absorb to
manage these injuries is significant, and can become catastrophic if the injury
results in the acquisition of an infectious disease.
257. Fry DE. Occupational blood-borne diseases in
surgery. [Review] [25 refs]. American Journal of Surgery 2005; 190(2):249-254.
ABSTRACT: BACKGROUND: Human
immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV)
infections are transmitted by blood exposure. Surgeons have been concerned
about the risks of blood exposure in the operating room as a potential source
of occupational infections from these viruses. The actual risk and frequency of
operating room transmission remains poorly understood by many surgeons.
METHODS: The pertinent recent literature on the pathophysiology, diagnosis, prevention,
and treatment of HIV, HBV and HCV were reviewed to address the current
understanding of these viruses as occupational risks to surgeons. RESULTS: HIV
transmission to surgeons has not been documented in the
258. Gutierrez EB, Lopes MH, Yasuda MA. Accidental
exposure to biological material in healthcare workers at a university hospital:
Evaluation and follow-up of 404 cases. Scand J Infect Dis 2005; 37(4):295-300.
ABSTRACT: The care and follow-up
provided to healthcare workers (HCWs) from a large teaching hospital who were
exposed to biological material between 1 August 1998 and 31 January 2002 is
described here. After exposure, the HCW is evaluated by a nurse and doctor in
an emergency consultation and receives follow-up counselling. The collection of
10 ml of blood sample from each HCW and its source patient, when known, is made
for immunoenzymatic testing for HIV, HBV and HCV. Evaluation and follow-up of
404 cases revealed that the exposures were concentrated in only a few areas of
the hospital; 83% of the HCWs exposed were seen by a doctor responsible for the
prophylaxis up to 3 h after exposure. Blood was involved in 76.7% (309) of the
exposures. The patient source of the biological material was known in 80.7%
(326) of the exposed individuals studied; 80 (24.5%) sources had serological
evidence of infection with 1 or more agents: 16.2% were anti-HCV positive, 3.8%
were HAgBs positive and 10.9% were anti-HIV positive. 67% (273) of the study
population completed the proposed follow-up. No confirmed seroconversion
occurred. In conclusion, the observed adherence to the follow-up was quite low,
and measures to improve it must be taken. Surprisingly, no difference in
adherence to the follow-up was observed among those exposed HCW at risk, i.e.
those with an infected or unknown source patient. Analysis of post-exposure
management revealed excess prescription of antiretroviral drugs, vaccine and
immunoglobulin. Infection by HCV is the most important risk of concern, in our
hospital, in accidents with biological material
259. Health Protection Agency Centre for
Infections, National Public Service for
ABSTRACT: This report includes
significant occupational exposure incidents reported to the HPA between 1st
July 1996 and 30th June 2004 from reporting centres, currently 150,
geographically scattered throughout
260. Hogan A. Gaps and successes of safety device
market conversion. Materials Management in Health Care 2005; 14(11):33-34.
ABSTRACT:Technology and the engineering
of safety devices has increased since the promulgation of the Bloodborne
Pathogens Standard (BPS) (29 CFR 1910.1030) in 1991.
As a result, OSHA revised its
enforcement procedures in 1999 (CPL 02-02-069) to include guidance for its
compliance safety and health officers to begin citing health care employers for
failure to use safety devices where their use is feasible and effective.
The Needlestick Safety and Prevention
Act (NSPA), passed unanimously by Congress in 2000, further amplified the need for
safety device adoption and use.
261.
ABSTRACT: In March 2000, the CDC
estimated that more than 380,000 percutaneous injuries from contaminated sharps
occur annually among healthcare workers in the
262. Iinuma Y, Igawa J, Takeshita M et al. Passive
safety devices are more effective at reducing needlestick injuries. Journal of
Hospital Infection 2005; 61(4):360-361.
ABSTRACT: Sir, Healthcare workers
(HCWs) who use or who are exposed to needles are at risk of receiving
needlestick injuries. Such injuries can
lead to serious infections with blood-borne pathogens such as human
immunodeficiency virus, hepatitis B virus or hepatitis C virus. To reduce
needlestick injuries, hospitals should replace their needles with needle-free
safety technology (primary prevention). Where needles cannot be replaced, a
safety engineered needle that covers the sharp after use should be used
(secondary prevention). There are two
categories of safety engineered devices: user-activated safety devices and
passive safety devices. A user-activated device requires HCWs to activate a
safety mechanism and cover the sharp themselves, and a passive safety device
features a design that automatically covers the sharp during use.
263. Ismail NA, boul Ftouh AM, El Shoubary WH.
Safe injection practice among health care workers,
ABSTRACT: A cross-sectional study
was conducted in 25 health care facilities in Gharbiya governorate to assess
safe injection practices among health care workers (HCWs). Two questionnaires,
one to collect information about administrative issues related to safe
injection and the other to collect data about giving injections, exposure to
needle stick injuries, hepatitis B vaccination status and safe injection
training. Practices of injections were observed using a standardized checklist.
The study revealed that there was lack of both national and local infection
control policies and lack of most of the supplies needed for safe injection
practices. Many safe practices were infrequent as proper needle manipulation
before disposal (41%), safe needle disposal (47.5%), reuse of used syringe
& needle (13.2%) and safe syringe disposal (0%). Exposure to needle stick
injuries were common among the interviewed HCWs (66.2%) and hand washing was
the common post exposure prophylaxis measure (63.4%). Only 11.3% of HCWs had
full course hepatitis B vaccination. Infection control -including safe
injections- training programs should be afforded to all HCWs
264. Jahan S. Epidemiology of needlestick injuries
among health care workers in a secondary care hospital in
ABSTRACT: BACKGROUND: Accidental
needlestick injuries sustained by health care workers are a common occupational
hazard in health care settings. The aim of this study was to review the
epidemiology of needlestick injuries in
265. Kermode M, Jolley D, Langkham B, Thomas MS,
Crofts N. Occupational exposure to blood and risk of bloodborne virus infection
among health care workers in rural north Indian health care settings. Am J
Infect Control 2005; 33(1):34-41.
ABSTRACT: BACKGROUND: Approximately
3 million health care workers (HCWs) experience percutaneous exposure to
bloodborne viruses (BBVs) each year. This results in an estimated 16,000
hepatitis C, 66,000 hepatitis B, and 200 to 5000 human immunodeficiency virus
(HIV) infections annually. More than 90% of these infections are occurring in
low-income countries, and most are preventable. Several studies report the
risks of occupational BBV infection for HCWs in high-income countries where a
range of preventive interventions have been implemented. In contrast, the
situation for HCWs in low-income countries is not well documented, and their
health and safety remains a neglected issue. OBJECTIVE: To describe the extent
of occupational exposure to blood and the risk of BBV infection among a group
of