Bibliography
September 2009
1. Hepatitis
cases spur safety measures. The
ABSTRACT: DENVER: By her own admission, Kristen Diane Parker, a surgical
technician, cruised for empty operating rooms at the Denver hospital where she
worked.
Parker would slip into the rooms and steal syringes of fentanyl, a powerful
painkiller, replacing them with syringes she had filled with saline solution.
Parker, who has hepatitis C, allegedly had used those decoy syringes - the
source of transmission, authorities believe - on at least 23 Coloradans now
infected with the liver-damaging disease, according to her confession to
investigators.
2. Hepatitis
C virus transmission at an outpatient hemodialysis unit--New York, 2001-2008.
MMWR Morb Mortal Wkly Rep 2009; 58(8):189-194.
ABSTRACT: In July 2008, the New York State Department of Health (NYSDOH)
received reports of three hemodialysis patients seroconverting from
anti-hepatitis C virus (HCV) negative to anti-HCV positive in a
3. 27
Cases of Hepatitis C Now Linked to Suspect.
ABSTRACT: According to an updated tally released Friday, state health officials
have now tentatively linked 27 hepatitis C cases to an infected surgical
technicians drug theft scheme. The
worker is alleged to have injected herself with a painkiller, then refilled the
syringes with saline that was administered to patients.
4. Africa:
Editorial - Safer Blood Collection For
ABSTRACT: "The following is an editorial reflecting the views of the US
Government"
Safer blood collection is a growing concern for Sub-Saharan African nations and
other developing countries severely impacted by the HIV/AIDS pandemic. Acess to HIV treatment in developing
countries has significantly increased in recent years, which in turn has
expanded the quantity of blood drawing for HIV screening and monitoring tests.
5. Akridge
J. Get sharp about safety. Healthcare Purchasing News 2009;(August 2009):16-24.
ABSTRACT: No discussion of needlestick injury trends would be complete without
considering the impact of the U.S. Needlestick Safety and Prevention Act of
2000 that mandated the use of safety-engineered sharp devices. The legislation
also prompted the Occupational Safety and Health Administration (OSHA) to
revise its Bloodborne Pathogens Standard in 2001, strengthening requirements
for employers to identify and make use of effective and safer medical devices.
6. Boal
WL, Leiss JK, Ratcliffe JM et al. The national study to prevent blood exposure
in paramedics: rates of exposure to blood. Int Arch Occup Environ Health 2009.
ABSTRACT: OBJECTIVE: The purpose of this analysis is to present incidence rates
of exposure to blood among paramedics in the
7. Chen
L, Zhang M, Yan Y et al. Sharp object injuries among health care workers in a
Chinese province. AAOHN J 2009; 57(1):13-16.
ABSTRACT: Health care workers in nine hospitals in
8. Chow
J, Rayment G, Wong J, Jefferys A, Suranyi M. Needle-stick injury: a novel
intervention to reduce the occupational health and safety risk in the
haemodialysis setting. J Ren Care 2009; 35(3):120-126.
ABSTRACT: Needle-stick injury (NSI) is a major occupational health and safety
issue facing healthcare professionals. The administration of
erythropoiesis-stimulating agents (ESA) in haemodialysis patients represents a
major cause for injections. The purpose of this initiative was to familiarise
nursing staff with needle-free administration of an ESA in haemodialysis
patients to reduce the risk of NSI. Epoetin beta comes in a commercial
presentation with a detached needle. Epoetin beta was administered to 10
haemodialysis patients via the venous bubble trap short line of the
haemodialysis circuit. An audit was conducted that included a retrospective
assessment of NSI for the previous six months; and a prospective assessment for
eight weeks to assess whether there is a nursing staff preference for
needle-free administration of ESA. There were no reports of NSI in the
needle-free group. Haemoglobin levels were maintained. Ninety-one percent of
the nursing staff preferred needle-free administration of ESA. In conclusion,
the commercial presentation of epoetin beta with the detached needle presents
an opportunity to reduce the potential risk of NSI in haemodialysis units
9. Safe Injection, Infusion and Medication Vial
Practices in Healthcare.: 2009.
ABSTRACT: The transmission of bloodborne viruses and other microbial pathogens
to patients during routine healthcare procedures continues to occur due to
unsafe and improper injection, infusion and medication vial practices being
used by healthcare professionals within various clinical settings throughout
the
10. Efetie
ER, Salami HA. Prevalence of, and attitude towards, needle-stick injuries by
Nigerian gynaecological surgeons.
ABSTRACT: Health care workers who have occupational exposure to blood and other
potentially infectious materials are at increased risk for acquiring
blood-borne infections. The emotional impact of a needle-stick injury can be
severe and long lasting, even when a serious infection is not transmitted.
OBJECTIVE: To assess the prevalence and attitude towards needle-stick injuries
by Nigerian gynaecological surgeons. METHODOLOGY: A cross-sectional study was
conducted at the 40th Annual General Meeting and Scientific Conference of the
Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in
11. Garcia
LP,
ABSTRACT: BACKGROUND: Primary health care workers (HCWs) represent a growing
occupational group worldwide. They are at risk of infection with blood-borne
pathogens because of occupational exposures to blood and body fluids (BBF).
AIM: To investigate BBF exposure and its associated factors among primary HCWs.
METHODS: Cross-sectional study among workers from municipal primary health care
centres in
12. Haiduven
D, Applegarth S, Shroff M. An experimental method for detecting blood splatter
from retractable phlebotomy and intravascular devices. Am J Infect Control
2009; 37(2):127-130.
ABSTRACT: BACKGROUND: This study was designed to evaluate the safety of
retractable intravascular devices in terms of their potential to produce blood
splatter. A method for measuring this blood splatter designed by the research
team was used to evaluate 3 specific intravascular devices. METHODS: Scientific
filters were positioned around the retraction mechanisms of the devices and
weighed with an analytical scale, both before and after activation, in a
simulated vein containing mock venous blood. The difference in filter mass was
used as the primary unit of analysis to detect blood splatter. In addition, the
filters were visually inspected for the presence or absence of blood. RESULTS:
A paired t-test revealed significant differences in the prefilter and
postfilter groups for 2 of the 3 devices tested (P < .0001). In addition,
visible blood was detected on 23% to 40% of the scientific filters for 2 of the
devices. CONCLUSIONS: Our findings indicate a potential for bloodborne pathogen
exposure with the use of intravascular devices with a retractable mechanism.
This experiment may serve as a model in the design and implementation of future
sharps device evaluation protocols to validate the threat of bloodborne
pathogen exposure
13. Hotaling
M. A retractable winged steel (butterfly) needle performance improvement
project. Jt Comm J Qual Patient Saf 2009; 35(2):100-5, 61.
ABSTRACT: A performance improvement project used an interdisciplinary,
systematic approach, including frontline staff input, in identifying,
selecting, and evaluating a safer needle device. Following adoption of a
retractable needle, needlesticks of health care workers decreased from 3.19 to
zero incidents per 100,000 needles
14. Jeong
IS, Park S. Use of hands-free technique among operating room nurses in the
ABSTRACT: BACKGROUND: The recently introduced concept of hands-free technique
(HFT) currently has no recommendations or formal educational program for use in
the
15. Lanini
S, Puro V, Lauria FN, Fusco FM, Nisii C, Ippolito G. Patient to patient
transmission of hepatitis B virus: a systematic review of reports on outbreaks
between 1992 and 2007. BMC Med 2009; 7(1):15.
ABSTRACT: ABSTRACT: BACKGROUND: Hepatitis B outbreaks in healthcare settings
are still a serious public health concern in high-income countries. To
elucidate the most frequent infection pathways and clinical settings involved,
we performed a systematic review of hepatitis B virus outbreaks published
between 1992 and 2007 within the EU and
16. Motamedifar
M, Askarian M. The prevalence of multidose vial contamination by aerobic
bacteria in a major teaching hospital,
ABSTRACT: BACKGROUND: Parenteral medications are usually given out in multidose
vials (MDVs) and can be used for a prolonged period for 1 or more patients. The
risk of extrinsic contamination of MDVs and its consequences may be serious and
may lead to an outbreak, especially in hospitals. Therefore, bacterial
contamination of multiple-dose medication vials in
17. Mulumba
M, Muhindo M. Faut-il exclure les donneurs parasités? Ann Afr Med 2009;
2(3):215-217.
ABSTRACT: For security of transfusion, blood donors who have evidence of
viruses such as HIV, hepatitis viruses ... are excluded systematically. All advanced technology must be used to detect
this group of donors. For donors who
have curable parasitic germs such as plasmodium, trypanosomes ..., their
exclusion is relative. In the endemic
area. But in non-endemic area,
travellers from endemic or epidemic area of parasitic disease transmissible by
transfusion could be subjects of cuation if they are blood donors. The presence of parasitic germs could be
criteria for temporary or definitively exclusion.
In endemic area such as in tropic, lack of diagnostic means did not allow a
good screening of blood donors. However,
some procedures are used to make transfusion safer. As we know that Trypanosoma gambiense
remains infectious in blood pocket during 48 hours, we could transfused only
after this period. Add Gentian violet in
blood pocket neutralized Trypanosoma cruizi. Destroying leucocytes in the collected blood
avoid transmission of infectious agents transmitted through leucocytes for
example leishmania. Other physical and
chemical methods are also available.
For the security of transfusion, parasitic germs are really an issue and have
to be considered to make transfusion act safer.
18. Nagao
M, Iinuma Y, Igawa J et al. Accidental exposures to blood and body fluid in the
operation room and the issue of underreporting. Am J Infect Control 2009; In
Press.
ABSTRACT: A retrospective review of all exposure injuries affecting members of
the operative care line at a single university hospital between January 2000
and December 2007 was performed. A questionnaire survey on current status of
adherence to barrier precautions was also completed by 164 staff members. Of
136 exposure injuries, 87 (64.0%) were in surgeons, and 49 (36.0%) were in
scrub nurses. Surgeons were most commonly injured during suturing (49, 56%),
followed by "handing over sharps" (7, 8%), whereas scrub nurses were
most commonly injured during "counting and sorting of sharps" (15,
41%), followed by "handing over sharps," and "splash." The
questionnaire survey revealed that compliance with goggles, face shields, and
double gloving was poor, and only 9% of respondents routinely used the
hands-free technique. Only 22% of staff who had experienced exposure injuries
reported every incident. Because circumstances of exposure injuries in operating
rooms differ by profession, appropriate preventive measures should address
individual situations. To reduce exposure injuries in the operating room,
further efforts are required including education, mentoring, and competency
training for operation personnel
19. Naghavi
SH, Sanati KA. Accidental blood and body fluid exposure among doctors. Occup
Med (Lond) 2009; 59(2):101-106.
ABSTRACT: AIM: To study the epidemiology and time trends of blood and body
fluids (BBF) exposures among hospital doctors. METHODS: A 3-year study was
carried out using data from the Exposure Prevention Information Network of four
teaching hospitals in the
20. Onakewhor
JU, Okonofua FE. Seroprevalence of Hepatitis C viral antibodies in pregnancy in
a tertiary health facility in
ABSTRACT: BACKGROUND: Liver disease due to Hepatitis C viral (HCV) infection is
the most common indication for liver transplant. It is a viral pandemic that is
five times as widespread as the human immunodeficiency virus type 1 infection.
In spite of this, vaccines were yet unavailable for protection of the human
race due to the morphology and fastidious nature of the organism. While the
scanty data available on this infection in our environment are limited to blood
donors, people continue to be screened for and deprived of renal dialysis if
any patient is found to have HCV infection. Also in this environment, data on
HCV infection in pregnancy is virtually nonexistent even though the infection
can have a deleterious effect on materno-fetal outcome. OBJECTIVE OF THE STUDY:
To determine the seroprevalence of hepatitis C viral antibodies among antenatal
women attending a tertiary health facility in
21. Shiao
JS, McLaws ML, Lin MH, Jagger J, Chen CJ. Chinese EPINet and Recall Rates for
Percutaneous Injuries: An Epidemic Proportion of Underreporting in the
ABSTRACT: Objectives: As an occupational injury, percutaneous injury (PI) can
result in chronic morbidity and death for healthcare workers (HCWs). A pilot
surveillance system for PIs using the Chinese version of Exposure Prevention
Information Network (EPINet) was introduced in
22. Stringer
B, Haines T, Goldsmith CH et al. Hands-Free Technique in the Operating Room:
Reduction in Body Fluid Exposure and the Value of a Training Video. Public
Health Reports 124[Supplement 1], 169-179. 2009.
ABSTRACT: Objectives. This study
sought to determine if (1) using a hands-free technique (HFT)—whereby no
two surgical team members touch the same sharp item simultaneously—$75% of the
time reduced the rate of percutaneous injury, glove tear, and contamination
(incidents); and (2) if a video-based intervention increased HFT use to
$75%, immediately and over time.
Methods. During three and four
periods, in three intervention and three control hospitals, respectively,
nurses recorded incidents, percentage of HFT use, and other information in
10,596 surgeries. The video was shown in intervention hospitals between Periods
1 and 2, and in control hospitals between Periods 3 and 4. HFT, considered used
when $75% passes were done hands-free, was practiced in 35% of all surgeries.
We applied logistic regression to (1) estimate the rate reduction for
incidents in surgeries when the HFT was used and not used, while adjusting for
potential risk factors, and (2) estimate HFT use of about 75% and 100%,
in intervention compared with control hospitals, in Period 2 compared with
Period 1, and Period 3 compared with Period 2.
Results. A total of 202
incidents (49 injuries, 125 glove tears, and 28 contaminations) were reported.
Adjusted for differences in surgical type, length, emergency status, blood
loss, time of day, and number of personnel present for $75% of the surgery, the
HFT-associated reduction in rate was 35%. An increase in use of HFT of $75% was
significantly greater in intervention hospitals, during the first
post-intervention period, and was sustained five months later.
Conclusion. The use of HFT and
the HFT video were both found to be effective.
23. Tasker
F. North
ABSTRACT: On July 20, Army veteran Juan Rivera filed notice that he is suing
the federal government afater allegedly becoming infected with HIV during a
colonscopy at the
24. Thomas
WJ, Murray JR. The incidence and reporting rates of needle-stick injury amongst
ABSTRACT: INTRODUCTION: Needle-stick injuries are common. Such accidents are
associated with a small, but significant, risk to our career, health, families
and not least our patients. National guidelines steer institution-specific
strategies to provide a consistent and safe method of dealing with such
incidents. Surgeon-specific guidelines are not currently available. We have
observed that hospital sharps policy is often considered cumbersome to the
surgeon, resulting in on-the-spot decision making with potential long-term
implications. By their essence, these decisions are inconsistent, not
reproducible and, thus, we believe them to be unsafe. The under-reporting to
occupational health departments is well documented. Current surgical practice
has the potential to expose the surgeon to unnecessary risk. The aims of this
study were to establish the true incidence of contaminations caused by
needle-stick injury in our hospital and to assess how well current protocols
are really implemented. SUBJECTS AND METHODS: We identified all surgeons of
consultant, non-career staff grade (NCSG) and registrar grade working in a
large 687-bed district general hospital serving a population of 550,000, in the
25. Thompson
ND, Perz JF, Moorman AC, Holmberg SD. Nonhospital health care-associated
hepatitis B and C virus transmission: United States, 1998-2008. Ann Intern Med
2009; 150(1):33-39.
ABSTRACT: In the
26. Varsou
O, Lemon JS, Dick FD. Sharps injuries among medical students. Occup Med (Lond)
2009.
ABSTRACT: BACKGROUND: Medical students may be at risk of sharps injuries for
several reasons. These exposures can transmit a range of blood-borne pathogens
including hepatitis B, hepatitis C and human immunodeficiency virus. AIMS: To
evaluate medical students' knowledge regarding the prevention and management of
sharps injuries and their experience of such exposures in the calendar year
2007. METHODS: A cross-sectional, web-based, survey of fourth and fifth year
medical students enrolled at the
27. Study
shows high occupational risk for Zambian health workers. The Post 2008.
ABSTRACT:
28. Adams
D, Elliott TS. Needle protective devices; where are we now? J Hosp Infect 2008;
70(2):197-198.
ABSTRACT: It is now seven years since the
29. 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).
30. Akinleye
AA, Omokhodion FO. Work practices of primary health care workers in urban and
rural health facilities in south-west
ABSTRACT: Occupational health and safety among primary health care (PHC)
workers has received scanty attention. In developing countries, excessive
handling of contaminated needles and unsafe work practices increase the risk of
occupational transmission of blood-borne pathogens among health care workers,
patients and the community at large.1 The risks may be
greater at PHC level because patients seen at this level are largely
unscreened. Furthermore, nurses in rural settings have been reported to be at
greater risk.2
This study was designed to assess the work practices of PHC workers in urban
and rural areas of south-west
31. 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
32. Alter
MJ. Healthcare should not be a vehicle for transmission of hepatitis C virus. J
Hepatol 2008; 48(1):2-4.
ABSTRACT: During the past 15 years, there have been more than 600 publications
on the topic of nosocomial or iatrogenic hepatitis C virus (HCV) transmission
not related to transfused blood, plasma-derived products, or transplantation
(ISI Web of Science® at http://portal.isiknowledge.com
accessed October 19, 2007). Most of them were from developed countries, such as
those in Western and Northern Europe, the
33. Anonymous.
Which Will You Choose: Staples, Sutures or Liquid Adhesives? Outpatient Surgery
Magazine 2008; IX(9).
ABSTRACT: With so many skin-closure options to choose from, how do you decide
which to stock? To help you make sound purchasing decisions, we asked surgeons
and administrators to walk us through how they choose among plain gut sutures,
synthetic sutures, adhesive strips, staples, tissue adhesive glue and skin
clips. As you'll see, you must consider a wide array of factors, from the
incision type and operative site to the patient's safety and cosmetic needs to
ease of application, physician preference, prevention of wound complications
and affordability.
34. 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.
35. Au
E, Gossage JA, Bailey SR. The reporting of needlestick injuries sustained in
theatre by surgeons: are we under-reporting? J Hosp Infect 2008; 70(1):66-70.
ABSTRACT: Surgeons frequently sustain needlestick injuries when operating. The
aim of this study was to evaluate the incidence and reporting rate of
needlestick injuries at one institution. A questionnaire was distributed
anonymously to 69 surgeons of all grades and specialties in a district general
hospital in the
36. Bickler
S, Spiegel D. Global surgery--defining a research agenda. The Lancet 2008;
Online 06/25/08.
ABSTRACT: In today's Lancet, Thomas Weiser and colleagues1
report that there are 234 million major surgical procedures worldwide each
year, one for every 25 people. This figure is more than twice the number of
yearly births, and seven times the 33·2 million2 people
infected with HIV. Because this estimate was based solely on major procedures,
and did not include minor procedures or non-operative surgical care (eg,
management of most blunt injuries), the actual surgical workload may be much
higher. This massive volume of procedures, along with the attendant risks,
clearly qualifies surgical diseases (any illness that requires surgical
expertise) and their treatment as a major public-health issue.
The study also reports disparities in the provision of surgical care on the
basis of finances within the health sector, with the estimate that 30% of the
world's population receives 73·6% of the world's surgical procedures and that
the poorest third receives only 3·5% of all surgical procedures. If we assume
no differences in burden of surgical disease between rich and poor countries,
these findings suggest that despite the number of procedures done worldwide,
there is an enormous unmet need for surgical care in poor countries. Patients'
safety is important in the delivery of surgical services, but these more fundamental
questions need to be addressed. The most pressing questions relate to the
global burden of surgical disease, the ability of surgical treatment to prevent
disability and death, and the best strategies for improving surgical care in
settings of limited resources. Answering these questions will also help to
establish where surgical care should be ranked among global health priorities.
37. Birk
S. An issue that can't be contained. Mater Manag Health Care 2008; 17(5):42-44.
ABSTRACT: The article discusses the impact of switching the single-use to
reusable sharps containers on hospital care. It states that reusable sharps
containers can reduce hospital medical waste by an average of about one ton per
100 beds per year. The author implies that most hospitals in the U.S. are
jumping to the reusable versus single-use bandwagon and are contracting with
third-party providers to collect, disinfect and return sharps disposal bins.
38. Blenkharn
JI, Odd C. Sharps injuries in healthcare waste handlers. Ann Occup Hyg 2008;
52(4):281-286.
ABSTRACT: Clinical waste disposal carries with it a risk of serious and
possibly life-threatening infection. Combining confidential questionnaires and
structured interviews with discrete observation, the attitudes and approach to
safe handling of bulk clinical wastes by staff in a specialist waste treatment
facility were assessed. With particular attention to glove use and hand
hygiene, observations were supplemented by review of group-wide accident and
incident records, with emphasis on sharps injuries and related blood and
bloodstained body fluid exposures. Deficiencies in glove selection and use, and
in hand hygiene, were noted despite extensive and on-going training and
supervision of waste handlers. Though ballistic puncture-resistant gloves
protect against sharps injury, these were uncomfortable in use and were
sometimes rejected by waste handlers who preferred thin-walled nitrile gloves
that were more comfortable in use though provide no resistance to penetrating
injury. Among the waste handlers working for a single specialist waste disposal
company, sharps injuries (n = 40) occurred at a rate of approximately 1 per 29
000 man hours. Injuries were caused by hypodermic needles from improperly
closed or overfilled sharps boxes (n = 6) or from sharps incorrectly discarded
into thin-walled plastic sacks intended only for soft wastes (n = 34). Most
injuries occurred to the fingers or hands. No seroconversions occurred, though
two individuals suffered anxiety/stress disorder necessitating prolonged leave
of absence with professional counselling and support. Glove use and hand
hygiene must feature prominently in the on-going training of waste handlers.
Though ballistic gloves afford protection against sharps injury, the initial
segregation and safe disposal of clinical wastes by healthcare professionals
must provide the primary control measure. Despite robust and unambiguous
legislation and good practice guidelines, serious errors by healthcare staff
that result in the disposal of hypodermic needles and other sharps to
thin-walled plastic waste sacks places waste handlers at risk of bloodborne
virus infection. Further improvement in the standards of waste segregation and
disposal by healthcare professionals are still required to protect ancillary
and support staff and waste handlers working in the disposal sector
39. 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
40. Bollin
M, Murry L. Reducing exposure risk in the operating room. Prairie Rose 2008;
77(2):10-13.
ABSTRACT: PURPOSE: The purpose of this article is to evaluate and recommend
current best practices related to safe handling of sharp instruments in
reducing transmission of blood borne pathogens, specifically HIV, in the
operating suite. OBJECTIVES: 1) To identify the risk of exposure to bloodborne
pathogens from sharps in the OR suite. 2) To identify practices to reduce the
risk of exposure to bloodborne pathogens in the OR suite
41. Boyce
R, Mull J. Complying with the Occupational Safety and Health Administration:
guidelines for the dental office. Dent Clin North Am 2008; 52(3):653-68, xi.
ABSTRACT: This article outlines Occupational Safety and Health Administration
(OSHA) guidelines for maintaining a safe dental practice workplace and covers
requirements, such as education and protection for dental health care
personnel. OSHA regulations aim to reduce exposure to blood-borne pathogens.
Environmental infection control in dental offices and operatories is the goal
of enforcement of OSHA codes of practice. Universal precautions reduce the risk
for infectious disease. OSHA has a mandate to protect workers in the
42. Chalupka
SM, Markkanen P, Galligan C, Quinn M. Sharps injuries and bloodborne pathogen
exposures in home health care. AAOHN J 2008; 56(1):15-29.
ABSTRACT: Home health care is one of the fastest growing industries in the
43. Chen
CJ, Gallagher R, Gerber LM, Drusin LM, Roberts RB. Medical students' exposure
to bloodborne pathogens in the operating room: 15 years later. Infect Control
Hosp Epidemiol 2008; 29(2):183-185.
ABSTRACT: We compared the rates of exposure to blood in the operating room
among third-year medical students during 2005-2006 with the rates reported in a
study completed at the same institution during 1990-1991. The number of medical
students exposed to blood decreased from 66 (68%) of 97 students during
1990-1991 to 8 (11%) of 75 students during 2005-2006 (P<.001)
44. Chevalier
B, Margery J, Wade B et al. [Perception of nosocomial risk among healthcare
workers at "Hopital Principal" in
ABSTRACT: Nosocomial Infection (NI) is also observed in healthcare facilities
in non-Western countries. The purpose of this report is to describe the
findings of a survey undertaken to evaluate hygiene procedures implemented at
the "Hopital Principal" in
45. 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
46. Coker
A, Sangodoyin A, Sridhar M, Booth C, Olomolaiye P, Hammond F. Medical waste
management in Ibadan, Nigeria: Obstacles and prospects. Waste Manag 2008.
ABSTRACT: Quantification and characterization of medical waste generated in
healthcare facilities (HCFs) in a developing African nation has been conducted
to provide insights into existing waste collection and disposal approaches, so
as to provide sustainable avenues for institutional policy improvement. The
study, in Ibadan city, Nigeria, entailed a representative classification of
nearly 400 healthcare facilities, from 11 local government areas (LGA) of
Ibadan, into tertiary, secondary, primary, and diagnostic HCFs, of which, 52
HCFs were strategically selected. Primary data sources included field
measurements, waste sampling and analysis and a questionnaire, while secondary
information sources included public and private records from hospitals and
government ministries. Results indicate secondary HCFs generate the greatest
amounts of medical waste (mean of 10,238kg/day per facility) followed by
tertiary, primary and diagnostic HCFs, respectively. Characterised waste
revealed that only approximately 3% was deemed infectious and highlights
opportunities for composting, reuse and recycling. Furthermore, the management
practices in most facilities expose patients, staff, waste handlers and the
populace to unnecessary health risks. This study proffers recommendations to
include (i) a need for sustained cooperation among all key actors (government,
hospitals and waste managers) in implementing a safe and reliable medical waste
management strategy, not only in legislation and policy formation but also
particularly in its monitoring and enforcement and (ii) an obligation for each
HCF to ensure a safe and hygienic system of medical waste handling,
segregation, collection, storage, transportation, treatment and disposal, with
minimal risk to handlers, public health and the environment
47. Cook
J. A safe and effective method to recover missing surgical needles. Dermatol
Surg 2008; 34(3):423.
ABSTRACT: The accountability of all sharps during and at the conclusion of any
dermatologic surgery procedure is of paramount importance to ensure the safety
of both the patient and the health care providers. The identification of the
human immunodeficiency virus served as the impetus for the recognition of
improved operative safety. The majority of percutaneous injuries to health care
workers are needle sticks
48. 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,
49. De
CG, Puro V, Jagger J. Needlestick-prevention devices: we should already be
there. J Hosp Infect 2008; In press.
ABSTRACT: In response to the comments of Adams and Elliott, several European
countries either have adopted or are planning to adopt prescriptive legislation
on needlestick-prevention devices (NPDs), including Austria, Germany, Spain,
France, and Italy.[1], [2], [3], [4],
[5] and [6] Despite the non-binding nature of some of these
rules, the adoption of NPDs in Europe is increasing. We would like to point
out, however, that these are operative regulations that further specify what is
already stated in the framework directive 89/391/EEC. This directive, which
aims to improve the protection of workers from accidents at work and from occupational
diseases by providing preventive measures, information, consultation, balanced
participation and training of workers and their representatives, and the
'daughter directive' 2000/54/EC on the protection of workers from risks related
to exposure to biological agents at work, state that: 'Employers must keep
abreast of new developments in technology with a view to improving the
protection of workers' health and safety', and in Article 6 on the Reduction of
risks '… the risk of exposure must be reduced to as low a level as necessary in
order to protect adequately the health and safety of the workers. In particular
the following measures are to be applied: … (b) design of work processes and
engineering control measures so as to avoid or minimise the release of
biological agents into the place of work.' Therefore, European legislation
already requires new technologies to be introduced to enhance workers' safety,
and in the healthcare setting, NPDs represent an engineering control measure
whose clinical efficacy has been widely demonstrated.
50. Dewhirst
CA, Hung JC. Comparison of the EZ-Cap recapper with the Mayo recapper for the
prevention of needlesticks. J Nucl Med Technol 2008; 36(3):151-154.
ABSTRACT: The purpose of this project was the development of a device that
improves the design of our current capping block, the Mayo recapper. The major
challenges for design and improvement included creating a device that is simple
to use and can be applied throughout our department. We wanted a recapper device
that increased safety and minimized the potential for needlesticks. Simplicity
was another important factor, along with versatility and low cost. A new
recapper, called EZ-Cap, was developed, and a comparison study was conducted to
evaluate the pros and cons of the EZ-Cap recapper and the Mayo recapper.
METHODS: Nuclear medicine technologists (n = 10) in our department used each
device when administering patient injections. At the conclusion of their
patient injection rotation, they recorded on a survey sheet the pros and cons
of each device. The results of this survey were used to evaluate the
effectiveness, comfort level during use, and safety of each recapping device.
We used a 2-level scoring system to help determine which device was more
favorable. The first level focused on comfort and convenience and was given a
score of +1 or -1. The second level focused on safety and was given a score of
+2 or -2. Because we believed that safety was a high priority for our capping
blocks, this level received a higher score than the first level. RESULTS: The
Mayo recapper was the device preferred by 9 of 10 technologists surveyed. The
EZ-Cap recapper had several technical issues that made it difficult to use and
that could potentially lead to safety concerns. According to our scoring
system, the Mayo recapper received a score of +9 for its pros and -4 for its
cons. By comparison, the EZ-Cap recapper received a score of +7 for its pros
and -16 for its cons. CONCLUSION: Our results show that the Mayo recapper was
the device of choice because its pros outweighed its cons. However, we will
continually improve the effectiveness of the Mayo recapper to prevent
needlesticks
51. 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.
52. Ertem
M, Dalar Y, Cevik U, Sahin H. Injury or body fluid splash incidence rate during
three months period in elective surgery procedures, at
ABSTRACT: BACKGROUND: In this study we aimed to determine the prevalence of
sharp injuries (SI) and blood and body fluid (BBF) splashes in health care
workers during elective surgery procedures (ESP). This study would help to plan
the preventive measures for injuries and BBF splashes. METHODS: All ESP were
recorded during three months period and SI and BBF splashes were analyzed in
Hospital of Dicle University. Hospital employees who reported SI or BBF
splashes were interviewed about the types of devices causing injury and the
circumstances of the injury. RESULTS: During three months period, 1988 ESPs
were recorded. SIs were reported in 111 procedures (5.6%) and BBF splashes were
in 145 (7.3%). Incidence rate of SI was 2.8 per person year in teaching staff,
5.6 in residents, 6.3 in nurses and 1.5 for other health care workers.
Incidence rate of BBF splashes was 14.5 per person year in trainers, 6.9 in
residents, 8.4 in nurses, respectively. Duration of ESP, start time of ESP and
number of employed personnel in the ESP were the factors that significantly
influenced SI incidence. Duration of ESP and total person worked in ESP was
effective on BBF splashes. SI was occurred in 14.4 of mandibulofacial, 12.2% of
general surgery, 10.5% of chest surgery and 8.4% of brain surgery ESP. BBF
splashes occurred in 14.4% of general surgery's, 13.5% of urology's, 14% of
chest surgery's, 14.7% of cardiovascular surgery's ESP. The most frequently
injured tissue was index finger (33.9%) and the pollex finger (31.4%).
CONCLUSION: SIs and BBFs are important health risks for health professionals
who are involved in surgery, as it is in all other medical practices. SI and
BBF splashes should be monitored and preventive measures should be planned
urgently
53. FitzSimons
D, Francois G, De CG et al. Hepatitis B virus, hepatitis C virus and other
blood-borne infections in healthcare workers: guidelines for prevention and
management in industrialised countries. Occup Environ Med 2008; 65(7):446-451.
ABSTRACT: The Viral Hepatitis Prevention Board (VHPB) convened a meeting of
international experts from the public and private sectors in order to review
and evaluate the epidemiology of blood-borne infections in healthcare workers,
to evaluate the transmission of hepatitis B and C viruses as an occupational
risk, to discuss primary and secondary prevention measures and to review
recommendations for infected healthcare workers and (para)medical students.
This VHPB meeting outlined a number of recommendations for the prevention and
control of viral hepatitis in the following domains: application of standard
precautions, panels for counselling infected healthcare workers and patients,
hepatitis B vaccination, restrictions on the practice of exposure-prone
procedures by infected healthcare workers, ethical and legal issues, assessment
of risk and costs, priority setting by individual countries and the role of the
VHPB. Participants also identified a number of terms that need harmonization or
standardisation in order to facilitate communication between experts
54. Ford
JL, Phillips P. How to evaluate sharp safety-engineered devices. Nurs Times
2008; 104(36):42-45.
ABSTRACT: With increasing concerns of occupational exposure to bloodborne
viruses in healthcare settings, NHS trusts are under pressure to consider
opting for safer sharps devices that are designed to protect users from
needlestick injuries. However, with an ever-increasing range of 'sharp safety'
devices on the market, deciding what to purchase is a complex issue. In
addition, evidence shows that purchasing safety devices alone will not
eliminate the problem of needlestick injuries. This article discusses the
criteria that should be taken into account when trusts consider introducing
sharp safety devices into their workplace
55. Fritzsche
FR, Dietel M, Weichert W, Buckendahl AC. Cut-resistant protective gloves in
pathology--effective and cost-effective. Virchows Arch 2008; 452(3):313-318.
ABSTRACT: Cutting injuries and needle-stitch injuries constitute a potentially
fatal danger to both pathologists and autopsy personnel. We evaluated such
injuries in a large German institute of pathology from 2002 to 2007 and
analysed the effect of the introduction of cut-resistant gloves on the
incidence of these injuries. In the observation period, 64 injuries (48 cutting
injuries and 16 needle-stitch injuries) were noted in the injury report books.
Most injuries were located at the non-dominant hand, preferentially at the
index finger and the thumb. Around one fifths of the injuries were at the side
of handedness. The average number of injuries per month was 1.22 for the 50
months prior to the introduction of cut-resistant gloves, more than seven times
higher than after their introduction (0.158; 19 months; p < 0.001).
Considering the medical and administrational costs of such injuries,
cut-resistant protective gloves are an effective and cost-effective completion
of personal occupational safety measures in surgical pathology and autopsy. We
strongly recommend the use of such gloves, especially for autopsy personnel
56. Ganczak
M, Barss P. Nosocomial HIV infection: epidemiology and prevention--a global
perspective. AIDS Rev 2008; 10(1):47-61.
ABSTRACT: Because, globally, HIV is transmitted mainly by sexual practices and
intravenous drug use and because of a long asymptomatic period,
healthcare-associated HIV transmission receives little attention even though an
estimated 5.4% of global HIV infections result from contaminated injections alone.
It is an important personal issue for healthcare workers, especially those who
work with unsafe equipment or have insufficient training. They may acquire HIV
occupationally or find themselves before courts, facing severe penalties for
causing HIV infections. Prevention of blood-borne nosocomial infections such as
HIV differs from traditional infection control measures such as hand washing
and isolation and requires a multidisciplinary approach. Since there has not
been a review of healthcare-associated HIV contrasting circumstances in poor
and rich regions of the world, the aim of this article is to review and compare
the epidemiology of HIV in healthcare facilities in such settings, followed by
a consideration of general approaches to prevention, specific countermeasures,
and a synthesis of approaches used in infection control, injury prevention, and
occupational safety. These actions concentrated on identifying research on
specific modes of healthcare-associated HIV transmission and on methods of
prevention. Searches included studies in English and Russian cited in PubMed
and citations in Google Scholar in any language. MeSH keywords such as
nosocomial, hospital-acquired, iatrogenic, healthcare associated,
occupationally acquired infection and HIV were used together with mode of
transmission, such as "HIV and hemodialysis". References of relevant
articles were also reviewed. The evidence indicates that while occasional
incidents of healthcare-related HIV infection in high-income countries continue
to be reported, the situation in many low-income countries is alarming, with
transmission ranging from frequent to endemic. Viral transmission in health
facilities occurs by unexpected and unusual as well as more frequent modes. HIV
can be transmitted to patients and to donors of blood products by specific
vehicles and vectors during blood transfusion, plasma donation, and artificial
insemination, by improperly sterilized sharps, by medical equipment during
activities such as dialysis and organ transplantation, and by healthcare
workers infected by occupational exposure to hazards such as blood-contaminated
sharps. Personal, equipment, and environmental factors predispose to
acquisition of nosocomial HIV and all are pertinent for prevention. For
infection and injury control, poverty is often an underlying determinant. While
sophisticated new tests offer improved HIV detection, increasingly higher
marginal costs limit their feasibility in many settings. Modest investment in
safer equipment and appropriate integrated training in infection control,
injury prevention, and occupational safety should provide greater benefit
57. 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
58. 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
59. 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
60. Gray
J. An accidental death. Nurs Stand 2008; 22(24):1.
ABSTRACT: Nurses everywhere will be filled with sorrow at th edeath of their
colleague Juliet Young who contracted HIV as a result of needlestick injury at
work. Last week, a south
61. 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: BACKGROUND: The growing AIDS epidemic in southern
62. Hassan
MM, Ahmed SA, Rahman KA, Biswas TK. Pattern of medical waste management:
existing scenario in
ABSTRACT: BACKGROUND: Medical waste is infectious and hazardous. It poses
serious threats to environmental health and requires specific treatment and
management prior to its final disposal. The problem is growing with an
ever-increasing number of hospitals, clinics, and diagnostic laboratories in
63. Hotaling
A. Efficacy of a Retractable Safety Winged Steel Needle (Butterfly Needle) to
Significantly Reduce Needlestick Injuries in Healthcare Workers: A 21-Month
Experience. Clinical Chemistry 2008; 54(S6):A51.
ABSTRACT: Objective Needlestick injuries (NIs) from winged steel
needles (WSNs), also referred to as butterfly needles, like other hollow-bore
blood collection needles are considered high-risk for bloodborne pathogen
transmission and are implicated in occupational HIV seroconversion. WSNs
compared to phlebotomy needles are also disproportionately involved in
Method
A second-generation safety WSN utilizing an in-vein retractable
needle technology (Push Button Blood Collection Set, BD) was implemented at a
431-bed hospital medical center following selection and successful pilot
testing by clinical laboratory and nursing staff members. This study device
replaced a longstanding first-generation safety WSN (Safety-Lok™ Blood
Collection Set, BD).
Results During the 52-month baseline period
(10/01-2/06), exclusively utilizing the 1 st generation safety WSN
(Safety-Lok, BD), the WSN NI rate was 3.76/100,000 safety WSNs purchased (20
NIs/532,000). During the 21-month study period (3/06-12/07), exclusively
utilizing the 2nd generation safety WSN (Push Button, BD), the WSN
NI rate was 0.64/100,000 safety WSNs purchased (2 NIs/310,000). Utilization of
the Push Button Blood Collection Set during the study period was associated an
83% reduction (P < 0.01), in reported WSN related needlestick
injuries compared to the baseline period utilizing the Safety-Lok, Blood
Collection Set.
Analysis of the baseline safety WSN device (Safety-Lok, BD)
Discussion The Push Button Blood Collection Set
(BD) safety WSN device has significantly reduced the incidence of reported
64. Hsieh
YH, Rothman RE, Newman-Toker DE, Kelen GD. National estimation of rates of HIV
serology testing in US emergency departments 1993-2005: baseline prior to the
2006 Centers for Disease Control and Prevention recommendations. AIDS 2008;
22(16):2127-2134.
ABSTRACT: OBJECTIVE: The 2006 Centers for Disease Control and Prevention
recommendations place increased emphasis on emergency departments (EDs) as one
of the most important medical care settings for implementing routine HIV
testing. No longitudinal estimates exist regarding national rates of HIV
testing in EDs. We analyzed a nationally representative ED database to assess
HIV testing rates and characterize patients who received HIV testing, prior to
the release of the 2006 guidelines. DESIGN: A cross-sectional analysis of US ED
visits (1993-2005) using the National Hospital Ambulatory Medical Care Survey
was performed. METHODS: Patients aged 13-64 years were included for analysis.
Diagnoses were grouped with Healthcare Cost and Utilization Project Clinical
Classifications Software. Analyses were performed using procedures for
multiple-stage survey data. RESULTS: HIV testing was performed in an estimated
2.8 million ED visits (95% confidence interval, 2.4-3.2) or a rate of 3.2 per
1000 ED visits (95% confidence interval, 2.8-3.7). Patients aged 20-39 years,
African-American, and Hispanic had the highest testing rates. Among those
tested, leading reasons for visit were abdominal pain (9%), puncture
wound/needlestick (8%), rape victim (6%), and fever (5%). The leading
medication class prescribed was antimicrobials (32%). The leading ED diagnosis
was injury/poisoning (30%) followed by infectious diseases (18%). Of note, 6%
of those tested were diagnosed with HIV infection during their ED visits.
CONCLUSION: Prior to the release of the 2006 Centers for Disease Control and
Prevention guidelines for routine HIV testing in all healthcare settings,
baseline national HIV testing rates in EDs were extremely low and appeared to
be driven by clinical presentation
65. Jagger
J, Perry J, Gomaa A, Phillips EK. The impact of
ABSTRACT: Summary: In the United States (U.S.) federal legislation requiring
the use of safety-engineered sharp devices, along with any array of other
protective measures, has played a crucial role in reducing healthcare workers
(HCWs) risk of occupational exposure to bloodborne pathogens over the last 20
years. We present the history of
66. Jagger
J. Retractable needles are only part of sharps protection. Nurs Stand 2008;
22(37):33.
ABSTRACT: The International Health Care Worker Safety Centre in the
67. Jagger
J, Gomaa AE, Phillips EK. Safety of surgical personnel: a global concern.
Lancet 2008; 372(9644):1149.
ABSTRACT: Thomas Weiser and colleagues (July 12, p 139)1 have
identified high surgical complication rates and the scarcity of surgical care
in low-income countries as unaddressed public-health issues of global
magnitude. Their focus on the unmet needs of surgical patients is wholly
justified, yet overlooks a risk group that is even more neglected: that of
surgical personnel in poor countries who are at exceptionally high risk of
occupational infections from HIV, hepatitis B, and hepatitis C.
A 2006 survey of surgeons from 14 sub-Saharan African countries3
found that more than 60% were not fully vaccinated against hepatitis B. There
was a near absence of availability of fluid-resistant barrier garments and 70%
wore no eye protection. The percutaneous injury rate was 20 times higher than
that of the average
68. Jagger
J. Fine points about safety syringes and level of risk. Am J Infect Control
2008; 36(7):501-502.
ABSTRACT: To the Editor:
The study by Whitby et al1 confirms the effectiveness and
importance of safety-engineered needle devices in reducing the risk of
needlestick injury in Australian health care workers, as has been similarly
demonstrated in the United States, France, Spain, and Japan.[2],
[3], [4], [5] and [6] Whitby et al noted an
81% drop in injuries from inline intravenous needles and a 35% drop in injuries
from butterfly-type needles after the implementation of safety-engineered
devices, along with a 57% drop in injuries from syringes after the
implementation of retractable needle syringes.
69. Jed
SL, von Zinkernagel D. Call to Action: The Rights of Nurses to Health and
Safety. Journal of the Association of Nurses in AIDS care 2008; 19(6):415-418.
ABSTRACT: The risk of occupational exposure to bloodborne and airborne
infectious diseases is well known, and nurses put themselves at risk every day
they work in wards and clinics where inadequate infection control measures
exist (Joint United Nations Programme on HIV/AIDS (UNAIDS). (2008), 2008
Joint United Nations Programme on HIV/AIDS (UNAIDS). (2008). Executive summary:
2008 report on the global AIDS epidemic. Retrieved September 4, 2008, from http://data.unaids.org/pub/GlobalReport/2008/JC1511_GR08_ExecutiveSummary_en.pdf.Joint
United Nations Programme on HIV/AIDS (UNAIDS). (2008), 2008 and [World
Health Organization, 2008]). Many nurses and other health care workers
(HCW) provide care in settings with limited basic resources including lack of
access to electricity, running water, gloves, tuberculosis masks, and
occupational postexposure prophylaxis for HIV (Medicins Sans Frontieres,
2007). These unsafe working conditions create fear and further increase the
risk of occupational exposure. Globally, WHO estimates that 2.5% of HIV cases
among HCW are the result of needle-stick injuries, while also acknowledging
that these exposures are likely to be grossly underreported (WHO, 2006).
This situation is unacceptable and untenable because essential caregivers who
are responding to HIV are themselves placed at risk, endangering their health
and fostering a desire to leave unsafe workplaces. Occupational exposures are
preventable; the tools for prevention are known and at hand. Standard infection
control measures, also called universal precautions, have drastically
reduced the risk of occupational exposure to HIV in the
70. Kamal
SM. Acute hepatitis C: a systematic review. Am J Gastroenterol 2008;
103(5):1283-1297.
ABSTRACT: INTRODUCTION: The annual incidence of acute hepatitis C virus (HCV)
has fallen in recent years, primarily because of effective blood screening
efforts and increased education on the dangers of needle sharing. However,
hepatitis C infection is still relatively frequent in certain populations. Most
patients infected with HCV are unaware of their exposure and remain
asymptomatic during the initial stages of the infection, making early diagnosis
during the acute phase (first 6 months after infection) unlikely. While some of
those infections will have a spontaneous resolution, the majority will progress
to chronic HCV. We scanned the literature for predictors of spontaneous
resolution and treatment during the acute stage of HCV to identify factors that
would assist in treatment decision making. METHODS: A medical literature search
through MEDLINE was conducted using the keyword "acute hepatitis C"
with a variety of keywords focused on (a) epidemiology, (b) natural history and
outcome, (c) diagnosis, (d) mode of transmission, and (e) treatment. RESULTS:
There are no reliable predictors for spontaneous resolution of HCV infection
and a significant percentage of individuals exposed to HCV develop persistent
infections that progress to chronic liver disease. An intriguing approach is to
treat acute HCV and prevent the development of chronic hepatitis. Several
clinical trials showed that treatment of hepatitis C infection during the acute
phase is associated with high sustained virological response (SVR) rates
ranging between 75% and 100%. Although there is a prevailing consensus that
intervention during the acute phase is associated with improved viral
eradication, relevant clinical questions have remained unanswered by clinical
trials. Optimization of therapy for acute hepatitis C infection and
identification of predictors of SVR represent a real challenge. CONCLUSION:
With more than 170 million chronic hepatitis C patients worldwide and an
increase in the related morbidity and mortality projected for the next decade,
an improvement in our ability to diagnose and treat patients with acute
hepatitis C would have a significant impact on the prevalence of chronic
hepatitis and its associated complications particularly in countries with a
high endemic background of the infection
71. Kanter
LJ, Siegel CJ. Safety needles. Ann Allergy Asthma Immunol 2008; 100(4):401-402.
ABSTRACT: To The Editor: We read
with interest the article by Wolf et al.
This artilce reiterates the fact that the Occupational Safety and Health
Administration's (OSHA's) guidelines for safety needles do not clearly reduce
accidental needle sticks (ANSs) in an allergist's practice. This finding is consistent with our article
that evaluated more than 7 million small-guage needle uses in allergy practices
and found that there was no proven benefit from current safety needles. In both studies, there was an apparent
increased rate of ANSs when using safety needles.
72. Khuroo
MS, Khuroo MS. Hepatitis E virus. Current Opinion in Infectious Diseases 2008;
21(5):539-543.
ABSTRACT: PURPOSE OF REVIEW: Hepatitis E is an emerging infectious disease.
This review will focus on recent advances in the zoonotic transmission, global
distribution and control of hepatitis E. RECENT FINDINGS: Hepatitis E virus
infection is known to cause waterborne epidemics and sporadic infections in
developing countries. Recently, there have been several reports on zoonotic
foodborne autochthonous infections of hepatitis E in developed countries.
Hepatitis E typically causes self-limited acute infection. Recent reports have
documented hepatitis E virus causing chronic hepatitis and cirrhosis in
patients after solid organ transplantation. High incidence and severity of
hepatitis E in pregnant women have been re-confirmed. The reason for high
mortality in pregnant women remains ill understood. A recombinant hepatitis E
vaccine has been evaluated in a phase 2, randomized, placebo-controlled trial
in
73. Klag
M. PEPFAR: Good to Great. Johns
ABSTRACT: Now is the time to get it right.
The President's Emergency Plan for AIDS Relief (PEPFAR), a $15 billion program,
has supported the care of 2.4 million people with AIDS, saving them from
certain death. President Bush's initiative and the American people's generosity
should be commended. Having met South Africans and Ugandans who are alive
because of the program, I have seen firsthand the difference PEPFAR is making.
After a February 2006 trip to
74. Laing
RM. Protection provided by clothing and textiles against potential hazards in
the operating theatre. Int J Occup Saf Ergon 2008; 14(1):107-115.
ABSTRACT: The typical hospital and operating theatre present multiple potential
hazards to both workers and patients, and protection against some of these is
provided through use of various forms of clothing and textiles. While many
standards exist for determining the performance of fabrics, most tests are
conducted under laboratory conditions and against a single hazard. This paper
provides an overview of selected developments in the principal properties of
fabrics and garments for use in these workplaces, identifies the key standards,
and suggests topics for further investigation
75. Larney
S, Dolan K. An exploratory study of needlestick injuries among Australian
prison officers. Int J Prison Health 2008; 4(3):164-168.
ABSTRACT: Prison officers face multiple occupational hazards including
needlestick injuries, which may result in the transmission of blood-borne viral
infections. This study aimed to assess the prevalence of needlestick injuries,
the circumstances under which needlestick injuries occur and the responses of
injured prison officers. Cross-sectional data were collected from prison
officers in two Australian jurisdictions between January and May 2006, using a
self-report questionnaire. Descriptive analyses were conducted. Of 246 prison
officers who completed the survey, two-thirds had found needles and syringes in
the workplace. Seventeen officers (7%) reported having experienced a
needlestick injury. Most injuries occurred during searches. Serological testing
for blood-borne viral infections following injury was common, but less than
half the injured officers accessed support services. Needlestick injuries
appear to be a relatively rare occurrence, but may be further reduced by
improving search techniques and equipment and regulating needles and syringes
in prisons
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
77. Leigh
JP, Wiatrowski W, Gillen M, Steenland N. Characteristics of persons and jobs
with needlestick injuries in a national data set. Am J Infect Control 2008;
2008.
ABSTRACT: Background: Physicians,
nurses, and others are at risk of needlesticks, yet little national information
is available regarding incidence across demographic and occupational
categories.
Methods: Analysis was conducted
on national data on occupational injuries for 1992-2003 from the Bureau of
Labor Statistics (BLS). Because BLS data were limited to cases with 1 or more
days of work loss, and reasons related to reporting of incidents, the data only
reflected a subset of all needlesticks. Nevertheless, the data were internally
consistent across categories so that relative magnitudes were reliable.
Statistical tests for differences in proportions were conducted that compared
needlesticks with all other occupational injuries and employment.
Results: Cases with 1 or more
days of work loss numbered 903 per year, on average, from 1992 through 2003.
Women comprised 73.3% (95% CI: 72.5%-74.2%) of persons injured. For those
reporting race, white, non-Hispanic comprised 69.3% of the total (95% CI:
68.1%-70.4%); black, non-Hispanic, 14.8% (95% CI: 13.9%-15.6%); and Hispanic,
13.8% (95% CI: 12.9%-14.6%). The age bracket 35 to 44 years had the highest
percentage of injuries at 34.0% (95% CI: 33.1%-34.9%). Ages over 54 years
reported smaller percentages of needlestick injuries than either all other
injuries or employment. Occupations with greatest frequencies included
registered nurses, nursing aides and orderlies, janitors and cleaners, licensed
practical nurses, and maids and housemen. Occupations with greatest risks
included biologic technicians, janitors and cleaners, and maids and housemen.
Almost 20% (95% CI: 18.88%-20.49%) of needlesticks occurred outside the
services industry. Seven percent (95% CI: 6.56%-7.53%) of needlesticks resulted
in 31 or more days of work loss in contrast to 20.46% (95% CI: 20.44%-20.48%)
of all other injuries.
Conclusion: In this nationally
representative sample, the most frequent demographic and occupational
categories were women; white, non-Hispanic; ages 35 to 44 years; and registered
nurses.
78. Luckhaupt
SE, Calvert GM. Deaths due to bloodborne infections and their sequelae among
health-care workers. Am J
ABSTRACT: BACKGROUND: The odds of dying from bloodborne infections among
health-care workers has not been well studied. METHODS: Using data from the
National Occupational Mortality Surveillance (NOMS) system, a matched
case-control design was employed to examine the relationship between
health-care employment and death from HIV, hepatitis B (HBV), hepatitis C (HCV;
non-A/non-B viral hepatitis), liver cancer, and cirrhosis from 1984 to 2004. We
examined the whole health-care industry and specific health-care occupations.
RESULTS: From 1984 to 2004, NOMS captured 248,550 deaths from bloodborne pathogens
and their sequelae. Employment in the health-care industry was associated with
increased risk of death from HIV (MOR = 2.27; 95% confidence interval [CI] =
2.11-2.44), HBV (MOR = 1.98; CI = 1.58-2.48), and cirrhosis (MOR = 1.09; CI =
1.04-1.15) among males, and death from HCV among both males (MOR = 1.46; CI =
1.22-1.75) and females (MOR = 1.22; CI = 1.05-1.40). Nursing was the occupation
with the highest
79. Mateen
FJ, Grant IA, Sorenson EJ. Needlestick injuries among electromyographers.
Muscle Nerve 2008; 38(6):1541-1545.
ABSTRACT: The objective of this study was to determine the self-reported
prevalence of needlestick injuries among practicing electromyographers. In
January 2008, an anonymous electronic survey was sent to all active members of
the American Association for Neuromuscular and Electrodiagnostic Medicine
(AANEM) who provided e-mail addresses to the Association. Eight hundred and eight
members (56% neurologists, 43% physiatrists; 97% practicing physicians, 3%
trainees) responded, with a response rate of 22% (808 of 3659). The mean number
of years in practice, involving electromyography (EMG) at least 1 day per week,
was 16 years. A majority of physicians (64%) reported at least one needlestick
injury involving EMG, and 8% reported five or more injuries. Needlestick
injuries involving patients with human immunodeficiency virus/acquired
immunodeficiency syndrome (HIV/AIDS), hepatitis B, and/or hepatitis C occurred
in 1 of every 11 electromyographers. Nearly half of all respondents (44%) who
experienced a needlestick injury stated that they did not report at least one
injury event to official centers. Injuries were most likely to occur during a
routine procedure (45%) or when a patient moved (26%). The most common
preventable reason for injury was a perceived lack of time. Muscle Nerve 38:
1541-1545, 2008
80. Mathews
R, Leiss JK, Lyden JT, Sousa S, Ratcliffe JM, Jagger J. Provision and use of
personal protective equipment and safety devices in the National Study to
Prevent Blood Exposure in Paramedics. Am J Infect Control 2008; 36(10):743-749.
ABSTRACT: BACKGROUND: Paramedics are at risk for human immunodeficiency virus,
hepatitis B virus, and hepatitis C virus infection from occupational blood
exposure. This study examined how often paramedics are provided with personal
protective equipment (PPE), sharps containers, and selected safety devices by
their employers; the frequency with which paramedics use sharps containers and
these safety devices; and paramedics' attitudes regarding this equipment.
METHODS: We conducted a mail survey among a nationally representative sample of
certified paramedics.
81. 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
82. 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
83. Mckenna
DJ, McGlennon S, McCallum M, Dolan OM. Evaluation of a novel 'needlecatcher'
surgical instrument designed to reduce the incidence of needle stick injuries
from suture needles during skin suturing. Br J Dermatol 2008; 158(3):649-651.
ABSTRACT: Sir, The use of a 'no touch' technique has been advocated as a method
to reduce the incidence of glove perforation and needle stick injury during
suture needle adjustment.1 This involves the use of forceps
held in the nondominant hand, in the reloading and adjustment of the suture
needle into the needle driver. The needle driver is held in the dominant hand.
While this method avoids any direct contact between the surgeon's gloved
fingers and the suture needle, it does not prevent the needle point from being
exposed while the needle is held in the forceps.
84. Mechai
F, Quertainmont Y, Sahali S et al. Post-exposure prophylaxis with a
maraviroc-containing regimen after occupational exposure to a multi-resistant
HIV-infected source person. Journal of Medical Virology 2008; 80(1):9-10.
ABSTRACT: We report the case of a health care worker who received a
post-exposure prophylaxis including an investigational drug, maraviroc, after a
needle stick percutaneous injury to an HIV-infected patient with late-stage
disease and harboring a multi-drug resistant virus. Post-exposure prophylaxis
including maraviroc was pursued for a total of 28 days, with a weekly clinical
and biological evaluation. Post-exposure prophylaxis was well tolerated, with
no increase in liver function tests. The health care worker remained
HIV-negative after a 6-month follow-up. (c) 2007 Wiley-Liss, Inc
85. Mengal
HU, Howteerakul N, Suwannapong N, Rajatanun T. Factors relating to acceptance
of hepatitis B virus vaccination by nursing students in a tertiary hospital,
Pakistan. J Health Popul Nutr 2008; 26(1):46-53.
ABSTRACT: This cross-sectional study aimed at assessing the prevalence of, and
factors relating to, the acceptance of hepatitis B virus (HBV) vaccination by
nursing students in a tertiary hospital in
86. 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.
87. Mills
EJ,
ABSTRACT: Shortages of health-care staff are endemic in sub-Saharan
88. Mitchell
A. OSHA BPS interpretations issued. Medical Laboratory Observer 2008; November
2008.
ABSTRACT: In light of the current global occupational and public-health
challenges and policies in healthcare, the Occupational Safety and Health
Administration (OSHA) has issued some new and important letters of
interpretation regarding the requirements promulgated in the Bloodborne
Pathogens Standard (BPS) (29 CFR 1910.1030). These challenges include
occupational safety and health application to the preparation and preparedness
for potential global pandemics, and the fundamentals of the sharps-injury log
and employee evaluation. This brief article summarizes these newly issued
interpretations and provides some additional compliance guidance.
89. Mizuta
N, Kurahashi K. [Incidence of a needle stick injury occurring in a needleless
intravenous system]. Masui 2008; 57(5):635-636.
ABSTRACT: A needle stick injury occurred with a needleless intravenous system.
When a nurse picked up a disposable glove left on the floor of an operating
room to discard it, there was an intravenous needle left under the glove and
caused a needle stick injury to the nurse. Although the needle was designed as
a needleless intravenous system, we found after a close observation that there
is a potential hazard for a needle stick injury regarding the needle. The
incidence happened due to the negligence of standard precaution by another
health care provider (a doctor); leaving the contaminated needle on the floor.
Unfortunately, the disposable glove fell on the needle for some reason and
concealed it. Should the doctor follow the standard precaution properly, i.e.
discard it in a puncture-resistant sharps container immediately, this incidence
might not have happened. Any safety device may not prevent incidence 100%, we
have to always heed and follow a standard precaution
90. Moghimi
M, Marashi SA, Kabir A et al. Knowledge, Attitude, and Practice of Iranian
Surgeons About Blood-Borne Diseases. J Surg Res 2008.
ABSTRACT: BACKGROUND: Perhaps more than any other healthcare worker, it is the
surgeons who are at an increased risk of exposure to hepatitis B (HB) virus,
hepatitis C virus, and human immunodeficiency virus. The aim of this study was
to evaluate surgeons' concerns regarding risk awareness and behavioral methods
of protection against blood-borne pathogen transmission during surgery.
MATERIALS AND METHODS: A 31-item questionnaire with a reliability coefficient
of 0.73 was used. Of 575 surgeons invited to participate from three
universities and one national annual surgical society between May and July
2007, 430 (75%) returned completed forms. RESULTS: Concern about being infected
with blood-borne diseases was more than 70 (from a total score of 100). Only
12.9% of surgeons always used double gloves. Complete vaccination against HB was
done in about 76% of surgeons and only 56.8% had checked their HB surface
antibody (anti-HBs) level. Older surgeons never used double gloves (P = 0.001).
CONCLUSION: Iranian surgeons are not aware of the correct percentage of
infected patients with and seroconversion rate of blood-borne diseases, do not
use double gloves adequately, do not report their needlestick injuries,
vaccinate against HB, and check anti-HBs after vaccination. Educational
meetings, pamphlets, and facilities must be provided to health care workers,
informing them of hazards, prevention, and postexposure prophylaxis to
needlestick injuries, vaccination efficacy, and wearing double gloves
91. Moghimi
M, Marashi SA, Kabir A et al. Knowledge, Attitude, and Practice of Iranian
Surgeons About Blood-Borne Diseases. J Surg Res 2008.
ABSTRACT: BACKGROUND: Perhaps more than any other healthcare worker, it is the
surgeons who are at an increased risk of exposure to hepatitis B (HB) virus,
hepatitis C virus, and human immunodeficiency virus. The aim of this study was
to evaluate surgeons' concerns regarding risk awareness and behavioral methods
of protection against blood-borne pathogen transmission during surgery.
MATERIALS AND METHODS: A 31-item questionnaire with a reliability coefficient
of 0.73 was used. Of 575 surgeons invited to participate from three
universities and one national annual surgical society between May and July
2007, 430 (75%) returned completed forms. RESULTS: Concern about being infected
with blood-borne diseases was more than 70 (from a total score of 100). Only
12.9% of surgeons always used double gloves. Complete vaccination against HB
was done in about 76% of surgeons and only 56.8% had checked their HB surface
antibody (anti-HBs) level. Older surgeons never used double gloves (P = 0.001).
CONCLUSION: Iranian surgeons are not aware of the correct percentage of
infected patients with and seroconversion rate of blood-borne diseases, do not
use double gloves adequately, do not report their needlestick injuries,
vaccinate against HB, and check anti-HBs after vaccination. Educational
meetings, pamphlets, and facilities must be provided to health care workers,
informing them of hazards, prevention, and postexposure prophylaxis to
needlestick injuries, vaccination efficacy, and wearing double gloves
92. Moorjani
GR, Bedrick EJ, Michael AA, Peisajovich A, Sibbitt WL, Jr., Bankhurst AD.
Integration of safety technologies into rheumatology and orthopedics practices:
a randomized, controlled trial. Arthritis Rheum 2008; 58(7):1907-1914.
ABSTRACT: OBJECTIVE: To identify and integrate new safety technologies into
outpatient musculoskeletal procedures and measure the effect on outcome,
including pain. METHODS: Using national resources for patient safety and
literature review, the following safety technologies were identified: a safety
needle to reduce inadvertent needlesticks to heath care workers, and the
reciprocating procedure device (RPD) to improve patient safety and reduce pain.
Five hundred sixty-six musculoskeletal procedures involving syringes and
needles were randomized to either an RPD group or a conventional syringe group,
and pain, quality, safety, and physician acceptance were measured. RESULTS:
During 566 procedures, no accidental needlesticks occurred with safety needles.
Use of the RPD resulted in a 35.4% reduction (95% confidence interval [95% CI]
24-46%) in patient-assessed pain (mean +/- SD scores on a visual analog pain
scale [VAPS] 3.12 +/- 2.23 for the RPD and 4.83 +/- 3.22 for the conventional
syringe; P < 0.001) and a 49.5% reduction (95% CI 34-64%) in
patient-assessed significant pain (VAPS score > or =5) (P < 0.001).
Physician acceptance of the RPD combined with a safety needle was excellent.
CONCLUSION: As mandated by the Joint Commission and the Occupational Safety and
Health Administration, safety technologies and the use of pain scales can be
successfully integrated into rheumatologic and orthopedic procedures. The
combination of a safety needle to reduce needlestick injuries to health care
workers and the RPD to improve safety and outcome of patients is effective and
well accepted by physicians
93. 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
94. Murphy
C. Improved surveillance and mandated use of sharps with engineered sharp
injury protections: a national call to action. Healthc Infect 2008;
13(2):33-37.
ABSTRACT: Based on the 2435 parenteral exposures sustained by staff reported in
2005 from 170 Australian hospitals, it is possible that an estimated more than
18-á500 needle-stick injuries (NSIs) could occur in Australian hospitals each
year. These injuries are largely preventable. Each injury causes significant
distress to the involved healthcare worker. To reduce the local burden of NSI,
administrators and clinicians require incident and organisation-specific
information. This information enables targeted prevention strategies, including
safety engineered devices, to be implemented. The larger the dataset of NSI
information, the better the opportunity to develop appropriate targeted
strategies. Unfortunately, the Australian healthcare sector has, to date,
largely overlooked the issue of standardising NSI monitoring, with a small
56-hospital, quasi-national surveillance system becoming non-operational in
1998. However, the recent initial enthusiasm the sector has demonstrated for
increased patient and healthcare worker safety provides an excellent platform
from which to consider possible models that could be adopted for routine monitoring
of NSIs and mandated use of safety engineered devices
95. 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
96. Nagao
Y, Matsuoka H, Kawaguchi T, Ide T, Sata M. HBV and HCV infection in Japanese
dental care workers. Int J Mol Med 2008; 21(6):791-799.
ABSTRACT: Protective measures against occupational exposure to the hepatitis B
virus (HBV) and hepatitis C virus (HCV) must be taken in order to prevent
infection in dental care workers. To determine the best way to protect these
workers, our study examined viral hepatitis infection in dental care workers in
regions with a high prevalence of HCV infections in
97. Nelson
BP. Making straight suture needles a little safer: a technique to keep fingers
from harm's way. J Emerg Med 2008; 34(2):195-197.
ABSTRACT: Straight suture needles are commonly employed to secure arterial and
venous catheters to the skin. These needles have been demonstrated to be more
dangerous than curved or blunt suture needles, with a higher rate of injury for
health care workers. This article describes a technique for using the straight
needle that may reduce the chances of injury. By utilizing the plastic needle
sheath present in most central venous line kits as a "thimble,"
counter pressure and skin puncture may be achieved without bringing the fingers
near the sharp end of the suture
98. Nelson
BP, Nelson BP. Making straight suture needles a little safer: a technique to
keep fingers from harm's way. Journal of Emergency Medicine 2008;
34(2):195-197.
ABSTRACT: Straight suture needles are commonly employed to secure arterial and
venous catheters to the skin. These needles have been demonstrated to be more
dangerous than curved or blunt suture needles, with a higher rate of injury for
health care workers. This article describes a technique for using the straight
needle that may reduce the chances of injury. By utilizing the plastic needle
sheath present in most central venous line kits as a "thimble,"
counter pressure and skin puncture may be achieved without bringing the fingers
near the sharp end of the suture
99. Nevin
R, Carbonell I, Thurmond V. Device-specific rates of needlestick injury at a
large military teaching hospital. Am J Infect Control 2008; 02(06).
ABSTRACT: The device-specific needlestick injury (NSI) rate provides a means of
comparing rates of injury between work sites and institutions over time. We
performed a retrospective study of intravenous and percutaneous injection NSI
at a large military teaching hospital using electronic purchase records and
occupational NSI exposure forms to define action levels for process improvements.
A rate of 2.25 NSI per 100,000 intravenous needles and 2.21 NSI per 100,000
percutaneous needles was found.
100. 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
101. 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.
102. Oszwald
M, Probst C, Bader C, Krettek C. [Accidental abdominal needlestick injury
incurred while discarding a disposal container]. Unfallchirurg 2008;
111(6):455-458.
ABSTRACT: Needlestick injuries routinely occur in everyday clinical practice.
Adequate instruction of employees in health care and correct prophylaxis
against exposure could conspicuously reduce the incidence. Successful
prevention of chronic infectious diseases comprises strict vaccination plans
and substantial knowledge of post-exposure prophylaxis. The introduction of
self-securing cannulas and injection instruments represents an important
technological advance
103. Ozgediz
D, Galukande M, Mabweijano J et al. The Neglect of the Global Surgical
Workforce: Experience and Evidence from
ABSTRACT: BACKGROUND:
104. 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
105. Papenburg
J, Blais D, Moore D et al. Pediatric injuries from needles discarded in the
community: epidemiology and risk of seroconversion. Pediatrics 2008;
122(2):e487-e492.
ABSTRACT: OBJECTIVES: Although anxiety exists concerning the perceived risk of
transmission of bloodborne viruses after community-acquired needlestick
injuries, seroconversion seems to be rare. The objectives of this study were to
describe the epidemiology of pediatric community-acquired needlestick injuries
and to estimate the risk of seroconversion for HIV, hepatitis B virus, and
hepatitis C virus in these events. METHODS: The study population included all
of the children presenting with community-acquired needlestick injuries to the
Montreal Children's Hospital between 1988 and 2006 and to Hopital
Sainte-Justine between 1995 and 2006. Data were collected prospectively at
Hopital Sainte-Justine from 2001 to 2006. All of the other data were reviewed retrospectively
by using a standardized case report form. RESULTS: A total of 274 patients were
identified over a period of 19 years. Mean age was 7.9 +/- 3.4 years. A total
of 176 (64.2%) were boys. Most injuries occurred in streets (29.2%) or parks
(24.1%), and 64.6% of children purposely picked up the needle. Only 36 patients
(13.1%) noted blood on the device. Among the 230 patients not known to be
immune for hepatitis B virus, 189 (82.2%) received hepatitis B immunoglobulin,
and 213 (92.6%) received hepatitis B virus vaccine. Prophylactic antiretroviral
therapy was offered beginning in 1997. Of the 210 patients who presented
thereafter, 82 (39.0%) received chemoprophylaxis, of whom 69 (84.1%) completed
a 4-week course of therapy. The use of a protease inhibitor was not associated
with a significantly higher risk of adverse effects or early discontinuation of
therapy. At 6 months, 189 were tested for HIV, 167 for hepatitis B virus, and
159 for hepatitis C virus. There were no seroconversions. CONCLUSIONS: We observed
no seroconversions in 274 pediatric community-acquired needlestick injuries,
thereby confirming that the risk of transmission of bloodborne viruses in these
events is very low
106. Parish
C. Call for ban on unsafe needles after inquest into nurse's death. Nurs Stand
2008; 22(24):9.
ABSTRACT: The RCN and Unison have called for a ban on non-retractable needles
to protect staff from the risk of contracting blood-borne infections.
107. Park
S, Jeong I, Huh J, Yoon Y, Lee S, Choi C. Needlestick and sharps injuries in a
tertiary hospital in the Republic of Korea. Am J Infect Control 2008;
36(6):439-443.
ABSTRACT: BACKGROUND: The high incidence of hepatitis B virus (HBV) in the
108. 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
109. 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
110. 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
111. 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
112. Prunet
B, Meaudre E, Montcriol A et al. A prospective randomized trial of two safety
peripheral intravenous catheters. Anesthesia & Analgesia 2008;
107(1):155-158.
ABSTRACT: BACKGROUND: To reduce the risk of accidental needlestick injuries,
first active then passive safety devices were developed on IV catheters.
However, whether these catheters are easy to implement and really protect
personnel from accidental needlestick is untested. METHODS: In this prospective
randomized survey, we compared a passive safety catheter with an active safety
catheter and a nonsafety classic catheter. The main objective was to evaluate
the difficulty of inserting the catheters in terms of the number of insertion
failures, difficulties introducing the catheter and withdrawing the needle, and
the normality of the blood reflux in the delivery system. The second objective
was to determine the degree of exposure to patients' blood evaluated as the
number of exposures of the staff and blood splashes of the environment, and the
staff's sense of protection. RESULTS: Seven hundred fifty-nine assessment cards
were collected. The number of failures for the three catheter groups was
similar and not statistically different. Introduction of the catheter was more
difficult with the active safety catheter. Needle withdrawal was more difficult
with the passive safety catheter. The blood reflux was abnormal more often with
the safety catheters. The staff's exposure was more frequent with the active
safety catheter. The number of blood splashes was more common with the safety
catheters. CONCLUSIONS: Safety catheters are not superior with regard to
failure rate in the catheter's placement. Users feel better protected, but find
the use of safety catheters more difficult, and their handling generates more
splashing of blood into the environment. The passive safety catheter is more
efficient than the active safety catheter with regard to ease of introduction
of the catheter into the vein and the staff's exposure to the patient's blood
113. Pyrek
K. Understanding Barrier-Level Protection of Medical Gowns. Infection Control
Today 2008.
ABSTRACT: Exposure to the pathogenic microorganisms harbored in blood, body
fluids and other potentially infectious material (OPIM) can lead to
occupationally acquired infections (OAIs) in healthcare workers (HCWs). That's
why it's critical that healthcare providers don key pieces of personal
protective equipment (PPE) and understand the levels of barrier protection
these PPE items can afford them in patient-care and surgical situations.
114. 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.
115. Roy
D. 'HIV fear chases 700 civic doctors annually'. Daily News & Analysis 2008
Aug 2.
ABSTRACT: It may sound alarming but close to 600-700 instances of needle prick
injuries are reported from the three major hospitals - KEM, Sion and
Even the state-run JJ Hospital that houses
DNA reported on Friday how a first-year post graduate student of
116. 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
117. Schatz
JJ.
ABSTRACT:
Just past the entrance to the sprawling University Teaching Hospital (UTH) in
118. Sheikh
J, Sheikh K. Potential bias in studies of accidental needle sticks. Ann Allergy
Asthma Immunol 2008; 100(4):389-391.
ABSTRACT: There are many types of bias in clinical and epidemiologic studies
that may distort the results. In his classic paper, Sackett 1 cataloged
35 biases in analytic research. Others have suggested useful subclassifications
of these biases. 2 The most common type of bias is confounding of the
association between exposure or intervention and the outcome by external
factors. Equally critical biases in comparative studies, particularly those
using retrospectively collected data, are selection, recall, and nonresponse
bias. Selection bias is often created by erroneous sampling and selection by
design or self-selection of study participants. Nonresponse bias, a form of
selection bias, may exist in studies in which the response rate is low and the
exposure and/or outcome among respondents is not representative of that in the
study population. Recall bias may affect the study results when the ability of
recalling past experiences and exposures in the groups of study participants is
unequal. Case-control studies often suffer from recall bias because all data on
risk factors are collected retrospectively. For example, cases of a disease tend
to recall history of exposures and other illnesses much better than the control
subjects. We chose 2 recently published studies of accidental needle sticks
(ANSs) in allergy practices as examples for a discussion of how potential
selection, recall, and nonresponse bias can affect the results of
retrospective, survey-based studies.
119. Shiao
JS, Lin MS, Shih TS, Jagger J, Chen CJ. National incidence of percutaneous
injury in
ABSTRACT: We established a standardized surveillance system using the Chinese
Exposure Prevention Information Network to estimate the frequency of
percutaneous injuries (PCIs) in Taiwanese healthcare workers (HCWs). Fourteen
hospitals employing 8,132 HCWs participated and a total of 583 PCIs were
reported. The annual number was estimated to be 8,058 PCIs per hospital size,
8,100 per HCWs, and 8,286 per inpatient-day; indicating similar estimates using
different denominators. The estimated annual frequency of pathogen-specific
PCIs was 1,168 for hepatitis B, 1,263 for hepatitis C, and 59 for HIV. This
study documents the annual incidence of PCI among HCWs showing important
potential exposure to viral hepatitis and HIV in
120. Singru
S, Banerjee A. Occupational exposure to blood and body fluids among health care
workers in a teaching hospital in Mumbai, India. Indian Jounral of Community
Medicine 2008; 33(1):26-30.
ABSTRACT: Objective: Exposure to
blood and body fluids is one of the hidden hazards faced by health care workers
(HCWs). The objective of the present study was to estimate the incidence of
such exposure in a teaching hospital. Materials
and Methods: A cross-sectional study among a random sample of
residents, interns, nurses and technicians ( n = 830) was carried out in
a teaching hospital to estimate the incidence of exposure to blood and body
fluids in the preceding 12-month period. Self-reported occurrence and the
circumstances of the same were recorded by face-to-face interviews using a semi-structured
questionnaire. Results: The
response rate to the study was 89.76%. Occupational exposure to blood and body
fluids in the preceding 12 months was reported by 32.75% of the respondents.
The self-reported incidence was the highest among the nurses. Needle-stick
injury was the most common mode of such exposures (92.21% of total exposures).
Index finger and thumb were the commonest sites of exposure. Only 50% of the
affected individuals reported the occurrence to concerned hospital authorities.
Less than a quarter of the exposed persons underwent post-exposure prophylaxis
(PEP) against HIV, although the same was indicated in about 50% of the affected
HCWs based on the HIV status of the source patient. Conclusions: Occupational exposure to blood and body fluids was a
common occurrence in the study sample. There was gross under-reporting of such
incidents leading to a lack of proper PEP against HIV in 50% of those in whom
the same appeared to be indicated.
121. Strauss
KW, Onia R, Van Zundert AA. Peripheral intravenous catheter use in
ABSTRACT: BACKGROUND: Peripheral intravenous catheters are among the most
widely used medical devices in the world. European patients are increasingly
aware of the risk of health care associated infections and the role catheters
play in their facilitation. AIMS: We intend to show that European health care providers
are increasingly aware of the occupational risks of bloodborne infections such
as HIV and hepatitis which can be transmitted by the needles from catheters and
that the political will is building to take action to ensure safer devices are
provided. METHODS: We review the wide variety of peripheral intravenous
catheters which are specially engineered to reduce these risks. RESULTS:
Available safety devices include spring-loaded retractable needles, guards that
shield the dangerous tips and closed, needle-free access valves for intravenous
sets. CONCLUSIONS: It is no longer necessary for patients and professionals to
take risks to health and life when solutions which minimize these risks are at
hand
122. Stroffolini
T, Coppola R, Carvelli C et al. Increasing hepatitis B vaccination coverage
among healthcare workers in Italy 10 years apart. Dig Liver Dis 2008;
40(4):275-277.
ABSTRACT: BACKGROUND: In Italy, vaccination against hepatitis B virus infection
was strongly recommended for healthcare workers since 1985. Update findings on
vaccination coverage are lacking. AIM: To assess current vaccination coverage
against hepatitis B in this job category. METHODS: In 2006, 1,632 healthcare
workers randomly selected in 15 Italian public hospitals completed a self-administered
precoded questionnaire. RESULTS: The overall vaccination coverage was 85.3%, a
figure higher than the 64.5% observed in 1996. Vaccine coverage showed a
significant downtrend (p<0.01) from the Northern (93.1%) to the Southern
(77.7%) areas. Logistic regression analysis showed that residence in the North
(Odds ratio 4.2; 95% confidence interval 2.6-6.7) and youngest age (Odds ratio
4.5; 95% confidence interval 2.6-7.8), both were independent predictors of
vaccine acceptance. CONCLUSIONS: Ten years apart, vaccine coverage has markedly
increased, closely paralleling the downtrend in the incidence of acute B
hepatitis among healthcare workers in
123. Sukriti,
Pati NT, Sethi A et al. Low levels of awareness, vaccine coverage, and the need
for boosters among health care workers in tertiary care hospitals in India. J
Gastroenterol Hepatol 2008; 23(11):1710-1715.
ABSTRACT: BACKGROUND AND AIM: The risk of acquiring hepatitis B virus (HBV)
infection through exposure to blood or its products is highest amongst health
care workers (HCWs). Despite potential risks, a proportion of HCWs never get
vaccinated.
124. Sullivan
R. Cleaner gets HIV from tainted syringes - Legal answers from
ABSTRACT:
"Jane", a 37-year old woman, used to work as a cleaning attendant at
a private medical office. While emptying the trash, Jane was pricked with
contaminated syringes and as a result, contracted the HIV virus. She decided to
bring a lawsuit against the doctors and their medical group to recover money
damages for her pain and suffering.
125. 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,
126. The
L. Finding solutions to the human resources for health crisis. The Lancet 2008;
371(9613):623.
ABSTRACT: Earlier this month, medical workers at
127.
ABSTRACT: Are safety knives the shape of things to come in ophthalmology?
That's the considered opinion of some leading cataract surgeons, who like the
way today's safety scalpels perform and protect in the OR. But these doctors
are quick to point out that one thing stands in the way of widespread
acceptance: their colleagues who are reluctant to give them a try, even though
the law says you have to at least consider them. Here are 10 tips for clearing
this high hurdle.
128. van
Wijk PT, Pelk-Jongen M, Wijkmans C et al. Variation in interpretation and
counselling of blood exposure incidents by different medical practitioners. Am
J Infect Control 2008; 36(2):123-128.
ABSTRACT: BACKGROUND: Blood exposure incidents pose a risk for transmission of
bloodborne pathogens for both health care workers and public health. Despite
several national and international guidelines, counsellors have often different
opinions about the risks caused by these incidents. Little is known about the
consequences of these variations in risk assessment on the effectiveness of the
treatment and the costs for the health care system. METHODS: The aim of this
study was to reveal differences among diverse groups of counsellors in
assessing the same blood exposure incidents. Subjects included 4 different
kinds of counsellors: public health physicians from infectious disease departments
and medical microbiologists, occupational health practitioners, and HIV/AIDS
specialists from hospital settings. Surveys with cases of blood exposure
incidents were sent to the counsellors in The Netherlands asking questions
about their risk assessment and consequent treatment. Questions were
categorized for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV
risks. RESULTS: Of the 449 surveys sent, 178 were returned, of which 158 were
eligible for the study. In general, occupational health practitioners and
medical microbiologists showed a more rigorous approach especially with regard
to prophylactic treatment when counselling HBV risk situations, whereas public
health physicians and HIV/AIDS specialists were more thorough in the handling
of HCV risk accidents. In HIV counselling, HIV/AIDS specialists were far more
rigorous in their treatment than the other groups. For 7 of the total of 12
cases, the risk assessment with regard to HBV, HCV, and HIV differed
significantly. CONCLUSION: The assessment of blood exposures significantly
differs depending on the medical background of the counsellor handling the
incident, leading to remarkable inconsistencies in the response to prevent the
transmission of bloodborne pathogens and/or to increased costs for unnecessary
diagnostic tests and preventive measures. Although national guidelines for the
counselling and treatment of blood exposure incidents are essential, the
assessment of blood exposure incidents should be limited to as few as possible,
well-trained professionals, operating in regional or national call centers, to
ensure comparable assessment and corresponding application of preventive
measures for all victims
129. 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
130. Watt
AM, Patkin M, Sinnott MJ, Black RJ, Maddern GJ. Scalpel injuries in the
operating theatre. BMJ 2008; 336(7652):1031.
ABSTRACT: Despite recognition of the need to reduce injuries from sharp instruments
in healthcare settings, the focus has been more on reducing
needlestick injuries than on other causes of injury, such as those
caused by scalpel blades in operating theatres.
131. Weiser
T, Regenbogen S, Thompson K, Haynes A, Lipsitz S,
ABSTRACT: Background: Little is
known about the amount and availability of surgical care globally. We estimated
the number of major operations undertaken worldwide, described their
distribution, and assessed the importance of surgical care in global
public-health policy.
Methods: We gathered
demographic, health, and economic data for 192 member states of WHO. Data for
the rate of surgery were sought from several sources including governmental
agencies, statistical and epidemiological organisations, published studies, and
individuals involved in surgical policy initiatives. We also obtained per-head
total expenditure on health from analyses done in 2004. Major surgery was
defined as any intervention occurring in a hospital operating theatre involving
the incision, excision, manipulation, or suturing of tissue, usually requiring
regional or general anaesthesia or sedation. We created a model to estimate
rates of major surgery for countries for which such data were unavailable, then
used demographic information to calculate the total worldwide volume of surgery.
Findings: We obtained surgical
data for 56 (29%) of 192 WHO member states. We estimated that 234·2 (95% CI
187·2-281·2) million major surgical procedures are undertaken every year
worldwide. Countries spending US$100 or less per head on health care have an
estimated mean rate of major surgery of 295 (SE 53) procedures per 100 000
population per year, whereas those spending more than $1000 have a mean rate of
11 110 (SE 1300; p<0·0001). Middle-expenditure ($401-1000) and
high-expenditure (>$1000) countries, accounting for 30·2% of the world's
population, provided 73·6% (172·3 million) of operations worldwide in 2004,
whereas poor-expenditure (=$100) countries account for 34·8% of the global
population yet undertook only 3·5% (8·1 million) of all surgical procedures in
2004.
Interpretation: Worldwide volume of
surgery is large. In view of the high death and complication rates of major
surgical procedures, surgical safety should now be a substantial global
public-health concern. The disproportionate scarcity of surgical access in
low-income settings suggests a large unaddressed disease burden worldwide.
Public-health efforts and surveillance in surgery should be established.
132. 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
133. 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
134. Wicker
S, Gottschalk R, Spickhoff A, Rabenau HF. [HIV testing after needlestick
injury: must the index patient be informed?]. Dtsch Med Wochenschr 2008;
133(28-29):1517-1520.
ABSTRACT: As a current case of needlestick injury (NSI) has demonstrated, it is
obvious that in clinical practice there is often uncertainty about the
procedure if the index patient refuses a blood test or is not able to give
his/her consent. The question about the legality of implementing HBV, HCV and
HIV testing after NSI is commented on from different points of view:
occupational medicine, infection control, virology and the legal system. The
testing of the index patient - without his/her consent - seems to be
appropriate. The protection of health care workers should be given priority
over the right of the index patient "not wanting to know" about
his/her infection status
135. 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
136. Wicker
S, Cinatl J, Berger A, Doerr HW, Gottschalk R, Rabenau HF. Determination of
risk of infection with blood-borne pathogens following a needlestick injury in
hospital workers. Ann Occup Hyg 2008; 52(7):615-622.
ABSTRACT: OBJECTIVES: Our paper measures the prevalence of hepatitis B virus
(HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in
patients at the University Hospital of Frankfurt/Main, and correlates the
prevalence with risk factors for exposure to and infection of healthcare
workers (HCWs). Individual risk assessments were calculated for exposed HCWs.
METHODS: Survey of patients admitted to a
137. Wicker
S, Ludwig AM, Gottschalk R, Rabenau HF. Needlestick injuries among health care
workers: Occupational hazard or avoidable hazard? Wien Klin Wochenschr 2008;
120(15-16):486-492.
ABSTRACT: OBJECTIVES: The objective of this study was to describe the
mechanisms and preventability of occupational percutaneous blood exposure of
healthcare workers through needlestick injuries and to discuss rational
strategies for prevention. METHODS: To calculate the preventability, we
surveyed in a first step the number and kind of needlestick injuries and in a
second step the reasons for the injuries and the working conditions of the
healthcare workers. Both data sets were collected in independent anonymous
questionnaire covering occupational blood exposure among healthcare workers in
a German university hospital. RESULTS: Needlestick injuries were caused through
unsafe procedures, difficult working conditions and unsafe devices. On average,
50.3% (n = 492/978) of all needlestick injuries could have been avoided by the
use of safety devices, whereas only 15.2% could have been prevented by
organizational measures. In our study, 31.5% (n = 503/1598) of participant healthcare
workers had sustained at least one needlestick injury in the past twelve
months. The rate of underreporting was about 75%. After introduction of safety
devices, 91.8% of the healthcare workers reported being satisfied with the
anti-needlestick devices and 83.4% believed that safety devices would increase
the safety of the work environment. CONCLUSIONS: Occupational exposure to blood
is a common problem among healthcare workers. The introduction of safety
devises is one of the main starting points for avoidance of needlestick
injuries, and acceptance among healthcare workers is high. Further targets for
preventive measures, such as training in safe working routines, are necessary
for improvement of safe work conditions
138. Wicker
S, Cinatl J, Berger A, Doerr HW, Gottschalk R, Rabenau HF. Determination of
Risk of Infection with Blood-borne Pathogens Following a Needlestick Injury in
Hospital Workers. Ann Occup Hyg 2008.
ABSTRACT: OBJECTIVES: Our paper measures the prevalence of hepatitis B virus
(HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in
patients at the University Hospital of Frankfurt/Main, and correlates the
prevalence with risk factors for exposure to and infection of healthcare
workers (HCWs). Individual risk assessments were calculated for exposed HCWs.
METHODS: Survey of patients admitted to a
139. Wicker
S, Nurnberger F, Schulze JB et al. Needlestick injuries among German medical
students: time to take a different approach? Medical Education 2008;
42(7):742-745.
ABSTRACT: CONTEXT: Medical students are at risk of occupational exposure to
blood-borne viruses following needlestick injuries (NSIs) during medical
school. The reporting of NSIs is an important step in the prevention of further
injuries and in the initiation of early prophylaxis or treatment. The objective
of this study was to describe the mechanisms whereby medical students experience
occupational percutaneous blood exposure through NSIs and to discuss rational
strategies for prevention. METHODS: Incidents of exposure to blood-borne
pathogens among medical students at a large German university were analysed.
Year 6 medical students completed a written survey immediately before the
clinical part of their training began, describing incidents that had occurred
during the previous 5 years. RESULTS: In our study, 58.8% (183/311) of
participating medical students recalled at least one NSI that had occurred
during their studies. Overall, 284 NSIs were reported via an anonymous
questionnaire. DISCUSSION: Occupational exposure to blood is a common problem
among medical students. Efforts are required to ensure greater awareness of the
risks associated with blood-borne pathogens among German medical students.
Proper training in percutaneous procedures and how to act in the event of
injury should be given in order to reduce the number of injuries
140.
ABSTRACT: OBJECTIVE: The objective of the study was to compare the rate of
glove perforation for blunt and sharp needles used during obstetrical
laceration repair. A secondary aim was to assess physician satisfaction with
blunt needles. STUDY DESIGN: This was an institutional review board-approved,
randomized, prospective trial. Patients with obstetric lacerations were
randomized to repair with either blunt or sharp needles. Patient demographics,
operator experience, and other clinical variables were collected. Physicians
reported any percutaneous injuries and were surveyed regarding satisfaction
with the assigned needles. Glove perforation was determined using a validated
water test method. RESULTS: There were 438 patients enrolled in the trial: 221
in the control group and 217 in the study group. There was no statistical
difference between groups in patient demographics, clinical variables, severity
of laceration, or experience level of the surgeon. There was no difference in
the glove perforation rate between blunt and sharp needles (risk ratio, 0.79,
95% confidence interval, 0.2 to 2.95). There was poor correlation between
reported perforations and those detected by water test (R(2) = 0.33). The
physicians reported that blunt needles were more difficult to use than sharp
needles (P = .0001). CONCLUSION: There was no difference in the rate of
surgical glove perforation for blunt, compared with sharp, needles used during
vaginal laceration repair. Physicians also reported increased difficulty
performing the repair with blunt needles
141. Zafar
A, Aslam N, Nasir N, Meraj R, Mehraj V. Knowledge, attitudes and practices of
health care workers regarding needle stick injuries at a tertiary care hospital
in
ABSTRACT: OBJECTIVE: To assess the knowledge, attitude and practices of HCWs
regarding needle stick injuries at the
142. Safety
in the Hospital Pharmacy. Managing Infection Control 2007; June 2007:102-110.
ABSTRACT: When President Bill Clinton signed the Needlestick Safety and
Prevention Bill into law it required OSHA to revise the decade-old Bloodborne
Pathogen Standard. Many were surprised
with the rapidity that OSHA responded to the challenge. When confronted with safety concerns of both patients
and healthcare workers, many institutions seem at a loss on how to proceed. Many of them have implemented the use of some
safety products, but feel like they have come to a brick wall. To them the problem of safety for patients
and healthcare workers seems overwhelming.
143. Nonhospital
health-care workers at substantial risk of exposure to bloodborne pathogens. 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.
144. 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.
145. 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.
146. 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.
147. 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.
148. 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.
149. 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
150. 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.
151. 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
152. 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:
153. 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
154. 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
155. 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
156. 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
157. 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
158. Atenstaedt
RL, Payne S, Roberts RJ, Russell IT, Russell D, Edwards RT. Needle-stick
injuries in primary care in Wales. J Public Health (Oxf) 2007; 29(4):434-440.
ABSTRACT: BACKGROUND: Accidental needle-stick injuries (NSIs) are a hazard for
health-care workers and for the general public. OBJECTIVES: To estimate the
presentation rate of NSIs to general medical practices, their relation to
practice characteristics, and review practice policies for managing NSIs.
METHOD: Descriptive study using logistic regression analysis. RESULTS: Annual
rates of 2.73 (95% CI 2.08, 3.50) occupational NSIs per 100 clinical practice
staff and 2.14 (95% CI 1.39, 3.13) non-occupational NSIs per 100,000 practice
population were recorded. Stepwise logistic regressions showed that chance of a
practice reporting at least one occupational NSI in previous five years was
best predicted by being a single-handed practice (decreased odds). In contrast,
the chance of a practice reporting at least one non-occupational NSI was best
predicted by being a rural practice (increased odds). About one in five
practices possessed no written policy on managing NSIs. Stepwise logistic
regressions showed that the chance of a practice owning a NSI policy was best
predicted by being located in an LHB area with a coastline (increased odds).
CONCLUSION: NSIs are an important public health issue in
159. 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
160. Bairy
I, Rao SP, Dey A, Bairy I, Rao SP, Dey A. Exposure to blood-borne viruses among
healthcare workers in a tertiary care hospital in south India. Journal of
Postgraduate Medicine 2007; 53(4):275-276.
ABSTRACT: Sir,
Healthcare workers (HCWs) are potentially at risk for human immunodeficiency
virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infection
through occupational exposures to blood and bloody body fluids. The first
report of a HCW infected with the HIV by a needlestick, published in a medical
journal in 1984,launched a new era of concern about the occupational
transmission of blood-borne pathogens. The risk of HIV transmission after a
percutaneous exposure to HIV infected blood has been estimated to be
approximately 0.3% and after a mucous membrane exposure its about 0.09%.The
risk of developing hepatitis B on exposure to HBsAg and HBeAg positive patients
was 22-31% whereas by comparison, exposure from HBsAg positive but HBeAg
negative blood was 1-6%. The average incidence of anti-HCV seroconversion after
accidental percutaneous exposure from an HCV positive source is 1.8% [range
0-7%]. A study by Mehta et
al . in a tertiary care hospital, Mumbai, found that 380 HCWs got needlestick
injuries in a six-year (1998-2003) time span in their hospital.
161. Bairy
I, Rao SP, Dey A. Exposure to blood-borne viruses among healthcare workers in a
tertiary care hospital in south
ABSTRACT: Sir,
Healthcare workers (HCWs) are potentially at risk for human immunodeficiency
virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) infection
through occupational exposures to blood and bloody body fluids. The first
report of a HCW infected with the HIV by a needlestick, published in a medical
journal in 1984, [1] launched a new era of concern about the
occupational transmission of blood-borne pathogens. The risk of HIV
transmission after a percutaneous exposure to HIV infected blood has been
estimated to be approximately 0.3% and after a mucous membrane exposure its
about 0.09%.The risk of developing hepatitis B on exposure to HBsAg and HBeAg
positive patients was 22-31% whereas by comparison, exposure from HBsAg
positive but HBeAg negative blood was 1-6%. The average incidence of anti-HCV
seroconversion after accidental percutaneous exposure from an HCV positive
source is 1.8% [range 0-7%]. [2] A study by Mehta et al
. in a tertiary care hospital, Mumbai, found that 380 HCWs got needlestick
injuries in a six-year (1998-2003) time span in their hospital.
162. 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
163. 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.
164. Bohannon
J. The Freeing of the
ABSTRACT: I was in
165. Borchert
M, Mulangu S, Lefevre P et al. Use of protective gear and the occurrence of
occupational
ABSTRACT: BACKGROUND: Occupational transmission to health workers (HWs) has
been a typical feature of
166. 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.
167. 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
168. 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,
169. 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
170. Chacko
J, Isaac R. Percutaneous injuries among medical interns and their knowledge
& practice of post-exposure prophylaxis for HIV. Indian J Public Health
2007; 51(2):127-129.
ABSTRACT: This was a prospective, questionnaire-based study to determine the
incidence of percutaneous injury among medical interns in a tertiary care
hospital in
171. 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.
172. 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
173. 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
174. 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
175. 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
176. 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
177.
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
178. 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
179. 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,
180. 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
181. Dagi
TF, Berguer R, Moore S et al. Preventable errors in the operating room--part 2:
retained foreign objects, sharps injuries, and wrong site surgery. [Review] [95
refs]. Current Problems in Surgery 2007; 44(6):352-381.
ABSTRACT: Exposure to blood borne pathogens via percutaneous sharp injuries or
mucocutaneous exposure has long been considered to be an accepted occupational
hazard for the surgeons and operating room (OR) personnel. In 1987 the Centers
for Disease Control and Prevention (CDC) passed the Universal Precautions Act1
and in 1991 the Occupational Safety and Health Administration (OSHA)
established the Blood Borne Pathogen Standard, most recently revised in 2001.2
Although these efforts have reduced the incidence of needlesticks and sharps
injuries outside the OR by 38% since 1993, the rate of percutaneous injuries in
the OR has only decreased by 5.7%.3 Even more alarming is the
finding that although hollow-bore needle injuries have decreased by 33%,
injuries by solid suture needles have increased by 27% over the same time
period (FIG 1, FIG 2, FIG 3 and FIG 4). 3
Studies report that surgeons continue to demonstrate poor compliance with
universal precautions and sharp-injury mitigation strategies.4
By all accounts, it appears that the Universal Precautions and the Blood Borne
Pathogen Standard has failed to address the safety needs of the high-risk OR
environment.
182. Daley
K. Needlestick injuries: How to improve safety in your workplace. American
Nurse Today 2007; 2(7):25-26.
ABSTRACT: Near the end of a 12-hour shift in the emergency department, I left
the triage area to help a colleague having trouble drawing blood from a
patient. It was a moment that changed my life. Seconds later, my gloved index
finger was bleeding. I had sustained a deep puncture wound from a needle
protruding from an overfilled sharps disposal box. That was 1998. By early
1999, I learned that I had contracted HIV and hepatitis C. The incident
signaled the beginning of the end of my 26-year career as a front-line nurse
and, for some time, transformed me from caregiver to patient.
183. 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.
184. Davanzo
E, Bruno A, Beggio M et al. [Biologic risk due to accident in academic
personnel]. G Ital Med Lav Ergon 2007; 29(3 Suppl):761-762.
ABSTRACT: Needlestick injuries since 2004 to 2006 were evaluated in University
healthcare workers that reported an accident by point, sharp or mucosal
contamination. During this period, 497 accidents with instruments contamined
with biological fluids were reported. The injuries were most frequent between 9
a.m. and 1 p.m. (233 accidents). There is no difference during the week
(excluding Saturday and Sunday), whereas February, May, June, and July were the
months at risk. The most of accidents were during the first four hours of the
job. They were identified 423 known sources and compliance with follow-up was
evaluated. Only 26.3% of subjects injured with known hepatitis B source, 32.3%
with known HIV source, and 40% with known HCV source completed follow-up.
Fortunately, no seroconversion was observed. The lack of compliance with the
follow-up, also if the source is known, needs to stimulate healthcare workers
to subject to the protocols and to follow the standard procedure to prevent the
needlestick injuries
185. 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
186. 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
187.
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.
188. De
Baets AJ, Sifovo S, Pazvakavambwa IE. Access to occupational postexposure
prophylaxis for primary health care workers in rural
ABSTRACT: BACKGROUND: For many primary health care workers in developing
countries, the limited availability and cost of public transport hinders timely
access to occupational postexposure prophylaxis (PEP) at referral hospitals.
Adapted PEP training and a starter's kit (for human immunodeficiency virus,
hepatitis B virus, and syphilis prophylaxis) could improve access. METHODS: The
evaluation method, based on the 12 steps of the decentralized phase of PEP
management, calculated different scores from the responses for 51 anonymous
surveys and allowed comparison among different groups. Listed obstacles and
clinic visits provided further information. RESULTS: Respondents who received
in-service PEP training had significantly higher mean knowledge and confidence
scores but no different mean attitude scores than those who did not. The mean
total score for those who received the adapted PEP training (10.7 of 12) was
significantly higher (P = .008) than for those who did not (8.8 of 12).
CONCLUSION: Decentralizing the first phase of PEP management for primary health
care workers in rural
189. DeBaun
B. Safety Syringes: Is Your Institution Stuck in the Stone Age? Infection
Control Today 2007.
ABSTRACT: Earl y man fashioned sharp instruments from flint and stone. Today, these implements are obsolte. Is the same thing happening with safety
syringes? Following passage of the Needlestick Safety and Prevention Act,
manufacturers responded with product modifications to meet regulatory
requirements. Seven years later, these
retor-fitted devices dominate the market.
Yet a closer look at the situation raises questions about whether these
early designs offer optimal protection to the healthcare employees and
patients, and are still the most cost-effective solution. Hae the products developed at the turn of the
century become outdated?
190. 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
191. ECRI
Institute., ECRI Institute. Needlestick-prevention devices. Disposable syringes
and injection needles. Health Devices 2007; 36(8):241-273.
ABSTRACT: Needlestick-prevention devices (NPDs) are an essential tool for
protecting healthcare workers from injuries that could result in exposure to
bloodborne pathogens. More than a dozen NPD varieties are available. They
generally take the same form as conventional (nonsafety) sharps but incorporate
some type of safety design--for example, a shield or a needle-retracting
mechanism. In this Evaluation, we focus on protective devices that are used in
place of conventional syringes and injection needles--namely, disposable
protective syringes and needle guards. We tested 14 products from 8 suppliers.
We give Preferred ratings to three products, all of which are needle-retracting
syringes. When used correctly, these devices provide the best protection
available. However, their primary safety advantage--preremoval activation--can
be negated if the user chooses to activate the safety mechanism after removing
the needle from the patient. For many facilities, one of the seven models we
rate Acceptable might be a better choice. We caution that our ratings should
not be the sole basis of a purchase decision. Staff members need to conduct a
hands-on assessment of the available products to identify those that best meet
their needs. We also stress that any NPD--even one we rate Not Recommended--is
preferable to using no protective device at all.
192. 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
193. 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
194. Franco
A, Aprea L, Dell'Isola C et al. Clinical case of seroconversion for syphilis
following a needlestick injury: why not take a prophylaxis? Infez Med 2007;
15(3):187-190.
ABSTRACT: A 47-year-old woman was pricked accidentally with a needle previously
used for a neurosyphilitic man. At day 0 she had no positive laboratory results
for the infection, while the source, at day 1, had TPHA positive, but no
post-exposure prophylaxis (PEP) against syphilis was prescribed. The subject
missed the day 30 follow-up, and underwent our visit at day 90, when she showed
no clinical signs, but she seroconverted (VDRL = positive 1/2; TPHA = positive
1/320; FTA-Abs IgG and IgM = present). She started antibiotic therapy, and
currently her serological status is VDRL = positive 1/2, TPHA = positive 1/160,
FTA-Abs IgM = negative
195. Fry
DE, Fry DE. Occupational risks of blood exposure in the operating room.
American Surgeon 2007; 73(7):637-646.
ABSTRACT: Bloodborne pathogens continue to be a source of occupational
infection for healthcare workers, but particularly for surgeons. Over 1 per
cent of the
196. 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
197. Ganczak
M. [Safe equipment to prevent injuries in medical staff]. Med Pr 2007;
58(1):13-17.
ABSTRACT: Sharp injures continue to pose a significant risk for the
transmission of blood-borne pathogens from the patient to health care workers.
Appropriate use of safe devices can significantly reduce such risk. On the
basic of a literature review, information is provided about active and passive
safety features of medical equipment, and the crucial elements needed for the
proper evaluation of a safe device are discussed. Examples of safety equipment
are presented. Barriers to the use of these new products are addressed. The
user-based system approach for the selection and implementation of safety
devices is also described
198. Ganczak
M, Szych Z, Ganczak M, Szych Z. Surgical nurses and compliance with personal
protective equipment. Journal of Hospital Infection 2007; 66(4):346-351.
ABSTRACT: The study objectives were to evaluate self-reported compliance with
personal protective equipment (PPE) use among surgical nurses and factors
associated with both compliance and non-compliance. A total of 601 surgical
nurses, from 18 randomly selected hospitals (seven urban and 11 rural) in the
Pomeranian region of
199. Gaujac
C, Ceccheti MM, Yonezaki F, Garcia IR, Jr., Peres MP. Comparative analysis of 2
techniques of double-gloving protection during arch bar placement for
intermaxillary fixation. J Oral Maxillofac Surg 2007; 65(10):1922-1925.
ABSTRACT: PURPOSE: This study was conducted to comparatively evaluate, in a
prospective and randomized manner, 2 techniques for providing double-gloving
protection during arch bar placement for intermaxillary fixation. MATERIALS AND
METHODS: A total of 42 consecutive patients in whom application of an Erich bar
was indicated for intermaxillary fixation were equally divided into 2 groups.
In group 1, 2 sterile surgical gloves were used; in group 2, a nonsterile
disposable inner glove was used under a sterile surgical glove. Wilcoxon,
Mann-Whitney, Kruskal-Wallis, and binomial statistical tests were used to
analyze the findings. RESULTS: A total of 103 perforations were found in the
outer gloves (47 in group 1 and 56 in group 2), along with 5 perforations in
inner gloves in both groups (alpha = .01). No significant statistical
difference was found between groups in terms of inner glove perforations (alpha
= .05). The nondominant hand presented with 70.9% of the perforations,
statistically significant to 1%. CONCLUSIONS: Both double-gloving techniques
were found to provide effective clinician protection. The use of a nonsterile
disposable glove under the surgical glove is possible for less-invasive
procedures, offering the same safety as using 2 sterile surgical gloves while
decreasing operational costs. This method does not eliminate the need to change
gloves when a perforation is suspected or noted during the surgery, however
200. 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
201. 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
202. 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
203. 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?
204. 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
205. 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
206. Haber
PS, Young MM, Dorrington L et al. Transmission of hepatitis C virus by
needle-stick injury in community settings. Journal of Gastroenterology &
Hepatology 2007; 22(11):1882-1885.
ABSTRACT: BACKGROUND: Hepatitis C virus (HCV) is predominantly transmitted by
blood-to-blood contact, typically by sharing of needles by injecting drug
users. Discarded needles could act as a vector for transmission of this
infection. METHODS: Two cases of HCV seroconversion following a needle-stick
injury in a community setting were identified. The effects of specimen
processing and storage conditions on detection of HCV RNA were assessed to
provide information about the likelihood of discarded needles containing
infectious HCV. RESULTS: Consistent with a role for discarded needles in viral
transmission, in vitro studies demonstrated that viral load declined by less
than one log following storage for 24 h. CONCLUSION: All needle-stick injuries
should be promptly investigated by serology and HCV-PCR
207. Hadadi
A, Afhami SH, Kharbakhsh M et al. [ Epidemiological determinants of
occupational exposure to HIV, HBV and HCV in health care workers ].
ABSTRACT: Background: Health
care workers (HCWs) are at substantial risk of acquiring bloodborne pathogen
infections through contact with blood and other potentially infectious
materials. The main objectives of this study were to determine the
epidemiological characteristics of occupational exposure to blood/body fluids,
related risk factors of such exposure, and hepatitis B vaccination status among
HCWs.
Methods: This cross-sectional
study was conducted from December 2004 to June 2005 at three university
hospitals in
Results: With a total number of
467 exposures (52.9%) and an annual rate of 0.5 exposures per HCW, 391 (43%) of
the 900 HCWs had at least one occupational exposure to blood and other infected
fluids during the previous year. The highest rate of occupational exposure was
found among nurses (26%) and the housekeeping staff (20%). These exposures most
commonly occurred in the medical and emergency wards (23% and 21%,
respectively). The rate of exposure in HCWs with less than five years of
experience was 54%. Percutaneous injury was reported in 280 participants (59%).
The history of hepatitis B vaccination was positive in 85.93% of the exposed
HCWs. Sixty-one percent had used gloves at the time of exposure. Hand washing
was reported in 91.4% and consultation with an infectious disease specialist in
29.4%. There were 72 exposures to HIV, HBV and HCV; exposure to HBV was the
most common. In 237 of the enrolled cases, the source was unknown. Job type,
years of experience and hospital ward were the risk factors for exposure.
Conclusion: Education,
protective barriers and vaccination are important in the prevention of viral
transmission among HCWs.
208. hado-Carvalhais
HP, Martins TC, Ramos-Jorge ML, Magela-Machado D, Paiva SM, Pordeus IA.
Management of occupational bloodborne exposure in a dental teaching
environment. J Dent Educ 2007; 71(10):1348-1355.
ABSTRACT: The aims of this cross-sectional study were to investigate the
prevalence of reporting occupational accidents regarding exposure to biological
material among undergraduate students of dentistry at an institution of higher
education and to estimate risk factors associated with underreporting. Data
were collected by means of a questionnaire, which had an 86.4 percent rate of
return. The sample was made up of 286 undergraduate dental students enrolled in
the clinical component of the curriculum, corresponding to the final six
semesters of study. The average age of the subjects was 22.4 years.
Descriptive, bivariate, simple logistic regression and multiple logistic
regression (Stepwise Forward Procedure) analyses were performed, with the
significance level set at p< or =0.05. Of the total 167 individuals who had
been exposed to biological material, 120 (71.9 percent) failed to report the
accidents. The variables that were statistically associated with the
nonreporting of occupational accidents were nonexposure to blood (OR=4.0; CI
95%: 1.7-10.0) and the fact that the students considered the exposure to be
minor or of low risk (OR=8.8; CI 95%: 3.5-23.0) or considered the protocol
adopted by the institution to be inadequate (OR=5.2; CI 95%: 1.2-17.1). The
development of a procedure review policy is recommended with the aim of
establishing continuous vigilance and encouraging the reporting of bloodborne
exposure
209. Haines
T, Stringer B. Could the death of a BC or nurse have been prevented by using
the hands-free technique? Can Oper Room Nurs J 2007; 25(4):8, 10-8, 20.
ABSTRACT: In 1991, Bernadette Stringer, a long time BC Nurses' Union health and
safety representative, learned about the death of a 48 year old Victoria, B.C.,
OR nurse who had sustained a hepatitis C contaminated needlestick. This
incident led to a study evaluating the hands-free technique's ability to
decrease the risk of percutaneous injury, glove tear and mucocutaneous
contamination during surgery that Ms. Stringer carried out in partial
fulfillment of her Ph.D. (granted in 1998, by
210. Hecht N, Wettan S. Percutaneous injuries. J
Am Dent Assoc 2007; 138(5):574.
ABSTRACT: Dr. Jennifer Cleveland and colleagues’ February JADA article, "Preventing
Percutaneous Injuries Among Dental Health Care Personnel" (JADA
2007;138[2]):169-78), was very informative and helpful, and points
out a very serious problem for the practicing dentist.
If an employee has a
percutaneous injury, it becomes a potentially serious problem for
all of us. To avoid the problem of an employee’s being injured, we
instituted a method several years ago: only the operating dentist
handles the sharps in our office. The operating surgeon removes all
sharps (needles, scalpels, sutures) and places them in a sharp
container in each operating room. No employee handles used sharps.
This has reduced injuries
to zero in our office, and the employees are very happy that we show
concern and care for their welfare.
211. Heneghan C, Perera R. Prevention of hepatitis
C in
ABSTRACT: today's Lancet, Hideo Yasunaga reports the devastating effect
that the use of fibrinogen products had in the transmission of hepatitis C
virus in Japan.1 Most disturbing is that this transmission
could have been prevented with knowledge of the available evidence. The review
presents the systematic failings that took place at all levels of the
health-care system when fibrinogen was routinely used to prevent bleeding in
patients with disseminated intravascular coagulation from 1964 until at least
1989.
The results of acquisition of
hepatitis C are dire; at present 2-4% of the world population is infected.2
85% of those infected will develop life-long disease which is characterised by
persistent liver dysfunction and possible liver failure. Hepatitis B and C
viral infections account for almost all cirrhosis and primary liver cancer
throughout most of the world.
212. Hiransuthikul
N, Hiransuthikul P, Kanasuk Y. Human immunodeficiency virus postexposure
prophylaxis for occupational exposure in a medical school hospital in
ABSTRACT: This is a retrospective review of occupational exposure to human
immunodeficiency virus (HIV) and subsequent postexposure prophylaxis (PEP)
among healthcare workers (HCWs) in King Chulalongkorn Memorial Hospital (KCMH),
213. 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
214. 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]
215. 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
216. 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.
217. 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
218. 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
219. Kabbash
IA,
ABSTRACT: A cross-sectional study was made in 32 haemodialysis units in the the
Nile delta,
220. 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
221. Khan
M, Younger G. Promoting safe administration of subcutaneous infusions. Nurs
Stand 2007; 21(31):50-56.
ABSTRACT: Despite the many benefits of subcutaneous therapy, this route is less
commonly used in general patients than the intravenous route. The authors
discuss safe practice for subcutaneous infusions, including anatomical sites,
guidelines for insertion and patient care
222. 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
223. Kubitschke
A, Bader C, Tillmann HL et al. Injuries from needles contaminated with
hepatitis C virus: how high is the risk of seroconversion for medical personnel
really?. [German]. Internist 2007;
48(10):1165-1172.
ABSTRACT: The risk of infection after injury with a needle contaminated with hepatitis
C virus (HCV) is thought to be about 3%, but this assumption is mainly based on
studies published in the 1990's, which were limited by small sample sizes and
insensitive HCV-RNA assays. We therefore investigated needle injuries at the
224. 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
225. Kushimo
OT, Akpan SG, Desalu I, Merah NA, Ilori IU. Knowledge, attitude and practices
of Nigerian anaesthetists in HIV infected surgical patients- a survey.
ABSTRACT: In the light of increasing prevalence of the human immunodeficiency
virus (HIV), anaesthetists are likely to see more patients with this virus in
their practice. This study evaluated, using a questionnaire format, the
knowledge, attitude and practices of anaesthetists in the management of HIV
infected surgical patients. The questionnaire sought demographic information,
the knowledge of risks involved as well as attitude and practices. One hundred
(66.7%) out of 150 questionnaires distributed amongst members of the Nigerian
Society of Anaesthetists were completed and returned. Fifty-five per cent (55%)
of the respondents confirmed their willingness to be screened but only 45% had
had a personal HIV screening test. Even though 23% of all the respondents will
transfuse unscreened blood in an emergency, only 1(8.3%) of the consultants
will do so. This trend was also reflected in gloving behaviour as 11(91.6%) of
consultants will routinely wear gloves whilst only 12(70.5%) of the senior
house officers will routinely glove for venepuncture despite the availability
of gloves. Other precautionary facilities such as goggles, sharp disposal bins,
routine screening of all surgical patients were more available in private than
in government hospitals. Ninety- six per-cent of all respondents will initiate
an action after a needle stick injury whilst 4% will ignore. General
Anaesthesia was the choice of anaesthetic in an HIV/AIDS infected patient by
43% of respondents whilst 22% of respondents would choose regional technique.
However, only 85% of respondents were willing to anaesthetise an infected
patient. This study suggested a dearth of knowledge and perception of risks of
HIV/AIDs amongst Nigerian Anaesthetists. Appropriate training and greater
education is highly recommended. Rigorous infection control policy is
imperative and hospital authorities must ensure availability of protective
facilities
226. Lal
P, Singh MM, Malhotra R, Ingle GK. Perception of risk and potential
occupational exposure to HIV/AIDS among medical interns in
ABSTRACT: A cross sectional study was conducted among 129 medical interns of
Maulana Azad Medical College, New Delhi for assessing the perceived levels of
risk of acquiring HIV infection in the health care settings among medical
interns, reasons for the same and their exposure to situations having potential
of HIV transmission. Majority of the interns (68.3%) perceived themselves to be
at a very high/high risk of acquiring HIV infection during their medical
career. The common reasons for perceived risk of acquiring HIV infection were
getting injuries due to needle pricks/cuts during surgical procedures (32.4%),
frequent exposure to the blood/ secretions of patients (28.5%) and insufficient
availability of gloves (17.6%). Some (23.2%) were of the opinion that students
in future might lose interest in the medical profession due to increasing risk
of HIV infection and few (3.1%) were even considering to leave the medical
profession for the same reason. Majority of the interns (72.9%) had experienced
needle pricks and more than half (53.7%) of them even had had blood splashes in
their eyes/ nose/ mouth during surgical procedures. The findings of the study
call for efforts for bringing a reduction in the risk perception of the interns
through awareness campaigns and reorientation trainings, ensuring availability
of gloves and other items necessary for observing universal work precautions
and proper disposal of potentially contaminated articles
227. 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
228. Leggat
PA, Kedjarune U, Smith DR. Occupational health problems in modern dentistry: a
review.
ABSTRACT: Despite numerous technical advances in recent years, many
occupational health problems still persist in modern dentistry. These include
percutaneous exposure incidents (
229. 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
230. Leigh
JP, Gillen M, Franks P et al. Costs of needlestick injuries and subsequent
hepatitis and HIV infection. Current Medical Research & Opinion 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
231. Loczenski
B. [Problems from general practice--solutions for general practice: preventing
needlestick injuries]. Pflege Z 2007; 60(8):434-436.
232. 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
233. 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.
234. 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.
235. 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
236. 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
237. 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
238. Markkanen
P, Quinn M, Galligan C, Chalupka S,
ABSTRACT: OBJECTIVE: Home health care (HHC) is one of the fastest growing
239. Massaro
T, Cavone D, Orlando G, Rubino M, Ciciriello M, Musti EM. [Needlestick and
sharps injuries among nursing students: an emerging occupational risk]. G Ital
Med Lav Ergon 2007; 29(3 Suppl):631-632.
ABSTRACT: The biohazard represents a major occupational risk among workers in
the health sector, this risk is not only exclusive for healthcare workers but
involve also nursing students. The study reports data of a survey on injuries
from accidental puncture in a group of 223 students of the third year of
Nursing of Bari University. The 18% of students say they have suffered over the
past 12 months an accidental puncture with sharp instruments. The cutting
device most frequently involved is the needle from the syringe and insulin. The
most at risk are the recovered and disposal of the needle. The biohazard in
training is further compounded by factors such as lack of experience and skill
manuals consolidated combined with a non perception of the risk. In the
obligation of protection, training and information to students of Nursing, the
University must implement programs aimed at both knowledge of the risks to
which they are exposed, as well as security procedures to contain an emerging
risk, which one of injury from sharp instruments, which are exposed young
students not yet in employment
240. 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
241. 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
242. Monsalve
Arteaga LC, Martinez Balzano CD, Carvajal De Carvajal AC. Medical students'
knowledge and attitudes towards standard precautions. J Hosp Infect 2007;
65(4):371-372.
ABSTRACT: Medical students are at risk of acquiring healthcare-associated
infections. According to Carvajal et al., students represent the third
largest group with blood and body fluid exposure accidents in the 'Hospital
Universitario de Caracas' (HUC) in
Knowledge of, and adherence to, universal and standard precautions are
important in the prevention of occupational accidents.3,
4 and 5 However, despite increasing education on these
measures, accidents appear to be increasing.
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
244. Mulanovich
GS, Lescano AG, Gonzaga VE, Blazes DL. Occupational health in the developing
world: a role for the medical research community? J Occup Environ Med 2007;
49(11):1184-1188.
ABSTRACT: Occupational health in the developing world is largely a neglected
concept, and this is ultimately very costly. The economic burden of
occupational injuries is estimated to be as high as 10% of the GDP in some
countries in Latin America and the
245. 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
246. Muller
N, Steele M, Balaji KA et al. Evaluating the use and acceptability of a
needle-remover device in
ABSTRACT: The objective of this study was to assess the effect of the use of a
manually operated needle remover on sharps-waste management practices in
clinical settings in
247. 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
248. Nemutandani
MS, Yengopal V, Rudolph MJ,
ABSTRACT: The risk of dental assistants acquiring injury and infections from
the dental clinics has received little attention, especially in
249. Ng
YW, Hassim IN, Ng YW, Hassim IN. Needlestick injury among medical personnel in
Accident and Emergency Department of two teaching hospitals. Medical Journal of
Malaysia 2007; 62(1):9-12.
ABSTRACT: Needlestick injury has been recognized as one of the occupational
hazards which results in transmission of bloodborne pathogens. A
cross-sectional study was carried out among 136 health care workers in the
Accident and Emergency Department of two teaching hospitals from August to
November 2003 to determine the prevalence of cases and episodes of needlestick
injury. In addition, this study also assessed the level of knowledge of
blood-borne diseases and Universal Precautions, risk perception on the practice
of Universal Precautions and to find out factors contributing to needlestick
injury. Prevalence of needlestick injury among the health care workers in the
two hospitals were found to be 31.6% (N = 43) and 52.9% (N = 87) respectively.
Among different job categories, medical assistants appeared to face the highest
risk of needlestick injury. Factors associated with needlestick injury included
shorter tenure in one's job (p < 0.05). Findings of this study support the
hypothesis that health care workers are at risk of needlestick injury while
performing procedures on patients. Therefore, comprehensive infection control strategies
should be applied to effectively reduce the risk of needlestick injury
250. 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
251. 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,
252. 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.
253. 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
254. 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.
255. Rapparini
C, Saraceni V, Lauria LM et al. Occupational exposures to bloodborne pathogens
among healthcare workers in
ABSTRACT: Healthcare workers (HCWs) frequently face the risk of occupational
infection from bloodborne pathogens following exposure to blood and body
fluids. This study describes the results of a surveillance system of
occupational exposure to bloodborne pathogens among HCWs in
256. 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.
257. 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
258. 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
259. 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
260. Sacco
A,
ABSTRACT: Occupational injuries represent an important risk factor in the
nurses. In this paper we have studied the characteristics of the phenomenon in
a group of nursing school students of one University of the Lazio. The results
show an elevated frequency of the phenomenon, characterized exclusively from
biological accidents and the necessity to plan preventive measures, insisting,
mainly on needles and sharps manipulation
261. 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.
262. 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
263. Scardino
PT. A hazard surgeons need to address. Nat Clin Pract Urol 2007; 4(7):347.
264. 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.
265. 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
266. Sherwood
CS. Needleguard systems: an evaluation. J R Soc Health 2007; 127(6):280-286.
ABSTRACT: AIMS: The National Blood Service is responsible for ensuring that the
NHS demand for blood products is met. The use of needles forms a fundamental
procedure in the collection of blood. A common engineering control used to
minimize needlestick injury is a needleguard. This study investigates the
effectiveness of needleguards as a risk reduction measure. Injury rates,
performance and the effectiveness of training are also addressed. METHODS: The
methodology adopted two techniques for collecting data, namely database
analysis and questionnaire analysis. In examining the accident database, it was
identified that the incidence of needlestick injuries fell when needleguards
were introduced in 2001. However, a rise in injuries was observed over the 12
months of 2003. RESULTS: Although the questionnaire showed that staff directly
involved in the collection of blood believed that needleguards act to reduce
the risk of injury, they also reported difficulties in the operation of the
needleguard system. An association was identified between the perceived quality
of training and the reported difficulties. It was also identified that training
provided by external organizations had the least effect in reducing the
operational difficulties. CONCLUSIONS: The study concludes that the use of
needleguards as a successful control measure requires further investigation and
that further research should be carried out to ensure the effectiveness of
training in reducing injuries
267. 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
268. 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.
269. 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
270. 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
271. Tanne
JH. Most
ABSTRACT: By the end of their five years of trainingin general surgery almost
every
272. Tosti
ME, Mariano A, Spada E et al. Incidence of parenterally transmitted acute viral
hepatitis among healthcare workers in
ABSTRACT: In
273. 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
274. 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
275. 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
276. 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
277. 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
278. 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
279. 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
280. Wittmann
A, Hofmann F, Kralj N. Needle stick injuries--risk from blood contact in
dialysis. J Ren Care 2007; 33(2):70-73.
ABSTRACT: This paper will examine the experience of Needle Stick Injuries (NSI)
in