International Healthcare Worker Safety
Center
Bibliography
Latest update: February 1, 2006
(1) Surveillance of significant occupational
exposure to bloodborne viruses in healthcare workers: 1 July 1996 to 30 June
2004. Communicable Disease Report 2005; 15(4):3-4.
ABSTRACT: The Health Protection Agency's Centre for Infections (CFI) has this
week published Eye of the Needle, the latest report from the surveillance of
significant occupational exposure to bloodborne viruses (BBVs) in healthcare
workers (HCWs) (1). This report includes significant occupational exposure
incidents reported to the CFI between 1 July 1996 and 30 June 2004 from
reporting centres. There are currently 150 reporting centres scattered
throughout England, Wales, and Northern Ireland.
(2) Anonymous. OR becomes last frontier for move
to sharps safety. Hospital Employee Health 2005; 24(12):149-155.
ABSTRACT: ACS endorses blunt needles, spurring change. American operating rooms may finally be ready
to move toward sharps safety. The
American College of Surgeons (ACS) has endorsed the use of blunt suture needles
and is poised to begin an educational push to reduce one of the most persistent
remaining causes of sharps injuries.
While sharps injuries have declined overall by about one-third, suturing
injuries have remained stable.
(3) Association of periOperative Registered
Nurses. AORN guidance statement: sharps injury prevention in the perioperative
setting. AORN Journal 2005; 81(3):662-666.
ABSTRACT: Occupational exposure to bloodborne pathogens via percutaneous
injuries is one of the most serious dangers perioperative team members face on
a daily basis. The risk of sustaining a percutaneous injury can be decreased
through employee education, clear communication, device engineering, and
focused work practice controls. Risk reduction strategies should include
specific practices aimed at reducing the unique risks of percutaneous injuries
encountered in the perioperative environment. AORN recognizes the various
settings in which perioperative RNs practice, and the suggested risk reduction
strategies in this guidance statement are intended to be adaptable to any
setting where surgical or other invasive procedures are performed
(4) Dix K. Best Practices for Purchasing Managers.
Infection Control Today 2005; 9(7):34-38.
ABSTRACT: Purchasing managers for the healthcare community face a unique
challenge--obtaining the best vales possible for the healthcare facility while
ensuring that patient safety and infection control issues are kept at the
forefront.
(5) Ellis K. Sharp Thinking: The Role of Technology
and Education in Promoting Sharps Safety. Infection Control Today 2005;
9(7):20-24.
ABSTRACT: Infection control practitioners (ICPs) are intimately aware of the
potential danger to healthcare workers (HCWs) posed by bloodborne pathogens via
accidental needlestick accidental injuries.
While the exact prevalence of such injuries is unknown, the National
Institute for Occupational Safety and Health (NIOSH) estimates put the number
somewhere between 600,000 and 800,000 per year.
Furthermore, about half of these are not reported. Other studies actively seeking to monitor the
rate of needlestick injuries have reported as many as 839 injuries per 1,000
HCWs. The cost that facilities must
absorb to manage these injuries is significant, and can become catastrophic if
the injury results in the acquisition of an infectious disease.
(6) Fry DE. Occupational blood-borne diseases in
surgery. [Review] [25 refs]. American Journal of Surgery 2005; 190(2):249-254.
ABSTRACT: BACKGROUND: Human immunodeficiency virus (HIV), hepatitis B (HBV),
and hepatitis C (HCV) infections are transmitted by blood exposure. Surgeons
have been concerned about the risks of blood exposure in the operating room as
a potential source of occupational infections from these viruses. The actual risk
and frequency of operating room transmission remains poorly understood by many
surgeons. METHODS: The pertinent recent literature on the pathophysiology,
diagnosis, prevention, and treatment of HIV, HBV and HCV were reviewed to
address the current understanding of these viruses as occupational risks to
surgeons. RESULTS: HIV transmission to surgeons has not been documented in the
United States by the Centers for Disease Control. HIV transmission from a
surgeon to a patient in the environment of the operating room, as well as
transmission from an HIV-infected surgeon to a patient, has not been
documented. HBV infection of surgeons has declined with the general acceptance
of the HBV vaccine. HCV infection remains a real risk for transmission in the
operating room, given that no vaccine is currently available and that the
overall number of chronically infected patients remains quite high. CONCLUSION:
The risk of occupational infection from known viral pathogens for surgeons is
low, but it is not zero. Effective barriers, modified patterns of behavior, and
prompt responses to blood exposure events are the best methods for prevention.
[References: 25]
(7) Health Protection Agency Centre for
Infections, National Public Service for Wales, CDSC Northern Ireland. Eye of
the Needle. Surveillance of Significant Occupational Exposure to Bloodborne
Viruses in Healthcare Workers.
Seven-year report. 2005.
Ref Type: Report
ABSTRACT: This report includes significant occupational exposure incidents
reported to the HPA between 1st July 1996 and 30th June 2004 from reporting
centres, currently 150, geographically scattered throughout England and four
actively reporting centres in Wales and one actively reporting entre in Belfast
in Northern Ireland.
(8) Hogan A. Gaps and successes of safety device
market conversion. Materials Management in Health Care 2005;(November 2005).
ABSTRACT: Technology and the
engineering of safety devices has increased since the promulgation of the
Bloodborne Pathogens Standard (BPS) (29 CFR 1910.1030) in 1991.
As a result, OSHA revised its
enforcement procedures in 1999 (CPL 02-02-069) to include guidance for its
compliance safety and health officers to begin citing health care employers for
failure to use safety devices where their use is feasible and effective.
The Needlestick Safety and Prevention
Act (NSPA), passed unanimously by Congress in 2000, further amplified the need
for safety device adoption and use.
(9) Hopkins S. Safety and the 'Stick'.
Advance/Laboratory 2005; 14(6):30-42.
ABSTRACT: In March 2000, the CDC estimated that more than 380,000 percutaneous
injuries from contaminated sharps occur annually among healthcare workers in
the United States. Estimates also
indicate that 600,000-800,000 work-related needlestick injuries occur annuall
in the United States--about half of which go unreported. And at an avaerage hospital, workers incur
approximately 30 reported needlestick injuries per 100 beds per year. Thus, it's extremely important that
healthcare workers are aware of how these injuries occur, how to prevent them
and what to do in case of injury.
(10)
Libois A, Fumero E, Castro P, Nomdedeu
M, Cruceta A, Gatell JM et al. Transmission of hepatitis C virus by discarded-needle injury. Clinical
Infectious Diseases 2005; 41(1):129-130.
ABSTRACT: SIR -- The transmission of virus infection by percutaneous injuries
from needles discarded in public settings is assumed to be biologically
possible but has remained unproven. To date, no reports have been published of
cases in which this route of virus transmission may have occurred [1]. We
report clearly documented hepatitis C virus (HCV) seroconversion that occurred
after an injury that involved a discarded needle.
(11) McCormick R. The No-Hands Technique for
Sharps. Outpatient Surgery Magazine 2005; VII(7):75-76.
ABSTRACT: One of our nurses was injured by a sharp during a procedure on an
HIV-positive patient about 15 years ago. The injury didn't result in a
bloodborne pathogen, but it did raise concern about sharps handling. To put a
positive spin on a potentially negative situation, we developed rules for the
handling of sharps devices, including their passing in the OR. Here's what we
did, and how you can enhance sharps safety in your facility.
(12) Panlilio AL, Cardo DM, Grohskopf LA, Heneine
W, Ross CS, U.S.Public Health Service. Updated U.S. Public Health Service
guidelines for the management of occupational exposures to HIV and
recommendations for postexposure prophylaxis. Morbidity & Mortality Weekly
Report 2005; Recommendations & Reports. 54(RR-9):1-17.
ABSTRACT: This report updates U.S. Public Health Service recommendations for
the management of health-care personnel (HCP) who have occupational exposure to
blood and other body fluids that might contain human immunodeficiency virus
(HIV). Although the principles of exposure management remain unchanged,
recommended HIV postexposure prophylaxis (PEP) regimens have been changed. This
report emphasizes adherence to HIV PEP when it is indicated for an exposure,
expert consultation in management of exposures, follow-up of exposed workers to
improve adherence to PEP, and monitoring for adverse events, including
seroconversion. To ensure timely postexposure management and administration of
HIV PEP, clinicians should consider occupational exposures as urgent medical
concerns
(13) Perry J, Jagger J. Cutting sharps risks in
ICUs and CCUs. Nursing 2005; 35(8):17.
ABSTRACT: With many crisis situations, fast-paced ICUs and CCus place nurses at
high risk for exposure to bloodborne pathogens.
Nurses in these units often
perform high-intensity therapies and rapid interventions. Critically ill patients need more procedures
and blood tests, so nurses use more sharps.
In addition, some invasive and diagnostic procedures, such as
thoracentesis, are more commonly performed in ICUs than inother patient units.
(14) Perry J, Jagger J. Slash sharps risk for
surgical personnel. Nursing 2005; 35(11 Suppl):28-29.
ABSTRACT: Injury patterns for OR staff members differ from those in other
healthcare settings. For this reason, tailor safety strategies to the OR
environment to reduce injuries and blood exposures in this setting.
(15) Perry J, Jagger J. Pass with care in the OR. Nursing2005 2005;
35(2):70.
ABSTRACT: Surgical personnel have unique injury patterns and n eed specific
strategies tailored to the OR to reduce sharps injuries and potential blood
exposures. An additional challenge for nurses is the fact that although nurses
are more likely than surgeons to be injured, surgeons choose which devices to
use. Nurses must speak up and call for
safer devices and procedures whenever they are available.
(16) Perry J, Jagger J. FAQs about implementing
safety devices. Nursing 2005; 35(10):74-76.
ABSTRACT: Questions are bound to come up as facilities work to comply with
standards on needle-stick safety from the Occupational Safety and Health
Administration (OSHA). Here are several
frequently asked questions (FAQs) and our answers.
(17) Perry J, Jagger J. Sharps safety update:
"Are we there yet?". Nursing 2005; July 2005:17.
ABSTRACT: More than 4 years have passed since the Needlestick Safety and
Prevention Act became law. The revised
Bloodborne Pathogens Standard, issued by the Occupational Safety and Health
Administration (OSHA), emphasizes using safety-engineered devices to reduce
health care workers' risk of needle-stick injuries. Here, we'll update you on recent progress and
highlight areas that need improvement.
(18) Perry J. How to Handle a Bleeding Surgeon.
Outpatient Surgery Magazine 2005; February 2005:82-84.
ABSTRACT: OR workers have to mentally multitask when sharps are in use,
focusing simultaneously on patient and worker safety. The human tendency is to
devise a pecking order, and most often, patient safety comes first. Even if
there is unexpected bleeding during a procedure, and speed becomes a factor,
patient safety is still at the fore, right? This is by no means wrong — it's
just that you must give worker safety nearly as much attention. An orthopedic
surgeon is performing a lengthy hip replacement case. Working in the patient's
open body cavity, where visualization is difficult, he uses his fingertips to
guide the suture needle tip as he places the bone pins. A sharp pain in his
finger tells him he's been stuck by the needle. Withdrawing his hand, he sees
both layers of his glove are torn and blood dripping from the wound. He reports
the needlestick to the OR administrator, and asks: What's our procedure for
reporting potential exposures to patients? Good question. What's yours?
(19) Pruss-Ustun A, Rapiti E, Hutin Y. Estimation
of the global burden of disease attributable to contaminated sharps injuries
among health-care workers. American Journal of Industrial Medicine 2005;
48(6):482-490.
ABSTRACT: BACKGROUND: The global burden of hepatitis B (HBV), hepatitis C
(HCV), and human immunodeficiency virus (HIV) infection due to percutaneous
injuries among health care workers (HCWs) is estimated. METHODS: The incidence
of infections attributable to percutaneous injuries in 14 geographical regions
on the basis of the probability of injury, the prevalence of infection, the
susceptibility of the worker, and the percutaneous transmission potential are
modeled. The model also provides the attributable fractions of infection in
HCWs. RESULTS: Overall, 16,000 HCV, 66,000 HBV, and 1,000 HIV infections may
have occurred in the year 2000 worldwide among HCWs due to their occupational
exposure to percutaneous injuries. The fraction of infections with HCV, HBV,
and HIV in HCWs attributable to occupational exposure to percutaneous injuries
fraction reaches 39%, 37%, and 4.4% respectively. CONCLUSIONS: Occupational
exposures to percutaneous injuries are substantial source of infections with
bloodborne pathogens among health-care workers (HCWs). These infections are
highly preventable and should be eliminated. Am. J. Ind. Med. 48:482-490, 2005.
(c) 2005 Wiley-Liss, Inc
(20) Pyrek K. Risky Business Occupational Hazards
& the Healthcare Worker. Infection Control Today 2005; 9(9):26-34.
ABSTRACT: While hospitals are designed
to be places of treatment and healing for patients, they present a significant
number of occupational hazards to healthcare workers (HCWs).
A survey of registered nurses by the
American Nurses Association revealed that stress/overwork, disabling back
injuries, and contracting a bloodborne disease were the top three health and
safety concerns.
(21) Schraag J. Avoiding the Point: Sharps Safety
Best Practices for HCWs. Infection Control Today 2005; 9(9):36-41.
ABSTRACT: Sharps safety goes beyond the infection control (IC) team, encircling
every aspect of today's healthcare systems.
Reducing the risks presented by occupational exposure begins with
awareness, proper compliance, education, and special care in handling and
disposal of sharps.
(22) Silverman R. Assess your sharps injury
prevention program. Mlo: Medical Laboratory Observer 2005; 37(4):20-21.
ABSTRACT: Sharps injury prevention programs are intended to reduce the risks
associated with the use of needles and other sharps.
(23) Stoker R. Sharps Safety in the Laboratory.
Advance/Laboratory 2005; 14(11):77.
ABSTRACT: Barbara was a lab tech who
worked the graveyard shift. Her job
included drawing blood and testing blood and urine samples in the hospital
laboratory. On one occasion she was called tao the emergency room in the
morning to draw blood on an HIV-positive drug abuser. As Barbara was attempting to draw the
addict's blood, the individual became violent, jerking her arm around after the
needle was already in her vein. The
needle pulled out and stabbed deep into Barbara's left thumb.
Unfortunately, this story is
true. Barbara soon seroconverted to HIV
and later gave birth to a beautiful daughter who was HIV positive as well. This type of needlestick injury could have
been prevented with the right safety equipment. Working in a labratory can be
dangerous, with some hospitals reporting that one-third of nursing and
laboratory staff suffer needlestick and other sharps injuries each year.
(24) Tuboku-Metzger J, Chiarello L,
Sinkowitz-Cochran RL, Casano-Dickerson A, Cardo D. Public attitudes and
opinions toward physicians and dentists infected with bloodborne viruses:
results of a national survey. Am J Infect Control 2005; 33(5):299-303.
ABSTRACT: BACKGROUND: There has been no recent assessment of public attitudes
and opinions concerning risk of bloodborne virus transmission during health
care. METHODS: Seven items in the 2000 annual Healthstyles survey were used to
assess current attitudes and opinions about health care providers infected with
human immunodeficiency virus (HIV) and the risk of bloodborne virus
transmission during health care in a sample of approximately 3000 US
households. RESULTS: Of the 2353 respondents, 89% agreed that they want to know
whether their doctor or dentist is infected with HIV; 82% agreed that
disclosure of HBV or HCV infection in a provider should be mandatory. However,
47% did not believe that HIV-infected doctors were more likely to infect
patients than doctors infected with HBV or HCV. Opinions were divided on
whether HIV-infected providers should be able to care for patients as long as
they use good infection control: only 38% thought that infected providers
should be allowed to provide patient care. CONCLUSIONS: These findings suggest
that improved public education and risk communication on health care-associated
bloodborne infections is needed
(25) Weiss ES, Makary MA, Wang T, Syin D, Pronovost
PJ, Chang D et al. Prevalence
of blood-borne pathogens in an urban, university-based general surgical
practice. Annals of Surgery 2005; 241(5):803-807.
ABSTRACT: OBJECTIVE: To measure the current prevalence of blood-borne pathogens
in an urban, university-based, general surgical practice. SUMMARY BACKGROUND
DATA: Human immunodeficiency virus (HIV), hepatitis B, and hepatitis C
represent significant occupational hazards to the surgeon. While the incidence
of these blood-borne pathogens is increasing in the general population, little
is known about the current prevalence of these exposures among patients
presenting for surgery. METHODS: We studied 709 consecutive operative cases
(July 2003 to June 2004) in a university practice that provides all inpatient,
emergency department, and outpatient consultative general surgical services.
Trauma cases and bedside procedures were excluded. Data collected included HIV,
hepatitis B and C test results, type of operation, age, sex, and history of
intravenous drug use. RESULTS: Testing for blood-borne pathogens was performed
in 53% (N = 373) of 709 patients based on abnormal liver function tests,
neutropenia, history of IV drug use, or patient request. Thirty-eight percent
of all operations (142/373) were found to involve a blood-borne pathogen when
tested: HIV (26%), hepatitis B (4%), hepatitis C (35%), and coinfection with
HIV and hepatitis C (17%). Forty-seven percent of men tested positive for at
least 1 blood-borne pathogen. Seventy-three different types of operations were
performed, ranging from Whipple procedures to amputations. Soft-tissue abscess
procedures 48% (34/71) and lymph node biopsies 67% (10/15) (P < 0.01) were
most often associated with blood-borne pathogens. Infections were more common
among men (P < 0.01), patients 41 to 50 years of age (P < 0.01), and
patients with a history of intravenous drug use (P < 0.01). CONCLUSIONS: HIV
and hepatitis C infections are common in an urban university general surgical
practice, while hepatitis B is less common. In addition, certain operations are
associated with significantly increased exposure rates. Given the high
incidence of these infections, strategies such as sharpless surgical techniques
should be evaluated and implemented to protect surgeons from blood-borne
pathogens
(26) Intensive OSHA inspection produces citations,
fines. Hospital Employee Health 2004; 23(3):39.
ABSTRACT: A wall-to-wall, comprehensive Occupational Safety and Health
Administration (OSHA) inspection resulted in 41 alleged health and safety
violations and $91,500 in fines for New Britain (CT) General Hospital.
(27) Safety needles lead price hikes. Hospital
Materials Management 2004; 29(2):1-4.
ABSTRACT: Syringes and needle prices will rise in the coming year, ending a
stable period marked by large group contracts and vendor consolidation.
How much will prices rise? That depends on whether and to what extent a
hospital elects to convert to newer, more expensive safety devices
(28) Medicare bill closes needle safety gap.
Hospital Employee Health 2004; 23(2):25-27.
ABSTRACT: A small section in the massive new Medicare law brings all hospitals
into compliance with the bloodborne pathogens standard. State and local hospitals now will be subject
to the same provisions--including the involvement of frontline health care
workers--as other hospitals that fall under the purview of the U.S.
Occupational Safety and Health Administration (OSHA).
(29) How do you counsel law enforcement officers on
bodily fluid exposures? Journal of Occupational & Environmental Medicine
2004; 46(5):510-513.
ABSTRACT: Exposure to bloodborne pathogens (BBP) remains an important
occupational problem for many occupations, law enforcement officers included
among them. The risk for infection with bloodborne pathogens is
disproportionately high in law enforcement officers because the groups with
which they come in contact, suspects and inmates in U.S. jails and prisons,
have high rates of preincarceration intravenous (IV) drug use. Indeed, the rate
of IV drug use among inmates is 25% to 40% compared with 0.6% in the general
population. This results in high rates
of infection with blood-borne pathogens such as hepatitis B (HBV) and hepatitis
C (HCV) and human immunodeficiency virus (HIV). The rates of HBV serologic
markers range from 19% to 47% in inmates versus 5% in the general population,
and the prevalence of HCV infection in inmates is reported to range from 15% to
38% versus 1% to 2% in healthcare workers (HCWs) and 0.05% to 1.5% in the
general population. The sero-prevalence of HIV in prisons depends on the region
of the country. Rates vary from 0% in Iowa to 27% in New York City. The number
of confirmed AIDS cases in state and federal prisons is approximately 54 per
10,000 inmates compared with 9 per 10,000 persons in the nonincarcerated U.S.
population. The rates of HIV infection among female inmates are higher than
that for males. Law enforcement personnel have varying levels of risk depending
on the likelihood of direct contact with high-risk individuals and the
geographic region
(30) Needlestick injury. HIV-related emotional
distress is compensable. AIDS Policy & Law 2004; 19(7):3.
ABSTRACT: BODY:
Case name: Galland, et al. v. Meridia Health System Inc., No. C.A. 21763 (Ohio
Ct. App. 03/24/04).
Ruling: An order of summary judgment in favor of a hospital was reversed in the
case of a 5-year-old's possible exposure to HIV.
What it means: Possible exposure to the HIV virus coupled with a physical
injury made a claim of emotional distress due to exposure to HIV compensable,
an Ohio appeals court said.
(31) Behrman AJ, Allan DA. Occupational exposure to
bloodborne pathogens.[see comment][comment]. Annals of Internal Medicine 2004;
140(6):492.
ABSTRACT: TO THE EDITOR: Dr. Seibert's
painful story of occupational HIV exposure (1) should resonate with all
clinicians. In our program, which serves 2 teaching hospitals, we have
evaluated more than 5000 employees with body fluid exposures since 1988, using
Centers for Disease Control and Prevention guidelines (2). Specific measures we
have found useful to minimize health care worker anxiety and facilitate
postexposure prophylaxis include 1) orienting hospital staff to report body
fluid exposures immediately to the occupational medicine clinic or the
emergency department, 2) implementing triage protocols to minimize waiting
times, 3) providing 24-hour consult coverage of occupational medicine by
experienced physicians, 4) offering confidential HIV testing for health care
workers through the occupational medicine clinic, 5) providing "starter
packs" of antiretroviral agents to minimize treatment delays, 6) using
individualized follow-up to rapidly provide health care workers with laboratory
results on their source patients and themselves, 7) monitoring health care
workers for side effects during and after postexposure prophylaxis, and 8)
facilitating confidential follow-up testing for HIV and hepatitis virus
infection if indicated.
These interventions, along with accurate assessment of risk magnitude, timely
source-patient testing, and appropriate consultation for questions of HIV drug
resistance, have increased health care workers' willingness to seek evaluation
and treatment immediately after exposures. Definitive postexposure prophylaxis,
if needed, is generally begun within 2 hours of exposure. The anxiety and risk
associated with body fluid exposures can be decreased by accessing a hospital's
dedicated treatment program.
(32) Berguer R, Heller PJ. Preventing sharps
injuries in the operating room. Journal of the American College of Surgeons
2004; 199(3):462-467.
ABSTRACT: In the past, percutaneous injuries and mucocutaneous exposures were
considered to be an accepted occupational hazard for the surgeon. Although the
potential for injury, exposure, and contraction of blood-borne disease was well
known, there were no attempts to reduce risk of such events. When the human immunodeficiency
virus was described in 1981 we began to pay greater attention to health care
worker safety in the operating room. In 1983 the Centers for Disease Control
and Prevention (CDC) recommended "caution" when handling body fluids
from patients suspected of having AIDS. Initially HIV and AIDS were considered
to be rare and confined to particular groups at high risk. This inaccurate
notion changed rapidly as the disease reached epidemic proportions, and by 1987
the CDC recommended "Universal Precautions,"[1] which state that
blood and body fluid precautions be used with all patients. It was at this time
that the CDC made their first recommendations for use of appropriate barrier
protection and against resheathing contaminated needles. In 1991 The Occupational
Safety and Health Administration required use of Universal Precautions with the
enactment of the Bloodborne Pathogen Standard. [2] This standard has been
revised and updated several times, most recently in 2001. [3] Although
discovery of AIDS and HIV was the driving force behind development of Universal
Precautions, it is widely appreciated that many serious illnesses can be
contracted through contact with contaminated blood and body fluids.
Unfortunately the published literature indicates that surgeons demonstrate poor
compliance with Universal Precautions. [4] Perhaps even more unfortunate is the
failure of Universal Precautions and the Bloodborne Pathogen Standard to fully
address the needs of the high-risk operating room environment. Injuries to
surgeons and scrub personnel continue to occur.
(33) Berry AJ. Needle stick and other safety
issues. [Review] [59 refs]. Anesthesiology Clinics of North America 2004;
22(3):493-508.
ABSTRACT: Percutaneous injuries such as accidental needle sticks are associated
with the greatest risk for occupational transmission of blood-borne pathogens
such as hepatitis B and C viruses and HIV. This article presents data on the
risk of transmission of these viruses after needle sticks, offers strategies
for prevention of injuries from sharp objects, and discusses postexposure
prophylaxis recommendations. [References: 59]
(34) Forns
X, Martinez-Bauer E, Feliu A, Garcia-Retorillo M, Martin M, Gay E et al. Nosocomial Transmission of HCV in
the Liver Unit of a Tertiary Care Center. Hepatology 2004; 41(1):115-122.
ABSTRACT: Despite its medical and legal implications, there are no prospective
studies analyzing the incidence and mechanisms involved in the nosocomial
transmission of hepatitis C virus (HCV) in liver units. This study prospectively investigates the
nosocomial transmission of HCV in the liver unit of a tertiary care center from
August 2000 to October 2002. The median prevalence of HCV infection among
hospitalized patients was 50%. Anti-HCV-
negative patients admitted to the liver unit during the study period were
prospectively followed, and serum markers of HCV infection were repeated 6
months after discharge. All known risk factors for HCV transmission (including
the physical allocation of HCV-infected and noninfected patients during
hospitalization) were recorded. Complete follow- up data were available in
1,301 (84.5%) of 1,540 patients. Six
patients (0.46%) acquired HCV infection (annual incidence: 0.27/100 admissions).
Phylogenetic analyses of recovered HCV sequences identified the source of
infection as an HCV- infected roommate (3 cases) and a patient receiving care
by the same nurse team (1 case). The most relevant risk factors associated with
HCV acquisition were duration of hospitalization (> 10 days; OR, 35; 95% CI,
1.96-622) and hospitalization with an HCV-infected roommate (>5 days; OR,
12; 95% CI, 1.39-103). In fact, HCV infection occurred in 1.7% of the 357
patients hospitalized longer than 10 days.
In conclusion, HCV nosocomial infection appears to occur via patient-to-
patient transmission in liver units, particularly in individuals who require
long hospitalizations. Continuous reinforcement of universal prevention
measures and, when possible, isolation of patients at higher risk might further
reduce nosocomial HCV transmission.
(35) Gorman C. Wash Those Hands! Time 2004;81.
ABSTRACT: Nearly 10% of Americans who are admitted to a hospital pick up an
infection while they are there.
Sometimes the culprit is a germ that they've brought with them to the
hospital--typically some bacteria on the skin that follow the path of a needle
or catheter into the body. But most
hospital infections are transmitted from one patient to another by doctors,
nurses and other health-care workers.
No, doctors and nurses aren't carrying vials of disease-causing bugs and
cracking them open at bedside. Often the
germs are hitching a ride on the hands of hospital workers.
(36) Gray J. Blunting sharps injuries. Nursing
Standard 2004; 19(3):3.
ABSTRACT: Needlestick injuries rank alongside back injury as a daily danger for
nurses. The number of healthcare workers
infected with hepatitis C in the course of their work leapt to six in 2003,
compared to three in the previous five years--all contracted through
needlestick injuries.
(37) Hernandez Navarrete MJ, Campins MM, Martinez
Sanchez EV, Ramos PF, Garcia dC, I, Arribas Llorente JL et al. [Occupational
exposures to blood and biological material in healthcare workers. EPINETAC
Project 1996-2000]. [Spanish]. Medicina Clinica 2004; 122(3):81-86.
ABSTRACT: BACKGROUND AND OBJECTIVE: The bloodborne injury is the most frequent
risk in healthcare workers. Among them, the hollow-bore needlesticks are the
most associated with the risk of acquire a bloodborne infection. In this study,
occupational percutaneous injuries and risk factors associated to hollow-bore
needlesticks registered in a national multicenter surveillance system are
described. PATIENTS AND METHOD: Prospective and analytical study of
percutaneous injuries registered in the surveillance system EPINETAC (Exposure
Prevention Information Network) in Spain between 1996-200. A descriptive
analysis of the variables related to the exposed healthcare worker, the
exposure and their mechanism and the source patient is performed. The incidence
rates were calculated by 100 occupied beds and by job category. A multivariable
analysis is performed in order to know the risk factors most associated to
hollow-bore needle. RESULTS: 16,374 percutaneous injuries has been registered,
which 87% are hollow-bore needlesticks. The incidence rate has been 11.8
expositions per 100 occupied beds. Midwives are the most risky workers (9
injuries per 100 occupied beds). The risk factors most associated to
hollow-bore needlesticks are the following: job category of midwife (OR = 7.5
95% CI, 4.1-13.7) and student nurse (OR = 2.1; 95% CI, 1.2-3.7), recapping (OR
= 28.8; 95% CI, 16.5-50.6), working in venipuncture room (OR = 3.3; 95% CI,
1.2-9.5) or in the dialysis unit (OR = 2.5; 95% CI, 1.4-4.3). CONCLUSIONS: The
incidence of occupational percutaneous injuries in Spain is similar to those
described in other countries using comparable surveillance systems. The risk of
hollow-bore needlestick is directly related to job category, work experience,
work area and the activities that the healthcare worker does
(38) Kuroiwa C, Suzuki A, Yamaji Y, Miyoshi M.
Hidden reality on the introduction of auto-disable syringes in developing
countries. Southeast Asian Journal of Tropical Medicine & Public Health
2004; 35(4):1019-1023.
ABSTRACT: With the growing concerns about the risk of unsafe injections (e.g.
unsterilized injection practices), WHO, UNICEF and UNFPA decided to introduce
the auto-disable (AD) syringe for immunization in the world. The AD syringe is
designed to be automatically locked after a single use, hence no chance of
reuse. Consequently, the risk of infection can be reduced for the recipient. On
the other hand, the management of increased medical waste is becoming
difficult, as the waste volume of AD syringes would be 200 times as much as
those of sterilizable syringes. The used and improperly disposed AD syringes
could be a huge source of blood-borne infections and environmental pollution at
the community level. This study attempted to explore the present situation with
regard to the introduction of AD syringes for immunization in Lao PDR. We
conclude that reviewing the present 'safe injection' policy is urgently
required in Lao PDR, as well as in other developing countries where the
disposal system for medical wastes is not yet well established
(39) Lee J, Botteman M, Nicklasson L. A Systematic
Review of the Economic and Humanistic Burden of Needlestick Injury in the
United States. American Journal of Infection Control 32[3], E43. 2004.
Ref Type: ABSTRACT
ABSTRACT: OBJECTIVE: Despite safety precaution legislation, needlestick
injuries (NI) continue to occur among hospital workers (HW). Prospective
studies suggest the incidence of NIs may be as high as 839 per 1000 HWs per
year, significantly higher than that reported through passive surveillance. We
reviewed the economic and humanistic burden of NIs to inform policymakers of
the need for and value of interventions aimed at reducing that burden.
METHODS: We conducted a systematic literature synthesis on the economic and
humanistic burden of NIs in the United States from 1990 to 2003.
RESULTS: Twelve formal economic studies reporting the cost of NIs were
identified. Depending on methodology and infection control protocol, the
medical costs of a NI range from $51 to $3,766. These figures exclude the cost
of expensive long-term complications (e.g., HIV, hepatitis), work time lost
from seeking and receiving care, and legal liability. In addition, HWs
experience significant fear, anxiety, and emotional distress following a NI, at
times resulting in occupational and behavioral changes. In contrast, the cost
to prevent a NI using safety devices ranges from $1,186 to $2,571. This is
consistent with estimates of what HWs and society are willing to pay to avoid
sharps injuries.
CONCLUSIONS: A NI carries significant economic and humanistic costs. While
preventing NIs requires investments in safer technologies, it is economically
warranted, especially when considered within the context of other commonly
accepted injury-prevention interventions. Continued efforts should be pursued
to decrease the incidence of NIs, especially among those at higher risk of
serious injury
(40) Marini MA, Giangregorio M, Kraskinski JC.
Complying with the Occupational Safety and Health Administration's Bloodborne
Pathogens Standard: implementing needleless systems and intravenous safety
devices. [Review] [12 refs]. Pediatric Emergency Care 2004; 20(3):209-214.
ABSTRACT: Preventing the transmission of bloodborne pathogens to healthcare
workers has been a mission and a challenge of the healthcare industry for over
20 years. The development of the Occupational Safety and Health Administration
Bloodborne Pathogens Standard in 1991 and the passing of the Needlestick Safety
Act in 2000 mandated hospitals to develop an Exposure Control Plan to protect
workers from these pathogens. Children's Hospital Boston began implementation
of a needleless system in 1993. Employees readily accepted these systems into
practice, because they were convenient and easy to use. A marked decrease in
exposures to bloodborne pathogens naturally followed, which is consistent with
the national data.The transition to intravenous (i.v.) safety devices at
Children's Hospital began in 2000 and proved to be more of a challenge. First,
the clinicians must choose a safety product, which requires developing and
implementing a trial plan with potential catheters. This selection process is
especially difficult in pediatrics where successful placement of the
smallest-gauge catheter, no. 24, is imperative. After choosing an i.v. safety
product, successful transition is dependent upon the thoroughness of i.v.
safety device training and a commitment by the clinicians to the use of these
products. Although the number of needlestick injuries and subsequent
transmission of bloodborne pathogens have been further reduced with the use of
i.v. safety devices, needlestick injuries still occur. This results from a lack
of familiarity with the engineering of the device and therefore poor technique
or a failure to activate the safety mechanism. Staff resistance due to loss of
expertise with the new device and patient care concerns are additional barriers
to the use of these new products. Addressing these obstacles and providing
adequate training for all clinicians were required for successful
implementation of these i.v. safety devices. [References: 12]
(41) Matthews MS, Plastic Surgery Educational
Foundation DATA Committee. Safer sharps. Plastic & Reconstructive Surgery
2004; 113(2):747-749.
ABSTRACT: The dangers of disease transmission from bodily fluids through
exposure to needlestick and other sharps injuries are well known. The Centers for Disease Control estimates
that 600,000 to 800,000 occupational needlestic injuries occur in healthcare
workers yearly, that half of these go unreported, and that 62 percent of sharps
injuries in hospitals are caused by hollow-bore needles.
(42) Muntz JE, Hultburg R. Safety syringes can
reduce the risk of needlestick injury in venous thromboembolism prophylaxis.
Journal of Surgical Orthopaedic Advances 2004; 13(1):15-19.
ABSTRACT: Patients undergoing major orthopaedic surgery of the lower
extremities are at high risk of developing venous thromboembolism (VTE).
Pharmacologic thromboprophylaxis has greatly reduced the likelihood of VTE. The
most effective medications are administered once or twice daily by subcutaneous
injection, a drug delivery route associated with an increased risk of
needlestick injury. Awareness of the potential lethality of needlestick
injuries has increased during the past decade, resulting in the development of
national safety guidelines from the Occupational Safety and Health
Administration on the handling and management of needles and other sharps. This
article reviews the potential risks and costs associated with needlestick
injury during the administration of VTE prophylaxis in patients undergoing
major orthopaedic surgery. The development of novel anticoagulants and
accompanying devices to prevent needlestick injury is also discussed
(43) Nelson R. Needlestick injuries: going but not
gone? American Journal of Nursing 2004; 104(11):25-26.
ABSTRACT: In 1997 Lisa Black, RN, was trying to aspirate blood from a line in
the arm of a patient with advanced AIDS.
When the patient jerked suddenly, the needle she was using to flush the
line punctured the skin of one of her palms.
Despite postexposure treatment, she became infected with HIV and
hepatitis C.
(44) Numaguchi Sakamoto F, Morimoto T, Shimbo T.
Blue Ribbon ABSTRACT Award, Best International ABSTRACT Award:
Cost-Effectiveness of Safety Devices in Preventing Hepatitis C Infection due to
Percutaneous Injuries in Japanese Healthcare Workers—A Markov Model Analysis.
American Journal of Infection Control 32[3], E12-E13. 2004.
Ref Type: ABSTRACT
ABSTRACT: BACKGROUND: High incidence of hepatitis C virus (HCV) infection among
Japanese healthcare workers (HCWs) following a percutaneous injury (PI) has
been reported in multiple studies. A lack of regulations mandating the use of
safety devices and their high costs prevent many Japanese hospitals from
purchasing these devices to prevent PIs. A few studies have evaluated the
cost-effectiveness of safety devices from hospital administrators' perspectives
using data from a single hospital; however, the results have been equivocal.
The cost-effectiveness of safety devices has never been analyzed from the
perspective of the Japanese government, which that compensates medical costs
incurred by PIs from known infective sources.
METHODS: We constructed a Markov model to assess the cost-effectiveness of two
types of safety devices—winged steel needles and intravenous catheters—in
preventing HCV infection due to PIs from the Japanese government's perspective.
Clinical and utility data were obtained from published studies. Costs were
based on both published and unpublished data in Japan. Cost-effectiveness was
measured by yen per quality-adjusted life year (¥/QALY).
RESULTS: The baseline analyses showed the use of both types of safety devices
to be cost-effective. Costs of safety and conventional winged steel needles per
QALY were ¥4680 and ¥5220, respectively. Safety winged steel needles were no
longer dominant when they reduced PI incidence by less than 46% (maximum
incremental cost ¥1650/QALY), the prevalence of HCV infection in patients was
less than 7% (maximum incremental cost ¥740/QALY), and their cost exceeded
¥8230/QALY (maximum incremental cost ¥6380/QALY). For IV catheters, costs of
safety and conventional devices per QALY were ¥18,850 and ¥20,010 respectively.
The use of safety IV catheter lost its dominance when the safety device reduced
PI incidence by 80% or less (maximum incremental cost ¥9670/QALY), the
prevalence of hepatitis C infection in patients was 7% or less (maximum
incremental cost ¥4310/QALY), and their cost exceeded ¥38,670/QALY (maximum
incremental cost ¥26,220/QALY).
CONCLUSIONS: From the Japanese government's perspective, use of safety winged
steel needles and IV catheters is cost-effective in preventing HCV infection
due to PIs. Creating legal and financial incentives for hospitals to use safety
devices and reinforcing needlestick prevention activities will result in lower
costs of safety devices as well as higher reduction rates in PIs, which will
further enhance the cost-effectiveness of these devices
(45) Panlilio AL, Orelien JG, Srivastava PU, Jagger
J, Cohn RD, Cardo DM et al. Estimate of the annual number of percutaneous
injuries among hospital-based healthcare workers in the United States,
1997-1998.[see comment]. Infect Control Hosp Epidemiol 2004; 2 5(7):556-562.
ABSTRACT: OBJECTIVE: To construct a single estimate of the number of
percutaneous injuries sustained annually by healthcare workers (HCWs) in the
United States. DESIGN: Statistical analysis. METHODS: We combined data collected
in 1997 and 1998 at 15 National Surveillance System for Health Care Workers
(NaSH) hospitals and 45 Exposure Prevention Information Network (EPINet)
hospitals. The combined data, taken as a sample of all U.S. hospitals, were
adjusted for underreporting. The estimate of the number of percutaneous
injuries nationwide was obtained by weighting the number of percutaneous
injuries at each hospital by the number of admissions in all U.S. hospitals
relative to the number of admissions at that hospital. RESULTS: The estimated
number of percutaneous injuries sustained annually by hospital-based HCWs was
384,325 (95% confidence interval, 311,091 to 463,922). The number of
percutaneous injuries sustained by HCWs outside of the hospital setting was not
estimated. CONCLUSIONS: Although our estimate is smaller than some previously
published estimates of percutaneous injuries among HCWs, its magnitude remains
a concern and emphasizes the urgent need to implement prevention strategies. In
addition, improved surveillance could be used to monitor injury trends in all
healthcare settings and evaluate the impact of prevention interventions
(46) Patrick RW. Ouch! Sharps and the needle-stick
challenge. Emergency Medical Services 2004; 33(10):139.
ABSTRACT: Needle-sticks and related sharps exposures occur all too often in the
prehospital setting. Prevention is the goal. If the unfortunate happens, report
the exposure to your employer immediately, following the steps listed above, to
ensure appropriate follow-up care. ESO management should establish sound policy
with supporting procedures so that every provider can comply with the
applicable expectations
(47) Perry J. The CDC Workbook: Total sharps-injury
improvement. Outpatient Surgery Magazine 2004; 5(6):84-85.
(48) Perry J, Robinson ES, Jagger J. Needle-stick
and sharps-safety survey. Getting to the
point about preventable injuries. Nursing2004 2004; 34(4):43-47.
ABSTRACT: In the Septmeber issue of Nursing 2003, readers were invited to
participate in a needle-stick and sharps-safety survey. A total of 498 nurses responded to the
questions, providing insightful comments about the utilization of
safety-engineered devices.
(49) Perry J, Jagger J. A tale of two safety
conversions. Nursing2004 2004; 34(6):70.
(50) Perry J, Jagger J. OSHA cracks downon
sharps-safety violators. Nursing2004 2004; 34(3):68.
ABSTRACT: The Occupational Safety and Health Administration (OSHA) is cracking
down on facilities that don't comply with sharps-safety regulations. Two citations issued in 2003 show that health
care facilities must fully comply with OSHA's requirement to use
safety-engineered sharp devices or pay a price.
(51) Perry J, Robinson ES, Jagger J. Needle-Stick
and Sharps-Safety Survey. Nursing2004 2004; 34(4):43-47.
ABSTRACT: In the September issue of Nursing2003,
readers were invited to participate in a needle-stick and sharps-safety
survey. A total of 498 nurses responded
to the questions, providing insightful comments about the availability and
utilization of safety-engineered devices.
The survey results reflect progress
in implementing safety devices and preventing sharps injuries in the health
care workplace, and provide information about areas of noncompliance. The results also underscore the need for
ongoing efforts in implemenating safety technology for all procedures where
it's available and appropriate and for continued vigilance in monitoring
compliance.
(52) Perry J, Jagger J. Tips on implementing safety
devices. Nursing2004 2004; 34(8):73.
ABSTRACT: The National Institute for Occupational Safety and Health Web site,
www.cdc.gov/niosh/topics/bbp/safer, offers five steps for implementing
safety-engineered sharps, along with tips from health care facilities that have
followed them.
(53) Perry J, Jagger J. Getting the most from your
personal protective gear. Nursing 2004; 34(12):72.
ABSTRACT: Prevent dangerous exposures to blood and body fluid by correctly
putting on, using, and removing personal protective equipment (PPE). To void or limit contact with blood and body
fluids (BBF), follow these guidelines from the Centers for Disease Control and
Prevention.
(54) Perry J. Survey Says Sharps Safety Lagging.
Outpatient Surgery Magazine 2004; 5(9):99.
ABSTRACT: What does your
sharps-safety training program look like?
Are safety sharps widely availa ble to your staff? For many of you, the answers might not be
what they ought to be. According to the
results of a survey, many healthcare facilities aren't doing a very good job of
training workers on how to use safety sharps correctly and consistently, and
many employees don't even have access to them.
The survey showed that sharps-safety
implementation, three-and-a-half years after OSHA mandated it, is a mixed
picture. Of the nearly 500 nurses who responded, 13
percent said they don't use or seldome use safety devices in their
facilities. Many with access to safety
devices said they'd had little or no training on how to use them.
(55) Perry J. Only Total Safety-Sharps Compliance
Will Do. Outpatient Surgery Magazine 2004; 5(January 2004):59-61.
ABSTRACT: A recent citation by the Occupational Safety and Health
Administration (OSHA) shows that facilities that are in the process of
converting to safety devices, and have made substantial progress in doing so,
are still subject to fines for using conventional devices when safety
alternatives are available.
(56) Perry J, Jagger J. Getting the most from your
personal protective gear. Nursing2004 2004; 34(12):72.
ABSTRACT: Prevent dangerous exposures to blood and body fluid by correctly
putting on, using, and removing personal protective equipment (PPE). To avoid or limit contact with blood and body
fluids (BBF), follow these guidelines from the Centers for Disease Control and
Prevention.
(57) Perry J, Jagger J. Collecting umbilical cord
blood. Nursing2004 2004; 34(10):20.
ABSTRACT: Since the Needlestick Safety and Prevention Act was passed more than
3 years ago, health care facilities in the United States have made substantial
progress in implementing safety-engineered devices. But for some specialized procedures, finding
a safe alternative to sharp devices can still be challenging. One example is umbilical cord blood
collection.
(58) Perry J. One Surgeon's Crusade for Safer Ors.
Outpatient Surgery Magazine 2004; 5(2):68-70.
ABSTRACT: Mark avis, MD, is a
gynecologic surgeon, an OR-safety consultant and author of the book Advanced
Precautions for Today's OR: The Operating Room Professional's Handbook for the
Prevention of Sharps Injuries and Bloodborne Exposures.
(59) Perry J, Jagger J. Administering smallpox
vaccine: A two-pronged risk. Nursing2004 2004; 34(1):30.
ABSTRACT: Administering smallpox vaccine doubles your risks: exposure to the
patient's blood and body fluids and exposure to vaccinia (the virus in the
vaccine) through an accidential needle stick or inadvertent inoculation. Related to the smallpox virus, live vaccinia
poses a risk of mild to life-threatening adverse reactions if you're
accidentally inoculated.
(60) Perry J, Jagger J. A tale of two safety
conversions. Nursing2004 2004; 34(6):70.
ABSTRACT: Since the Needlestick Safety and Prevention Act took full effect in
April 2001, health care facilities have been switching to safety-engineered
needle devices. Here's how two hospitals
tailored the process to their needs.
(61) Perry J, Jagger J. Ground-Breaking Citations
Issued By OSHA For Failure To Use Safety
Devices. AOHP Journal 2004; 24(3):20-22.
ABSTRACT: Maximum Penalty Issued to Nursing Home for " Willful"
Violation. Two citations issued by
the Occupational Safety and Health Administration (OSHA) in the last six
months--to Beaver Valley Nursing and Rehabilitation Home (BVNRH) and its parent
company Northern HealthFacility, Inc., in Beaver Falls, Pennsylvania, and
Montefiore Medical Center in New York City--show that the federal agency is
looking for full compliance with the requirement to use safety-engineered sharp
devices, and that it is willing to impose big fines when they are not
implemented facility-wide. Since the
bloodborne pathogens standard (BPS) was revised in 2001 to clarify and
emphasize the requirement to use safety devices to reduce bloodborne pathogen
exposure risk, the number of citations issued by OSHA for BPS violations has
increased dramatically. These two
citations, however, break new ground--one for the size
of the fine imposed, the other for its detail and scope. In both cases, the facilities are contesting
the citations.
(62) Perry J. The CDC Workbook: Total Sharps-injury
Improvement. Outpatient Surgery Magazine 2004; June 2004:84-85.
ABSTRACT: Let me walk you through a new online workbook from the Centers for
Disease Control and Prevention (CDC) that offers the most comprehensive program
yet for implementing and maintining a sharps-injury prevention program.
(63) Perry J, Metules T. How to avoid needlesticks.
RN 2004; 67(11):28ns2-28ns7.
ABSTRACT: In 2000, the Needlestick
Prevention and Safety Act made it mandatory for hospitals to provide nurses
with safety devices for sharps injury protection and to solicit their input on
which ones to select. Yet, nearly four
years later, many healthcare facilities are still not fully compliant.
Hospitals that don't take the law
seriously could face big fines. In fact,
one facility was recently fine $70,000--the maximum penalty for a willful
violation--for failing to provide frontline workers with safety devices. The facility had to shell out an additional
$22,000 for deficiencies in its exposure control plan and another $5,000 for
failing to remove a single sharps disposal container that was filled to the
top.
These citations represent a
milestone in needlestick safety. While
the facility above did take some steps, OSHA sent a message that partial
compliance is not good enough.
(64) Pugliese G, Bartley JM. On point. Reducing
sharps injuries in the ES department. Health Facilities Management 2004;
17(5):35-39.
ABSTRACT: On a daily basis, housekeeping, laundry and other types of
environmental services personnel are at risk of being injured by contaminated
sharps while performing their routine duties.
Sharps injuries can occur when emptying trash containers, replacing
over-filled sharps disposal containers, picking up glass or sharps from the
floor, or processing laundry or linens in which sharps have been placed by
other health care personnel
(65) Rogues AM, Verdun-Esquer C., Buisson-Valles
I., Laville MF., Lasheras A., Sarrat A. et al. Impact of safety devices for preventing percutaneous
injuries related to phlebotomy procedures in health care workers. Am J Infect
Control 2004; 32(8):441-444.
ABSTRACT: BACKGROUND: Use of protective devices has become a common
intervention to decrease sharps injuries in the hospitals; however few studies
have examined the results of implementation of the different protective devices
available. OBJECTIVE: To determine the effectiveness of 2 protective
devices in preventing needlestick injuries to health care workers. METHODS:
Sharps injury data were collected over a 7-year period (1993-1999) in a
3600-bed tertiary care university hospital in France. Pre- and
postinterventional rates were compared after the implementation of 2 safety
devices for preventing percutaneous injuries (PIs) related to phlebotomy
procedures. RESULTS: From 1993 to 1999, an overall decrease in the
needlestick-related injuries was noted. Since 1996, the incidence of
phlebotomy-related PIs has significantly decreased. Phlebotomy procedures
accounted for 19.4% of all percutaneous injuries in the preintervention period
and 12% in the postintervention period (RR, O.62; 95% CI, 0.51-0.72; P <
.001). Needlestick-related injuries incidence rate decreased significantly
after the implementation of the 2 safety devices, representing a 48% decline in
incidence rate overall. CONCLUSIONS: The implementation of these safety
devices apparently contributed to a significant decrease in the percutaneous
injuries related to phlebotomy procedures, but they constitute only part of a
strategy that includes education of health care workers and collection of
appropriate data that allow analysis of residuals percutaneous injuries
(66) Rogues AM, Verdun-Esquer C, Buisson-Valles I,
Laville MF, Lasheras A, Sarrat A et al. Impact of safety devices for preventing percutaneous
injuries related to phlebotomy procedures in health care workers. Am J Infect
Control 2004; 32(8):441-444.
ABSTRACT: BACKGROUND: Use of protective devices has become a common
intervention to decrease sharps injuries in the hospitals; however few studies
have examined the results of implementation of the different protective devices
available. OBJECTIVE: To determine the effectiveness of 2 protective devices in
preventing needlestick injuries to health care workers. METHODS: Sharps injury
data were collected over a 7-year period (1993-1999) in a 3600-bed tertiary
care university hospital in France. Pre- and postinterventional rates were
compared after the implementation of 2 safety devices for preventing
percutaneous injuries (PIs) related to phlebotomy procedures. RESULTS: From
1993 to 1999, an overall decrease in the needlestick-related injuries was
noted. Since 1996, the incidence of phlebotomy-related PIs has significantly
decreased. Phlebotomy procedures accounted for 19.4% of all percutaneous
injuries in the preintervention period and 12% in the postintervention period
(RR, O.62; 95% CI, 0.51-0.72; P < .001). Needlestick-related injuries
incidence rate decreased significantly after the implementation of the 2 safety
devices, representing a 48% decline in incidence rate overall. CONCLUSIONS: The
implementation of these safety devices apparently contributed to a significant
decrease in the percutaneous injuries related to phlebotomy procedures, but
they constitute only part of a strategy that includes education of health care
workers and collection of appropriate data that allow analysis of residuals
percutaneous injuries
(67)
Romero de Lama MC, Gomez SE, Quintana
Gomez JL. [Acute
hepatitis C in a health worker after accidental exposure.]. [Spanish].
Atencion Primaria 2004; 33(5):284-285.
ABSTRACT: Introducción. Entre leas
enfermedades profesionales más comunes en el personal sanitario incluimos la
hepatitis viral. Hoy dia, y debido en
partre a la introducción de la vacuna frente al virus de la hepatitis B (VHB) y
al desarrollo de programas de vacunación sistenática del personal sanitario, la
incidencia de infección por VHB has disminuido.
Asi, en el momento actual, la mayor parte de las hepatitis virales en el
personalsanitario se deben a virus de la hepatitis C (VHC). El riesgo de infección por VHC en sanitarios
como consecuencia de su activadad laboral tras la exposición accidental con
agujas se estima que es del 0-3%, y la carga viral inoculada es uno de los factores
que pueden influir en la probabilidad de adquirir la infección (a mayor carga
viral, mayor riesgo). La incidencia de
hepatitis aguda por VHC no es alta, aunque cabe la posibilidad de que algunos
casos pasen despercibidos si no se realiza un seguimiento serológico tras
inoculación accidental, ya que la mayoria de los casos cursa de forma
asintomática
(68) Shelton P,
Rosenthal K. Sharps injury prevention: select a safer needle. [Review] [16
refs]. Nursing Management 2004; 35(6):25-31.
ABSTRACT: Explore the clinical benefits of passive safety needles, including
reduced exposure risk, ease of use, and minimal training requirements.
[References: 16]
(69) Silverman R. New guide to safer sharps for the
OR. Or Manager 2004; 20(5):22-23.
ABSTRACT: Many health care workers--from
physicians and nurses to housekeeping personnel and waste handlers--are at risk
of accidental injuries from needles and other potentially contaminated sharps,
with potential for exposure to bloodborne pathogens.
Sharps and needlestick safety has
received a lot of attention, especially since Congress passed the Needlestick
Safety and Prevention Act in 2000 requiring hospitals to implement protective
devices. Many facilities have
successfully implemented injury prevention devices, such as protective blood
collection needles and needleless intravenous connectors.
Though needlestick injuries generally
receive the most attention, dangerous injuries also can be caused by other
sharps, such as sutures, scalpels, and glass capillary tubes. In fact, a detailed analysis from the
International Health Care Worker Safety Center's EPINet data from 2000 and 2001
led Perry et al to conclude that "scalpel blades are more likely than
needles to cause deep or otherwise severe injuries." Thus, facilities need to take steps to
protect workers from injuries caused by these types of devices as well.
(70) Sohn S, Eagan J, Sepkowitz KA, Zuccotti G.
Effect of implementing safety-engineered devices on percutaneous injury
epidemiology.[see comment]. Infect Control Hosp Epidemiol 2004; 25(7):536-542.
ABSTRACT: OBJECTIVE: To assess the effect of implementing safety-engineered
devices on percutaneous injury epidemiology, specifically on percutaneous
injuries associated with a higher risk of blood-borne pathogen exposure.
DESIGN: Before-and-after intervention trial comparing 3-year preintervention
(1998--2000) and 1-year postintervention (2001--2002) periods. Percutaneous
injury data have been entered prospectively into CDC NaSH software since 1998.
SETTING: A 427-bed, tertiary-care hospital in Manhattan. PARTICIPANTS: All
employees who reported percutaneous injuries during the study period.
INTERVENTION: A "safer-needle system," composed of a variety
of safety-engineered devices to allow for needle-safe IV delivery, blood
collection, IV insertion, and intramuscular and subcutaneous injection, was
implemented in February 2001. RESULTS: The mean annual incidence of
percutaneous injuries decreased from 34.08 per 1,000 full-time-equivalent
employees preintervention to 14.25 postintervention (P < .001).
Reductions in the average monthly number of percutaneous injuries resulting
from both low-risk (P < .01) and high-risk (P was not significant)
activities were observed. Nurses experienced the greatest decrease (74.5%, P
< .001), followed by ancillary staff (61.5%, P = .03). Significant rate
reductions were observed for the following activities: manipulating patients or
sharps (83.5%, P < .001), collisions or contact with sharps (73.0%, P =
.01), disposal-related injuries (21.41%, P = .001), and catheter insertions
(88.2%, P < .001). Injury rates involving hollow-bore needles also
decreased (70.6%, P < .001). CONCLUSIONS: The implementation of
safety-engineered devices reduced percutaneous injury rates across occupations,
activities, times of injury, and devices. Moreover, intervention impact was
observed when stratified by risk for blood-borne pathogen transmission
(71) Tansley P. Infection of patients by bloodborne
viruses (Br J Surg 2004; 91: 395-399). British Journal of Surgery 91(6):778,
2004.
ABSTRACT: The Editors welcome topical correspondence from readers relating to
articles published in the Journal. Responses can be sent electronically via the
BJS website (www.bjs.co.uk) or by post. All letters will be reviewed and, if
approved, appear on the website. A selection of these will be edited and
published in the Journal. Letters must be no more than 250 words in length.
Letters submitted by post should be typed on A4-sized paper in double spacing
and should be accompanied by a disk. Copyright 2004 British Journal of Surgery
Society Ltd. Published by John Wiley & Sons, Ltd
(72) Trape-Cardoso M, Schenck P. Reducing
percutaneous injuries at an academic health center: a 5-year review. Am J
Infect Control 2004; 32(5):301-305.
ABSTRACT: BACKGROUND: The University of Connecticut Health Center Employee
Health Service collected and used National Surveillance System for Hospital
Health Care Workers (NaSH) data to (1) improve surveillance of health care
worker blood and body fluid exposures (BBFEs) and (2) target specific
interventions for higher-risk groups (nursing staff, medical and dental
students, and residents). METHODS: All 870 BBFE incidents were ABSTRACTed from
the NaSH database from the 1997 through 2002 academic years. Incidence rates
per 100 full-time-equivalent workers were determined for each targeted
occupation group with 95% confidence intervals. RESULTS: The number of
percutaneous injuries declined among medical/dental students and nursing staff,
and to a lesser degree for residents. The incidence rates decreased from 7.9%
in 2000 to 2001 to 2.6% in 2001 to 2002 for students and from 9.2% in 1997 to
1998 to 2.7% in 2001 to 2002 for nursing staff. CONCLUSIONS: Data from a
surveillance database provided guidance for administrative, educational, and
engineering control interventions. Active surveillance and periodic review of
interventions are important aspects to reduce BBFEs in targeted high-risk
occupational groups, especially when the workforce has a high turnover, as is typical
in academic health centers
(73) Trim JC. A review of needle-protective devices
to prevent sharps injuries. [Review] [34 refs]. British Journal of Nursing
2004; 13(3):144-153.
ABSTRACT: The risk of occupational transmission of blood-borne pathogens via
sharp devices remains a significant hazard to both healthcare and ancillary
workers. Previously, education, training, universal precautions and hepatitis B
vaccination have been implemented in an attempt to reduce the risk. However,
the most recent preventive strategy is needle-protective devices. These have
been developed from conventional products but incorporate a safety mechanism
that, when activated, covers the needletip and thus assists in the prevention
of needlestick injuries and potential seroconversion to blood-borne pathogens.
To date, a number of studies have been undertaken to evaluate these products,
the majority of which show these devices to be safe and reliable in addition to
potentially reducing associated needlestick injuries. However, to encourage the
introduction of these devices in the UK, further studies are needed to either
support or refute initial findings and to encourage the evaluation and
subsequent implementation of needle-protective devices. [References: 34]
(74) Trossman S. A 'Safety Net': an ANA workshop
creates a cadre of experts on needlestick injury prevention. American Journal
of Nursing 2004; 104(8):69-2.
ABSTRACT: When Vonna Cranston, MS, RN, first became a nurse in 1973, she didn't
worry about contrcting a bloodborne illness from one of her patients. Neither did her peers.
(75) Watson KJ. Surgeon, test (and heal) thyself:
sharps injuries and hepatitis C risk. [Review] [18 refs]. Medical Journal of
Australia 2004; 181(7):366-367.
ABSTRACT: Sharps injuries experienced by surgeons are common, but are
under-recognised and under-reported. The overall risks of transmission of
blood-borne viruses to surgeons are low, with hepatitis C posing the greatest
transmission risk. Recent trials show that early treatment of acute hepatitis C
results in a cure rate approaching 100%. Surgeons and theatre staff should be
encouraged to report and follow up sharps injuries to allow early detection and
treatment. Additionally, because exposures to blood-borne viruses may be
unrecognised, surgeons should have regular tests for blood-borne viruses. There
should be no restriction of practice in the "window period" between
potential exposure and obtaining results of testing, because of the overall low
risk of transmission. [References: 18]
(76) Watterson L. Monitoring sharps injuries:
EPINet surveillance results.[see comment]. [Review] [17 refs]. Nursing Standard
2004; 19(3):33-38.
ABSTRACT: Sharps injuries are one of the main types of accident sustained by
NHS staff. The RCN's Be Sharp Be Safe campaign was launched in 2001 with the
aim of reducing sharps injuries and includes a surveillance project to describe
the current pattern of sharps injuries being experienced in participating
trusts. This article gives an overview of the results from the second year of
the surveillance project and indicates how the data can be used to help improve
practice. Nurses emerge as the staff group reporting the highest proportion of
injuries recorded in the study period. The most common sharps injury scenario
involves nurses giving injections in the patient's room or ward area. Aspects
of poor disposal practice and incidents involving the recapping of needles
continue to result in injuries and are worthy of further investigation.
Analysis of the data by location can highlight specific tasks which could be
reviewed to identify safer working practices. [References: 17]
(77) At-home sharps disposal causes concern. Home
Healthcare Nurse 2003; 21(11):722-723.
ABSTRACT: With more patients managing their health at home, communities are
seeing an increase in "at-home" sharps usage. Approximately 2 billion injections per year
are self-administered by people with disabilities and patients receiving home
healthcare treatment for allergies, infertility, multiple sclerosis, migraines,
etc.
(78) What OSHA inspectors look for in visits to the
operating room. Or Manager 2003; 19(3):1-7.
ABSTRACT: If OSHA comes to your facility and visits the OR, inspectors will
want to see that surgeons and staff are using no-hands passing of sharps-or
have at least attempted to implement it.
The same is true for safety scalpels and blunt suture needles
(79) Abdul MS, Adil MM, Altaf A, Hutin Y, Luby S.
Recycling of injection equipment in Pakistan. Infect Control Hosp Epidemiol
2003.
ABSTRACT: The prevalence of hepatitis C virus (HCV) infection is high in the
general population in Pakistan, ranging from 2% to 6%. Reuse of injection equipment in the absence
of sterilization is common, particularly in healthcare facilities that serve
low-income populations. Studies have
identified unsafe injection practices as a major route of transmission of HCV
in Pakistan. Changing the behavior of
injection providers so that they would use new freshly opened disposable
syringes would improve injection safety in Pakistan. However, frequent reports of recycling of
injection equipment in the local media question the safety of apparently new
syringes. Clinical laboratories are one
of the major sources of production of used syringes. To evaluate the resale of used syringes, we
followed the course of used syringes from their initial use to their final
destination.
(80) Adams D, Elliott TS. A comparative user
evaluation of three needle-protective devices. British Journal of Nursing 2003;
12(8):470-474.
ABSTRACT: Needlestick injuries (NSI) can result in healthcare workers being
exposed to blood-borne viruses. Between 1997 and 2002, three healthcare workers
in the UK have seroconverted to hepatitis C and one to human immunodeficiency
virus (Public Health Laboratory Service (PHLS), 2003). Experience both in the
UK and the USA suggests that even robust educational strategies may be
insufficient to reduce the number of occupationally acquired NSI (Jagger et al,
1988). Needle-protective devices have now become more widely available and
several studies have demonstrated an associated reduced risk of NSK. It is,
however, essential that the devices are appropriately evaluated before
introduction to ensure that they meet user requirements, do not interfere with
function and reduce NSI risk. This article describes an evaluation programme
carried out at the University Hospital Birmingham, UK. The programme focused on
three key areas: safety, usability and compatibility. Results demonstrated that
nurses rapidly adapt their practices to use the new safety devices and the
study highlighted key education requirements that would be required before
implementation. In addition, without this evaluation, it would not have been
identified that attachment of the safety needles to the syringes requires a
push-and-twist method or the use of LuerLok syringes to prevent detachment on
activation of the safety procedure
(81)
Alvarado-Ramy F, Beltrami EM. New guidelines for occupational
exposure to blood-borne viruses. [Review] [30 refs]. Cleveland Clinic Journal
of Medicine 2003; 70(5):457-465.
ABSTRACT: The US Public Health Service recently updated its guidelines for
managing health care workers exposed to blood or other body fluids that might
contain blood-borne viruses. The update addresses, among other things, timely
administration of hepatitis B immune globulin and hepatitis B vaccine,
appropriate testing for hepatitis C exposure, and new information on
prophylaxis after exposure to human immunodeficiency virus (HIV). [References:
30]
(82) Alvarado-Ramy F, Beltrami EM, Short LJ,
Srivastava PU, Henry K, Mendelson M et al. A comprehensive approach to
percutaneous injury prevention during phlebotomy: results of a multicenter
study, 1993-1995. Infect Control Hosp Epidemiol 2003.
ABSTRACT: OBJECTIVE: To examine a comprehensive approach for preventing
percutaneous injuries associated with phlebotomy procedures. DESIGN AND
SETTING: From 1993 through 1995, personnel at 10 university-affiliated
hospitals enhanced surveillance and assessed underreporting of percutaneous
injuries; selected, implemented, and evaluated the efficacy of phlebotomy
devices with safety features (ie, engineered sharps injury prevention devices
[ESIPDs]); and assessed healthcare worker satisfaction with ESIPDs. Investigators
also evaluated the preventability of a subset of percutaneous injuries and
conducted an audit of sharps disposal containers to quantify activation rates
for devices with safety features. RESULTS: The three selected phlebotomy
devices with safety features reduced percutaneous injury rates compared with
conventional devices. Activation rates varied according to ease of use,
healthcare worker preference for ESIPDs, perceived "patient adverse
events," and device-specific training. CONCLUSIONS: Device-specific
features and healthcare worker training and involvement in the selection of
ESIPDs affect the activation rates for ESIPDs and therefore their efficacy. The
implementation of ESIPDs is a useful measure in a comprehensive program to
reduce percutaneous injuries associated with phlebotomy procedures
(83) Babcock HM, Fraser V. Differences in
percutaneous injury patterns in a multi-hospital system. Infect Control Hosp
Epidemiol 2003; 24(10):731-736.
ABSTRACT: OBJECTIVE: Determine differences in patterns of percutaneous injuries
(PIs) in different types of hospitals. DESIGN: Case series of injuries
occurring from 1997 to 2001. SETTING: Large midwestern healthcare system with a
consolidated occupational health database from 9 hospitals, including rural and
urban, community and teaching (1 pediatric, 1 adult) facilities, ranging from
113 to 1,400 beds. PARTICIPANTS: Healthcare workers injured between 1997 and
2001. RESULTS: Annual injury rates for all hospitals decreased during the study
period from 21 to 16.5/100 beds (chi-square for trend = 22.7; P = .0001).
Average annual injury rates were higher at larger hospitals (22.5 vs 9.5
PIs/100 beds; P = .0001). Among small hospitals, rural hospitals had higher
rates than did urban hospitals (14.87 vs 8.02 PIs/100 beds; P = .0143). At
small hospitals, an increased proportion of injuries occurred in the emergency
department (13.7% vs 8.6%; P = .0004), operating room (32.3% vs 25.4%; P =
.0002), and ICU (12.3% vs 9.4%; P = .0225), compared with large hospitals. Rural
hospitals had higher injury rates in the radiology department (7.7% vs 2%; P =
.0015) versus urban hospitals. Injuries at the teaching hospitals occurred more
commonly on the wards (28.8% vs 24%; P = .0021) and in ICUs (11.4% vs 7.8%; P =
.0006) than at community hospitals. Injuries involving butterfly needles were
more common at pediatric versus adult hospitals (15.8% vs 6.5%; P = .0001). The
prevalence of source patients infected with HIV and hepatitis C was higher at
large hospitals. CONCLUSIONS: Significant differences exist in injury rates and
patterns among different types of hospitals. These data can be used to target
intervention strategies
(84) Baffoy-Fayard N, Maugat S, Sapoval M, Cluzel
P, Denys A, Sellier N et al. Potential exposure to hepatitis C virus through
accidental blood contact in interventional radiology. Journal of Vascular &
Interventional Radiology 2003; 14(2 Pt 1):173-179.
ABSTRACT: PURPOSE: To quantify the prevalence of accidental blood exposure
(ABE) among interventional radiologists and contrast that with the prevalence
of patients with hepatitis C virus (HCV) undergoing interventional radiology
procedures. MATERIALS AND METHODS: A multicenter epidemiologic study was
conducted in radiology wards in France. The risk of ABE to radiologists was
assessed based on personal interviews that determined the frequency and type of
ABE and the use of standard protective barriers. Patients who underwent
invasive procedures underwent prospective sampling for HCV serologic analysis.
HCV viremia was measured in patients who tested positive for HCV. RESULTS: Of
the 77 radiologists who participated in 11 interventional radiology wards, 44%
reported at least one incident of mucous membrane blood exposure and 52%
reported at least one percutaneous injury since the beginning of their
occupational activity. Compliance with standard precautions was poor,
especially for the use of protective clothes and safety material. Overall, 91
of 944 treated patients (9.7%) tested positive for HCV during the study period,
of whom 90.1% had positive viremia results, demonstrating a high potential for
contamination through blood contacts. CONCLUSIONS: The probability of HCV
transmission from contact with contaminated blood after percutaneous injury
ranged from 0.013 to 0.030; the high frequency of accidental blood exposure and
high percentage of patients with HCV could generate a risk of exposure to HCV
for radiologists who perform invasive procedures with frequent blood contact.
The need to reinforce compliance with standard hygiene precautions is becoming
crucial for medical and technical personnel working in these wards
(85) Beltrami EM, Kozak A, Williams IT, Saekhou AM,
Kalish ML, Nainan OV et al. Transmission of HIV and hepatitis C virus from a
nursing home patient to a health care worker.[see comment]. Am J Infect Control
2003; 31(3):167-175.
ABSTRACT: BACKGROUND: We report a case of simultaneous HIV and hepatitis C
virus (HCV) transmission from a nursing home patient to a health care worker
(HCW) whose HIV and HCV infections were diagnosed during routine blood donor
screening. METHODS: Detailed information about the HCW, possible occupational
and nonoccupational blood and body fluid exposures, and possible source patient
was collected. Blood samples were drawn from the HCW and patient, and HIV and
HCV laboratory testing was performed at the Centers for Disease Control and
Prevention. RESULTS: The HCW, who worked as a nursing home aide, had no
nonoccupational risk factors for HIV or HCV infection but provided care for 1
HIV-infected patient with dementia and urinary and fecal incontinence. The HCW
had numerous exposures to the patient's emesis, feces, and urine to unprotected
chapped and abraded hands. HCW and patient blood samples were positive for
anti-HCV by enzyme immunoassay and recombinant immunoblot assay testing. The
HCW's and patient's HCV were genotyped as 1a, and their HIV-1 was genotyped as
subtype B. HIV and HCV ribonucleic acid (RNA) sequence analysis showed that the
HCW's and patient's viruses were very closely related. CONCLUSIONS: HIV and HCV
transmission from the patient to the HCW appears to have occurred through
nonintact skin exposure. Bloodborne pathogen transmission may have been
prevented in this situation by consistent, unfailing use of barrier precautions
(86) Beltrami EM, Cheingsong R, Heneine WM, Respess
RA, Orelien JG, Mendelson MH et al. Antiretroviral drug resistance in human
immunodeficiency virus-infected source patients for occupational exposures to
healthcare workers. Infect Control Hosp Epidemiol 2003; 24(10):724-730.
ABSTRACT: OBJECTIVE: To assess the prevalence of HIV antiretroviral resistance
among source patients for occupational HIV exposures. DESIGN: Blood and data
(eg, stage of HIV, previous antiretroviral drug therapy, and HIV RNA viral
load) were collected from HIV-infected patients who were source patients for
occupational exposures. SETTING: Seven tertiary-care medical centers in five
U.S. cities (San Diego, California; Miami, Florida; Boston, Massachusetts;
Albany, New York; and New York, New York quarters filled circle]; [three
quarters filled circle] sites]) during 1998 to 1999. PARTICIPANTS: Sixty-four
HIV-infected patients who were source patients for occupational exposures.
RESULTS: Virus from 50 patients was sequenced; virus from 14 patients with an
undetectable (ie, < 400 RNA copies/mL) viral load could not be
sequenced. Overall, 19 (38%) of the 50 patients had primary genotypic mutations
associated with resistance to reverse transcriptase or protease inhibitors.
Eighteen of the 19 viruses with primary mutations and 13 wild type viruses were
phenotyped by recombinant assays; 19 had phenotypic resistance to at least one
antiretroviral agent. Of the 50 source patients studied, 26 had taken
antiretroviral agents in the 3 months before the occupational exposure
incident. Sixteen (62%) of the 26 drug-treated patients had virus that was
phenotypically resistant to at least one drug. Four (17%) of 23 untreated
patients had phenotypically resistant virus. No episodes of HIV transmission
were observed among the exposed HCWs. CONCLUSIONS: There was a high prevalence
of drug-resistant HIV among source patients for occupational HIV exposures.
Healthcare providers should use the drug treatment information of source
patients when making decisions about post-exposure prophylaxis
(87) Bosch X. Second case of doctor-to-patient HIV
transmission. The Lancet Infectious Diseases 2003; 3(5):261.
ABSTRACT: In March, Spanish health authorities reported what is believed to be
the second world case of doctor-to-patient HIV transmission. The case involves
a gynaecologist who passed on HIV to a woman during a caesarean section. The
Official Medical College of Barcelona (COMB) announced the case on March 18
after it was leaked to the press that another woman assisted by the same
gynaecologist had been recalled for an HIV test.
(88) Bricout F, Moraillon A, Sonntag P, Hoerner P,
Blackwelder W, Plotkin S. Virus-inhibiting surgical glove to reduce the risk of
infection by enveloped viruses. Journal of Medical Virology 2003;
69(4):538-545.
ABSTRACT: Needle puncture and other accidents that occur during surgery and
other procedures may lead to viral infections of medical personnel, notably by
hepatitis C (HCV) and human immunodeficiency virus (HIV), now that hepatitis B
can be prevented by vaccination. A new surgical glove called G-VIR, which
contains a disinfecting agent for enveloped viruses, has been developed. Herpes
simplex type 1 (HSV) was used as a standard enveloped virus in both in vitro and
in vivo tests of the virucidal capacity of the glove. Bovine viral diarrhea
virus (BVDV) and feline immunodeficiency virus (FIV) were used as models for
HCV and HIV, respectively. For in vitro study, a contaminated needle was passed
through a glove and residual virus was titrated; for in vivo studies, animals
were stuck with a contaminated needle through a glove. Despite variation in
virus enumeration inherent in the puncture technique, statistical evaluation
showed that infection was reproducibly and substantially reduced by passage
through the virucidal layer. For BVDV, the amount of virus passing through the
virucidal glove was reduced in 82% of pairwise comparisons with control gloves
that lacked the virucidal agent; when plaque counts were adjusted to a common
dilution, the median count for the virucidal glove was on the average reduced
>10-fold. In experiments in which the proportion of wells infected with FIV
was measured, the ratio of TCID(50) values (control glove to G-VIR) was >15,
and probably much higher. For HSV, the amount of virus passing through the
virucidal glove was reduced in 81% of comparisons with control gloves; the
median of adjusted plaque counts was reduced on the average approximately
eightfold or ninefold. In vivo tests with FIV and HSV in cats and mice,
respectively, found smaller percentage reductions in infection than the in
vitro tests but confirmed the virucidal effect of the gloves. Copyright 2003
Wiley-Liss, Inc
(89) Denis MA, Ecochard R, Bernadet A, Forissier
MF, Porst JM, Robert O et al. Risk of occupational blood exposure in a cohort
of 24,000 hospital healthcare workers: position and environment analysis over
three years. Journal of Occupational & Environmental Medicine 2003;
45(3):283-288.
ABSTRACT: Early and efficient prevention of occupational blood exposure at
hospital requires knowledge of exposures and risks according to staff
characteristics. Calculation of annual exposure rates and relative rates from
personal and occupational data. The overall annual incidence was 3.5 per 100
workers per year; maximum for nurses and midwives (6.5); minimum for cleaners
and paramedics (0.6). Exposures affected mainly nurses (57.81% of accidents,
12.12% of cohort) and occurred mostly in the surgical and the medical
departments (26.34 and 25.20% of accidents). Men/women and students/physicians
rate differences were not significant. Emergency and intensive care staffs had
the highest relative rates (4.27 and 3.05) compared with maintenance staff.
Nurses and laboratory staff were more exposed than physicians (3.76 and 2.30
times) were. Our results prompt prevention and training to be precisely focused
and efficiently devised
(90) Do AN, Ciesielski CA, Metler RP, Hammett TA,
Li J, Fleming PL. Occupationally acquired human immunodeficiency virus (HIV)
infection: national case surveillance data during 20 years of the HIV epidemic
in the United States. Infect Control Hosp Epidemiol 2003.
ABSTRACT: OBJECTIVE: To characterize occupationally acquired human
immunodeficiency virus (HIV) infection detected through case surveillance
efforts in the United States. DESIGN: National surveillance systems, based on
voluntary case reporting. SETTING: Healthcare or laboratory (clinical or
research) settings. PATIENTS: Healthcare workers, defined as individuals
employed in healthcare or laboratory settings (including students and
trainees), who are infected with HIV. METHODS: Review of data reported through
December 2001 in the HIV/AIDS Reporting System and the National Surveillance
for Occupationally Acquired HIV Infection. RESULTS: Of 57 healthcare workers
with documented occupationally acquired HIV infection, most (86%) were exposed
to blood, and most (88%) had percutaneous injuries. The circumstances varied
among 51 percutaneous injuries, with the largest proportion (41%) occurring
after a procedure, 35% occurring during a procedure, and 20% occurring during
disposal of sharp objects. Unexpected circumstances difficult to anticipate
during or after procedures accounted for 20% of all injuries. Of 55 known source
patients, most (69%) had acquired immunodeficiency syndrome (AIDS) at the time
of occupational exposure, but some (11%) had asymptomatic HIV infection. Eight
(14%) of the healthcare workers were infected despite receiving postexposure
prophylaxis (PEP). CONCLUSIONS: Prevention strategies for occupationally
acquired HIV infection should continue to emphasize avoiding blood exposures.
Healthcare workers should be educated about both the benefits and the
limitations of PEP, which does not always prevent HIV infection following an
exposure. Technologic advances (eg, safety-engineered devices) may further
enhance safety in the healthcare workplace
(91) Doebbeling BN. Lessons regarding percutaneous
injuries among healthcare providers. Infect Control Hosp Epidemiol 2003.
ABSTRACT: This issue of Infection Control and Hospital Epidemiology contains
four important articles on the epidemiology and prevention of sharps or
percutaneous injuries among healthcare workers.
These articles as a group convincingly demonstrate the importance of a
multidimensional occupational safety programs within hospitals, including
surveillance and data analysis, administrative and engineering control
measures, consistent use of protective equipment, and safer personal work
practices.
(92) Edlich RF, Wind TC, Heather CL, Degnan GG,
Drake DB. Recommendations for postexposure prophylaxis of operating room
personnel and patients exposed to bloodborne diseases. [Review] [63 refs].
Journal of Long-Term Effects of Medical Implants 2003; 13(2):103-116.
ABSTRACT: The purpose of this collective review is to discuss management of
operating room personnel who have had occupational exposure to blood and other
body fluids that might contain hepatitis B virus (HBV), hepatitis C virus
(HCV), human immunodeficiency virus (HIV), and human T-cell lymphotropic virus
type I (HTLV-I). HBV postexposure prophylaxis includes starting hepatitis B
vaccine series in any susceptible unvaccinated operating room personnel who
sustain an exposure to blood or body fluid during surgery. Postexposure
prophylaxis with hepatitis B immune globulin (HBIG) is an important
consideration after determining the hepatitis B antigen status of the patient.
Ideally, all operating room personnel should be vaccinated with hepatitis B
vaccine before they pursue their career in surgery. Immune globulin and
antiviral agents (e.g., interferon with or without ribavirin) should not be
used for postexposure prophylaxis of operating room personnel exposed to
patients with HCV; rather, follow-up HCV testing should be initiated to
determine if infection develops. Postexposure prophylaxis for HIV involves a
basic four-week regimen of two drugs (zidovudine and lamivudine; lamivudine and
stavudine; or didanosine and stavudine) for most exposures. An expanded regimen
that includes a third drug must be considered for HIV exposures that pose an
increased risk for transmission. When developing a postexposure prophylaxis
regimen, it is helpful to contact the National Clinicians' Postexposure
Prophylaxis Hotline (1-888-448-4911). [References: 63]
(93) Edlich RF, Wind TC, Heather CL, Thacker JG.
Reliability and performance of innovative surgical double-glove hole puncture
indication systems. Journal of Long-Term Effects of Medical Implants 2003;
13(2):69-83.
ABSTRACT: During operative procedures, operating room personnel wear sterile
surgical gloves designed to protect them and their patients against
transmissible infections. The Food and Drug Administration (FDA) has set
compliance policy guides for manufacturers of gloves. The FDA allows surgeons'
gloves whose leakage defect rates do not exceed 1.5 acceptable quality level
(AQL) to be used in operating rooms. The implications of this policy are
potentially enormous to operating room personnel and patients. This
unacceptable risk to the personnel and patient could be significantly reduced
by the use of sterile double surgical gloves. Because double-gloves are also
susceptible to needle puncture, a double-glove hole indication system is
urgently needed to immediately detect surgical needle glove punctures. This
warning would allow surgeons to remove the double-gloves, wash their hands, and
then don a sterile set of double-gloves with an indication system. During the
last decade, Regent Medical has devised non-latex and latex double-glove hole
puncture indication systems. The purpose of this comprehensive study is to
detect the accuracy of the non-latex and latex double-glove hole puncture
indication systems using five commonly used sterile surgical needles: the taper
point surgical needle, tapercut surgical needle, reverse cutting edge surgical
needle, taper cardiopoint surgical needle, and spatula surgical needle. After
subjecting both the non-latex and latex double-glove hole puncture indication
systems to surgical needle puncture in each glove fingertip, these double-glove
systems were immersed in a sterile basin of saline, after which the
double-gloved hands manipulated surgical instruments. Within two minutes, both
the non-latex and latex hole puncture indication systems accurately detected
needle punctures in all of the surgical gloves, regardless of the dimensions of
the surgical needles. In addition, the size of the color change visualized
through the translucent outer glove did not correlate with needle diameter. On
the basis of this extensive experimental evaluation, both the non-latex and
latex double-glove hole puncture indication systems should be used in all
operative procedures by all operating room personnel
(94) Edlich RF, Wind TC, Hill LG, Thacker JG,
McGregor W. Reducing accidental injuries during surgery. Journal of Long-Term
Effects of Medical Implants 2003; 13(1):1-10.
ABSTRACT: Extensive clinical investigations have demonstrated that
double-gloves and blunt-tipped surgical needles dramatically reduced the risk
of accidental injuries during surgery. During the last decade, double-glove
hole puncture indication systems have been developed that reduce the clinical
risk of accidental needlestick injuries as well as detect the presence of glove
hole puncture in the presence of fluids. When the outer glove is punctured, the
colored underglove becomes apparent through the translucent outer glove,
necessitating glove removal, hand washing, and donning of another double-glove
hole puncture Indicator system. This article presents the first biomechanical
performance study that documents the puncture resistance of blunt surgical
needles in latex and nonlatex single gloves and double-glove hole puncture
indication systems. The technique for measuring glove puncture resistance
simulates the standard test for material resistance to puncture outlined by the
American Society for Testing and Materials. The maximum puncture resistance
force was measured by the compression load cell and recorded in grams with a strip
chart recorder. Ten puncture resistance measurements for the taper point
needle, blunt taper point needle, and blunt needle were taken from five samples
of the Biogel Indicator underglove, Biogel Super-Sensitive glove, Biogel glove,
Biogel Skinsense N Universal underglove, and Biogel Skinsense Polyisoprene
glove; and the Biogel, Biogel Super-Sensitive, and Biogel Skinsense
Polyisoprene double-glove hole puncture indication systems. The magnitude of
puncture resistance forces recorded was influenced by several factors: glove
material, number of glove layers, and type of surgical needle. For each type of
curved surgical needle,the resistance to needle penetration by the nonlatex
gloves was significantly greater than those encountered by the latex glove materials.
The resistance to needle puncture of all three double-glove systems was
significantly greater than that of either the nonlatex or latex underglove or
outer glove. The taper point needle encountered the lowest puncture resistance
forces in the five single gloves and the three double-glove systems. Blunting
the sharp end of the taper point needle markedly increased its resistance to
glove puncture in the five single gloves and five double-glove systems. The
blunt-point surgical needle elicited the greatest needle penetration force in
all of the single and double-glove systems
(95) Edlich RF, Wind TC, Hill LG, Thacker JG.
Resistance of double-glove hole puncture indication systems to surgical needle
puncture. Journal of Long-Term Effects of Medical Implants 2003; 13(2):85-90.
ABSTRACT: Double-gloving has been shown to reduce conclusively the risk of
operating room personnel's exposure to blood. Limiting risk of exposure to
blood by double-gloving provides protection against the transmission of
bloodborne diseases. Realizing the importance of double-gloving, a double-glove
hole puncture indication system exists that accurately detects the presence of
glove hole puncture in the presence of fluid. Once a glove puncture is
recognized by this double-glove hole puncture indication system, it provides a
warning to the surgeon to remove the punctured gloves, wash hands, and don a
new, sterile double-glove hole puncture indication system. While accurately
identifying the presence of glove hole puncture in the presence of fluid, this
double-glove hole puncture indication system also has resistance to needle
puncture superior to that of single gloves. It is the purpose of this study to
document the resistance to needle puncture of latex and non-latex double-glove hole
puncture indication systems using a reproducible experimental model. The
resistance to needle puncture of the double-glove systems was significantly
greater than that of the undergloves or outer gloves alone. The resistance to
glove puncture of the non-latex and latex single and double-glove systems was
significantly greater than those encountered by the latex single and
double-glove systems, respectively. On the basis of their accuracy in detecting
glove hole puncture, combined with their demonstrated superior resistance to
surgical needle puncture as compared to single gloves, these latex and
non-latex double-glove hole puncture indication systems are recommended for all
surgical procedures
(96) Edlich RF, Wind TC, Hill LG, Thacker JG.
Creating another barrier to the transmission of bloodborne operative infections
with a new glove gauntlet. Journal of Long-Term Effects of Medical Implants
2003; 13(2):97-101.
ABSTRACT: While disposable surgical gowns are designed to be either
liquid-resistant or liquid-proof apparel, the woven cuffs of surgical gowns are
easily permeable to water, an invitation to the transmission of bloodborne
infections. Regent Medical has redesigned the diameter of some of its surgical
glove gauntlets to enhance the security of the glove/surgical cuff interface.
The purpose of this biomechanical performance study was to evaluate the benefit
of a narrow glove gauntlet in enhancing the security of the gown and cuff
interface. Using three types of disposable gown, the narrow glove gauntlet
significantly increased the security of the gown-glove interface. On the basis
of this biomechanical performance study, Regent Medical has announced that it
will be using this narrow glove gauntlet design on more of their glove products
to further reduce the transmission of bloodborne operative infections
(97) Ezzati M, Hoorn SV, Rodgers A, Lopez AD,
Mathers CD, Murray CJ et al. Estimates of global and regional potential health
gains from reducing multiple major risk factors.[see comment]. Lancet 2003; 362(9380):271-280.
ABSTRACT: BACKGROUND: Estimates of the disease burden due to multiple risk
factors can show the potential gain from combined preventive measures. But few
such investigations have been attempted, and none on a global scale. Our aim
was to estimate the potential health benefits from removal of multiple major
risk factors. METHODS: We assessed the burden of disease and injury
attributable to the joint effects of 20 selected leading risk factors in 14
epidemiological subregions of the world. We estimated population attributable
fractions, defined as the proportional reduction in disease or mortality that
would occur if exposure to a risk factor were reduced to an alternative level,
from data for risk factor prevalence and hazard size. For every disease, we
estimated joint population attributable fractions, for multiple risk factors,
by age and sex, from the direct contributions of individual risk factors. To
obtain the direct hazards, we reviewed publications and re-analysed cohort data
to account for that part of hazard that is mediated through other risks.
RESULTS: Globally, an estimated 47% of premature deaths and 39% of total
disease burden in 2000 resulted from the joint effects of the risk factors
considered. These risks caused a substantial proportion of important diseases,
including diarrhoea (92%-94%), lower respiratory infections (55-62%), lung
cancer (72%), chronic obstructive pulmonary disease (60%), ischaemic heart
disease (83-89%), and stroke (70-76%). Removal of these risks would have
increased global healthy life expectancy by 9.3 years (17%) ranging from 4.4
years (6%) in the developed countries of the western Pacific to 16.1 years
(43%) in parts of sub-Saharan Africa. INTERPRETATION: Removal of major risk
factors would not only increase healthy life expectancy in every region, but
also reduce some of the differences between regions. The potential for disease
prevention and health gain from tackling major known risks simultaneously would
be substantial
(98) Fairfax R. Richard Fairfax of OSHA talks about
the bloodborne pathogens standard. Interview by Dennis Ernst. Mlo: Medical
Laboratory Observer 2003; 35(2):32-34.
ABSTRACT: Interview with Richard Fairfax of OSHA answers questions regarding
the Bloodborne Pathogens Standard
(99) Gillen M, McNary J, Lewis J, Davis M, Boyd A,
Schuller M et al. Sharps-related injuries in California healthcare facilities:
pilot study results from the Sharps Injury Surveillance Registry. Infect
Control Hosp Epidemiol 2003.
ABSTRACT: BACKGROUND AND OBJECTIVES: In 1998, the California Department of
Health Services invited all healthcare facilities in California (n = 2,532) to
participate in a statewide, voluntary sharps injury surveillance project. The
objectives were to determine whether a low-cost sharps registry could be
established and maintained, and to evaluate the circumstances surrounding
sharps injuries in California. RESULTS: Approximately 450 facilities responded
and reported a total of 1,940 sharps-related injuries from January 1998 through
January 2000. Injuries occurred in a variety of healthcare workers (80
different job titles). Nurses sustained the highest number of injuries (n =
658). In hospital settings (n = 1,780), approximately 20% of the injuries were
associated with drawing venous blood, injections, or assisting with a procedure
such as suturing. As expected, injuries were caused by tasks conventionally
related to specific job classifications. The overall results approximate those
reported by the Centers for Disease Control and Prevention's National
Surveillance System for Health Care Workers and the University of
Virginia's Exposure Prevention Information Network. CONCLUSION: These
data further support findings from previous studies documenting the complex and
persistent nature of sharps-related injuries in healthcare workers. In the
future, mandated reporting using standardized forms and consistent application
of decision rules would facilitate a more thorough analysis of injury events
(100) Gillen M, McNary J, Lewis J, Davis M, Boyd A,
Schuller M et al. Sharps-related injuries in California healthcare facilities:
pilot study results from the Sharps Injury Surveillance Registry.[see comment].
Infection Control & Hospital Epidemiology 2003; 24(2):113-121.
ABSTRACT: BACKGROUND AND OBJECTIVES: In 1998, the California Department of
Health Services invited all healthcare facilities in California (n = 2,532) to
participate in a statewide, voluntary sharps injury surveillance project. The
objectives were to determine whether a low-cost sharps registry could be
established and maintained, and to evaluate the circumstances surrounding
sharps injuries in California. RESULTS: Approximately 450 facilities responded
and reported a total of 1,940 sharps-related injuries from January 1998 through
January 2000. Injuries occurred in a variety of healthcare workers (80
different job titles). Nurses sustained the highest number of injuries (n =
658). In hospital settings (n = 1,780), approximately 20% of the injuries were
associated with drawing venous blood, injections, or assisting with a procedure
such as suturing. As expected, injuries were caused by tasks conventionally
related to specific job classifications. The overall results approximate those
reported by the Centers for Disease Control and Prevention's National
Surveillance System for Health Care Workers and the University of Virginia's
Exposure Prevention Information Network. CONCLUSION: These data further support
findings from previous studies documenting the complex and persistent nature of
sharps-related injuries in healthcare workers. In the future, mandated
reporting using standardized forms and consistent application of decision rules
would facilitate a more thorough analysis of injury events
(101) Grimmond T, Rings T, Taylor C, Creech R,
Kampen R, Kable W et al. Sharps injury reduction using Sharpsmart--a reusable
sharps management system. J Hosp Infect 2003; 54(3):232-238.
ABSTRACT: Sharps containers are associated with 11-13% of total sharps injuries
(SI) yet have received little attention as a means of SI reduction. A newly
developed reusable sharps containment system (Sharpsmart) was trialed in eight
hospitals in three countries. The system was associated with an 86.8% reduction
of container-related SI (CRSI) (P=0.012), a 25.7% reduction in non-CRSI
(P=0.003), and a 32.6% reduction in total SI (P=0.002) compared with historical
data. The study concludes that the Sharpsmart system is an effective engineered
control in reducing SI
(102) Jagger J, De Carli G, Perry J, Puro V, Ippolito
G. Occupational exposure to bloodborne pathogens: epidemiology and prevention.
In: Wenzel RP, editor. Prevention and Control of Nosocomial Infections.
Lippincott Williams & Wilkins, 2003: 430-465.
(103) Jagger J, Perry J. Comparison of EPINet data for 1993 and 2001 shows Marked
Decline in Needlestick Injury Rates. Adv Exposure Prev 2003; 6(3):25-27.
ABSTRACT: For more than a decade the United States has abeen the leader in the
development, testing and implementation
of safety-engineered sharp medical devices.
The new devices became widely available in the U.S. in the early 1990s,
and their acceptance and implementation in the workplace has been gradual but
steady. The Needlestick Safety and
Prevention Act of 2000, which became fully enforceable in July 2001, turned a
trend into a requirement and made the use of safety devices mandatory. The benefits of the new technology have been
documented in numerous ways, including clinical trails and demonstration projects
comparing conventional needles to their safety counterparts, and in reports
from specific institutions showing downward trrends in percutaneous injury
rates following the adoption of a variety of safety-engineered devices. These focused reports have been encouraging,
but there has been a lack of impact of both the new technology and the
Needlestick Safety Act in a multihospital sharps injury surveillance
network. In this report we present data
from the EPINet Multihospital Sharps Injury database, coordinated by the
International Healthcare Worker Safety Center at the University of Virginia,
which documents the impact on needlestick injury rates associated with the
widespread adoption of safety devices.
(104) Jagger J, Perry J, Parker G. Lab workers:
Small group, big risk. Nursing2003 2003; 33(1):72.
ABSTRACT: According to surveillance data from the Centers for Disease Control
and Prevention, nurses rank first among health care workers who acquire HIV on
the job. But a much smaller
group--clinical lab employees--comes in second, accounting for a surprising 29%
of cases. Most of these cases involved
phlebotomists injured by blood-drawing needles--injuries that are most likely
to result in bloodborne pathogen transmission.
(105) Jagger J, Perry J. Mesures réglementaires et
législatives mises en place aux Etates-Unis (Legal and regulation measures set
up in the United States to prevent occupational exposures to blood). Hygienes
2003; XI(2):186-189.
ABSTRACT: In the United States, after the adoption of the universal precaution
concept aiming to prevent the risks of accidental blood exposure (ABE) in 1985,
the "Blood-borne Pathogens Standards" directives imposed in 1991 that
all the healthcare facilities had to set up a plan to fight against ABE. The first revision of these directives was published
in 1999 and insisted on using secured material.
The States were also legislated, in 1998 California adopted the A.B.
1208 law, which imposed that the needles and other wounding objects must have
an internal safety device. Between 1999
and 2001, 20 other States adopted laws regarding protected needles. To homogenise the different State laws, the
"Needlestick Safety and Prevention Act" was promulgated as a federal
law by the President Clinton on the 6th November 2000. This law was the first one of it's kind in
the world and gave a protection and safety level without precedent as much for
the sataff as for the patients. In 2001,
the new revision of the "Blood-borne Pathogens Standard" directives
integrated the notions of optimal implantation of safety material under the
responsibility of the employers, the keeping of an ABE record ... The legal measures in the United States
therefore envisage that the use of secured material is not the employer's
choice but a legal obligation and puts forward an example in this field for
other countries.
(106) Kanter LJ, Siegel C. Needle sticks and adverse
outcomes in office-based allergy practices.[see comment]. Annals of Allergy,
Asthma, & Immunology 2003; 90(4):389-392.
ABSTRACT: BACKGROUND: In 1984 the first case of needle stick transmitted human
immunodeficiency virus was reported. In 1986 Occupational Safety and Health
Administration was petitioned by various unions representing health care
employees to develop a standard which protects employees from occupational
exposure to blood-borne diseases. Congress passed the Needle Stick Safety and
Prevention Act. This specifies that "safer medical devices, such as sharps
with engineered sharps injury protections and needle-less systems"
constitute an effective engineering control, and must be used where feasible.
This has been mandated in California as part of the labor code. Blood-borne
pathogens of concern in needle stick injuries are human immunodeficiency virus,
hepatitis virus B, and hepatitis virus C. OBJECTIVE: The objective of this
study was to determine the incidence of accidental needlesticks (ANSs) and
disease transmission in the allergy setting. METHODS: A retrospective survey of
most California allergy practices and a few large multi-physician allergy practices.
We received and used 121 of 400 surveys. RESULTS: Analysis of the survey data
showed an overall incidence of 45 ANSs with 7.026 million 26-/27-gauge needles
reported. There was zero rate of disease transmission; 6.41 ANSs per million
compares favorably with an estimated 267 ANSs per million in the general
medical setting. CONCLUSIONS: The rate of ANSs in the allergist's office is 2%
that of general medical ANSs. The current "safety" needles have no
proven effectiveness. There is no reported disease transmission in the
allergist's office setting using existent methods. This solution needs further
study before there is generalized implementation of the engineering devices of
no proven effectiveness that may in fact increase ANSs
(107) Le Pont F, Hatungimana V, Guiguet M,
Ndayiragije A, Ndoricimpa J, Niyongabo T et al. Assessment of occupational
exposure to human immunodeficiency virus and hepatitis C virus in a referral
hospital in Burundi, Central Africa. Infect Control Hosp Epidemiol 2003;
24(10):717-718.
(108) Magnavita N, Placentino RA, Puro V, Sacco A.
Management of health care workers with blood-borne infections.[comment].
Archives of Internal Medicine 2003; 163(12):1489-1490.
ABSTRACT: Ciuffa et al,1 in moving from the article by Cody et al,2 pose the problem
of the management of health care workers (HCWs) with blood-borne infections.
The risk of transmission of blood-borne pathogens from worker to patient is one
of the most controversial topics in occupational medicine. A number of
organizations have proposed guidelines,3-7 most of which are advisory in
nature, and their enforcement is generally poor owing to practical difficulties
in defining the authority who can effectively manage the problem.
(109) Mendelson MH, Lin-Chen BY, Solomon R, Bailey
E, Kogan G, Goldbold J. Evaluation of a safety resheathable winged steel needle
for prevention of percutaneous injuries associated with intravascular-access
procedures among healthcare workers. Infect Control Hosp Epidemiol 2003.
ABSTRACT: OBJECTIVE: To compare the percutaneous injury rate associated with a
standard versus a safety resheathable winged steel (butterfly) needle. DESIGN:
Before-after trial of winged steel needle injuries during a 33-month period
(19-month baseline, 3-month training, and 11-month study intervention),
followed by a 31-month poststudy period. SETTING: A 1,190-bed acute care
referral hospital with inpatient and outpatient services in New York City.
PARTICIPANTS: All healthcare workers performing intravascular-access procedures
with winged steel needles. INTERVENTION: Safety resheathable winged steel
needle. RESULTS: The injury rate associated with winged steel needles declined
from 13.41 to 6.41 per 100,000 (relative risk [RR], 0.48; 95% confidence
interval [CI95], 0.31 to 0.73) following implementation of the safety device.
Injuries occurring during or after disposal were reduced most substantially
(RR, 0.15; CI95, 0.06 to 0.43). Safety winged steel needle injuries occurred
most often before activation of the safety mechanism was appropriate (39%); 32%
were due to the user choosing not to activate the device, 21% occurred during
activation, and 4% were due to improper activation. Preference for the safety
winged steel needle over the standard device was 63%. The safety feature was
activated in 83% of the samples examined during audits of disposal containers.
Following completion of the study, the safety winged steel needle injury rate
(7.29 per 100,000) did not differ significantly from the winged steel needle
injury rate during the study period. CONCLUSION: Implementation of a safety
resheathable winged steel needle substantially reduced injuries among
healthcare workers performing vascular-access procedures. The residual risk of
injury associated with this device can be reduced further with increased
compliance with proper activation procedures
(110) Nolte KB, Yoon SS. Theoretical risk for
occupational blood-borne infections in forensic pathologists. Infect Control
Hosp Epidemiol 2003; 24(10):772-773.
ABSTRACT: Using a cumulative probability analysis and published data, we
calculated the theoretical career risk of occupational HIV (2.4%) and HCV (39%;
possible range, 13% to 94%) infections for forensic pathologists. Serologic
studies of these physicians are needed to clarify occupational exposure and
infection risks. Autopsy personnel should wear cut-resistant undergloves to
decrease percutaneous injuries
(111) Parker G. Needlestick injuries: a paramedic's
perspective. Emergency Medical Services 32(9):132-3, 2003; 32(9):132-133.
ABSTRACT: Paramedics and Ed personnel face similar risks for blood
exposures. They are both confronted by
the unpredictability of the patient's condition, and must perform a daunting
variety of tasks under intense pressure.
I experienced those risks firsthand as a paramedic in rural West
Virginia for four years.
(112) Patterson JM, Novak CB, Mackinnon SE, Ellis
RA. Needlestick
injuries among medical students. Am J Infect Control 2003; 31(4):226-230.
ABSTRACT: BACKGROUND: Concern about occupational exposure to bloodborne
pathogens exists, and medical students, who lack in experience in patient care
and surgical technique, may be at an increased exposure risk. METHODS: This
prospective cohort study evaluated needlestick injuries and practices regarding
the use of protective strategies against bloodborne pathogens in medical
students. A questionnaire was developed and sent to 224 medical students.
RESULTS: Of 224 students, 146 students (64%) returned questionnaires.
Forty-three students (30%) reported needlestick injuries that most commonly
occurred in the operating room; 86% of students reported always using double
gloves in the operating room; 90% reported always wearing eye protection, and
all but one student had been vaccinated against hepatitis B. A concern about
contracting a bloodborne pathogen through work was noted in 125 students,
although they usually reported that this concern only slightly influenced their
decision regarding a career subspecialty. CONCLUSION: Medical students have a
high risk for needlestick injuries, and attention should be directed to
protection strategies against bloodborne pathogens
(113) Pegues DA. Building better programs to prevent
transmission of blood-borne pathogens to healthcare personnel: progress in the
workplace, but still no end in sight. Infect Control Hosp Epidemiol 2003;
24(10):719-721.
ABSTRACT: In 2001, there were an estimated 9.2 million individuals working in
healthcare in the United States. Despite
the use of standard precautions and the introduction of safety-engineered
devices, healthcare workers remain at substantial risk of occupational exposure
to bloodborne pathogens, including hepatitis B virus (HBV), hepatitis C virus
(HCV), and human immunodeficiency virus (HIV).
Estimates of the annual number of percutaneous injuries among U.S.
healthcare personnel vary widely but represent a substantial occupational
risk. Using national occupational health
surveillance data from 1997 and 1998, Panlilio et al. estimated that in the
United States there were approximately 384,000 percutaneous injuries annually
mong hospital-based healthcare workers.
(114) Perry J, Jagger J, Parker G. Statistically,
your risk of HCV infection has dropped. Nursing2003 2003; 33(6):82.
ABSTRACT: The global hepatitis C virus (HCV) epidemic has generated growing
concern about the risk of occupational transmission of HCV in health care
workers. But recent research has
identified significantly lower transmission rates in workers injured by
HCV-contaminated needles than rates indicated in earlier studies.
(115) Perry J. Reducing the Risk of Scalpel-Blade
Injuries. Outpatient Surgery Magazine 2003; 4(May 2003):98-99.
ABSTRACT: Is your surgery staff vulernable to scalpel-blade injuries such as
these three real-life scenarios?
-As a surgery attendant passed a scalpel to a surgeon, the surgeon
simultaneously reached for it. They
bumpted hands, and the attendant's left index finger was cut.
-After a cosmetic procedure, a nurse used a hemostat to remove the blade from a
reusable scalpel handle. The blade
slipped and the nurse cut her middle right finger.
-Having completed a hand case, a physician and nurse were cleaning the
patient. As the nurse reached back for a
towel, she was cut by a scalpel held by the OR technician.
From 1993 to 2001, scalpels ranked third as a cause of sharps injuries across
all healthcare settings, accounting for 7 percent of injuries. In operating rooms (ORs) specifically,
reusable and disposable scalpels caused 18 percent of injuries -- second only
to suture needles, with 41 percent of injuries.
(116) Perry J. Preventing Percutaneous Injuries in
Outpatient Settings. Outpatient Surgery Magazine 2003; 4(April 2003):94-95.
ABSTRACT: Little has been published on percutaneous injury risks to healthcare
workers employed in outpatient surgery settings. And when it come to implementing regulations
that protect the health and safety of employees in these settings, the maximum
"no data, no problem" applies in full force. But healthcare workers in ambulatory surgery
centers may be more vulnerable to injuries than others if there are no data to
support the need for protective measurers.
(117) Perry J. Lessons Learned in Safety-Device
Implement. Outpatient Surgery Magazine 2003; 4(October 2003):70-72.
ABSTRACT: If you want to avoid some
common pitfalls when implementing safety-engineered sharps in your facility,
check out www.cdc.gov/niosh/topics/bbp/safer.
This Website from the National Institute for Occupational Safety and
Health (NIOSH), "Safer Medical Device Implementation in Health Care
Facilities: Lessons Learned," offers insights from several healthcare
facilities on implementing safety devices.
The facilities sharing their
experiences include a large hospital chain with a clinical staff of 4,500; a
950-bed academic medical center with two ASCs and a clinical staff of 4,000;
and a 300-bed hospital with 2,000 healthcare workers
NIOSH outlines five steps for
developing and maintaining a needlestick-prevention program; for each step, the
participating facilities discuss problems they encountered and how they tackled
them.
(118) Perry J. Conventional Sharp Devices: A Dying
Breed? Outpatient Surgery Magazine 2003; 4(June 2003):70.
ABSTRACT: The sharps market has undergone a major transformation during the
last 15 years. In the mid-1980s,
manufacturers of needle-based I.V. access systems that eliminated a source of
unnecessary needles (and unnecessary needlesticks). At the same time, designs for
safety-engineered needles, which cover the sharp after use, expanded rapidly.
(119) Perry J, Jagger J. On-the-job exposure to HIV.
Emergency Medical Services 32(9):131-2, 2003; 32(9):131-132.
ABSTRACT: In 2000, Steve Derrig was a 32-year-old firefighter and paramedic
living in Akron, OH. That was the year
he made a shattering discovery: He was
infected with HIV.
(120) Perry J, Jagger J, Parker G. Nurses and
needlesticks, then and now. Nursing2003 2003; 33(4):22.
ABSTRACT: According to EPInet (Exposure Prevention Information Network) data
for 2001, nurses sustained the largest porportion (44%) of sharps injuries of
all health care professionals. And
cumulative statistics from the Centers for Disease Control and Prevention show
that nurses had 42% of documented occupational HIV infections through 2001,
more than ny other occupationsl group.
(121) Perry J, Jagger J. Reducing risks from
combative patients. Nursing 2003; 33(10):28.
ABSTRACT: Vanessa Burkhart, an ED
nurse for 13 years, was working the night shift when the police brought in a
woman who'd taken an overdose of pills with alcohol. Initially, the woman seemed farily
cooperative.
But as Burkhart started an I.V.
line with an 18-guage, nonsafety catheter, the patient suddenly tried to hit
her. As Burkhart blocked the blow, the
needle came out of the catheter. The
patient grabbed it, and jammed it into the nurse's finger.
She then shocked Burkhart by sahing,
"You'd better get your blood tested; I have hepatitis." Testing confirmed that the patient was
positive for hepatitis C virus (HCV).
Four months after Burkhart's needle-stick injury, follow-up testing
revealed that she'd been infected with HCV.
(122) Perry J. Protecting Your Eyes from Sprayed,
Splashed Blood. Outpatient Surgery Magazine 2003; 4(August 2003):82-83.
ABSTRACT: The eye exposure incidents below underscore the need not only to
include protective eye equipment as part of proper surgical attire, but also to
make sure that goggles and faceshields don't slip down to leave unprotected
gaps.
(123) Perry J, Jagger J. Healthcare Worker Blood
Exposure Risks: Correcting Some Outdated Statistics. Adv Exposure Prev 2003;
6(3):28-31.
ABSTRACT: In the last few years, statistics on needlestick injuries have become
more precise; several benchmark numbers are lower than previously thought. The availability of data on occupational
exposures to bloodborne pathogens has increased dramatically during the last
decade. Articles in the medical
literature on needlestick injuries and blood exposures have proliferated, as
numerous researchers have reported results of single institution or multicenter
studies, or focused studies of specific occupational groups and clinical
settings. There are two ongoing
large-scale surveillance programs in the United States (U.S.) that collect data
on sharps injuries: the Exposure Prevention Information Network (EPINet)
Multi-hospital Needlestick and Sharp-Object Injury database, established in
1993 and maintained by the International Healthcare Worker Safety Center at the
University of Virginia; and the National Surveillance System for Health Care
Workers (NaSH), established in 1995 by the Division of Healthcare Quality
Promotion at the Centers for Disease Control and Prevention (CDC). (Other countries, including Italy, Canada,
Japan, and Spain, conduct national-level needlestick surveillance as well.)
(124) Perry J, Jagger J. The International Health
Care Worker Safety Center. Hospital Decisions International 2003; Spring
2003:171-173.
ABSTRACT: Millions of healthcare workers around the globe face a daily risk of
contracting life-threatening occupational infections--such as H IV, hepatitis
B, and hepatitits C--from occupational exposures to patients' blood and body
fluids. The International Health Care
Worker Safety Center at the University of Virginia is dedicated to reducing
this serious risk.
(125) Perry J. Improving Your Sharps Safety Program.
Outpatient Surgery Magazine 2003; 4(September 2003):94-96.
ABSTRACT: Since the revised
bloodborne pathogens standard (BPS) took effect in July 2001, the largest
number of OSHA citations to healthcare facilities have been been for, you
guessed it, violations of the BPS.
The standard now directs healthcare
facilities to use safety-engineered sharp devices whenever possible to lower
employees' risk of needlestick injuries and blood exposures. Between April 2001 and May 2002, OSHA issued 132 citations for
failure to use engineering and work practice controls--four times the number
issued for this specific violation in the previous 10 years.
(126) Perry J, Jagger J. A Surgeon, A Suture Needle
and Hepatitis C. Outpatient Surgery Magazine 2003; 4(March 2003):64-70.
ABSTRACT: Alvin Heller, MD, chief of plastic and reconstructive surgery at a
U.S. academic medical center, remembers the moment in the OR that he believes
he became infected with hepatitis C.
"We were working on a patient with elevated liver enzymes who had
tested negative for hepatitis B and was thought to have non-A non-B hepatitis
[later identified as hepatitis C].
During the procedure, I sustained a deep injury from a large (3.5-inch)
retention suture needle and was probably infected as a result. But no test for hepatitis C was available
then."
(127) Perry J, Jagger J. Don't reuse that blood tube
holder. Nursing2003 2003; 33(8):74.
ABSTRACT: After you draw blood, the blood tube holder provides your only
protection from the back end of the phlebotomy needle. Removing the needle in order to reuse the
holder poses a risk, even if it's a safety-engineered needle. The tube-puncturing back end of the needle is
exposed, and its rubber sheath provides little or no protection.
(128) Perry J, Parker G, Jagger J. 2001 Percutaneous
Injury Rates. Adv Exposure Prev 2003; 6(3):32-36.
ABSTRACT: In 2001, the International Healthcare Worker Safety Center at the
University of Virginia collected data on percutaneous injuries and blood and
body fluid exposures from 58 healthcare facilities in the United States that
use the EPINet surveillance program to tract exposure incidents. These facilities voluntarily participate in the
collaorative EPINet network coordinated by the Center, and their exposure data
are combined into an aggregate database.
The 2001 percutaneous injury report and blood and body fluid exposure
report are presented on pages 33 and 34, and a list of the facilities that
contributed data can be found on page 31.
(129) Perry J. A Hepatitis-Infected Surgeon Speaks
Out on OR Safety. Outpatient Surgery Magazine 2003; 4(November 2003):68-71.
ABSTRACT: William Fiser, MD, is one
of few surgeons who has acknowledged publicly he is infected with hepatitis C
virus (HCV). Last year, he published a
letter in Infection Control and Hospital Epidemiology that discussed
surgeon-to-patient transmission of bloodborne pathogens. He was also featured in an article in Newsday,
a Long Island (N.Y.) daily; the headline was telling: "Deciding to Step
Away." After becoming ill with HCV,
he resigned his private practice and took a faculty position in the surgery
department at the University of Arkansas medical center.
Dr. Fiser can't pinpoint a specific
injury, but believes he was infected from an occupational sharps injury, since
he had no other risk factors for HCV and has sustained multiple needlesticks
during his career. This should sound an
alarm for all OR staffers in the outpatient setting. Here is Dr. Fiser's story, and the changes he
advocates based on his experience.
(130) Puro V, Scognamiglio P, Ippolito G. [HIV, HBV,
or HDV transmission from infected health care workers to patients]. [Review]
[84 refs] [Italian]. Medicina del Lavoro 2003; 94(6):556-568.
ABSTRACT: BACKGROUND: The report of transmission of viruses, such as human
immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus
(HCV), from health care workers (HCWs) to patient has alarmed public opinion
with potential repercussions on health organisation. OBJECTIVES: To review
available information on cases of transmission of HIV, HBV and HCV from HCW to
patient reported worldwide. METHODS: A literature review was conducted with a
Medline search of English language full papers, using the following key terms:
HIV, HBV, HCV; healthcare workers, occupational and hospital transmission,
outbreak, look back investigation. The Medline search was supplemented by a
manual search using reference lists of published studies and proceedings of
meetings, including some personal communications already reported in a previous
review. RESULTS: Since 1972, 50 outbreaks have been reported in which 48 HBV
infected HCWs (39 surgeons) transmitted the infection to approximately 500
persons. To date, 3 cases of transmission of HIV and 8 confirmed cases of
transmission of HCV (to a total of 18 patients) from infected healthcare
workers to patients have been reported. The factors influencing the
transmissibility of infection include: type of procedures performed, surgical
techniques used, compliance with infection control precautions, the clinical
status and viral burden of the infected HCW and susceptibility of the patient
to infection. The risk of transmission of HIV, HBV and HCV from HCWs to
patients is associated primarily with certain types of surgical specialties
(obstetrics and gynaecology, orthopaedics, cardiothoracic surgery) and surgical
procedures that can expose the patient to the blood of the HCW: exposure-prone
procedures. Since the early 90's industrialized countries have issued
recommendations for preventing transmission of blood-borne pathogens to
patients during "exposure prone" invasive procedures. With regard to
HBV there is common consent to restricting or excluding HCWs tested HbeAg
positive or HBV DNA-positive from performing exposure-prone procedures, while
there are still some discrepancies in the different countries for dealing with
HCV-infected personnel and in some cases also for those with HIV infection.
CONCLUSIONS: Efforts to prevent surgeon-to-patient transmission of blood-borne
infections should focus not only on ascertaining the infection status of the
HCW but principally on eliminating the cause of blood-borne exposures, for
example by the use of blunt suture needles, improved instruments, reinforced
gloves, changes in surgical technique and the use of less invasive alternative
procedures. These measures should be implemented in order to minimize the risk
of blood exposure and consequently of virus transmission both to and from HCW
to patients. [References: 84]
(131) Tammelleo A. Class actions for needle sticks
are still alive and well. Nursing Law's Regan Report 2003; 44(1):1-2.
ABSTRACT: Virtually all nurses are subjected to needle sticks at one time or
another. However, to the extent that there are needles and syringes available
which can minimize the risks of needle sticks, if not outright eliminate the
risks, are manufacturers of needles and syringes who fail to employ the latest available
techniques to ensure maximum reduction of risk vulnerable to class actions by
nurses as well as all other healthcare professionals who might be subjected to
such risks? That was the principal issue with which the courts were confronted
in this unusual Ohio case in which a Nurse brought a product liability against
the manufacturer of the syringe needles. The nurse moved to have the suit
certified as a Class Action.
(132) Tarantola A, Golliot F, Astagneau P, Fleury L,
Brucker G, Bouvet E et al. Occupational blood and body fluids exposures in health care workers:
four-year surveillance from the Northern France network. Am J Infect Control
2003; 31(6):357-363.
ABSTRACT: The risk of accidental blood and body fluid (BBF) exposure is a daily
concern for health care workers throughout the world, and various strategies
have been introduced during the past decade to help reduce that risk. To assess
the impact of multifocal reduction strategies introduced in hospitals
affiliated with the Northern France network, we recently examined data from 4
years of BBF-exposure reports filed by network employees. A total of 7,649 BBF
exposures were reported by health care workers to occupational medicine
departments in 61 hospitals. Nurses and nursing students accounted for 4,587
(60%) of exposures, followed by nurses' aides and clinicians. Most (77.6%) of
the reports were related to needlestick injury (NSI). In addition, we examined
BBF exposure trends over time by analyzing data from 18 hospitals (29.5%) with
data available for the time period of 1995 to 1998. These were assessed in
nurses, who have the highest and most consistent reporting rate. We noted that
the BBF-exposure incidence rate for all BBF exposures in nurses decreased from
10.8 to 7.7 per 100 nurses per year between 1995 and 1998 (P <.001), whereas
the NSI rate decreased 8.9 per 100 nurses per year in 1995 to 6.3 in 1998 (P
<.001). The percentage of NSIs that resulted from noncompliance with
universal precautions also decreased significantly (P =.04). Widespread
improvements in procedures and engineering controls were implemented in the
Northern France network before and during the study period. Significant
reductions were observed in reports of BBF exposures and NSIs, particularly in
nurses. These findings are similar to those in other countries and reflect the
overall improvement in the management of occupational risk of BBF in health
care workers
(133) Trim JC, Elliott TS. A review of sharps
injuries and preventative strategies. [Review] [51 refs]. Journal of Hospital
Infection 2003; 53(4):237-242.
ABSTRACT: Exposure to bloodborne pathogens from sharps injuries continues to
pose a significant risk to healthcare workers (HCW). The number of sharps
injuries sustained by HCW is still unclear, primarily due to under-reporting.
In this review a mean rate of 4.0% (range 1.0-6.2%) sharps injuries per 10000
HCW was calculated from eight studies involving more than 7000 HCW. Nurses and
doctors were most at risk of sharps injuries, frequently from hollow-bore
needles. Approaches to reduce this risk have included education and training on
the safe handling and disposal of sharp devices, awareness campaigns and
legislative action. More recently, preventative strategies have focused on
needle protective devices, which may reduce the rate of sharps injuries.
Introducing needle protective devices should be considered particularly in
high-risk areas, after training, education, evaluation and cost-benefit
analysis. [References: 51]
(134) Tumolo J. Needle stick injuries. Providers
bear ultimate responsibility--and consequence. Advance for Nurse Practitioners
2003; 11(2):73-74.
ABSTRACT: They are pivotal seconds that could rob years from your life. You've just given an injection and are in the
process of withdrawing the needle from your patient. During the next few moments, you're at
highest risk of poking yourself with a needle and potentially exposing your
body to a number of infectious diseases.
Do you: (A) set the needle aside while your quickly apply a bandage to
the patient, or (B) dispose of the needle and then apply the bandage?
(135) FDA seeks comment on banning of some sharps.
Hospital Employee Health 2002; 21(9):102-104.
ABSTRACT: Agency asks for device data, other opinions If a federal law mandates the use of safety
sharps devices, should conventional versions be banned? The Food and
Drug Administration (FDA) is soliciting comment on that question and
others posed by the Service Employees International Union (SEIU) in Washington,
DC, and the consumer group, Public Citizen, in a petition to the agency.
(136) New OSHA directive will cite hospitals for
reuse of blood tube holders. Hospital Employee Health 2002; 21(2):14-15.
ABSTRACT: Hospitals that reuse blood tube holders risk getting a citation from
the U.S. Occupational Safety and Health Administration (OSHA), according to a
new directive issued to inspectors.
(137) Many hospitals may lag in needle safety
compliance. Hospital Employee Health 2002; 21(2):15-17.
ABSTRACT: The step-by-step process of phasing in safer sharps may leave many
hospitals out of compliance with Occupational Safety and Health
Administration's (OSHA) bloodborne pathogen standard.
(138) Surgeon-to-patient HCV infections raise
questions. Hospital Employee Health 2002; 21(8):88-91.
ABSTRACT: Will this be the case that changes national policy? A Long
Island, NY, cardiac surgeon, who unknowlingly was infected with hepatitis C for
about 10 years, transmitted the virus to at least three patients. This is the first such documented
transmission in the United States that did not involve known lapses in
infection control practices, and it has now prompted new questions about the
adequacy of patient protections.
(139) When will safe needles offer better designs?
Hospital Employee Health 2002; 21(4):37-40.
ABSTRACT: If you are frustrated with your choices of safer sharps devices,
consider this: Last year, dozens of patents were issued for safety syringes
alone. The number of manufacturers has
risen to more than 100, and the variety of safety products continues to grow.
(140) Alain S, Loustaud-Ratti V, Dubois F, Bret M,
Rogez S, Vidal E et al. Seroreversion
from Hepatitis C after Needlestick Injury. Clinical Infectious Diseases 2002;
34(5):717.
ABSTRACT: 719
(141) Anonymous. Safer workerplace not yet obvious
from needle data. Hospital Employee Health 2002; 21(4):41-42.
ABSTRACT: Safer needle devices reduce needlesticks, but that truism so far has
been difficult to demonstrate through multihospital data collection. Two new data reports show the persistence of
needlestick and the continued need to implement safer devices and work
practices.
(142) Anonymous. Take away the needle--and the
needlestick (Devices replace syringes, lancets, sutures). Hospital Employee
Health 2002; 21(4):39.
ABSTRACT: What is the best possible safety device? One with no needle at
all. New developments have led to a
rapid increase in the use of needleless technology. Hospitals can now administer vaccines or
medication with needleless injectors.
Nasal and intradermal alternatives are emerging. Adhesives are replacing sutures, and there's
even a laser that eliminates the need for a lancet.
(143) Baldo V, Floreani A, Dal Vecchio L,
Cristofoletti M, Carletti M, Majori S et al. Occupational Risk of Blood-Borne
Viruses in Healthcare Workers: A 5-Year Surveillance Program. Infect Control
Hosp Epidemiol 2002; 23(6):325-327.
ABSTRACT: OBJECTIVE
This study presents the results of a 5-year surveillance program involving
the prospective follow-up of healthcare workers (HCWs) in the Veneto region of
Italy exposed to blood-borne viruses.
DESIGN
All HCWs who reported an occupational exposure to blood-borne infection
joined the surveillance program. Both HCWs and patients were tested for viral
markers (hepatitis B surface antigen [HBsAg], antibody to hepatitis B surface
antigen [anti-HBs], antibody to hepatitis B core antigen [anti-HBc], antibody
to hepatitis C virus [anti-HCV], HCV RNA, and antibody to human
immunodeficiency virus [HIV]) and had these markers plus transaminases assayed
at 3, 6, and 12 months and then yearly thereafter. Moreover, a program of
hepatitis B virus (HBV) prophylaxis was offered to those whose anti-HBs levels
were less than 10 IU/mL.
PARTICIPANTS
Two hundred forty-five HCWs (156 women and 89 men) with a mean age of 37 (±
10) years who reported occupational exposure during the 5-year period.
RESULTS
At the time of exposure, 1 HCW was positive for HBsAg (0.4%) and 2 were
positive for HCV RNA (0.8%). Among the patients involved, 28 (11.4%) were
positive for HBsAg, 68 (27.8%) were positive for HCV RNA, 6 (2.4%) were
positive for HIV, and 147 (60.0%) were negative for all viral markers (4
patients were positive for both HCV and HIV). During the follow-up period after
exposure (mean, 2.7 [± 1.6] years), there was no increase in transaminases or
seroconversions to any of the viral markers.
CONCLUSION
Our accurate postexposure follow-up revealed a lack of transmission of HBV,
HCV, and HIV (Infect Control Hosp Epidemiol 2002;23:325-327).
(144) Ball JrRT. Protecting Patients from Surgical
Hepatitis C Virus Infection (letter). Infect Control Hosp Epidemiol 2002;
23(6):297-298.
ABSTRACT: Although postexposure
treatment of healthcare workers as mandated by the Occupational Safety and
Health Administration has been well established and recommendations for
protecting healthcare workers have been updated by the CDC, most hospitals have
yet to accept responsibility for protecting patients to the same degree when
exposures occur. They should establish patient postexposure treatment procedures
(including baseline and follow-up testing and prophylactic and curative therapy
similar to that provided for healthcare workers). Hospitals could opt to notify patients of an
intraoperative exposure without revealing which member of the surgical team is
infected, while providing for the exposed patient's postexposure medical needs.
In general, we should apply
patient-to-surgeon exposure management principles to any surgeon-to-patient
exposures, including notification, baseline and follow-up testing, and any
appropriate postexposure prophylaxis, treatments, or both. HCV is clearly transmissible in both
directions between patients and surgeons and should be added to the 1991 CDC
guidelines for protecting patients from infection by surgeons infected with
blood-borne viruses. There remain
several complex unanswered questions, which should also inspire more aggressive
investigation.
(145) Beltrami EM, Luo C-C, de la Torre N, Cardo D.
Transmission of Drug-Resistant HIV After an Occupational Exposure Despite
Postexposure Prophylaxis With a Combination Drug Regimen. Infect Control Hosp
Epidemiol 2002; 23(6):345-348.
ABSTRACT: We documented a case of occupational human immunodeficiency virus
(HIV) despite postexposure prophylaxis (PEP) with a combination drug regimen
after percutaneous injury with a needle from a sharps disposal container in the
hospital room of an HIV-infected patient. This failure of PEP with a
combination drug regimen may have been related to antiretroviral drug resistance,
other factors, or both. This case highlights the importance of preventing
injury to prevent occupational transmission of HIV (Infect Control Hosp
Epidemiol 2002;23:345-348).
(146) Bruno R, Cotler S, Sacchi P, Ciappina V.,
Rondanelli M., Filice G. Challenges for hepatitis C patients coinfected with
HIV. American Clinical Laboratory 2002; 21(3):26-31.
ABSTRACT: The hepatitis C virus (HCV) infects an estimated 170 million people
worldwide and thus represents a viral pandemic, five times more widespread than
infection with the human immunodeficiency virus type (HIV-1).
HIV-HCV coinfection is common and affects more than one-third of
all HIV-infected subjects. While the effects of HCV infection on the
outcome of HIV disease remain to be established, several studies suggest that
HIV disease modifies the natural history of HCV infection, leading to a faster
course of progression from active hepatitis to cirrhosis, end-stage liver
disease, and death. The latest NIH
conference and the European Consensus on hepatitis C held in 1997 and 1999,
respectively, provided very useful recommendations for clinicians to treat
patients coinfected with HIV and HCV. It
was specifically stated, "the progression of chronic hepatitis C is
accelerated in HCV-HIV coinfected patients and, therefore, treatment of
hepatitis C may be indicated in those with stable HIV infection." However, two years later, specific and
effective actions that are required to contain the damage of hepatitis C in
HIV-positive subjects have not been implemented and many questions remain
unanswered.
(147) Centers for Disease Control and Prevention.
Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and
Adolescents. MMWR Morb Mortal Wkly Rep 2002; 47(RR-5):43.
ABSTRACT: With the development and FDA approval of an increasing number of
antiretroviral agents, decisions regarding the treatment of HIV-infected
persons have become complex; and the field continues to evolve rapidly. In
1996, the Department of Health and Human Services and the Henry J. Kaiser
Family Foundation convened the Panel on Clinical Practices for the Treatment of
HIV to develop guidelines for the clinical management of HIV-infected persons.
This report includes the guidelines developed by the Panel regarding the use of
laboratory testing in initiating and managing antiretroviral therapy,
considerations for initiating therapy, whom to treat, what regimen of
antiretroviral agents to use, when to change the antiretroviral regimen,
treatment of the acutely HIV-infected person, special considerations in
adolescents, and special considerations in pregnant women. Viral load and CD4+
T cell testing should ideally be performed twice before initiating or changing
an antiretroviral treatment regimen. All patients who have advanced or
symptomatic HIV disease should receive aggressive antiretroviral therapy.
Initiation of therapy in the asymptomatic person is more complex and involves
consideration of multiple virologic, immunologic, and psychosocial factors. In
general, persons who have less than 500 CD4+ T cells per mm3 should be offered
therapy; however, the strength of the recommendation to treat should be based
on the patient's willingness to accept therapy as well as the prognosis for
AIDS-free survival as determined by the HIV RNA copy per mL of plasma and the
CD4+ T cell count. Persons who have greater than 500 CD4+ T cells per mm3 can
be observed or can be offered therapy; again, risk of progression to AIDS, as
determined by HIV RNA viremia and CD4+ T cell count, should guide the decision
to treat. Once the decision to initiate antiretroviral therapy has been made,
treatment should be aggressive with the goal of maximal viral suppression. In
general, a protease inhibitor and two non-nucleoside reverse transcriptase
inhibitors should be used initially. Other regimens may be utilized but are
considered less than optimal. Many factors, including reappearance of
previously undetectable HIV RNA, may indicate treatment failure. Decisions to
change therapy and decisions regarding new regimens must be carefully
considered; there are minimal clinical data to guide these decisions. Patients
with acute HIV infection should probably be administered aggressive
antiretroviral therapy; once initiated, duration of treatment is unknown and will
likely need to continue for several years, if not for life. Special
considerations apply to adolescents and pregnant women and are discussed in
detail.
(148) Centers for Disease Control and Prevention.
Laboratory-acquired West Nile virus infections--United States, 2002. MMWR -
Morbidity & Mortality Weekly Report 2002; 51(50):1133-1135.
ABSTRACT: West Nile virus (WNV), a mosquito-borne flavivirus introduced
recently to North America, is a human, equine, and avian neuropathogen. The
majority of human infections with WNV are mosquito-borne; however,
laboratory-acquired infections with WNV and other arboviruses also occur. This
report summarizes two recent cases of WNV infection in laboratory workers
without other known risk factors who acquired infection through percutaneous
inoculation. Laboratory workers handling fluids or tissues known or suspected
to be WNV-infected should minimize their risk for exposure and should report
injuries and illnesses of suspected occupational origin to their supervisor
(149) Chiarello LA, Cardo DM. Preventing
transmission of hepatitis B virus from surgeons to patients. Infect Control
Hosp Epidemiol 2002; 23(6):301-302.
ABSTRACT: Isolated episodes of transmission of hepatitis B virus (HBV),
hepatitis C virus, and human immunodeficiency virus (HIV) from infected
healthcare providers to patients in healthcare settings have been reported.
Most HBV transmission have occurred
during invasive surgical or obstetric procedures. In general, three conditions are necessary
for transmission of blood-borne viruses from healthcare personnel to patients:
(1) the healthcare provider must be infected and have the virus circulating in
the bloodstream; (2) the healthcare provider must be injured or have a
condition that provides some other source of direct exposure to infected blood
or body fluids; and (3) the injury mechanism or condition must present an
opportunity for the healthcare provider's blood to directly contact a patient's
mucous membranes, wound, or traumatized tissue (recontact).
(150) Ciuffa V, Tirrozzo SF, Vento S. Blood-borne
viruses and health care workers.[see comment][comment]. Archives of Internal
Medicine 2002; 162(18):2141-2142.
ABSTRACT: Sara Cody and colleagues,1 in their interesting
report of transmission of hepatitis C virus (HCV) from a patient to an
anesthesiologist and then to a second patient, outline once again the problem
of transmission of blood-borne viruses in hospital settings. Transmission of
another hepatitis virus, namely, hepatitis B virus (HBV), from surgeons to
patients has been widely documented,2-6 whereas reports of HCV transmission are
rare7-9 and human immunodeficiency virus (HIV) transmission exceptional.10
Health care workers are also at risk of acquiring blood-borne infections during
their duties.
(151) Cody SH, Nainan OV, Garfein RS, Meyers H, Bell
BP, Shapiro CN et al. Hepatitis C Virus Transmission From an Anesthesiologist
to a Patient. Arch Intern Med 2002; 162(3):345-350.
ABSTRACT: Background An anesthesiologist was diagnosed as having acute hepatitis
C 3 days after providing anesthesia during the thoracotomy of a 64-year-old man
(patient A). Eight weeks later, patient A was diagnosed as having acute
hepatitis C.
Methods We performed tests for antibody to hepatitis C virus (HCV) on
serum samples from the thoracotomy surgical team and from surgical patients at
the 2 hospitals where the anesthesiologist worked before and after his illness.
We determined the genetic relatedness of the HCV isolates by sequencing the
quasispecies from hypervariable region 1.
Results Of the surgical team members, only the anesthesiologist was
positive for antibody to HCV. Of the 348 surgical patients treated by him and
tested, 6 were positive for antibody to HCV. Of these 6 patients, isolates from
2 (patients A and B) were the same genotype (1a) as that of the
anesthesiologist. The quasispecies sequences of these 3 isolates clustered with
nucleotide identity of 97.8% to 100.0%. Patient B was positive for antibody to
HCV before her surgery 9 weeks before the anesthesiologist's illness onset. The
anesthesiologist did not perform any exposure-prone invasive procedures, and no
breaks in technique or incidents were reported. He denied risk factors for HCV.
Conclusions Our investigation suggests that the anesthesiologist acquired
HCV infection from patient B and transmitted HCV to patient A. No further
transmission was identified. Although we did not establish how transmission
occurred in this instance, the one previous report of bloodborne pathogen
transmission to patients from an anesthesiologist involved reuse of needles for
self-injection.
(152) Delarocque-Astagneau E, Baffoy N, Thiers V,
Simon N, de Valk H, Laperche S et al. Outbreak of Hepatitis C Virus Infection in a Hemodialysis
Unit: Potential Transmission by the Hemodialysis Machine? Infect Control Hosp
Epidemiol 2002; 23(6):328-334.
ABSTRACT: OBJECTIVE
To identify the routes of transmission during an outbreak of infection with
hepatitis C virus (HCV) genotype 2a/2c in a hemodialysis unit.
DESIGN
A matched case–control study was conducted to identify risk factors for HCV
seroconversion. Direct observation and staff interviews were conducted to
assess infection control practices. Molecular methods were used in a comparison
of HCV infecting isolates from the case-patients and from patients infected
with the 2a/2c genotype before admission to the unit.
SETTING
A hemodialysis unit treating an average of 90 patients.
PATIENTS
A case-patient was defined as a patient receiving hemodialysis with a
seroconversion for HCV genotype 2a/2c between January 1994 and July 1997 who
had received dialysis in the unit during the 3 months before the onset of
disease. For each case-patient, 3 control-patients were randomly selected among
all susceptible patients treated in the unit during the presumed contamination
period of the case-patient.
RESULTS
HCV seroconversion was associated with the number of hemodialysis sessions
undergone on a machine shared with (odds ratio [OR] per additional session,
1.3; 95% confidence interval [CI95], 0.9 to 1.8) or in the same room
as (OR per additional session, 1.1; CI95, 1.0 to 1.2) a patient who
was anti-HCV (genotype 2a/2c) positive. We observed several breaches in
infection control procedures. Wetting of transducer protectors in the external
pressure tubing sets with patient blood reflux was observed, leading to a
potential contamination by blood of the pressure-sensing port of the machine,
which is not accessible to routine disinfection. The molecular analysis of HCV
infecting isolates identified among the case-patients revealed two groups of
identical isolates similar to those of two patients infected before admission
to the unit.
CONCLUSIONS
The results suggest patient-to-patient transmission of HCV by breaches in
infection control practices and possible contamination of the machine. No
additional cases have occurred since the reinforcement of infection control
procedures and the use of a second transducer protector (Infect Control Hosp
Epidemiol 2002;23:328-334).
(153) Evans B. Personal Communication. 4-24-2002.
Ref Type: Personal Communication
(154) Fiser JrWP. Should Surgeons Be Tested for
Blood-Borne Pathogens? (letter). Infect Control Hosp Epidemiol 2002;
23(6):296-297.
ABSTRACT: I am a cardiac surgeon infected with hepatitis C virus (HCV), and
approximately 2 years ago, I realized that it was highly likely that I had
infected one of my patients. Because of
this, I have spent an inordinate amount of time reading and thinking about the
ethical issues of HCV and other blood-borne pathogens. There is no doubt in my mind that cardiac
surgeons are at higher risk than most other surgical specialists for acquiring
and transmitting hepatitis C and other blood-borne pathogens. Currently, I know of three reports of cardiac
surgeons transmitting HCV during surgery to one, three, and five patients,
respectively. The most recent report
comes from the United States and sparked a controversy over patient
notification and disclosure. In this
case, three transmissions were recognized and confirmed from one surgeon;
thousand of that surgeon's patients are now being contacted for testing in a
look-back procedure. The State of New
York Department of Health has directed the surgeon to obtain written consent
preoperatively regarding his HCV.
Transmission of hepatitis B virus (HBV) has been traced to cardiac
surgeons in several clusters of infection.
Because of this, HBV was included in human immunodeficiency virus (HIV)
policies mandated in 1991, but there has been little enforcement of these
policies. Most institutions seem to have
adopted a "don's ask and don't tell" approach.
(155) Frieden TRCTCoNYDoH. New York City Health
Department Investigation of Patients Infected by Hepatitis B and Hepatitis C.
Colleagues, editor. 3-2-2002.
Ref Type: Personal Communication
ABSTRACT: The New York City Department of Health is investigating two recent
hepatitis outbreaks in outpatient medical offices in New York City. In May 2001, the New York City Department of
Health was notified that at least 8 individuals who underwent endoscopic
procedures at a medical practice in Brooklyn has become infected with hepatitis
c; individuals who had undergone endoscopic procedures at this clinic were
advised to be tested for infections with bloodborne pathogens (hepatitis B,
hepatitis C, and HIV). Our investigation
indicates that the endoscopy itself was not the source of the
transmission. In late December 2001, the
Department began investigating an outbreak of acute hepatitis B that now
involves at least 33 individuals who had received vitamin shots containing at
least three different medications at a medical practice in Manhattan. All persons who received injections at this
practice were advised to be tested for infection with bloodborne pathogens. Both outbreaks are believed to be related to
improper handling of contaminated needles, syringes and/or multiuse vials. Although the extent and cause of these
outbreaks are still under investigation, both outbreaks emphasize the
importance of adherence to infection control protocol in both inpatient as well
as outpatient medical care settings. The
communication goes on to make recommendations regarding relevant infection
control protocol.
(156) Goldstein ST, Alter MJ, Williams IT, Moyer LA,
Judson FN, Mottram K et al. Incidence and risk factors for acute hepatitis B in
the United States, 1982-1998: implications for vaccination programs. J Infect
Dis 2002; 185(6):713-719.
ABSTRACT: From 1982-1998, enhanced sentinel surveillance for acute hepatitis B
was conducted in 4 counties in the United States to determine trends in disease
incidence and risk factors for infection. During this period, the reported
incidence of acute hepatitis B declined by 76.1% from 13.8 cases per 100,000 in
1987 to 3.3 cases per 100,000 in 1998. Cases associated with injection drug use
(IDU) decreased by 90.6%, men who have sex with men (MSM) by 63.5%, and
heterosexual activity by 50.7%. During 1994-1998, the most commonly reported
risk factor for infection was high-risk heterosexual activity (39.8%) followed
by MSM activity (14.6%) and IDU (13.8%). Over half of all patients (55.5%)
reported treatment for a sexually transmitted disease (STD) or incarceration in
a prison or jail prior to their illness, suggesting that more than half of the
acute hepatitis B cases might have been prevented through routine hepatitis B
immunization in STD clinics and correctional health care programs
(157) Jagger J, Parker G, Perry J. Comparing U.S.,
Japanese systems in effective infection control. Healthcare Purchasing News
2002; May 2002:46-48.
ABSTRACT: There is a quiet revolution taking place in Japan, well outside the
public limelight, that is slowly but surely affecting the everyday working
conditions of Japanese healthcare workers.
It began in 1994 with Dr. Kiyoshi Kidouchi, a pediatrician working at
Nagoya Municipal Hospital. Dr. Kidouchi
was concerned about exposures to hepatitis C among healthcare personnel in his
hospital, but realized there was no system in place to document and track these
exposures. Japan's regulatory structures
are very different from those in the U.S., and there is no equivalent of the
Bloodborne Pathogens standard or an agency like the Occupational Safety and
Health Administration.
(158) Jagger J. Are Australia's healthcare workers
stuck with inadequate needle protection? The Medical Journal of Australia 2002;
177(8):405-406.
ABSTRACT: The most direct way to reduce percutaneous injuries is to make
devices safer. In this issue of the
Journal, Whitby and McLaws (page
418) provide a thorough epidemiological account of occupational exposure to
bloodborne pathogens by hollowborne needles in one hospital. More studies such as theirs are needed in
Australia, where there has been relatively little attention focused on this
issue, as indicated by the few references to studies by Australian
investigators cited in their article. As
an American I find this surprising, because many successful prevention programs
introducted in Australia have earned the admiration of public health
professionals in other countries. Three
examples come to mind: laws requiring seatbelt use and advanced passenger
protection in motor vehicles; progressive HIV prevention programs; and programs
to prevent ultraviolet light exposure and skin cancer. I am among the admirers of Australia's strong
prevention record. In light of these
progressive programs, how might one explain the relative neglect in Australia
of such serious occupational risk as bloodborne pathogen exposure?
(159) Jagger J, Perry J. Using needlestick data to
target safety device implementation. In: Bennett-Bailey E, Weissman D, Huy JM,
editors. Clinics in Occupational and Environmental Medicine. Philadelphia, PA:
W.B. Saunders Company, 2002: 557-573.
ABSTRACT: With the passage of the Needlestick Safety and Prevention Act in 2000
[1] and the revision of the bloodborne pathogens standard that followed in 2001
[2], collection of sharp-object injury data in healthcare facilities became a
requirement under the law. This article
reviews the criteria set forth by the Occupational Safety and Health
Administration (OSHA) for sharp-object injury logs and discuses how data on
such injuries can be used to target and prioritize the implementation of safety
devices, which was also mandated by the Needlestick Safety and Prevention Act.
(160) Jagger J, Perry J. Realistic expectations for
safety devices. Nursing 2002; 32(3):72.
ABSTRACT: The transition from conventional to safety needles is well under way
in the United States, spurred by the passage of the Needlestick Safety and
Prevention Act in November 2000. How do
changes at your facility affect your practice?
Will needle sticks eventually be eliminated? Will safety devices reduce
or eliminate the need for sharps disposal containers?
(161) Jagger J, Puro V, De Carli G. Occupational
Transmission of Hepatitis C Virus. JAMA 2002; 288(12):1469.
ABSTRACT: To The Editor: Dr Sulkowski and colleagues present a case of
occupational hepatitis C virus (HCV) infection in a medical itern following a
needlestick from an intravenous (IV) catheter stylet. In reviewing the occupational risk of HCV
infection, they state that "HCV transmission following a single
needlestick accident occurs approximately 10 times more often than HIV [human
immunodeficiency virus] transmission."
This estimate appears to derive from studies reported in their Table 1,
which reported a total of 333 HCV-exposed health care workers (HCWs), 14 of
whom became infected, for an overall transmission rate of 4.2%.
(162) Jagger J, Perry J. Power in Numbers: Using
EPINet Data to Promote Protective Policies for Healthcare Workers. Journal of
Infusion Nursing 2002; 25(6S):S15-S20.
ABSTRACT: The authors present major epidemiological findings from the EPINet
multihospital research database of the International Healthcare Worker Safety
Center, and discuss how the data hasa been used to promote protective policies
for healthcare workers. The authors also
take a comparative look at US, Italian, and Japanese EPINet data, and highlight
key differences.
(163) Jagger J. Safer Generation of Spring-Loaded
Fingerstick Lancets. Infect Control Hosp Epidemiol 2002; 23(6):298-299.
ABSTRACT: Desenclos et al. present a convincing case for the nosocomial
transmission of hepatitis C virus associated with the use of a fingerstick
device in a cystic fibrosis and diabetes hospital in France. They attribute transmission to the
inappropriate reuse of a disposable platform attached to the spring-loaded base
unit of a fingerstick device. The same
device was implicated in a similar nosocomial outbreak of hepatitis B virus
reported by Polish et al. Both reports
identify the device in their titles as a "spring-loaded finger-stick
device." Although true, this term
suggests an association between the spring-loaded mechanism and the risk of
infection, when, in fact, the removable platform is implicated as the
transmission vehicle in both cases.
(164) Lundstrom T, Pugliese G, Bartley J, Cox J,
Guither C. Organizational and environmental factors that affect worker health
and safety and patient outcomes. [Review] [169 refs]. AJIC: American Journal of
Infection Control 2002; 30(2):93-106.
ABSTRACT: This article reviews organizational factors that influence the
satisfaction, health, safety, and well-being of health care workers and
ultimately, the satisfaction, safety, and quality of care for patients. The
impact of the work environment on working conditions and the effects on health
care workers and patients are also addressed. Studies focusing on worker health
and safety concerns affected by the organization and the physical work
environment provide evidence of direct positive and/or adverse effects on
performance and suggest indirect effects on the quality of patient care. The
strongest links between worker and patient outcomes are demonstrated in
literature on nosocomial transmission of infections. Transmission of infections
from worker to patient and from patient to patient via health care worker has
been well documented in clinical studies. Literature on outbreaks of infectious
diseases in health care settings has linked the physical environment with
adverse patient and worker outcomes. An increasing number of studies are
looking at the relationship between improvement in organizational factors and
measurable and positive change in patient outcomes. Characteristics of selected
magnet hospitals are reviewed as one model for improving patient and worker
outcomes. [References: 169]
(165) Madan AK, Raafat A, Hunt JP, Rentz D, Wahle
MJ, Flint LM. Barrier precautions in trauma: is knowledge enough? J Trauma
2002; 52(3):540-543.
ABSTRACT: OBJECTIVES: The risk of blood and body fluid exposure and, therefore,
risk of blood-borne disease transmission is increased during trauma
resuscitations. Use of barrier precautions (BPs) to protect health care workers
(HCWs) from exposure and infection has been codified in hospital rules and in
national trauma education policy. Despite these requirements, reported rates of
BP compliance vary widely. The reasons for noncompliance are not known. This
study assesses self-reported rates of BP usage during resuscitations among
trauma professionals, explores reasons for noncompliance, and compares
self-reported compliance rates with actual observed compliance rates. METHODS:
A survey regarding BPs was distributed to all HCWs involved in trauma resuscitations
at our Level I trauma center. All surgical and emergency medicine residents as
well as attending faculty from both disciplines and nursing staff were included
in this study. A total of 161 surveys were distributed and 123 were returned.
RESULTS: Most HCWs (114 of 123 [93%]) reported at least one exposure (usually
intact skin contact) to blood or other body fluids. A considerable variation in
the type of BP used was reported for those HCWs who reported use of BPs
"all of the time." Of the HCWs who reported universal use of BPs,
reported usage rates were as follows: gloves, 105 of 123 (85%); eyewear (no
side protectors), 58 of 123 (47%); eyewear (side protectors), 20 of 123 (16%);
gowns, 22 of 123 (18%); and masks, 5 of 123 (4%). The two most common reasons
for noncompliance were "time factors" (61%) and "BPs are too
cumbersome" (29%). Observed compliance rates were statistically
significantly lower than self-reported rates in all BPs except gloves (p <
0.02). CONCLUSION: The wide variation in BP use and the gap between perceived
and actual usage that we have observed suggest that the effectiveness of
current educational approaches to ensure BP use is inadequate
(166)
Moro ML, Romi R, Severini C, Casadio GP,
Sarta G, Tampieri G et al. Nosocomial Transmission of Hepatitis B Virus Infection Among Residents
With Diabetes in a Skilled Nursing Facility. Infect Control Hosp Epidemiol
2002; 23(6):338-341.
ABSTRACT: OBJECTIVE
To identify exposures associated with acute hepatitis B virus (HBV)
infection among residents with diabetes in a skilled nursing facility.
DESIGN
Residents from Unit 3 and other skilled nursing facility residents with
diabetes were tested for serologic evidence of HBV infection. Two retrospective
cohort studies were conducted. Potential routes of HBV transmission were
evaluated by statistical comparison of attack rates.
SETTING
A 269-bed skilled nursing facility.
PARTICIPANTS
All skilled nursing facility residents with diabetes and skilled nursing
facility residents who lived on the same unit as the index case (Unit 3) for
some time during the case's incubation period.
RESULTS
All 5 residents with acute HBV infection had diabetes and resided in Unit
3. The attack rate among the 12 patients with diabetes in Unit 3 was 42%,
compared with 0% among 43 patients without diabetes (relative risk, 37.2; 95%
confidence interval, 4.7 to ). Acutely infected patients with diabetes received
more morning insulin doses (P = .05), and more insulin doses (P =
.03) and finger sticks (P = .02) on Wednesdays than did noninfected
patients with diabetes. Two chronically infected patients with diabetes in Unit
3 were positive for hepatitis B e antigen and regularly received daily insulin
and finger sticks. Of the 4 acute and 3 chronically infected residents from
whom HBV DNA was amplified, all were genotype F and had an identical 678-bp S
region sequence. Although no component of the lancets or injection devices was
shared among residents, opportunities for HBV contamination of diabetes care
supplies were identified.
CONCLUSIONS
Contamination of diabetes care supplies resulted in resident-to-resident
transmission of HBV. In any setting in which diabetes care is performed, staff
need to be educated regarding appropriate infection control practices (Infect
Control Hosp Epidemiol 2002;23:313-318).
(167) Nothdurft HD, Dietrich M, Zuckerman JN,
Knobloch J, Kern P, Vollmar J et al. A new accelerated vaccination schedule for
rapid protection against hepatitis A and B. Vaccine 2002; 20(7-8):1157-1162.
ABSTRACT: Background: Increasing travel stresses the requirement for rapid
protection against infections such as hepatitis A and B.Methods: This
randomised, multicentre study investigated an accelerated vaccination schedule
using a combined hepatitis A and B vaccine (Twinrix, Smithkline Beecham
Biologicals) compared with simultaneous administration of the two corresponding
monovalent vaccines. The combined vaccine was administered on days 0, 7 and 21,
whereas the comparison group received hepatitis A vaccine on day 0 and
hepatitis B vaccine on days 0, 7 and 21. All subjects received booster
vaccination at month 12.Results: At month 1, 100% of subjects in the combined
group and 99% of the controls were seropositive for anti-HAV antibodies. The
corresponding seroprotection rates for anti-HBs antibodies were 82.0 and 83.9%,
respectively. Examination of the 95% confidence intervals (CIs) for the
treatment differences showed the two vaccines to be equivalent in terms of
immunogenicity 1 week after the initial vaccination course. Just prior to the
booster, the seropositivity rate for anti-HAV was 96.2% in the combined group
and 95% in the control group. For anti-HBs, this was 94 and 91.6%,
respectively. All subjects were seropositive for anti-HAV and seroprotected
against hepatitis B at month 13. The anti-HAV GMCs were 9571mIU/ml with the
combined vaccine and 5206mIU/ml in control subjects. The anti-HBs titre was
26002 and 29,196mIU/ml, respectively. Both groups had a similar reactogenicity
profile.Conclusions: The accelerated schedule of the combined vaccine provides
a good immune response against hepatitis A and B antigens and is suitable for
last minute immunisation. ST -
(168) Occupational Safety and Health Administration.
Standard Interpretations:Re-use of blood tube holders. Washington, D.C. Issued
06/12/2002. Occupational Safety and Health Administration 2002.
ABSTRACT:
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=24040
(169) Orelien JG. Choice of Demonimator Variables
for Computing Rates of Percutaneous Injuries. GS-39F-4750G. 2002. Division of Health Quality and Promotion,
Centers for Disease Control and Prevention.
Ref Type: Report
(170) Panlilio AL, Burwen DR, Curtis AB, Srivastava
PU, Bernardo J, Catalano MT et al. Tuberculin skin testing surveillance of
health care personnel. Clinical Infectious Diseases 2002; 35(3):219-227.
ABSTRACT: To estimate the incidence of and assess risk factors for occupational
Mycobacterium tuberculosis transmission to health care personnel (HCP) in 5 New
York City and Boston health care facilities, performance of prospective
tuberculin skin tests (TSTs) was conducted from April 1994 through October
1995. Two-step testing was used at the enrollment of 2198 HCP with negative TST
results. Follow-up visits were scheduled for every 6 months. Thirty (1.5%) of
1960 HCP with >/=1 follow-up evaluation had TST conversion (that is, an
increase in TST induration of >/=10 mm). Independent risk factors for TST
conversion were entering the United States after 1991 and inclusion in a
tuberculosis-contact investigation in the workplace. These findings suggest
that occupational transmission of M. tuberculosis occurred, as well as possible
nonoccupational transmission or late boosting among foreign-born HCP who recently
entered the United States. These results demonstrate the difficulty in
interpreting TST results and estimating conversion rates among HCP, especially
when large proportions of foreign-born HCP are included in surveillance
(171) Parker G. Needlestick Injuries: A Paramedic's
Perspective. Adv Exposure Prev 2002; 6(2):19-24.
ABSTRACT: Paramedics and ED personnel face similar risks for blood
exposures. They are both confronted by
the unpredictability of the patient's condition, and must perform a daunting variety
of tasks under intense pressure. I
experienced those risks firsthand as a paramedic in rural West Virginia for our
years.
(172) Patel R, Germer JJ. Treatment of acute
hepatitis C with interferon alfa-2b. [letter; comment.]. New England Journal of
Medicine 2002; 346(14):1091-1092.
ABSTRACT: To the Editor: Jaeckel and colleagues (Nov. 15 issue) report
that treatment of acute hepatitis C virus (HCV) infection with interferon
alfa-2b prevents chronic infection.
Their conclusion is based on the finding that in 42 of 43 patients who
could be evaluated, HCV RNA in serum was undetectable 24 weeks after the end of
treatment with interferon alfa-2b. To
measure HCV RNA in serum, the authors used the Cobas Amplicor HCV C monitor,
version 2.0 (Roche Diagnostics, Mannheim, Germany). This assay has a lower limit of detection of
600 IUS per milliliter, not 600 copies per
milliliter, as stated in the article.
their international unit is an internationally accepted standard of
measurement; 100,000 IU is defined as the amount of virus in 1 ml of the World
Health Organization's International Standard for Nucleic Acid Amplification
Technology Assays for HCV RNA (Standard 96/790).
(173) Paton S, Zou S, Giulivi A. More should be done
to protect surgical patients from intraoperative hepatitis B infection. Infect
Control Hosp Epidemiol 2002; 23(6):303-305.
ABSTRACT: When do we, s a society, have the right or the duty to deny a
person's right to work in a chosen profession?
The article by Spijkerman et al. in this issue of Infection control and
Hospital Epidemiology once again raises this question. The article reports that a surgeon was
unresponsive to repeated attempts at hepatitis B vaccination, and then was
infected with hepatitis B at least a decade before discovery through public
health department investigations of symptomatic infections among some of his
most recent patients. During the course
of 4 years, the surgeon, unknowingly infected with hepatitis B virus (HBV),
appears to have transmitted HBV to 28 patients.
(174) Perry J, Jagger J, Parker G. Percutaneous
Injuries and Blood Exposures in Emergency Department Settings. Adv Exposure
Prev 2002; 6(2):19-22.
ABSTRACT: Emergency Department (ED) staff are especially vulnerable to
bloodborne pathogen exposures. Like
operating room (OR) personnell, ED workers are more likely to be exposed to
large quantities of blood than health care workers in other settings; unlike
the OR, however, such exposures are more apt to occur under unpredictable
circumstances. Compounding the risk are
combative or uncooperative patients, all-too-familiar to ED staff.
(175) Perry J, Jagger J. HIV Infection in a
Firefighter/Paramedic. Adv Exposure Prev 2002; 6(2):14-23.
ABSTRACT: John Smith (A pseudonym) is a 32-year-old firefighter and paramedic
living in a large midwestern city in the U.S.; he is infected with HIV. He reports a history of occupational
exposures to blood and body fluids (BBF), and he and his wife report no risk
factors for HIV. At the time of his
diagnosis, he had been a firefighter/paramedic for nine years, and has been
married for 10 years. He and his wife
have two young children.
(176) Perry J. A Needlestick in the ER: A patient
turned agressive and Vanessa Burkhart was infected with HCV. Adv Exposure Prev
2002; 6(2):15-18.
ABSTRACT: In 1999, Vanessa Burkhart was a 39-year-old emergency nurse who was
supremely confident in her clinical skills.
She had worked in a variety of settings during her thirteen years as a
nurse--including medical/surgical, orthopedics and home health--but emergency
nursing had always been her passion. It
was, she says, "all I ever wanted to do."
(177) Perry J, Jagger J. Lessons from an
HCV-infected surgeon. Bulletin of the American College of Surgeons 2002;
87(3):9-13.
ABSTRACT: The International Health
Care Worker Safety Center at the University of Virginia, Charlottesville, is
devoted to the prevention of occupational exposures to blood-borne pathogens in
the health care workplace. Recently, a
plastic surgeon contacted us who was occupationally infected with hepatitis C
virus (HCV) from a sharps injury he sustained during his residency. At our request, he consented to be
interviewed about his exposure and infection.
The surgeon, who prefers to remain
anonymous, is chief of plastic and reconstructive surgery at an academic
medical center in the U.S. He is married
and the father of four children. His
experience sheds light on the personal and professional realities confronting
an infected surgeon. "Dr.
Jones," as we call him in this article, hopes to educate surgeons about
the potential consequences of sharps exposures and the need to make the
operating room as safe as possible - both for patients and the operating room
personnel who care for them.
(178) Perry J, Jagger J. Safer needles: Not
optional. Nursing 2002; 32(10):20-21.
ABSTRACT: A decade afater the Bloodborne Pathogens (BBP) Standard was first
issued in 1991, the Occupational Safety and Health Administration (OSHA)
revised it in April 2001 to emphasize the requirement to use safety-engineered
devices. Over the last several years,
OSHA has sharply stepped up enforcement of the BBP Standard. Its recent compliance directive and letters
of interpretation on the standard further underscore its commitment to reduce
needle sticks through the use of safer devices and practices.
(179)
Petrosillo N, Raffaele B, Martini L,
Nicastri E, Nurra G, Anzidei G et al. A Nosocomial and Occupational Cluster of Hepatitis A Virus
Infection in a Pediatric Ward . Infect Control Hosp Epidemiol 2002;
23(6):343-345.
ABSTRACT: We describe a cluster of acute hepatitis A virus (HAV) infection that
involved two patients and one physician in the pediatric unit where two
children with acute HAV infection had been housed. An interview with the unit personnel
revealed several breaches in infection control measures and the lack of
vaccination of healthcare workers against HAV (Infect Control Hosp Epidemiol
2002;23:343-345).
(180) Playford EGHBHDLW. Intradermal recombinant
hepatitis B vaccine for healthcare workers who fail to respond to intramuscular
vaccine. Infect Control Hosp Epidemiol 2002; 23(2):87-90.
ABSTRACT: OBJECTIVE: To study the humoral immune responses, safety, and
tolerability of intradermal recombinant hepatitis B vaccination in healthcare
workers (HCWs) nonresponsive to previous repeated intramuscular vaccination.
DESIGN: An open, prospective, before-after trial. SETTING: A tertiary referral
hospital and surrounding district health service in Queensland, Australia.
PARTICIPANTS: Hospital and community HCWs nonresponsive to previous
intramuscular hepatitis B vaccination. METHODS: Intradermal recombinant
hepatitis B vaccine was administered every second week for a maximum of 4
doses. Hepatitis B surface antibody (anti-HBs) responses were assessed 2 weeks
after each dose. RESULTS: Protective anti-HBs levels developed in 17 (94%) of
18 study subjects. Three doses resulted in seroconversion of all responding
subjects and the highest geometric mean antibody concentration. The vaccine was
well tolerated. CONCLUSION: More than 90% of previously nonresponsive HCWs
responded to intradermal recombinant hepatitis B vaccine with protective
anti-HBs levels. ST -
(181) Rabin R. No Outreach Over Hepatitis C;
Ex-patients responsible for contacting hospital. Newsday 2002 Mar 29;A22.
ABSTRACT: Officials at North Shore University Hospital in Manhasset, where
several patients were inadverently infected with hepatitis C by their surgeon,
are not planning to call in all of the physician's former patients for free
testing, they said yesterday.
(182) Rabin R. Hepatitis C Link; Officials: Surgeon
likely infected at least 3 patients. Newsday 2002 Mar 27;A03.
ABSTRACT: A cardiac surgeon at North Shore University Hospital in Manhasset
apparently has infected three patients with hepatitis C, and he may be
responsible for transmitting the virus to four additional patients, in an
extremely unusual cluster of doctor-to-patient infections, state Health
Department investigators said.
(183) Rabin R. Former Patients Seeking Answers;
Hospital fields calls on surgeon with hepatitis C. Newsday 2002 Mar 28;A04.
ABSTRACT: Former heart surgery patients jammed telephone lines at North Short
University Hospital in Manhasset yesterday in an effort to find out whether
they were operation on by a docotor who apparently transmitted hepatitis C to
several patients in the course of surgery during the past decade.
(184) Rabin R. Infected Surgeon's Work
"Unjustifiable". Newsday 2002 Apr 2;A08.
ABSTRACT: A nationally known epidemiologist who specializes in health care
worker safety said yesterday she found it "unjustifiable" and
'incredible" that a surgeon with hepatitis C who appears to have infected
several patients is continuing to perform open heart surgery.
(185) Rabin R. Seeking a legal remedy patient sues
heart surgeon he says gave him hepatitis C. Newsday 2002 Apr 12;A02.
ABSTRACT: The Manhasset physician who infected at least three patients with
hepatitis C is Dr. Michael H. Hall, a brilliant heart surgeon ranked as one of
the top 10 in the state, according to a lawsuit filed today by one of the
patients.
(186) Rabin R. Patients: He Never Told us; 5 Say
Surgeon Didn't Reveal his Hepatitis. Newsday 2002 Apr 17;A03.
ABSTRACT: Five patientes who were operated on recently by Dr. Michael H. Hall
say the Manhasset surgeon did not inform them he was infected with hepatitis C,
even though the state recommended he tell patients he was a carrier and may
have transmitted the virus during surgery in the past.
(187) Robson G, Fraser A. Hepatitis C infected
health care workers. 1-4. 11-22-2002.
Ref Type: Personal Communication
ABSTRACT: Summarises and draws attention to the revised guidance on the
management of hepatitis C infected health care workers. A copy of the attached
guidance was sent out with the letter.
(188) Ross RS, Viazov S, Thormahlen M, Bartz L, Tamm
J, Rautenberg P et al. Risk of hepatitis C virus transmission from an infected
gynecologist to patients: results of a 7-year retrospective
investigation.[erratum appears in Arch Intern Med 2002 May 27;162(10):1139].
Archives of Internal Medicine 2002; 162(7):805-810.
ABSTRACT: BACKGROUND: Currently, it is not known how often hepatitis C virus
(HCV) is transmitted from infected health care workers to patients during
medical care. In the present investigation, we tried to determine the rate of
provider-to-patient transmission of HCV among former patients of an
HCV-positive gynecologist after it was proven that he infected one of his
patients with HCV during a cesarean section. METHODS: All 2907 women who had
been operated on by the HCV-positive gynecologist between July 1993 and March
2000 were notified about potential exposure and were offered free counseling
and testing. The crucial differentiation between HCV transmissions caused by
the gynecologist and infections contracted from other sources was achieved by
epidemiological investigations, nucleotide sequencing, and phylogenetic
analysis. RESULTS: Of the 2907 women affected, 78.6% could be screened for
markers of HCV infection. Seven of these former patients were found to have
HCV. Phylogenetic analysis of HCV sequences from the gynecologist and the women
did not indicate that the virus strains were linked. Therefore, no further
iatrogenic HCV infections caused by the gynecologist could be detected. The
resulting overall HCV transmission rate was 0.04% (1 per 2286; 95% confidence
interval, 0.008%-0.25%). CONCLUSION: To our knowledge, this is the largest
retrospective investigation of the risk of provider-to-patient transmission of HCV
conducted so far. Our findings support the notion that such transmissions are
relatively rare events and might provide a basis for future recommendations on
the management of HCV-infected health care workers
(189) Ross RS, Viazov S, Roggendorf M. Phylogenetic
analysis indicates transmission of hepatitis C virus from an infected
orthopedic surgeon to a patient. Journal of Medical Virology 2002;
66(4):461-467.
ABSTRACT: During recent years, a controversial discussion has emerged in the
medical community on the real number and possible public health implications of
hepatitis C virus (HCV) transmissions from infected medical staff to
susceptible patients. We report here on molecular virological and
epidemiological analyses involving 229 patients who underwent exposure-prone
operations by an HCV-infected orthopedic surgeon. Of the 229 individuals
affected, 207 could be tested. Three were positive for HCV antibodies.
Molecular and epidemiological investigation revealed that two of them were not
infected by the surgeon. The third patient, a 50-year-old man, underwent
complicated total hip arthroplasty with trochanteric osteotomy. He harbored an
HCV 2b isolate that in phylogenetic analysis of the hypervariable region 1 (HVR
1) was closely related to the HCV strain recovered from the infected surgeon,
indicating that HCV-provider-to-patient transmission occurred intraoperatively.
To our knowledge, this is the first documented case of HCV transmission by an
orthopedic surgeon. The recorded transmission rate of 0.48% (95% confidence
interval: 0.09-2.68%) was within the same range reported previously for the
spread of hepatitis B virus during orthopedic procedures. Since the result of
our investigation sustains the notion that patients may contract HCV from
infected health-care workers during exposure-prone procedures, a series of
further retrospective exercises is needed to assess more precisely the risk of
HCV provider-to-patient transmission and to delineate from these studies
recommendations for the guidance and management of HCV-infected medical
personnel. Copyright 2002 Wiley-Liss, Inc
(190) Salgado CD, Flanagan HL, Haverstick DM, Farr
BM. Low Rate of False-Positive Results with Use of a Rapid HIV Test. Infect
Control Hosp Epidemiol 2002; 23(6):335-337.
ABSTRACT: BACKGROUND
Occupational exposure to human immunodeficiency virus (HIV) is an important
threat to healthcare workers. Centers for Disease Control and Prevention
guidelines recommend prompt institution of prophylaxis. This requires (1)
immediate prophylaxis after exposure, pending test results that may take more
than 24 hours in many hospitals; or (2) performance of a rapid test. The Single
Use Diagnostic System (SUDS)® HIV-1 Test is used to screen rapidly for
antibodies to HIV type 1 in plasma or serum, with a reported sensitivity of
more than 99.9%. We used this test from January 1999 until September 2000, when
it was withdrawn from the market following reports claiming a high rate of
false-positive results.
METHODS
We reviewed the results of postexposure HIV testing during 21 months.
RESULTS
A total of 884 SUDS tests were performed on source patients after
occupational exposures (883 negative results, 1 reactive result). The results
of repeat SUDS testing on the reactive specimen were also reactive, but the
results of enzyme immunoassay and Western blot testing were negative. A new
specimen from the same patient showed a negative result on SUDS testing. This
suggested a specificity of 99.9%. In the 4 months after SUDS testing was
suspended, there was 1 false-positive result on enzyme immunoassay for 1 of 132
source patients (presumed specificity, 99.2%).
CONCLUSION
Use of the SUDS test facilitated rapid and accurate evaluation of source
specimens, obviating unnecessary prophylaxis (Infect Control Hosp Epidemiol 2002;23:335-337).
(191) Sivapalasingam S, Malak SF, Sullivan JF, Lorch
J, Sepkowitz KA. High Prevalence of Hepatitis C Infection Among Patients
Receiving Hemodialysis at an Urban Dialysis Center. Infect Control Hosp
Epidemiol 2002; 23(6):319-324.
ABSTRACT: OBJECTIVE
To determine the seroprevalence and risk factors for hepatitis C virus
(HCV) infection among patients at an urban outpatient hemodialysis center.
METHODS
This was a cross-sectional study of 227 patients undergoing hemodialysis at
the Rogosin Kidney Center on December 15, 1998, with a response rate of 90%
(227 of 253). Laboratory records were used to retrieve the total number of
blood transfusions received and serologic study results. Univariate and
multivariate analyses were used to examine the relationship among HCV
serostatus, patient demographics, and HCV risk factors (eg, intravenous drug
use [IVDU], intranasal cocaine use, multiple sexual partners, comorbidities,
length of time receiving hemodialysis, and total number of blood transfusions
received).
RESULTS
The seroprevalence of antibody to HCV (anti-HCV) was 23.3% (53 of 227) in
the population. In univariate analysis, factors associated with HCV
seropositivity included male gender, younger age, history of IVDU, history of
intranasal cocaine use, history of multiple sexual partners, human
immunodeficiency virus coinfection, increased time receiving dialysis, history
of renal transplant, and positive antibody to hepatitis B core antigen.
Multivariate logistic regression analysis showed that longer duration receiving
dialysis and a history of IVDU were the only risk factors that remained
independently associated with HCV seropositivity.
CONCLUSIONS
HCV is markedly more common in our urban cohort of patients receiving
hemodialysis compared with patients receiving dialysis nationally and is
associated with a longer duration of receiving dialysis and a history of IVDU.
Stricter and more frequent enforcement of universal precautions may be required
in hemodialysis centers located in areas with a high prevalence of HCV
infection or IVDU among the general population (Infect Control Hosp
Epidemiol 2002;23:319-324).
(192) Spijkerman IJ, van Doorn LJ, Janssen MH,
Wijkmans CJ, Bilkert-Mooiman MA, Weers-Pothoff G. Transmission of Hepatitis B
Virus From a Surgeon to His Patients During High-Risk and Low-Risk Surgical
Procedures During 4 Years. Infect Control Hosp Epidemiol 2002; 23(6):306-312.
ABSTRACT: OBJECTIVE
We investigated cases of acute hepatitis B in The Netherlands that were
linked to the same general surgeon who was infected with hepatitis B virus
(HBV).
DESIGN
A retrospective cohort study was conducted of 1,564 patients operated on by
the surgeon. Patients were tested for serologic HBV markers. A case-control
study was performed to identify risk factors.
RESULTS
The surgeon tested positive for hepatitis B surface antigen (HBsAg) and
hepatitis B e antigen (HBeAg) with a high viral load. He was a known
nonresponder after HBV vaccination and had apparently been infected for more
than 10 years. Forty-nine patients (3.1%) were positive for HBV markers.
Transmission of HBV from the surgeon was confirmed in 8 patients, probable in
2, and possible in 18. In the remaining 21 patients, the surgeon was not
implicated. Two patients had a chronic HBV infection. One case of secondary
transmission from a patient to his wife was identified. HBV DNA sequences from
the surgeon were completely identical to sequences from 7 of the 28 patients
and from the case of secondary transmission. The duration of the operation and
the occurrence of complications during or after surgery were identified as
independent risk factors. Although the risk of HBV infection during high-risk
procedures was 7 times higher than that during low-risk procedures, at least 8
(28.6%) of the 28 patients were infected during low-risk procedures.
CONCLUSIONS
Transmission of HBV from surgeons to patients at a low rate can remain
unnoticed for a long period of time. Prevention requires a more stringent
strategy for vaccination and testing of surgeons and optimization of infectious
disease surveillance. Policies allowing HBV-infected surgeons to perform
presumably low-risk procedures should be reconsidered (Infect Control Hosp
Epidemiol 2002;23:306-312).
Case-Control Study:
To identify risk factors for HBV infection after an operation performed
by the infected surgeon, each (confirmed, probable, or possible) case was
compared with a random sample of three uninfected patients operated on by the
surgeon (controls). Factors related to
host and surgery were collected and entered into standardized forms. Associations between these factors and HBV
infection were assessed by univariate and stratified logistic regression
analysis using SPSS 8.0 software (SPSS Inc., Chicago, IL). Odds ratios (ORs) and 95% confidence
intervals (CL95) were calculated.
Continuous variables were categories with smiliar risk of infection were
combined. Because the date of
transmission could not be determined for patients who underwent multiple
operations by the surgeon, characteristics of these procedures were
combined. To study whether this approach
overestimated the effect of surgery-related variables, a separate analysis was
performed stratifying for the number of operations. In addition, an analysis was performed selecting
the confirmed and probable cases only.
The Spearman correlation coefficient was calculated to study the
correlation between variables.
(193) Stringer B. Transmissions from infected
healthcare providers to patients are medical errors.[comment]. Infect Control
Hosp Epidemiol 2002; 23(11):638.
ABSTRACT: To the Editor: Do no
harm. This is a principle all medical
personnel live by and should be referred to whenever we discuss interactions
between patients and healthcare providers.
In the June issue of Infection Control and Hospital Epidemiology,
there were two editorials, one article, and two letters regarding the
transmission of hepatitis B virus, hepatitis C virus, and human
immunodeficiency virus from surgical personnel to patients. It serves our collective interest to analyze
this issue through the principle stated above and its necessary practical
companion, reducing medical errors.
After all, isn't transmission of disease in our healthcare institution
by definition a medical error?
(194) The Associated Press. State directs
hepatitis-infected surgeon obtain signed consent before operating. Newsday 2002
Apr 19.
ABSTRACT: A Long Island heart
surgeon infected with hepatitis C must obtain a signed consent from patients
before performing any surgeries.
The directive from the state Health
Department was issued in an April 10 letter to North Shore University Hospital
where the doctor works, said Kristine Smith, a spokeswoman from the government
agency.
(195) Thomas T. Towards a standard HIV post exposure
prophylaxis for healthcare workers in Europe. Eurosurveillance 2002; 6(34).
ABSTRACT: The transmission of HIV from patient to healthcare worker in an
occupational setting was first documented in 1984 (1). In countries that have
surveillance and HIV testing systems to recognise occupationally acquired
cases, over 100 cases of HIV transmission after an occupational exposure were
reported worldwide up to June 1999 (2). Antiretroviral drugs are used for
post-exposure prophylaxis (PEP), and zidovudine alone is said to reduce
transmission of HIV by 81% (3), but failures of PEP have been
documented (4). The European Commission has recently funded a project to
develop guidelines for the standardised management of occupational exposures to
HIV/bloodborne infections and evaluation of PEP in Europe. The EuRoPEP
(European Registry of Post-Exposure Prophylaxis) project is coordinated by the
Istituto Nazionale per le Malattie Infettive, Lazzaro Spallanzani, Rome, and
involves a group of expert representatives from Croatia, Denmark, France,
Germany, Italy, Portugal, Spain, Switzerland, and the United Kingdom. The group
presented two ABSTRACTs at the XIV International AIDS Conference in Barcelona,
Spain (7-12 July 2002, http://www.aids2002.com/). The first assessed current
policies and practice for the management of occupational exposures and PEP (5);
the second aimed to provide a set of recommendations based on a review of
national management strategies as discussed during a consensus meeting (6), and
copies are available on request: (irapep@inmi.it).
(196) Whitby RM, McLaws ML. Hollow-bore needlestick
injuries in a tertiary teaching hospital: epidemiology, education and
engineering.[comment]. Medical Journal of Australia 2002; 177(8):418-422.
ABSTRACT: OBJECTIVE: To describe the frequency, cause and potential cost of
prevention of hollow-bore dirty needlestick injury (NSI) sustained by
healthcare workers. DESIGN AND PARTICIPANTS: Ten-year prospective surveillance
study, 1990-1999, with triennial anonymous questionnaire surveys of nursing
staff. SETTING: 800-bed university tertiary referral hospital in Brisbane,
Australia. MAIN OUTCOME MEASURES: Rates and circumstances of NSI in medical,
nursing and non-clinical staff; knowledge of NSI consequences in nurses; and
minimum costs of safety devices. RESULTS: Between 1990 and 1999, there was a
significant increase (P < 0.001) in the trend of the reported rate of NSI.
Of the 1836 "dirty" NSIs reported, most were sustained in nursing
(66.2%) and medical (16.8%) staff, with 62.7% sustained before disposal.
Hollow-bore injuries from hypodermic needles (83.3%) and winged butterfly
needles (9.8%) were over-represented. Knowledge among nursing staff of some of
the risks and outcomes of NSI improved over the decade. A trend (chi(2 )= 9.89;
df = 9; P = 0.0016) with increasing rate of reported injuries in this group was
detected. The estimated cost of consumables only, associated with the
introduction of self-retracting safety syringes with concomitant elimination of
butterfly needles, where practicable, would be about $365 000 per year.
CONCLUSION: More than one NSI occurs for every two days of hospital operation.
Introduction of self-retracting safety syringes and elimination of butterfly
needles should reduce the current hollow-bore NSI by more than 70% and almost
halve the total incidence of NSI
(197) Yamamoto AJ, Solomon JA, Soulen MC, Tang J,
Parkinson K, Lin R et al. Sutureless Securement Device Reduces Complications of
Peripherally Inserted Central Venous Catheters. Journal of Vascular and
Interventional Radiology 2002; 13:77-81.
ABSTRACT: PURPOSE: This study was conducted to evaluate the performance of
a sutureless adhesive-backed device, StatLock, for securement of
peripherally inserted central venous catheters (PICCs). Earlier studies
have demonstrated that StatLock significantly reduces catheter-related
complications when compared to tape. The purpose of this study was
to determine whether a sutureless securement device offers an
advantage over suture in preventing catheter-related complications.
MATERIALS AND METHODS: 170 patients requiring PICCs, which were randomized
to suture (n = 85) or StatLock (n = 85) securement were
prospectively studied. Patients were followed throughout their
entire catheter course, and PICC-related complications including
dislodgment, infection, occlusion, leakage, and central venous
thrombosis were documented. Catheter outcome data were compared to
determine if statistically significant differences existed between
the suture and StatLock groups.
RESULTS: The groups had equivalent demographic characteristics and
catheter indications. Average securement time with StatLock was
significantly shorter (4.7 minutes vs 2.7 minutes;P < .001).
Although StatLock was associated with fewer total complications (42
vs 61), this difference did not achieve significance. However, there
were significantly fewer PICC-related bloodstream infections in the
StatLock group (2 vs 10; P = .032). One securement-related needle-stick
injury was documented during suturing of a PICC.
CONCLUSION: The sutureless anchor pad was beneficial for both patients
and health care providers. Further investigation to determine how
StatLock helps reduce catheter-related blood stream infections is
necessary.
(198) Zaaijer HLLV-GK. Concurrence of hepatitis B
surface antibodies and surface antigen: implications for postvaccination
control of health care workers. Journal of Viral Hepatitis 2002; 9(2):146-148.
ABSTRACT: Among 1081 persons testing positive for hepatitis B surface antigen,
106 (10%) tested positive for antibodies to surface antigen (anti-HBs) in the
same blood sample. Thirty of these persons were studied in detail: seven tested
positive for hepatitis B e-antigen, nine were apparently healthy blood donors,
and in 14 chronic infection could be demonstrated in follow-up samples. Frozen
samples of 14 persons were available for additional quantitative anti-HBs
testing using another anti-HBs assay: three showed no anti-HBs reactivity,
seven showed borderline anti-HBs levels (1--5 IU/L), and anti-HBs titres ranged
from 23 to 66 IU/L in four HBsAg-positive persons, including an apparently
healthy blood donor. Thus, after hepatitis B vaccination of medical personnel,
presence of anti-HBs may erroneously suggest immunity, while in fact chronic
infection with hepatitis B virus is present. ST -
(199) Prevention of Occupational Blood Borne Virus
Transmission in Europe. Frontline Health Care Workers' Safety Foundation 2001.
(200) Health officials estimate more than one
billion Chinese are infected with hepatitis B virus (HBV) and 1.26 million have
HIV. CDC HIV/STD/TB Prevention News Update.August 23, 2001.CDC HIV/STD/TB
Prevention News Update.August 24, 2001.
2001.
Ref Type: Electronic Citation
(201) Occupational HIV transmission in Europe.:
2001.
ABSTRACT: As of December 1999, 35 documented and 68 possible cases of
occupationally acquired HIV infections have been reported in Europe (32% of
reports worldwide). Of the 35 documented cases, 91% were percutaneous
accidental blood exposures (ABE). 80% occurred in nurses. Furthermore, 3
occupational infections occurred in non-HCWs: 2 sanitation workers and 1 police
officer.
The cumulative risk of occupational HIV infection depends on:
-
Population prevalence: in European countries with adequate surveillance
systems, documented cases are proportional to the incidence of AIDS cases.
-
Rate of HIV transmission following ABE: estimated at 0.32% for a
percutaneous and 0.03% for a mucocutaneous exposure by most authors. Use of post-exposure prophylaxis
(PEP) has a protective effect.
-
Type of ABE: identified risk factors are deep injury, hollow-bore
needle, placed in the patient's vein or artery and source patient with a high
viral load.
-
Frequency of ABE: presented elsewhere.
Most European countries have issued PEP guidelines. PEP, however, is not always
used as recommended, after careful assessment of risks and benefits and only if
associated with a primary ABE prevention program. Preventive measures will
protect both HCWs and patients, as transmission from HIV+HCWs to patients,
although extremely rare, has been described.
(202) Adams T, McClearly J, Peterson P. Guarded
Fistual Needle (Masterguard [R] Proven to Reduce Needlestick Injuries in
Hemodialysis. Nephrology Nursing Journal 2001; 28(2):128.
ABSTRACT: The Federal Needlestick Safety and Protection Act, signed into law on
November 6, 2000, mandates that the 1991 OSHA Bloodborne Pathogens Standard (29
CFR 1930.1030) be revised to require the use of safety engineered sharps
devices. There are no documented studies
demonstrating the effectiveness of guarded fistula needles in reducing the
incidence of needlestick injuries in hemodialysis. The purpose of this study therefore was to
compare the incidence of needlesticks with a non-guarded fistula needle with
Engineered Sharps Injury Prevention (ESIP).
Control data regarding needlesticks with non-guarded fistula needle was
collected retrospectively at an institution with approximately 400
patients. The fistula needle with ESIP
was implemented at the same institution for a subsequent period. The needlestick data for the evaluation
period was compared to the control data.
Results showed that the fistula needle with ESIP was effective in reducing the
incidence of needlesticks. No accidental
needlesticks occurred during the evaluation period. These results indicate that this fistula
needle with ESIP is effective in reducing the risk of exposure to bloodborne
pathogens (BBP) and accidental needlesticks.
Healthcare workers using large hollow bore needles in hemodialysis and
apheresis settings have a high risk of exposure to BBP. The hemodialysis population has a higher
Hepatitis C (HCV) incidence than the general population. Non-guarded fistula needles account for
almost half of all hemodialysis exposure events. The proper use of guarded fistula needle
device to prevent needlestick injuries can reduce the risk of exposure to HBV,
HCV, HIV and other BBP and ensure the safety of the frontline healthcare
worker.
(203) Alrawi S, Houshan L, Satheesan R, Raju R,
Cunningham J, Acinapura A. Glove reinforcement: an alternative to double
gloving. Infect Control Hosp Epidemiol 2001; 22(8):526-527.
ABSTRACT: Gloves, worn by the surgical team to prevent transmission of
infections from and to patients, are prone to tears and perforations. This
study was done to determine the frequency and sites of unrecognized glove
perforation during surgical procedures. The percentage of glove perforation was
14%. Of the punctures, 73% occurred in one of four contiguous locations on the
glove. We recommend glove reinforcement at these locations to provide better
protection, as well as to reduce the burden of double gloving
(204) Alvarado-Ramy F, Alter MJ, Bower W, Henderson
DK, Sohn AH, Sinkowitz-Cochran RL et al. Management of occupational exposures
to hepatitis C virus: current practice and controversies. Infect Control Hosp
Epidemiol 2001; 22(1):53-55.
ABSTRACT: Unlike hepatitis B virus and human immunodeficiency virus, there
currently are no immunization or chemoprophylactic interventions available to
prevent infection after an occupational exposure to hepatitis C virus (HCV). A
"Reality Check" session was held at the 4th Decennial International
Conference on Nosocomial and Healthcare- Associated Infections to gather
information on current practices related to management of occupational
exposures to HCV, generate discussion on controversial issues, and identify
areas for future research. Infection control professionals in attendance were
knowledgeable in most issues addressed regarding the management of occupational
exposures to HCV. Areas of controversy included the use of antiviral therapy
early in the course of HCV infection and the appropriate administrative
management of an HCV-infected healthcare worker
(205) Alvarado-Ramy F, Alter MJ, Bower W, Henderson
DK, Sohn AH, Sinkowitz-Cochran RL et al. Management of occupational exposures
to hepatitis C virus: current practice and controversies. Infect Control Hosp
Epidemiol 2001; 22(1):53-55.
ABSTRACT: Unlike hepatitis B virus and human immunodeficiency virus, there
currently are no immunization or chemoprophylactic interventions available to
prevent infection after an occupational exposure to hepatitis C virus (HCV). A
"Reality Check" session was held at the 4th Decennial International
Conference on Nosocomial and Healthcare-Associated Infections to gather
information on current practices related to management of occupational
exposures to HCV, generate discussion on controversial issues, and identify
areas for future research. Infection control professionals in attendance were
knowledgeable in most issues addressed regarding the management of occupational
exposures to HCV. Areas of controversy included the use of antiviral therapy
early in the course of HCV infection and the appropriate administrative
management of an HCV-infected healthcare worker
(206) Anonymous. Catheter Drawn Blood Avoids Painful
Needlesticks. RN 2001; 64(1):21.
ABSTRACT: Frequent blood sampling
causes severe distress, both from the pain of repeated venipunctures and
anticipation of the pain. But nurse
researchers report that samples obtained through a peripheral saline lock
device are comparable to those obtained from venipuncture, and prevent repeated
needlesticks.
Patients in the study served as
their own controls. Blood was taken from
the saline lock device--in this case, a venous over-the-needle catheter with an
intermittent infusion cap applied to the hub--in either the hand or forearm and
from a vein in the opposite arm. Saline
locks are used in many healthcare facilities as an alternative to an
intravenous apparatus for keeping the vein open, so many patients who need
frequent blood draws already have them in place.
Researchers established a strict
protocol for collecting blood from the saline locks to keep variables to a
minimum. The biggest problem--hemoloysis
in 20% of the port samples--might have been caused by nurses' unfamiliarity
with drawing blood from the ports. In
two instances, nurses were unable to obtain sufficient samples from ports.
Overall, chemical assays performed
on the samples from saline locks were clinically acceptable, and researchers
recommend the method for inpatients
undergoing multiple blood draws necessary for short-term investigative
procedures or crisis management.
(207) Anonymous. Blood exposure rates in hospitals
too high. Healthcare Purchasing News 2001; 25(4):33.
ABSTRACT: The February issue of Infection Control and Hospital Epidemiology reported too many hospital workers
are exposed to blood and other body fluids, while prevention is often
inadequate. The survey, conducted by the
University of Iowa, in Iowa and Virginia found an overall percutaneous exposure
rate of 5/3 per 100 hospital employees per year for 106 reporting
hospitals. The report considered those
numbers "unacceptably high."
(208) Anonymous. HIV Infected Health Care Workers:
Are Patients Safe? Health & Medicine Week 2001;18.
ABSTRACT: Balancing the rights of
HIV infected health-care workers with patient safety is the topic of a review
of the evidence for risk of HIV transmission from health care workers.
Two studies of HIV infected health
care workers have shwon probably transmission during dental or surgical
procedures. This led the reviewers to
the conclusion that the risk of HIV transmission to patients is small, but not negligible.
Current guidelines reject mandatory
testing but have variable recommendations on voluntary testing, expert review
of risks, and practice restrictions for health-care workers with known HIV
infection. Workers at risk are
considered ethically obligated to know their HIV status, and professional
associations and regulatory bodies require reporting and review. However, these protocols remain potentially subject
to legal challenge, said the review, published in the June 2001 issue of the Canadian
Medical Association Journal.
(209) Anonymous. New warnings and alerts in HIV
care. AIDS Alert 2001; 16(5):67-68.
ABSTRACT: Severe, life-threatening hepatitis has been reported in two health
care workers who received nevirapine (NVP) for postexposure prophylaxis (PEP)
for occupational exposure. The first
case was that of a 43-year old female health care worker who received AZT, 3TC,
and NVP following a needlestick injury, and developed such fulminant hepatitis
and hepatic failure that she required liver transplantation. The second case was of a 38-year old male
physician who received the identical regimen following a mucous
membrane exposure, with resuulting severe fulminant hepatitis. Both cases occurred last fall.
(210) Anonymous. Health care workers taking
nevirapine for postexposure prophylaxis after HIV exposure are at risk for
life-threatening adverse events. American Journal of Nursing 2001; 101(4):21.
ABSTRACT: According to the January 5, 2001 Morbidity and Mortality Weekly
Report, the FDA received 22 reports of serious adverse events in health
care workers resulting from abreviated treatment with nevirapine between March
1997 and September 2000. The events
included hepatoxoicity (including fulminant hepatitis, which is one patient
resulted in end-stage liver failure requiring transplantation), skin reactions
(including two possible cases of Stevens-Johnson syndrome), and rhabdomyolysis.
(211) Ascherio A, Zhang SM, Hernan MA, Olek MJ,
Coplan PM, Brodovicz K et al. Hepatitis B vaccination and the risk of multiple
sclerosis. New England Journal of Medicine 2001; 344(5):327-332.
ABSTRACT: BACKGROUND: Reports of multiple sclerosis developing after hepatitis
B vaccination have led to the concern that this vaccine might be a cause of
multiple sclerosis in previously healthy subjects. METHODS: We conducted a
nested case-control study in two large cohorts of nurses in the United States,
those in the Nurses' Health Study (which has followed 121,700 women since 1976)
and those in the Nurses' Health Study II (which has followed 116,671 women
since 1989). For each woman with multiple sclerosis, we selected as controls
five healthy women and one woman with breast cancer. Information about
hepatitis B vaccination was obtained by means of a mailed questionnaire and was
confirmed by means of vaccination certificates. The analyses included 192 women
with multiple sclerosis and 645 matched controls and were conducted with the
use of conditional logistic regression. RESULTS: The multivariate relative risk
of multiple sclerosis associated with exposure to the hepatitis B vaccine at
any time before the onset of the disease was 0.9 (95 percent confidence
interval, 0.5 to 1.6). The relative risk associated with hepatitis B
vaccination within two years before the onset of the disease was 0.7 (95
percent confidence interval, 0.3 to 1.8). The results were similar in analyses
restricted to women with multiple sclerosis that began after the introduction
of the recombinant hepatitis B vaccine. There was also no association between
the number of doses of vaccine received and the risk of multiple sclerosis.
CONCLUSIONS: These results indicate no association between hepatitis B vaccination
and the development of multiple sclerosis
(212) Aslam M, Aslam J. Seroprevalence of the
antibody to hepatitis c in select groups in the punjab region of Pakistan. J
Clin Gastroenterol 2001; 33(5):407-411.
ABSTRACT: GOALS: Hepatitis C is on the rise in clinics in Pakistan. To
estimate the
occurrence of hepatitis C in the region and to create awareness about the
disease in the general public, two studies were conducted in Punjab,
Pakistan. Before this, no such effort has been made in Pakistan.
BACKGROUND: Two studies were held in Lahore and Gujranwala of Punjab,
Pakistan. These studies were advertised throughout the city, and people who
participated were screened for anti-hepatitis C virus (anti-HCV)-positive
serology at a concession rate and were surveyed through a questionnaire. In
Lahore, there were 488 participants (mean age, 28 years; male-to-female
ratio, 1.4 to 1). In Gujranwala, there were 1,922 participants (mean age, 27
years; male-to-female ratio, 1.5 to 1). The patients' blood was tested using
an immuno-chromatography to identify the antibody to hepatitis C using
Instatest HCV, with very high sensitivity.
RESULTS: In Lahore, the occurrence of anti-HCV-positive serology was
15.9%.
In Gujranwala, the occurrence of anti-HCV-positive serology was 23.8%. In
Lahore, the occurrence was 1.2% in participants 20 years of age and younger
and was 23.5% in those who were more than 20 years of age. In Gujranwala,
the occurrence of anti-HCV-positive serology was 5.4% in participants 20
years of age and younger and was 34% in those who were more than 20 years of
age.
CONCLUSION: It can be seen that in those younger than 20 years of age,
the
occurrence of hepatitis C is almost at par with the rest of the world
(0.5-2%). However, those more than 20 years of age had a very high
occurrence, as high as 50% in certain age groups. The time-frame of
contraction of the HCV for those individuals more than 20 years of age
(approximately 20 to 35 years ago) corresponds with that of the smallpox
eradication program conducted in Pakistan from 1964 to 1982. This may
indicate the likelihood of a relationship between the high rate of hepatitis
C and the administration of the smallpox vaccine in Pakistan.
(213) Beekmann SE, Vaughn TE, McCoy KD, Ferguson KJ,
Torner JC, Woolson RF et al. Hospital bloodborne pathogens programs: program
characteristics and blood and body fluid exposure rates. [letter; comment.].
Infect Control Hosp Epidemiol 2001; 22(2):73-82.
ABSTRACT: OBJECTIVE: To describe hospital practices and policies relating to bloodborne
pathogens and current rates of occupational exposure among healthcare workers.
PARTICIPANTS AND METHODS: Hospitals in Iowa and Virginia were surveyed in 1996
and 1997 about Standard Precautions training programs and compliance. The
primary outcome measures were rates of percutaneous injuries and mucocutaneous
exposures. RESULTS: 153 (64%) of 240 hospitals responded. New employee training
was offered no more than twice per year by nearly one third. Most (79%-80%)
facilities monitored compliance of nurses, housekeepers, and laboratory
technicians; physicians rarely were trained or monitored. Implementation of
needlestick prevention devices was the most common action taken to decrease
sharps injuries. Over one half of hospitals used needleless intravenous
systems; larger hospitals used these significantly more often. Protected
devices for phlebotomy or intravenous placement were purchased by only one
third. Most (89% of large and 80% of small) hospitals met the recommended
infection control personnel-to-bed ratio of 1:250. Eleven percent did not have
access to postexposure care during all working hours. Percutaneous injury
surveillance relied on incident reports (99% of facilities) and employee health
records (61%). The annual reported percutaneous injury incidence rate from 106
hospitals was 5.3 injuries per 100 personnel. Compared to single
tertiary-referral institution rates determined more than 5 years previously,
current injury rates remain elevated in community hospitals. CONCLUSIONS:
Healthcare institutions need to commit sufficient resources to Standard
Precautions training and monitoring and to infection control programs to meet
the needs of all workers, including physicians. Healthcare workers clearly
remain at risk for injury. Further effective interventions are needed for
employee training, improving adherence, and providing needlestick prevention
devices
(214) Behrman AJ, Shofer FS, Green-McKenzie J.
Trends in bloodborne pathogen exposure and follow-up at an urban teaching
hospital: 1987 to 1997. J Occup Environ Med 2001; 43(4):370-376.
ABSTRACT: Health care workers (HCWs) risk occupational exposure to bloodborne
pathogens. Effective postexposure treatment and testing depend on compliance
with follow-up, but compliance rates are poorly understood. We examined trends
in exposure and follow-up at a large teaching hospital after interventions to
improve compliance. We reviewed exposures from October 1987 to September 1988
(group 1) and July 1996 to June 1997 (group 2). Data were analyzed for HCW
demographics, source patient characteristics, and follow-up outcomes. We found
that group 2 source patient serologic data were obtained more often. Group 1
source patients were more likely to be positive for the human immunodeficiency
virus (HIV). Group 2 HCWs were more likely to be immune to hepatitis B virus,
to agree to HIV testing, and to comply with follow-up. Follow-up rates remained
suboptimal, even after high-risk exposures. Non-licensed HCWs were less likely
to accept postexposure testing than physicians or nurses in group 2. General
and targeted interventions to improve compliance and follow-up are still needed
(215) Booth JC, O'Grady J, Neuberger J. Clinical
guidelines on the management of hepatitis C. Gut 2001; 49 Suppl 1:I1-21.
(216) Brown P. Kofi Annan describes new health fund
for developing countries. BMJ 2001; 322(7297):1265.
(217) Carrico RM. What to do if you're exposed to a
bloodborne pathogen. Home Healthcare Nurse 2001; 19(6):362-368.
(218) Centers for Disease Control and Prevention.
Impact of the 1999 AAP/USPHS joint statement on thimerosal in vaccines on
infant hepatitis B vaccination practices. MMWR Morb Mortal Wkly Rep 2001;
50(6):94-97.
ABSTRACT: On July 8,1999, the American Academy of Pediatrics (AAP) and the U.S.
Public Health Service (PHS) jointly recommended reducing infant exposure to
thimerosal, a commonly used vaccine preservative that contains mercury.
Specific recommendations were made to postpone the first hepatitis B vaccine
dose until 2-6 months of age for infants born to hepatitis B surface antigen
(HBsAg)-negative (i.e., not hepatitis B virus [HBV]-infected) women. Infants
born to HBsAg-positive (i.e., HBV-infected) women, or to women whose HBsAg
status was unknown, were recommended to receive postexposure prophylaxis with
the first dose of hepatitis B vaccine administered within 12 hours of birth. By
mid-September 1999, when adequate supplies of preservative-free hepatitis B
vaccine became available, PHS advocated a return to previous infant hepatitis B
vaccination practices, including administering the first dose of hepatitis B
vaccine to newborns in hospitals that had discontinued the practice. In 2000,
preliminary assessments of the impact of these policy changes on routine
hepatitis B vaccination practices were conducted by public health officials in
Wisconsin, Oklahoma, Oregon, and Michigan. This report summarizes the results
of these analyses, which indicate that many hospitals in Wisconsin have not
reinstated policies to ensure routine administration of hepatitis B vaccine to
newborns despite the availability of preservative-free hepatitis B vaccine,
that the number of hepatitis B vaccine doses given to newborns in Oklahoma and
Oregon has declined, and that an unvaccinated Michigan infant died from
fulminant hepatitis B. Restoring routine newborn hepatitis B vaccination
practices may require active advocacy by professional and government groups.
(219) Centers for Disease Control and Prevention.
Outbreak of Ebola hemorrhagic fever Uganda, August 2000-January 2001. MMWR -
Morbidity & Mortality Weekly Report 2001; 50(5):73-77.
ABSTRACT: On October 8, 2000, an outbreak of an unusual febrile illness with
occasional hemorrhage and significant mortality was reported to the Ministry of
Health (MoH) in Kampala by the superintendent of St. Mary's Hospital in Lacor,
and the District Director of Health Services in the Gulu District. A
preliminary assessment conducted by MoH found additional cases in Gulu District
and in Gulu Hospital, the regional referral hospital. On October 15, suspicion
of Ebola hemorrhagic fever (EHF) was confirmed when the National Institute of
Virology (NIV), Johannesburg, South Africa, identified Ebola virus infection
among specimens from patients, including health-care workers at St. Mary's Hospital.
This report describes surveillance and control activities related to the EHF
outbreak and presents preliminary clinical and epidemiologic findings
(220) Centers for Disease Control and Prevention.
Impact of the 1999 AAP/USPHS joint statement on thimerosal in vaccines on
infant hepatitis B vaccination practices. MMWR Morb Mortal Wkly Rep 2001;
50(6):94-97.
ABSTRACT: On July 8,1999, the American Academy of Pediatrics (AAP) and the U.S.
Public Health Service (PHS) jointly recommended reducing infant exposure to
thimerosal, a commonly used vaccine preservative that contains mercury.
Specific recommendations were made to postpone the first hepatitis B vaccine
dose until 2-6 months of age for infants born to hepatitis B surface antigen
(HBsAg)-negative (i.e., not hepatitis B virus [HBV]-infected) women. Infants
born to HBsAg-positive (i.e., HBV- infected) women, or to women whose HBsAg
status was unknown, were recommended to receive postexposure prophylaxis with
the first dose of hepatitis B vaccine administered within 12 hours of birth. By
mid- September 1999, when adequate supplies of preservative-free hepatitis B
vaccine became available, PHS advocated a return to previous infant hepatitis B
vaccination practices, including administering the first dose of hepatitis B
vaccine to newborns in hospitals that had discontinued the practice. In 2000,
preliminary assessments of the impact of these policy changes on routine
hepatitis B vaccination practices were conducted by public health officials in
Wisconsin, Oklahoma, Oregon, and Michigan. This report summarizes the results
of these analyses, which indicate that many hospitals in Wisconsin have not
reinstated policies to ensure routine administration of hepatitis B vaccine to
newborns despite the availability of preservative-free hepatitis B vaccine,
that the number of hepatitis B vaccine doses given to newborns in Oklahoma and
Oregon has declined, and that an unvaccinated Michigan infant died from
fulminant hepatitis B. Restoring routine newborn hepatitis B vaccination
practices may require active advocacy by professional and government groups
(221) Centers for Disease Control and Prevention.
From the Centers for Disease Control and Prevention. Outbreak of Ebola
hemorrhagic fever--Uganda, August 2000-January 2001. MMWR Morb Mortal Wkly Rep
2001; 50(5):73-77.
(222) Centers for Disease Control and Prevention.
Updated U.S. Public Health Service Guidelines for the Management of
Occupational Exposures to HBV, HCV, and HIV and Recommendations for
Postexposure Prophylaxis. MMWR Morb Mortal Wkly Rep 2001; 50(RR-11):1-52.
ABSTRACT:
This report updates and consolidates all previous U.S. Public Health Service
recommendations for the management of health-care personnel (HCP) who have
occupational exposure to blood and other body fluids that might contain
hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency
virus (HIV).
Recommendations for HBV postexposure management include initiation of the
hepatitis B vaccine series to any susceptible, unvaccinated person who sustains
an occupational blood or body fluid exposure. Postexposure prophylaxis (PEP)
with hepatitis B immune globulin (HBIG) and/or hepatitis B vaccine series
should be considered for occupational exposures after evaluation of the
hepatitis B surface antigen status of the source and the vaccination and
vaccine-response status of the exposed person. Guidance is provided to
clinicians and exposed HCP for selecting the appropriate HBV PEP.
Immune globulin and antiviral agents
(e.g., interferon with or without ribavirin) are not recommended for PEP of
hepatitis C. For HCV postexposure
management, the HCV status of the source
and the exposed person should be determined, and for HCP exposed to an HCV
positive source, follow-up HCV testing should be performed to determine if
infection develops.
Recommendations for HIV PEP include a
basic 4-week regimen of two drugs (zidovudine [ZDV] and lamivudine [3TC]; 3TC
and stavudine [d4T]; or
didanosine [ddI] and d4T) for most HIV
exposures and an expanded regimen that includes the addition of a third drug
for HIV exposures that pose an
increased risk for transmission. When
the source person's virus is known or suspected to be resistant to one or more
of the drugs considered for the PEP regimen, the selection of drugs to which
the source person's virus is unlikely to be resistant is recommended.
In addition, this report outlines
several special circumstances (e.g., delayed exposure report, unknown source
person, pregnancy in the exposed person, resistance of the source virus to
antiretroviral agents, or toxicity of the PEP regimen) when consultation with
local experts and/or the National
Clinicians' Post-Exposure Prophylaxis
Hotline ([PEPline] 1-888-448-4911) is advised.
Occupational exposures should be
considered urgent medical concerns to ensure timely postexposure management and
administration of HBIG, hepatitis B vaccine, and/or HIV PEP.
(223) Centers for Disease Control and Prevention.
Recommendations for preventing transmission of infections among chronic
hemodialysis patients. MMWR Morb Mortal Wkly Rep 2001; 50 RR-5:1-43.
ABSTRACT: These recommendations replace previous recommendations for the
prevention of bloodborne virus infections in hemodialysis centers and provide
additional recommendations for the prevention of bacterial infections in this
setting. The recommendations in this report provide guidelines for a
comprehensive infection control program that includes a) infection control
practices specifically designed for the hemodialysis setting, including routine
serologic testing and immunization; b) surveillance; and c) training and
education. Implementation of this program in hemodialysis centers will reduce
opportunities for patient-to-patient transmission of infectious agents,
directly or indirectly via contaminated devices, equipment and supplies,
environmental surfaces, or hands of personnel. Based on available knowledge,
these recommendations were developed by CDC after consultation with staff
members from other federal agencies and specialists in the field who met in
Atlanta on October 5-6, 1999. They are summarized in the Recommendations
section. This report is intended to serve as a resource for health-care
professionals, public health officials, and organizations involved in the care
of patients receiving hemodialysis
(224) Centers for Disease Control and Prevention.
Outbreak of Ebola Hemorrhagic Fever ---Uganda, August 2000--January 2001. MMWR
Morb Mortal Wkly Rep 2001; 50(05):73-77.
ABSTRACT: On October 8, 2000, an outbreak of an unusual febrile illness with
occasional hemorrhage and significant mortality was reported to the Ministry of
Health (MoH) in
Kampala by the superintendent of St.
Mary's Hospital in Lacor, and the District Director of Health Services in the
Gulu District. A preliminary assessment
conducted by MoH found additional cases
in Gulu District and in Gulu Hospital, the regional referral hospital. On
October 15, suspicion of Ebola hemorrhagic fever
(EHF) was confirmed when the National
Institute of Virology (NIV), Johannesburg, South Africa, identified Ebola virus
infection among specimens from patients,
including health-care workers at St.
Mary's Hospital. This report describes surveillance and control activities
related to the EHF outbreak and presents preliminary
clinical and epidemiologic findings.
(225) Centers for Disease Control and Prevention.
Updated U.S. Public Health Service Guidelines for the Management of
Occupational Exposures to HBV, HCV, and HIV and Recommendations for
Postexposure Prophylaxis. MMWR Morb Mortal Wkly Rep 2001; 50(RR-11):1-52.
ABSTRACT: This report updates and consolidates all previous U.S. Public Health
Service recommendations for the management of health-care personnel (HCP) who
have occupational exposure to blood and other body fluids that might contain
hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency
virus (HIV). Recommendations for HBV postexposure management include initiation
of the hepatitis B vaccine series to any susceptible, unvaccinated person who
sustains an occupational blood or body fluid exposure. Postexposure prophylaxis
(PEP) with hepatitis B immune globulin (HBIG) and/or hepatitis B vaccine series
should be considered for occupational exposures after evaluation of the
hepatitis B surface antigen status of the source and the vaccination and
vaccine-response status of the exposed person. Guidance is provided to
clinicians and exposed HCP for selecting the appropriate HBV PEP. Immune
globulin and antiviral agents (e.g., interferon with or without ribavirin) are
not recommended for PEP of hepatitis C. For HCV postexposure management, the
HCV status of the source and the exposed person should be determined, and for
HCP exposed to an HCV positive source, follow-up HCV testing should be performed
to determine if infection develops. Recommendations for HIV PEP include a basic
4-week regimen of two drugs (zidovudine [ZDV] and lamivudine [3TC]; 3TC and
stavudine [d4T]; or didanosine [ddI] and d4T) for most HIV exposures and an
expanded regimen that includes the addition of a third drug for HIV exposures
that pose an increased risk for transmission. When the source person's virus is
known or suspected to be resistant to one or more of the drugs considered for
the PEP regimen, the selection of drugs to which the source person's virus is
unlikely to be resistant is recommended. In addition, this report outlines
several special circumstances (e.g., delayed exposure report, unknown source
person, pregnancy in the exposed person, resistance of the source virus to
antiretroviral agents, or toxicity of the PEP regimen) when consultation with
local experts and/or the National Clinicians' Post-Exposure Prophylaxis Hotline
([PEPline] 1-888-448- 4911) is advised. Occupational exposures should be
considered urgent medical concerns to ensure timely postexposure management and
administration of HBIG, hepatitis B vaccine, and/or HIV PEP
(226) Chiarello L, Cardo DM, Panlilio AL, Alter MJ,
Gerberding J. Risks and Prevention of Bloodborne Virus Transmission from
Infected Healthcare Providers. Seminars in Infection Control 2001; 1(1):61-72.
(227) Confavreux C, Suissa S, Saddier P, Bourdes V,
Vukusic S. Vaccinations and the risk of relapse in multiple sclerosis. Vaccines
in Multiple Sclerosis Study Group. New England Journal of Medicine 2001;
344(5):319-326.
ABSTRACT: BACKGROUND: There has been some concern that vaccination may
precipitate the onset of multiple sclerosis or lead to relapses. Since the
recent hepatitis B vaccination program in France, there have been new reports
of an increased risk of active multiple sclerosis after vaccination. METHODS:
We conducted a case-crossover study to assess whether vaccinations increase the
risk of relapse in multiple sclerosis. The subjects were patients included in
the European Database for Multiple Sclerosis who had a relapse between 1993 and
1997. The index relapse was the first relapse confirmed by a visit to a
neurologist and preceded by a relapse-free period of at least 12 months.
Information on vaccinations was obtained in a standardized telephone interview
and confirmed by means of medical records. Exposure to vaccination in the
two-month risk period immediately preceding the relapse was compared with that
in the four previous two-month control periods for the calculation of relative
risks, which were estimated with the use of conditional logistic regression.
RESULTS: Of 643 patients with relapses of multiple sclerosis, 15 percent
reported having been vaccinated during the preceding 12 months. The reports of
94 percent of these vaccinations were confirmed. Of all the patients, 2.3
percent had been vaccinated during the preceding two-month risk period as
compared with 2.8 to 4.0 percent who were vaccinated during one or more of the
four control periods. The relative risk of relapse associated with exposure to
any vaccination during the previous two months was 0.71 (95 percent confidence
interval, 0.40 to 1.26). There was no increase in the specific risk of relapse
associated with tetanus, hepatitis B, or influenza vaccination (range of
relative risks, 0.22 to 1.08). Analyses based on risk periods of one and three
months yielded similar results. CONCLUSIONS: Vaccination does not appear to
increase the short-term risk of relapse in multiple sclerosis
(228) D'Agata EM, Wise S, Stewart A, Lefkowitz LB,
Jr. Nosocomial transmission of Mycobacterium tuberculosis from an
extrapulmonary site. Infect Control Hosp Epidemiol 2001; 22(1):10-12.
ABSTRACT: OBJECTIVE: To assess the extent of nosocomial transmission and risk
factors associated with tuberculin skin test (TST) conversions among healthcare
workers (HCWs) exposed to a patient with genitourinary Mycobacterium
tuberculosis. DESIGN: Retrospective cohort study of exposed HCWs. SETTING: A
275-bed community hospital in Middle Tennessee. PARTICIPANTS: A total of 128
exposed HCWs and the index patient, who required drainage of a prostatic
abscess and bilateral orchiectomy and expired after a 27-day hospitalization.
Disseminated tuberculosis was diagnosed at autopsy. METHODS: Contact tracing was
performed on exposed HCWs. Logistic regression was used to identify independent
risk factors associated with TST conversion. RESULTS: A total of 128 HCWs were
exposed to the index patient. There was no evidence of active pulmonary
tuberculosis throughout the patient's hospitalization; TST conversions occurred
only among HCWs who were exposed to the patient during or after his surgical
procedures. A total of 12 (13%) of 95 exposed HCWs who were previously
nonreactive had newly positive TST: 6 of 28 nurses, 3 of 3 autopsy personnel, 2
of 17 respiratory therapists, and 1 of 12 surgical staff. By logistic
regression, irrigation or packing of the surgical site was the only independent
risk factor associated with TST conversion among nurses (odds ratio, 9; 95% confidence
interval, 1.2-67; P=.03). CONCLUSION: Manipulation of infected tissues of the
genitourinary tract can result in nosocomial transmission of tuberculosis
(229)
De Carli G, Puro V, Petrosillo N, Finzi
G, Ferraresi I, Daglio M et al. "Side" effects of HAART: decreasing and changing
occupational exposure to HIV-infected patients. J Biol Regul Homeost Agents
2001; 15(3):235-237.
ABSTRACT: To investigate percutaneous exposures to HIV in the highly active
antiretroviral therapy (HAART) era, we performed an analysis of all
percutaneous exposures reported from January 1994 to December 1998 in 18
Italian acute-care hospitals. Frequency and rate per 100 prevalent AIDS cases
of HIV exposures decreased by 40% (from 4.3% to 2.6%, and from 1.0% to 0.6%,
respectively; p<0.001), which were mainly those related to the
insertion/manipulation of peripheral vascular access devices (from 7.2% to
4.8%; p=0.05). We conclude that the benefits of HAART have changed the
complexity of care required and therefore, the number and type of procedures
performed on HIV patients that place the HCW at risk of injury.
(230) Proceedings of the Consensus Conference on
Infected Health Care Worker Risk for transmission of bloodborne pathogens.
[Review] [43 refs]. 98 Jul; 2001.
ABSTRACT: The Laboratory Centre for Disease Control (LCDC) of Health Canada
held a consensus conference on "Infected Health Care Workers: Risk for
Transmission of Bloodborne Pathogens", on November 20-21, 1996. A wide
range of opinion was sought (see Appendix 1 for a list of participants). This
document represents the consensus achieved at that meeting as agreed upon by
the participants at the final "consensus achieving" session.
[References: 43]
(231) Drucker E, Alcabes P, Marx P. The injection
century: massive unsterile injections and the emergence of human pathogens.
Lancet 2001; 358:1989-1992.
ABSTRACT: Unsterile medical injections are common in the less-developed world,
where most visits to a doctor result in the (general unnecessary)
administration of intramuscular, or subcutaneous drugs. WHO estimates that every year unsafe
injections result in 80,000 - 160,000 new HIV-1 infections, 8-16 million
hepatitis B infections, and 2.3-4.7 million hepatitis C infections worldwide
(this figure does not include transfusions).
Together, these illnesses account for 1.3 million deaths and 23 million
years of lost life. Even under the
auspices of WHO regional immunisation programmes, which constitute 10% of all
mass vaccination campaigns, an estimated 30% of injections are done with
unclean syringes that are commonly reused.
And, for other medicinal injections, over 50% are deemed unsafe, with
rates as high as 90% in some campaigns.
(232) Ernst J. Is your phlebotomy technique putting
you at risk? Home Healthcare Nurse 2001; 19(6):345-347.
(233) Ernst J. Guide to needlestick prevention
devices. Home Healthcare Nurse 2001; 19(6):345-347.
(234) Evans B, Duggan W, Baker J, Ramsay M,
Abiteboul D. Exposure of healthcare workers in England, Wales, and Northern
Ireland to bloodborne viruses between July 1997 and June 2000: analysis of
surveillance data. BMJ 2001; 322(7283):397-398.
ABSTRACT: In 1997, the United Kingdom adopted an improved program of
surveillance
regarding occupational exposure to bloodborne viruses. Under the program,
occupational health departments must document any work-related exposures to
potentially infectious material from patients testing positive for antibodies
to HIV or hepatitis C virus (HCV) or for hepatitis B surface antigens. For HIV
and HCV, more information is required about the incident after six weeks,
including baseline testing of the employee and the source patient. In addition,
details of post-exposure prophylaxis (PCP) are required for HIV exposure.
Between July 1997 and June 2000, 813 initial reports were filed from health
care workers who were exposed to bloodborne viruses, including 725 reports of
exposure to just one virus, 83 reports of exposure to two, and five reports to
three. An evaluation of the reports revealed that the most commonly reported
exposed groups were midwives, nurses, and doctors, with percutaneous injuries
the most frequent type of exposure. Of the 293 exposures to HIV, there was one
incidence of transmission, despite the use of PCP, while there were none in the
nearly 500 exposures to HCV. Follow-up reports after six months are not yet
available for all the cases, however.
(235) Favero MS. Infection control strategies
involved in hemodialysis or continuous ambulatory peritoneal dialysis for
patients with human immunodeficiency virus or hepatitis B virus infection. In:
Sommer BG, Henry ML, editors. Vascular Access for Hemodialysis II.
Napierville,IL: W.L. Gore and Associates, Inc. and Precept Press Inc., 2001:
99-104.
ABSTRACT: Infection control strategies for controlling hepatitis B virus (HBV)
infection among patients and staff of hemodialysis centers were developed in
the early 1970s and are the basis upon which infection control strategies for
other bloodborne agents, whose recent examples include the human immunodeficiency
virus (HIV), and non-A, non-B hepatitis. The purpose for this presentation is
to describe strategies recommended by the Centers for Diseases Control (CDC)
for dialyzing patients infected with HBV, HIV, or non-A, non-B hepatitis virus
and to discuss whether or not the patient should be exclusively dialyzed by
hemodialysis or continuous ambulatory peritoneal dialysis (CAPD), as a means of
reducing risk of transmission of bloodborne agents to staff members and to
other patients.
(236) Ferreiro RB, Sepkowitz KA. Management of
needlestick injuries. [Review] [42 refs]. Clinical Obstetrics & Gynecology
2001; 44(2):276-288.
ABSTRACT: Hepatitis B, which is vaccine-preventable, and hepatitis C, for which
no vaccine is available, are the other two common blood-borne pathogens that
may be transmitted in this fashion. The first case of occupationally
transmitted HIV infection was reported in 1983, 2 and since then,
subsequent reports have documented that exposure to contaminated blood or
blood-containing body fluids can result in HIV transmission. Needlesticks and
other injuries caused by contaminated sharp instruments account for the
majority of cases of occupational infection among health care workers.
Percutaneous and other exposures continue to occur in health care settings,
despite technologic improvements such as "needleless" systems and
various gadgets to quickly conceal the exposed needle tip. At hospitals of 400
to 500 beds, up to 100 exposures may be reported annually. This underestimates the
frequency of actual occurrence by 10-50%. Health care workers, especially
physicians, may not report sharp injuries if they fear that their medical
practice would be affected if they contract an infectious illness and that
information becomes public. 3 However, in contrast to hepatitis B in
the 1970s and 1980s, transmission of HIV in the occupational setting continues
to be uncommon. To minimize risk, the Centers for Disease Control and
Prevention (CDC) has published guidelines for management of health care worker exposures,
4,5 most recently updated in 1998. This article reviews the basis of
the current recommendations, the approach to exposure assessment, and the
factors influencing decisions about antiviral therapy after exposure. For a
more complete text, readers are referred to the CDC document "Public
Health Service Guidelines for the Management of Health-Care Workers Exposures
to HIV and Recommendations for Postexposure Prophylaxis."5
(237) Friedman MM. The impact of the Needlestick
Ssafety and Prevention Act on home care and hospice organizations. Home
Healthcare Nurse 2001; 19(6):356-360.
(238) Frosh A, Joyce R, Johnson A. Iatrogenic vCJD
from surgical instruments. BMJ 2001; 322(7302):1558-1559.
(239) Green-McKenzie J, Gershon RM, Karkashian C.
Infection Control Practices Among Correctional Healthcare Workers: Effect of
Management Attitudes and Availability of Protective Equipment and Engineering
Controls. Infect Control Hosp Epidemiol 2001; 22(9):555-559.
ABSTRACT: OBJECTIVES: To determine the relation of the availability of
personal protective equipment (PPE) and engineering controls to infection
control (IC) practices in a prison healthcare setting, and to explore the
effect on IC practices of a perceived organizational commitment to safety.
DESIGN: Cross-sectional survey.
SETTING: The study population was drawn from the 28 regional
Correctional Health Care Workers Facilities in Maryland.
PARTICIPANTS: All full-time Maryland correctional healthcare workers
(HCWs) were surveyed, and 225 (64%) of the 350 responded.
METHOD: A confidential, self-administered questionnaire was mailed to
all correctional HCWs employed in the 28 Maryland Correctional Health Care
Facilities. The questionnaire was analyzed psychometrically and validated
through extensive pilot testing. It included items on three major constructs:
IC practices, safety climate (defined as the perception of organizational
commitment to safety), and availability of IC equipment and supplies.
RESULTS: A strong correlation was found between the availability of PPE
and IC practices. Similarly, a strong correlation was found between IC
practices and the presence of engineering controls. In addition, an equally
strong association was seen between the adoption of IC practices and employee perception of
management commitment to safety. Those employees who perceived a high level of
management support for safety were more than twice as likely to adhere to
recommended IC practices. IC practices were significantly more likely to be
followed if PPE was always readily available. Similarly, IC practices were more
likely to be followed if engineering controls were provided.
CONCLUSION: These findings suggest that ready availability of PPE and
the presence of engineering controls are crucial to help ensure their use in
this high-risk environment. This is especially important because correctional
HCWs are potentially at risk of exposure to bloodborne pathogens such as human
immunodeficiency virus and hepatitis B and C viruses. Commitment to safety was
found to be highly associated with the adoption of safe work practices. There
is an inherent conflict of "custody versus care" in this setting;
hence, it is especially important that we understand and appreciate the
relation between safety climate and IC practices. Interventions designed to
improve safety climate, as well as availability of necessary IC supplies and
equipment, will most likely prove effective in improving employee compliance
with IC practices in this healthcare setting (Infect Control Hosp Epidemiol 2001;22:555-559).
(240) Greub G, Maziero A, Burgisser P, Telenti A,
Francioli P. Spare post-exposure prophylaxis with round-the-clock HIV testing
of the source patient. AIDS 2001; 15(18):2451-2452.
ABSTRACT: After occupational exposures, immediate HIV testing of source
patients may avoid the unnecessary use of post-exposure prophylaxis (PEP). Two
time periods were compared. Before the availability of 24 h a day immediate
testing, PEP was initiated after 12.6% of exposures, compared with 3.7% during
the second period. The adjusted relative odds ratio of PEP during the second
compared with the first period, was 0.23. The availability of immediate HIV
testing limits unnecessary occupational PEP.
(241) Harty-Golder B. Lab portion of OSHA Exposure
Control Plan for Bloodborne Pathogens. Medical Laboratory Observer 2001;
33(6):10.
ABSTRACT: Question: I am in charge of revising the lab's portion of the OSHA
Exposure Control Plan for Bloodborne Pathogens.
What is the best way to proceed?
Answer: Revising policies always involves an integration of the current state
of scientific knowledge as well as an understanding of applicable law. The best way to start your task is to get a
copy of the revised bloodborne pathogen standard and read it through,
highlighting all the "musts" it contains, as well as making it easy
to reference the language of the standard.
Annual review of the Exposure Control Plan is required.
(242) Hawkins DA, Asboe D, Barlow K, Evans B.
Seroconversion to HIV-1 following a needlestick injury despite combination
post-exposure prophylaxis. J Infect 2001; 43(1):12-15.
ABSTRACT: Post-exposure prophylaxis with antiretroviral drugs for at-risk
needlestick injuries has become routine practice and is usually empirical. With
increasing numbers of treatment-experienced patients, the choice of
antiretroviral may need to be individually tailored. Infection can still occur
despite attempts to optimize the drug combination used. Copyright 2001 The
British Infection Society
(243) Henderson DK. HIV postexposure prophylaxis in
the 21st century. Emerg Infect Dis 2001; 7(2):254-258.
ABSTRACT: The administration of postexposure prophylaxis has become the
standard of care for occupational exposures to HIV. We have learned a great
deal about the safety and potential efficacy of these agents, as well as the
optimal management of health-care workers occupationally exposed to HIV. This
article describes the current state of knowledge in this field, identifies
substantive questions to be answered, and summarizes basic principles of
postexposure management
(244) Hoofnagle JH. Therapy for acute hepatitis C.
[letter; comment.]. New England Journal of Medicine 2001; 345(20):1495-1497.
(245) Ioannidis JP, Abrams EJ, Ammann A, Bulterys M,
Goedert JJ, Gray L et al. Perinatal transmission of human immunodeficiency
virus type 1 by pregnant women with RNA virus loads <1000 copies/ml. J
Infect Dis 2001; 183(4):539-545.
ABSTRACT: In a collaboration of 7 European and United States prospective
studies, 44 cases of vertical human immunodeficiency virus type 1 (HIV-1)
transmission were identified among 1202 women with RNA virus loads <1000
copies/mL at delivery or at the measurement closest to delivery. For mothers
receiving antiretroviral treatment during pregnancy or at the time of delivery
(or both), there was a 1.0% transmission rate (8 of 834; 95% confidence
interval [CI], 0.4%-1.9%), compared with 9.8% (36 of 368; 95% CI, 7.0%-13.4%)
for untreated mothers (risk ratio, 0.10; 95% CI, 0.05-0.21). In multivariate
analysis adjusting for study, transmission was lower with antiretroviral
treatment (odds ratio [OR], 0.10; P<.001), cesarean section (OR, 0.30;
P=.022), greater birth weight (P=.003), and higher CD4 cell count (P=.039). In
12 of 44 cases, multiple RNA measurements were obtained during pregnancy or at
the time of delivery or within 4 months after giving birth; in 10 of the 12
cases, the geometric mean virus load was >500 copies/mL. Perinatal HIV-1
transmission occurs in only 1% of treated women with RNA virus loads <1000
copies/mL and may be almost eliminated with antiretroviral prophylaxis
accompanied by suppression of maternal viremia
(246) Jaeckel E, Cornberg M, Wedemeyer H,
Santantonio T, Mayer J, Zankel M et al. Treatment of acute hepatitis C with
interferon alfa-2b. [see comments.]. New England Journal of Medicine 2001;
345(20):1452-1457.
ABSTRACT: BACKGROUND: In people who are infected with the hepatitis C virus
(HCV) chronic infection often develops and is difficult to eradicate. We sought
to determine whether treatment during the acute phase could prevent the
development of chronic infection. METHODS: Between 1998 and 2001, we identified
44 patients throughout Germany who had acute hepatitis C. Patients received 5
million U of interferon alfa-2b subcutaneously daily for 4 weeks and then three
times per week for another 20 weeks. Serum HCV RNA levels were measured before
and during therapy and 24 weeks after the end of therapy. RESULTS: The mean age
of the 44 patients was 36 years; 25 were women. Nine became infected with HCV
through intravenous drug use, 14 through a needle-stick injury, 7 through
medical procedures, and 10 through sexual contact; the mode of infection could
not be determined in 4. The average time from infection to the first signs or
symptoms of hepatitis was 54 days, and the average time from infection until
the start of therapy was 89 days. At the end of both therapy and follow-up, 43
patients (98 percent) had undetectable levels of HCV RNA in serum and normal
serum alanine aminotransferase levels. Levels of HCV RNA became undetectable
after an average of 3.2 weeks of treatment. Therapy was well tolerated in all
but one patient, who stopped therapy after 12 weeks because of side effects.
CONCLUSIONS: Treatment of acute hepatitis C with interferon alfa-2b prevents
chronic infection
(247) Jagger J, Perry J. Risky phlebotomy with a
syringe. Nursing 2001; 31(2):73.
ABSTRACT: Using a disposable needle ans syringe for phlebotomy is a common but
hazardous practice. Drawing blood is one
of the highest risk procedures for transmitting bloodborne pathogens; using a
syringe to draw blood is even riskier.
(248) Jagger J, Parker G, Perry J. Reducing sharps
injuries in dialysis settings. Nursing 2001; 31(6):78.
(249) Jagger J, Perry J. Risky reuse of blood tube holders.
Nursing 2001; 31(4):24.
(250) Jagger J, Perry J. Exposure prevention, point
by point. Nursing 2001; 29(6):12-15.
(251) Jagger J, Perry J. Reducing risks to
anesthesia staff. Nursing 2001; 31(10):85.
(252) Jagger J, Perry J. Beware of glass capillary
tubes. Nursing 2001; 31(11):92.
(253) Kallenborn JC, Price TG, Carrico R, Davidson
AB. Emergency department management of occupational exposures: cost analysis of
rapid HIV test. Infect Control Hosp Epidemiol 2001; 22(5):289-293.
ABSTRACT: OBJECTIVE: To compare costs for evaluation and treatment of a
healthcare worker (HCW) experiencing an occupational exposure, using a rapid
human immunodeficiency virus (HIV) test versus a standard enzyme- linked
immunosorbent assay (ELISA) HIV test. DESIGN: Retrospective chart review of all
HCWs presenting to the emergency department (ED) for care of an occupational
exposure over a 13-month period. SETTING: A 404-bed university-based level 1
trauma center with an annual ED census of approximately 35,000. PARTICIPANTS:
All HCWs experiencing an occupational exposure treated in the ED using a rapid
HIV protocol were included in the analysis. METHODS: A calculation of selected
costs of the initial evaluation and treatment of patients whose evaluation
included a rapid HIV test on the source patient were performed. A similar
calculation was then made for these patients, had the standard ELISA test been
used. Evaluated costs included laboratory tests, postexposure prophylactic
medications, and estimated lost work time. Other costs were constant and were
not included in the evaluation. RESULTS: Total evaluated cost using the rapid
HIV test as part of the evaluation and treatment protocol was $465.80 for 17
patients. Had the ELISA test been used instead of the rapid test, the total
evaluated cost for the 17 patients would have been $5,965.81. CONCLUSIONS: When
used as part of the evaluation and treatment of the HCW with an occupational
exposure, the rapid HIV test results in substantial cost savings over the ELISA
test
(254) King AM, Osterwalder JJ, Vernazza PL. A
randomised prospective study to evaluate a rapid HIV-antibody assay in the
management of cases of percutaneous exposure amongst health care workers. Swiss
Med Wkly 2001; 131(1-2):10-13.
ABSTRACT: A rapid start of post-exposure prophylaxis with an antiretroviral
regime is recommended after percutaneous exposure to blood from an HIV-
positive source. Since the HIV-antibody status of the source is usually not
known at the time of injury, antiretroviral treatment is started pending the
results of HIV testing of the source. A randomised prospective study was
designed to compare the use of a rapid-screening assay in the management of
cases of percutaneous exposure with the conventional procedure. Prior to the
comparative study, the accuracy of a rapid-screening assay performed by
non-laboratory trained personnel was evaluated. 123 blinded HIV-positive and
HIV-negative samples were correctly identified. In a randomised comparison with
the conventional procedure, the application of the rapid-screening assay
resulted in a significant reduction of psychological stress, drug use and cost.
The estimated net benefit per case was CHF 93.-(62 US$). This study strongly
supports the use of the rapid-screening assay in the management of
post-exposure prophylaxis for HIV after percutaneous exposure in health care
workers
(255) Konstantinou D, Paschalis C, Maraziotis T,
Dimopoulos P, Bassaris H, Skoutelis A. Two episodes of leukoencephalitis
associated with recombinant hepatitis B vaccination in a single patient.
Clinical Infectious Diseases 2001; 33(10):1772-1773.
ABSTRACT: Cases of central nervous system demyelination have been reported
after recombinant hepatitis B vaccination, but no causal link has been clearly
demonstrated. We present the first case report involving the occurrence of 2
episodes of leukoencephalitis in a previously healthy patient after vaccination
and rechallenge with hepatitis B vaccine
(256) Lauer GM, Walker BD. Hepatitis C virus
infection. New England Journal of Medicine 2001; 345(1):41-52.
(257) Lohiya GS, Tan-Figueroa L, Lohiya S.
Bloodborne pathogen exposures in a developmental center: 1993-2000. Infect
Control Hosp Epidemiol 2001; 22(6):382-385.
ABSTRACT: In a developmental center, 257 potential bloodborne pathogen
exposures (119 bites, 91 scratches, 30 sharps injuries, 17 mucosal breaks)
occurred during 8 years (13,187 employee-years and 6,980 resident-years). Of
the residents, 9% were hepatitis B virus (HBV) surface antigen carriers.
Serological follow-up of exposed, susceptible employees and residents
identified no transmission of HBV, hepatitis C virus (HCV), or human
immunodeficiency (HIV) virus. This outcome has been due primarily to hepatitis
B immunization and low prevalences of HCV or HIV infections among the subjects.
Proper follow-up of all potential exposures is crucial to identify transmission
promptly, allay anxiety, and prevent unwarranted workmen's compensation claims.
Measures are suggested to reduce exposure further
(258) Ly TD, Laperche S, Courouce AM. Early
detection of human immunodeficiency virus infection using third- and
fourth-generation screening assays. Eur J Clin Microbiol Infect Dis 2001;
20(2):104-110.
ABSTRACT: Early detection of infection with human immunodeficiency virus (HIV)
is critical for clinical diagnosis and treatment of patients, as well as for
ensuring the safety of blood transfusion products. Recently, a number of
fourth-generation HIV screening assays have been developed that offer increased
sensitivity over earlier tests by combining detection of anti-HIV antibodies
with detection of the p24 viral antigen. Previously, six different HIV assays
were compared against a broad range of 30 seroconversion panels. In the present
study, three of the newer fourth-generation assays were tested together with
three of the third-generation HIV antibody-only assays. This extensive analysis
highlights (i) the importance of p24 antigen detection for early diagnosis,
(ii) the improved sensitivity of fourth-generation assays over antibody-only
tests, and (iii) the superior performance of the Vidas Duo assay, which allows
reduction of the diagnostic window by up to 2 weeks. Finally, the results
emphasize the detection limitations of the different assays and suggest
improvements for future HIV screening assays
(259) Madan AK, Rentz DE, Wahle MJ, Flint LM.
Noncompliance of health care workers with universal precautions during trauma
resuscitations. South Med J 2001; 94(3):277-280.
ABSTRACT: BACKGROUND: Universal precautions during resuscitations are mandated
by hospital regulations. We documented adherence to universal precautions
during trauma resuscitations at our level I trauma center. METHODS: During
trauma resuscitations, a medical student using an elevated viewing platform
observed health care workers (HCWs) for the use of barrier precautions (BPs):
gloves, masks, gowns, and eyewear. Only HCWs having direct patient contact were
included. The purpose of the observation was not disclosed to those being
observed. RESULTS: In 12 resuscitations involving 104 HCWs, none had 100%
compliance with BPs. Compliance rates for individual BPs were gloves, 98%;
eyewear (any type), 52%; gowns, 38%; masks, 10%; and eyewear (with side
protectors), 9%. Resuscitations in which bleeding was observed involved 59 HCWs
with 38% compliance; only 2 used full BPs. No difference in compliance rates
occurred during the study period. CONCLUSIONS: Experienced trauma care HCWs are
cavalier regarding blood-borne disease exposure risks. Measures to encourage
(or force) compliance are needed
(260) Mawyer D, Perry J. One nurse's fight. RN 2001;
64(4):59-60.
ABSTRACT: The CDC estimates that there are almost 400,000 needlestick injuries
annually among hospital-based healthcare workers. Up to 4% develop acute hepatitis C. But nothing brings home the reality of the
disease like this nurse's story.
(261)
Mele A, Tancredi F, Romano L, Giuseppone
A, Colucci M, Sangiuolo A et al. Effectiveness of hepatitis B vaccination in babies born to
hepatitis B surface antigen-positive mothers in Italy. J Infect Dis 2001;
184(7):905-908.
ABSTRACT: This study examined 522 children born to hepatitis B surface antigen
(HBsAg)-positive mothers from 1985 through 1994 and evaluated the protection
provided by anti-hepatitis B virus (HBV) immunization at birth. Babies were
given hepatitis B immunoglobulin and hepatitis B vaccine at birth. At 5-14
years after immunization, 17 children (3.3%) were anti-HB core antigen
positive, and 3 also were HBsAg positive. One carrier child had a double
mutation, with substitution of proline-->serine at codons 120 (P120S) and
127 (P127S) within the a determinant of HBsAg. Of the 522 children, 400 (79.2%)
of 505 still had protective anti-HBsAg titers > or =10 mIU/mL. Thus, HBV
vaccination of children born to HBsAg-positive mothers is effective and confers
long-term immunity. There is no evidence that the emergence of HBV escape
mutants secondary to the immune pressure against wild-type HBV is of concern
(262) Merchant RC, Keshavarz R. Human
immunodeficiency virus postexposure prophylaxis for adolescents and children.
Pediatrics 2001; 108(2):E38.
ABSTRACT: Children and adolescents are at risk for human immunodeficiency virus
(HIV) infection. Transmission occurs through perinatal exposures, injecting
drug use, consensual and nonconsensual sex, needle-stick and sharp injuries,
and possibly some unusual contacts. Youth engaging in high-risk sexual
activities are especially endangered. Half of the estimated worldwide 5.3
million new HIV infections occur in adolescents and young adults aged 15 to 24.
Of 20 000 known new adult and adolescent cases in the United States, 25%
involve 13- to 21-year-olds. More than 1.4 million children worldwide (aged 15
and younger) are believed to be infected, and >1640 new cases are diagnosed
daily. Of the 432 000 people reported to be living with HIV or acquired
immunodeficiency syndrome (AIDS) in the United States, 5575 are children under
13. HIV postexposure prophylaxis (PEP) is a form of secondary HIV prevention
that may reduce the incidence of HIV infections. HIV PEP is commonly conceived
of as 2 types: occupational and nonoccupational. Occupational HIV PEP is an
accepted form of therapy for health care workers exposed to HIV through their
jobs. A landmark study of healthcare workers concluded that occupational HIV
PEP may be efficacious. Well-established US national guidelines for
occupational HIV PEP exist for this at-risk population. Nonoccupational HIV PEP
includes all other forms of HIV PEP, such as that given after sexual assault and
consensual sex, injecting drug use, and needle-stick and sharp injuries in
non-health care persons. Pediatric HIV PEP is typically the nonoccupational
type. The efficacy of nonoccupational HIV PEP is unknown. The presumed efficacy
is based on a collection of animal and human data concerning occupational,
perinatal, and nonoccupational exposures to HIV. In contrast to occupational
HIV PEP, there are no national US guidelines for nonoccupational HIV PEP, and
few recommendations are available for its use for adolescents and children.
Regardless of this absence, there is encouraging evidence supporting the value
of HIV PEP in its various forms in pediatrics. Although unproven, the presumed
mechanism for HIV PEP comes from animal and human work suggesting that shortly
after an exposure to HIV, a window period exists during which the viral load is
small enough to be controlled by the body's immune system. Antiretroviral
medications given during this period may help to diminish or end viral
replication, thereby reducing the viral inoculum to a more potentially
manageable target for the host's defenses. HIV PEP is accepted practice in the
perinatal setting and for health care workers with occupational injuries. The
medical literature supports prescribing HIV PEP after community needle-stick
and sharp injuries and after sexual assault from sources known or likely to be
HIV-infected. HIV PEP after consensual unprotected intercourse between HIV
sero-opposite partners has had growing use in the adult population, and can probably
be utilized for children and adolescents. There is less documented experience
and support for HIV PEP after consensual unprotected intercourse between
partners of unknown HIV status, after prolonged or multiple episodes of sexual
abuse from an assailant of unknown HIV status, after bites, and after the
sharing of personal hygiene items or exposure to wounds of HIV-infected
individuals. There are no formal guidelines for HIV PEP in adolescents and
children. A few groups have commented on its provision in pediatrics, and some
preliminary studies have been released. Our article provides a discussion of
the data available on HIV transmission and HIV PEP in pediatrics. In our
article, we propose an HIV PEP approach for adolescents and children. We recommend
a stratified regimen, based on the work of Gerberding and Katz and other
authors, that attempts to match seroconversion risk with an appropriate number
of medications, while taking into account adverse side-effects and the amount
of information that is typically available upon initial presentation. Twice
daily regimens should be used when possible, and may improve compliance. HIV
PEP should be administered within 1 hour of exposure. We strongly recommend
that physicians trained in this form of therapy review the indications for HIV
PEP within 72 hours of its provision. We advocate that due diligence in
determining level of risk and appropriateness of drug selection be conducted as
soon as possible after an exposure has occurred. When such information is not
immediately available, we recommend the rapid treatment using the maximum level
of care followed by careful investigation and reconsideration in follow-up or
whenever possible. HIV PEP may be initiated provisionally after an exposure and
then discontinued if the exposure source is confirmed to not be HIV-infected.
In most cases, consultations with the experts in HIV care can occur after the
rapid start of therapy. (ABSTRACT TRUNCATED)
(263) Moloughney BW. Transmission and postexposure
management of bloodborne virus infections in the health care setting: where are
we now?. [Review] [78 refs]. CMAJ 2001; 165(4):445-451.
ABSTRACT: There has been considerable debate about the need for mandatory
serologic testing of individuals who are the source of bloodborne pathogen
exposures in health care and other occupational settings. The transmission of
hepatitis B (HBV), hepatitis C (HCV) and HIV between patients and health care
workers (HCWs) is related to the frequency of exposures capable of allowing
transmission, the prevalence of disease in the source populations, the risk of
transmission given exposure to an infected source and the effectiveness of
postexposure management. Transmission of HBV from patients to HCWs has been
substantially reduced by vaccination and universal precautions. The
transmission of HCV and HIV to HCWs does occur, although postexposure
prophylaxis (PEP) is available to reduce the risk of HIV transmission.
Transmission of bloodborne pathogens from infected HCWs to patients has also
been documented. Policy-making concerning the mandatory postexposure testing of
patients who may be the source of infection must weigh the relative infrequency
of patients' refusals to be tested and the consequences for PEP recommendations
with the ethical and legal considerations of bypassing informed consent and
mandating testing. Mandatory postexposure testing of HCWs who are the source of
infection will have a limited impact on reducing transmission because of the
lack of recognition and reporting of exposures. Comprehensive approaches have
been recommended to reduce the risk of transmission of bloodborne virus
infections. [References: 78]
(264) Monge V, Mato G, Mariano A, Fernández C,
Fereres J, the GERABTAS Working Group. Epidemiology of Biological-Exposure Incidents
Among Spanish Healthcare Workers. Infect Control Hosp Epidemiol 2001;
22(12):776-780.
ABSTRACT: OBJECTIVE: To determine the frequency and the epidemiological
characteristics of biological-exposure incidents occurring among healthcare
personnel.
DESIGN: Prospective surveillance study.
SETTING: Participating Spanish primary-care and specialty centers from January
1994 to December 1997.
PARTICIPANTS: 70 centers in 1994, 87 in 1995, 97 in 1996, and 104 in 1997.
METHODS: Absolute and relative frequencies were calculated for several
variables (position held, area of care, type of injuring object, activity, etc)
and for the different categories of each variable.
RESULTS: There were 20,235 registered incidents. Annual incidence rates were as follows: 1994,
51 per 1,000; 1995, 58 per 1,000; 1996, 54 per 1,000; and 1997, 59 per
1,000. Mean age of accident victims was
as follows: 1994, 35.68 (standard deviation [SD], 16.26); 1995, 33.6 (SD,11.9);
1996, 38.2 (SD, 17.27); and 1997, 36.7 (SD, 16.33) years. Of the 20,235 incidents, 15,860 (80.7%)
occurred to women; 50% (9,833) accidents were among nursing staff. The type of incident most frequently reported
was percutaneous injury (81.1%).
The highest frequency of
accidents was seen in medical and surgical areas (28% and 25.6%,
respectively). Blood and blood products
were the most commonly involved material
(87.6%). Administration of intramuscular
or intravenous medication was the activity associated with the highest accident
rate (20.3%). The most frequent
immediate action in response was rising and disinfecting (65.6%).
CONCLUSIONS: The incident registry was highly stable in terms of incidence
rates over the observation period and served to highlight the large number of
incidents recorded each year. The potential
implications of the results are the need to explore reasons for increased
exposure in certain areas, with the aim of focusing presentation efforts, and,
similarly, to establish the factors associated with diminished incidence rates
to model successful measurers.
(265) Morand P, Dutertre N, Minazzi H, Burnichon J,
Pernollet M, Baud M et al. Lack of seroconversion in a health care worker after polymerase chain
reaction-documented acute hepatitis C resulting from a needlestick injury.
Clinical Infectious Diseases 2001; 33(5):727-729.
ABSTRACT: We present a case of documented acute hepatitis C that occurred in a
health care worker who sustained a needlestick injury while caring for an
individual who was infected with both hepatitis C virus (HCV) and human
immunodeficiency virus (HIV). According to the findings of third-generation
serological assays performed during a follow-up of >1 year, the health care
worker, who was treated with interferon-alpha (during weeks 2-6) and ribavirin
(during weeks 5-9), did not develop antibodies against HCV, in spite of
documentation of an HCV-specific T cell response
(266) Nichols S. Occupational Risk for Infection Low
Among Japanese Health Care Workers. Virus Weekly 2001; May 8, 2001:1.
ABSTRACT: Health care workers appear to be at a low risk for acquiring TT virus
through occupational exposures according to investigators in Japan.
Information gathered by researchers at Kitasato University School of Medicine
sheds more light on TT virus (TTV), a virus identified in the lat 1990s as a
cause of post-transfusion hepatitis in some patients.
(267) Nichols S. Occupational Risk for Infection Low
Among Japanese Health Care Workers. TB & Outbreaks Week 2001;1.
ABSTRACT: Health care workers appear to be at a low risk for acquiring TT virus
through occupational exposures according to investigators in Japan.
Information gathered by researchers at Kitasato University School of Medicine
sheds more light on TT virus (TTV), a virus identified in the lat 1990s as a
cause of post-transfusion hepatitis in some patients.
(268) Nichols S. Occupational Risk for Infection Low
Among Japanese Health Care Workers. Hepatitis Weekly 2001; May 7, 2001:1.
ABSTRACT: Health care workers appear to be at a low risk for acquiring TT virus
through occupational exposures according to investigators in Japan.
Information gathered by researchers at Kitasato University School of Medicine
sheds more light on TT virus (TTV), a virus identified in the lat 1990s as a
cause of post-transfusion hepatitis in some patients.
(269) Occupational Safety and Health Administration.
Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens
(CPL 2.2.69). 11-27-2001. Washington,
D.C., U.S. Dept. of Labor.
Ref Type: Report
ABSTRACT: This instruction establishes policies and provides clarification to
ensure uniform inspection procedures are followed when conducting inspections
to enforce the Occupational Exposure to Bloodborne Pathogens Standard.
(270) Occupational Safety and Health Administration.
Occupational Safety and Health Administration. 29 CFR Part 1910.1030:
Occupational Exposure to bloodborne pathogens; needlestick and other
shaprsinjuries; final rule. Fed Regist 2001; 66(12):5318-5325.
(271) Peate WF. Preventing needlesticks in emergency
medical system workers. J Occup Environ Med 2001; 43(6):554-557.
ABSTRACT: Emergency medical system (EMS) workers frequently use sharp devices
in injury-prone circumstances that involve limited visibility, confined spaces,
rapidly moving vehicles, and uncooperative victims. This study examined the
efficacy of an automatic self-retracting lancet in reducing needlestick
injuries and related direct and indirect costs. Subjects were 477 active-duty
EMS workers. Counseling, laboratory testing (hepatitis B and C, hepatic
function enzymes, and human immunodeficiency virus), antiviral prophylaxis, and
immunizations were provided according to US Public Health Service guidelines.
Baseline and biennial laboratory testing for hepatitis B and C and liver
function enzymes were conducted. After the introduction of a spring-loaded
automatic-retracting type glucometer lancet device, needlestick injuries
decreased from 16 per 954 EMS worker-years to 2 per 477 EMS worker-years. The
annualized cost of treatment declined from $8276 to $2068. The change to a
self-retracting device decreased the number of needlestick injuries and was
cost-effective with a minimal increase in device cost (annualized $366 per
year)
(272) Perry J. The Bloodborne Pathogens Standard,
2001: What's changed? Nursing Management (Springhouse) 2001; 32(6):25-26.
ABSTRACT: In an extraordinary sequence of events that unfolded rapidly in 8
months, the U.S. Congress introduced and passed the Needlestick Safety and
Prevention Act, and, as mandated by the law, the bloodborne pathogens standard
was revised by the Occupational Safety and Health Administration (OSHA) to
strengthen sharps safety requirements.
The revised standard was published January 18 and became effective April
18--although OSHA won't start enforcing the new requirements in the standard
until July 18. States with their own
OSHA program have until July 18 to publish an equivalent standard.
(273) Perry J, Parker G, Jagger J. Percutaneous
injuries in home healthcare settings. Home Healthcare Nurse 2001;
19(6):342-344.
ABSTRACT: Home care has been one of
the fastest growing sectors in the healthcare industry, but the prevention of
occupational exposures in this setting has not received the attention it
deserves. Of the more than 8 million U.S.
healthcare workers employed in hospitals and other healthcare settings (NIOSH,
1999), approximately 650,000 are employed in home healthcare (U.S. Department
of Labor, 1998).
There are few data and no national
estimates on the number of needlestick injuries that occur each year in home
care settings. Perhaps because of this
lack of documentation, some recent state bills on needlestick prevention, such
as the one passed in August, 2000 in Massachusetts, overlook home care and
other nonhospital settings. But, does
the absence of data mean absence of risk?
(274) Perry J. The Bloodborne Pathogens Standard,
2001. Nursing 2001; 31(6):16.
ABSTRACT: Learn how OSHA's changed standards affect your practice.
(275) Perry J. The bloodborne pathogens standard,
2001: What's changed. Dimensions of Critical Care Nursing 2001; 20(5):44-45.
ABSTRACT: In an extrordinary sequence of events that unfolded rapidly in 8
months, the U.S. Congress introduced and passed the Needlestick Safety and
Prevention Act, and, as mandated by the law, the bloodborne pathogens standard
was revised by Occupational Safety and Health Administration (OSHA) to
strengthen sharps safety requirements.
The revised standard was published January 18 and became effective April
18--although OSHA did not start enforcing the new requirements in the standard
until July 18. States with their own
OSHA program had until July 18 to publish and equivalent standard.
(276) Perry J. When Home is Where the Risk Is. Home
Healthcare Nurse 2001; 19(6):338-341.
(277) Perry J. Attention All Nurses! American
Journal of Nursing 2001; 101(9):24AA-24CC.
ABSTRACT: New legislation puts safe sharps in your hands
(278) Petrosillo N, Gilli P, Serraino D, Dentico P,
Mele A, Ragni P et al. Prevalence of infected patients and understaffing have a
role in hepatitis C virus transmission in dialysis. [see comments]. American
Journal of Kidney Diseases 2001; 37(5):1004-1010.
ABSTRACT: To assess hepatitis C virus (HCV) incidence rates and identify
determinants of infection among hemodialysis patients, a multicenter study was
conducted in 58 units in ITALY: An initial seroprevalence survey was conducted
among 3,492 patients already on hemodialysis therapy as of January 1997 and
among an additional 434 patients who began dialysis up to January 1998. HCV
antibodies were assessed by third-generation enzyme immunoassays. Patients
testing seronegative at baseline were enrolled into a 1-year incidence study
with serological follow-up at 6 and 12 months. For patients who seroconverted, an
HCV RNA assay was performed on stored baseline samples to confirm new
infection. A nested case-control study was subsequently performed to
investigate potential risk factors. For each incident case, three controls
negative for both HCV antibodies and HCV RNA were randomly selected. At
enrollment, HCV seroprevalence was 30.0%. During follow-up, 23 new HCV cases
were documented, with a cumulative incidence of 9.5 cases/1,000 patient-years.
By logistic regression analysis, an increased risk for HCV infection emerged
for patients attending the dialysis units with a high prevalence of
HCV-infected patients at baseline (odds ratio [OR], 4.6) and for those
attending units with a low personnel-patient ratio (OR, 5.4). Among
extradialysis factors, a history of surgical intervention in the previous 6
months (OR, 16.7) significantly increased HCV risk. These findings suggest that
the combination of understaffing and a high level of infected patients in the
dialysis setting increases the risk for HCV nosocomial transmission. This is
likely related to an increased likelihood for breaks in infection control
measures
(279) Petrosillo N, Puro V, De Carli G, Ippolito G.
Occupational exposure in healthcare workers: an Italian study of occupational
risk of HIV and other blood-borne viral infections. British Journal of
Infection Control 2001; 2(2):15-17.
ABSTRACT: From January 1994 to December 1999, 44 hospitals were enrolled in the
Studio Italiano Rischio Occupazionale da HIV (SIROH), an Italian hospital
network established in 1986 to study, monitor and prevent the risk of
occupational transmission of blood-borne pathogens in the healthcare
setting. During the study period, 21,118
percutaneous exposure and 6,400 mucocutaneous exposures were reported. Nurses were the most exposed (57%), and had
the highest combined (percutaneous and mucocutaneous) exposure rates in all
working areas, ranging from 15.1 per 100 full-time equivalent positions in
general surgery to 9.5% in medical specialities. Among percutaneous exposures, 66.2% involved
a hollow-bore (HB) needle device.
Device-specific exposure rates per 100,000 devices used for disposable
syringes, winged steel needles, vacuum tube phlebotomy sets, and IV catheters
(90% of involved HB devices) were higher for those devices with a more
complicated design. Twelve cases of
occupational infection were detected; the seroconversion rates following
percutaneous and mucocutaneous exposures to HIV, HCV and HBV were all <0.5%. No cases of infection followed non-intact
skin exposure. Our study shows that the
implementation of standardised program by a network of acute care hospitals
provides us with the ability to address many important questions concerning the
safety of HCWs.
(280) Porco TC, Aragon TJ, Fernyak SE, Cody SH,
Vugia DJ, Katz MH et al. Risk of infection from needle reuse at a phlebotomy
center. Am J Public Health 2001; 91(4):636-638.
ABSTRACT: OBJECTIVES: This study determined infection risk for HIV, hepatitis B
virus (HBV), and hepatitis C virus (HCV) from needle reuse at a phlebotomy
center that possibly exposed 3810 patients to infection. METHODS: We used a
model for the risk of infection per blood draw, supplemented by subsequent
testing results from 1699 patients. RESULTS: The highest risk of transmission
was for HBV infection: 1.1 x 10(-6) in the best case and 1.2 x 10(-3) in the
(unlikely) worst case. Subsequent testing yielded prevalence rates of 0.12%,
0.41%, and 0.88% for HIV, HBV, and HCV, respectively, lower than National
Health and Nutrition Examination Survey III prevalence estimates. CONCLUSIONS:
The infection risk was very low; few, if any, transmissions are likely to have
occurred
(281) Pugliese G, Germanson TP, Bartley J, Luca J,
Lamerato L, Cox J et al. Evalulating sharps safety devices: Meeting OSHA's intent.
Infect Control Hosp Epidemiol 2001; 22(7):456-458.
ABSTRACT: The Occupational Safety and Health Administration (OSHA) revised the
Bloodborne Pathogen Standard and, on July 17,2001, began enforcing the use of
appropriate and effective sharps devices with engineered sharps-injury
protection. OSHA requires employers to maintain a sharps-injury log that
records, among other items, the type and brand of contaminated sharps device
involved in each injury. Federal OSHA does not require needlestick injury rates
to be calculated by brand or type of device. A sufficient sample size to show a
valid comparison of safety devices, based on injury rates, is rarely feasible
in a single facility outside of a formal research trial. Thus, calculations of
injury rates should not be used by employers for product evaluations to compare
the effectiveness of safety devices. This article provides examples of
sample-size requirements for statistically valid comparisons, ranging form
100,000 to 4.5 million of each device, depending on study design, and expected
reductions in needlestick injury rates.
(282)
Puro V, DeCarli G, Orchi N, Palvarini L,
Chiodera A, Fantoni M et al. Short-term adverse effects from and discontinuation of antiretroviral
post-exposure prophylaxis. J Biol Regul Homeost Agents 2001; 15(3):238-242.
ABSTRACT: OBJECTIVE: To evaluate short-term toxicity from and discontinuation
of antiretroviral combination prophylaxis in HIV-exposed individuals in Italy.
DESIGN: Longitudinal, open study conducted by prospective collection of data in
the National Registry of PEP. SETTING: All the Italian centres dedicated to HIV
related care and licensed by the Ministry of Health to dispense antiretroviral
drugs. STUDY POPULATION: Health care workers and other persons consenting to be
treated with post exposure prophylaxis (PEP) after exposures to HIV. RESULTS:
Until October, 2000, 207 individuals receiving two nucleoside reverse
transcriptase inhibitors (NRTIs), and 354 receiving two NRTIs plus a protease
inhibitor (PI) were enrolled. More individuals experienced side-effects in the
3-drug group (53% and 62%, respectively; OR 0.68, (95% CI 0.48-0.98), p <
0.03). However, the proportion of individuals discontinuing prophylaxis because
of side-effects did not differ significantly between the 2 groups (21% and 25%
respectively; OR 0.82 (95% CI 0.53-1.26); p=0.4). The 43 individuals in the 2
NRTI group discontinued PEP after a mean of 10.4 days of treatment (median 8,
range 1-27), similarly to the 88 discontinuations observed in the 3-drug group
(mean duration 10.5 days, median 7.5, range 1-26). Type and incidence of
specific adverse effects were similar to those reported in the literature.
CONCLUSION: Our study indicates that the difference in the proportion of
individuals developing side effects and discontinuing PEP is not significant.
The rate of discontinuation because of protease inhibitor side-effects does not
justify per se the initial use of a less potent PEP regimen. We suggest
initiating PEP with a three-drug regimen and discontinuing the protease
inhibitor in the case of adverse effects.
(283)
Puro V, De Carli G, Scognamiglio P,
Porcasi R, Ippolito G, Studio Italiano Rischio Occupazionale HIV. Risk of HIV and other blood-borne
infections in the cardiac setting: patient-to-provider and provider-to-patient
transmission. [Review] [80 refs]. Annals of the New York Academy of Sciences
2001; 946:291-309.
ABSTRACT: Health care workers (HCWs) face a well-recognized risk of acquiring
blood-borne pathogens in their workplace, in particular hepatitis B and C
viruses (HBV/HBC) and human immunodeficiency virus (HIV). Additionally,
infected HCWs performing invasive exposure-prone procedures, including in the
cardiac setting, represent a potential risk for patients. An increasing number
of infected persons could need specific cardiac diagnostic procedures and
surgical treatment in the future, regardless of their sex or age. The risk of
acquiring HIV, HCV, HBV infection after a single at-risk exposure averages
0.5%, and 1-2%, and 4-30%, respectively. The frequency of percutaneous exposure
ranges from 1 to 15 per 100 surgical interventions, with cardiothoracic surgery
reporting the highest rates of exposures; mucocutaneous contamination by
blood-splash occurs in 50% of cardiothoracic operations. In the Italian
Surveillance (SIROH), a total of 987 percutaneous and 255 mucocutaneous
exposures were reported in the cardiac setting; most occurred in cardiology
units (46%), and in cardiovascular surgery (44%). Overall, 257 source patients
were anti-HCV+, 54 HBsAg+, and 14 HIV+. No seroconversions were observed. In
the literature, 14 outbreaks were reported documenting transmission of HBV from
12 infected HCWs to 107 patients, and 2 cases of HCV to 6 patients, during
cardiothoracic surgery, especially related to sternotomy and its suturing. The
transmission rate was estimated to be 5% to 13% for HBV, and 0.36% to 2.25% for
HCV. Strategies in risk reduction include adequate surveillance, education,
effective sharps disposal, personal protective equipment, safety devices, and
innovative technology-based intraoperative procedures. [References: 80]
(284) Puro V, De Carli G, Petrosillo N, Ippolito G.
Risk of exposure to bloodborne infection for Italian healthcare workers, by job
category and work area. Studio Italiano Rischio Occupazionale da HIV Group.
Infect Control Hosp Epidemiol 2001; 22(4):206-210.
ABSTRACT: OBJECTIVE: To analyze the rate of occupational exposure to blood and
body fluids from all sources and specifically from human immunodeficiency virus
(HIV)-infected sources among hospital workers, by job category and work area.
DESIGN: Multicenter prospective study. Occupational exposure data (numerator)
and full-time equivalents ([FTEs] denominator) were collected over a 5-year
period (1994-1998) and analyzed. SETTING: 18 Italian urban acute-care hospitals
with infectious disease units. RESULTS: A total of 10,988 percutaneous and
3,361 mucocutaneous exposures were reported. The highest rate of percutaneous
exposure per 100 FTEs was observed among general surgery (11%) and general
medicine (10.6%) nurses, the lowest among infectious diseases (1.1%) and
laboratory (1%) physicians. The highest rates of mucocutaneous exposure were
observed among midwives (5.3%) and dialysis nurses (4.7%), the lowest among pathologists
(0%). Inadequate sharps disposal and the prevalence of sharps in the working
unit influence the risk to housekeepers. The highest combined HIV exposure
rates were observed among nurses (7.8%) and physicians (1.9%) working in
infectious disease units. The highest rates of high-risk percutaneous exposures
per 100 FTE were again observed in nurses regardless of work area, but this
risk was higher in medical areas than in surgery (odds ratio, 2.1; 95%
confidence interval, 1.9-2.5; P<.0001). CONCLUSION: Exposure risk is related
to job tasks, as well as to the type and complexity of care provided in
different areas, whereas HIV exposure risk mainly relates to the prevalence of
HIV-infected patients in a specific area. The number of accident-prone procedures,
especially those involving the use of hollow-bore needles, performed by job
category influence the rate of exposure with high risk of infection. Job- and
area-specific exposure rates permit monitoring of the effectiveness of targeted
interventions and control measures over time
(285) Pybus OG, Charleston MA, Gupta S, Rambaut A,
Holmes EC, Harvey PH. The epidemic behavior of the hepatitis C virus. Science
2001; 292(5525):2323-2325.
ABSTRACT: Hepatitis C virus (HCV) is a leading worldwide cause of liver
disease. Here, we use a new model of HCV spread to investigate the epidemic
behavior of the virus and to estimate its basic reproductive number from gene
sequence data. We find significant differences in epidemic behavior among HCV
subtypes and suggest that these differences are largely the result of
subtype-specific transmission patterns. Our model builds a bridge between the
disciplines of population genetics and mathematical epidemiology by using
pathogen gene sequences to infer the population dynamic history of an
infectious disease
(286) Quaglio G, Lugoboni F, Vento S, Lechi A,
Accordini A, Bossi C et al. Isolated presence of antibody to hepatitis B core antigen in injection
drug users: do they need to be vaccinated? Clinical Infectious Diseases 2001;
32(10):E143-E144.
ABSTRACT: In a study of 497 injection drug users who had isolated presence of
antibody to hepatitis B core antigen (anti-HBc) at the time of enrollment, 404
(81%) retained this condition after a mean of 49 months of follow-up, during which
time no new hepatitis B surface antigen marker was detected. These findings
support the hypothesis that patients with isolated presence of anti-HBc have
strong resistance to reinfection and do not need vaccination
(287) Raglow GJ, Luby SP, Nabi N. Therapeutic
injections in Pakistan: from the patients' perspective. Trop Med Int Health
2001; 6(1):69-75.
ABSTRACT: OBJECTIVE: To investigate the behaviour, knowledge of risks, and
attitudes towards injections among patients at a clinic in Karachi. METHODS: In
March 1995, trained staff administered a structured questionnaire to 198
consecutive new adult patients attending a university clinic in Karachi,
Pakistan. RESULTS: Half (97:49%) of the patients received injections at their
last visit to a health care provider. 3.5% had received 10 or more injections
in the last year. 64% felt that injections were more powerful and were willing
to pay more for them than for pills. 84% preferred pills or advice over
injections if told they were equally effective, 83% believed that a used needle
could transmit a fatal disease, and 86% believed that it is usually possible to
get better without an injection. 91% reported that the doctor always recommends
an injection; few patients (9%) ever asked for one. Injections were given
without much regard for the chief complaint of the patient. Sonic needles (n =
21) for the injection came from bowls of water: of those from closed packets (n
= 116), 68 were 'cleaned' by wiping ot placing them in water. 91% of patients
(180) knew at least one risk of reuse of needles. Patients who knew three or
more risks of using unclean needles were 0.14 times as likely to have had more
than five injections per year in the last 5 years hut only if the patients had
s or more years of education. CONCLUSION : Patients receive injections from
doctors in Pakistan frequently, indiscriminately and often without proper
safety precautions. They are aware of both positive and negative aspects of
injections but are likely to do what the doctor suggests. Interventions to
reduce risky overuse of injections should focus on patients' general education
and knowledge of the risks of injections to empower them to choose healthier
therapies
(288) Reddy SG, Emery RJ. Assessing the effect of
long-term availability of engineering controls on needlestick injuries among
health care workers: a 3-year preimplementation and postimplementation
comparison. Am J Infect Control 2001; 29(6):425-427.
ABSTRACT: Health care workers are continually exposed to a number of
potentially dangerous bloodborne pathogens in the workplace. Needlesticks have long been identified as
abeing capable of transmitting more than 20 different pathogens, including HIV
and hepatitis B and C.
(289)
Respess RA, Rayfield MA, Dondero TJ. Laboratory testing and rapid HIV
assays: applications for HIV surveillance in hard-to-reach populations. AIDS
2001; 15 Suppl 3:S49-S59.
ABSTRACT: Most HIV surveillance has been performed through serologic surveys in
relatively stable, accessible populations. Similar surveillance, with or
without counseling and testing, in populations that are hard-to- reach,
presents logistical challenges, including the selection of laboratory testing
strategy and algorithm. The advent of rapid serologic assays for HIV now allows
for on-site testing, including confirmatory testing, and rapid provision of
test results and counseling. The possibility of only a single contact makes
repeat sampling, which current diagnostic testing recommendations include,
difficult. To address the logistical complexities in surveillance in
hard-to-reach populations and the increased availability of rapid tests, we
propose adapting the testing strategies for HIV of the World Health
Organization/the joint United Nations Programme on HIV/AIDS in order to
facilitate this surveillance, including, where carried out, the provision of
test results back to individuals. The choice of enzyme- linked immunosorbent
assay (ELISA) versus rapid testing for these settings is discussed, as is the
choice of specimen--blood, oral fluid, or urine. Three appendices summarize:
(1) test algorithms for the various testing strategies; (2) advantages and
disadvantages of ELISA and of rapid test formats, and (3) the characteristics
and status of currently available rapid HIV tests. We also discuss the
potential application of the recently developed 'detuned' methodology for
estimating HIV incidence in hard-to-reach populations
(290) Rischitelli G, Harris J, McCauley L, Gershon
R, Guidotti T. The risk of acquiring hepatitis B or C among public safety
workers: a systematic review. [Review] [56 refs]. American Journal of
Preventive Medicine 2001; 20(4):299-306.
ABSTRACT: CONTEXT: Determination of the occupational risk of hepatitis B and C
to public safety workers is important in identifying prevention opportunities
and has significant legal and policy implications. OBJECTIVES: Characterize the
risk of occupationally acquired infection: (1) risk of exposure to blood and
body fluids, (2) seroprevalence of hepatitis B and C in the source population,
and (3) risk of infection after exposure. DATA SOURCES: Electronic search of
MEDLINE (1991-1999), HealthStar (1982-1999), and CINAHL (1975-1999)
supplemented by selected reference citations and correspondence with authors of
relevant articles. STUDY SELECTION: Peer-reviewed journal articles (N=702) that
addressed the transmission of hepatitis B and C in law enforcement,
correctional, fire, emergency medical services, and healthcare personnel were
identified. One hundred five (15.0%) articles were selected for full-text
retrieval; 72 (68.6%) were selected for inclusion. DATA ABSTRACTION: Articles
selected for inclusion were ABSTRACTed by two reviewers and checked by a third
reviewer, using a standard reporting form. DATA SYNTHESIS: Evidence tables were
constructed, using the standardized ABSTRACTs. The tables were designed to
summarize data for the key elements of the risk analysis. CONCLUSIONS: Data
suggest that emergency medical service (EMS) providers are at increased risk of
contracting hepatitis B, but data have failed to show an increased prevalence
of hepatitis C. EMS providers have exposure risks similar to those of
hospital-based healthcare workers. Other public safety workers appear to have
lower rates of exposure. Urban areas have much higher prevalence of disease,
and public safety workers in those areas are likely to experience a higher
incidence of exposure events. [References: 56]
(291) Rutala WA, Weber DJ. A review of single-use
and reusable gowns and drapes in health care. [Review] [63 refs]. Infect
Control Hosp Epidemiol 2001; 22(4):248-257.
ABSTRACT: Gowns and drapes are used widely in healthcare facilities. Gowns have
been used to minimize the risk of disease acquisition by healthcare providers,
to reduce the risk of patient-to-patient transmission, and during invasive
procedures to aid in maintaining a sterile field. Drapes have been used during
invasive procedures to maintain the sterility of environmental surfaces,
equipment, and patients. This article reviews the use of gowns and drapes in healthcare
facilities, including the characteristics, costs, benefits, and barrier
effectiveness of single-use and reusable products. Currently, gowns protect
healthcare personnel performing invasive procedures from contact with
bloodborne pathogens. Although gowns have been recommended to prevent
patient-to-patient transmission in certain settings (eg, neonatal intensive
care unit) and for certain patients (eg, those infected with
vancomycin-resistant enterococci), scientific studies have produced mixed results
of their efficacy. While appropriate use of drapes during invasive procedures
is recommended widely as an aid in minimizing contamination of the operative
field, the efficacy of this practice in reducing surgical-site infections has
not been assessed by scientific studies. Based on an evaluation of the
functional requirements, environmental impact, and economics of gowns and
drapes, clear superiority of either reusable or single-use gowns and drapes
cannot be demonstrated. The selection of particular gowns and drapes by
individual healthcare facilities requires an assessment of the facility's
requirements, available products, and costs and should be based on the desired
characteristics of an ideal gown or drape as defined in this paper.
[References: 63]
(292) Sagoe-Moses C, Pearson RD, Perry J, Jagger J.
Risks to health care workers in developing countries. New England Journal of
Medicine 2001; 345(7):538-541.
ABSTRACT: The first report of a health care worker infected with the human
immunodeficiency virus (HIV) by a needle stick, published in the medical
literature in 1984,1 launched a new era of concern about the
occupational transmission of blood-borne pathogens. In the United States,
universal precautions were implemented,2 regulations such as the Bloodborne
Pathogens Standard were issued,3 and the rate of vaccination against
hepatitis B virus (HBV) among health care workers increased dramatically.4
After a decade of phenomenal technological advances in sharp devices engineered
for safety, the federal Needlestick Safety and Prevention Act, requiring the
use of safer devices, became law in November 2000.5,6
(293) Sagoe-Moses C, Pearson RD, Perry J, Jagger J.
Risks to Health Care Workers in Developing Countries (author's reply). New
England Journal of Medicine 2001; 345(26):1916.
ABSTRACT: Letters to the Editor and Author's Reply
(294) Sattar SA, Tetro J, Springthorpe VS, Giulivi
A. Preventing the spread of hepatitis B and C viruses: where are germicides
relevant? Am J Infect Control 2001; 29(3):187-197.
ABSTRACT: Hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most
prevalent bloodborne pathogens. Infections caused by these organisms can become
chronic and may lead to liver cirrhosis and carcinoma. Limited chemotherapy is
now available, but only HBV can be prevented through vaccination. Both viruses
are enveloped and relatively sensitive to many physical and chemical agents;
their ability to survive in the environment may not be as high as often
believed. As a result, their spread occurs mainly through direct parenteral or
percutaneous exposure to tainted body fluids and tissues. Careful screening of
and avoiding contact with such materials remain the most effective means of
protection. Nevertheless, the indirect spread of these viruses, although much
less common, can occur when objects that are freshly contaminated with tainted
blood enter the body or contact damaged skin. Germicidal chemicals are
important in the prevention of HBV and HCV spread through shared injection
devices, sharps used in personal services (such as tattooing and body
piercing), and heat- sensitive medical/dental devices (such as flexible
endoscopes) and in the cleanup of blood spills. Microbicides in vaginal gels
may also interrupt their transmission. General-purpose environmental
disinfection is unlikely to play a significant role in the prevention of the
transmission of these viruses. Testing of low-level disinfectants and label
claims for such products against HBV and HCV should be discouraged. Both
viruses remain difficult to work with in the laboratory, but closely related
animal viruses (such as the duck HBV) and the bovine viral diarrhea virus show
considerable promise as surrogates for HBV and HCV, respectively. Although
progress in the culturing of HBV and HCV is still underway, critical issues on
virus survival and inactivation should be addressed with the use of these
surrogates
(295) Documented lack of efficacy of safety
butterfly needle device. 01 Apr; Montefiore Medical Center, 111 east 210th
Street, Bronx, NY.: 2001.
ABSTRACT: Background:Montefiore Medical Center has established a program to
review and implement engineering controls to prevent occupational blood-borne
pathogen exposure. In 1998/99 butterfly needle devices accounted for 20% of
total self-reported needlesticks at our hospital and this device was selected
for intervention. In September 1999, a Safety Butterfly Needlestick (SBN)
program was instituted to pilot alternative devices with enhanced safety
features. A device was chosen to be used hospital wide that required the user
to withdraw the needle after use with activation of a safety shield using a
two-handed technique. 100% of employee users were intensively inserviced and
the product was introduced. Methods: Six months after implementing the SBN
program, the self-reported butterfly needlestick rate was evaluated. The contents
of 53 randomly chosen sharps containers were examined and the percent of non-activated
safety butterflys was ascertained. Staff
were all surveyed regarding compliance with the program and reasons for
variance. Results: After six months of
implementation, the butterfly needlestick rate remained unchanged. Container analysis indicated that 72% of 616 deposited
safety butterflys were not activated.
Staff survey determined that 90% of users were non-compliant with
activating the device secondary to design issues and that additional education/training
would not influence behavior.
Conclusions: Although highly successful at other regional hospitals, our
SBN was without significant impact and was associated with an additional
$250,000 annual cost. Selection of engineering controls requires attention to
design issues and
success rates may vary considerably between hospitals with the same engineering
control.
(296) Sermoneta-Gertel S, Donchin M, Adler R, Baras
M, Perlstein T, Manny N et al. Hepatitis C Virus Infection in Employees of a
Large University Hospital in Israel. Infect Control Hosp Epidemiol 2001;
22(12):754-761.
ABSTRACT: OBJECTIVE: To assess whether hospital work constitutes a risk factor
for hepatitis C virus (HCV) infection among employees of a large hospital in
Israel.
DESIGN: Seroprevalence survey.
PARTICIPATNS: All 5,444 employees (18-35 years old) were eligible; 4,287 (79%)
participated in the survey.
METHODS: Sera were tested for antibodies to HCV (anti-HCV) using a
third-generation enzyme immunoassay. A
third-generation strip immunoblot assay was used for confirmation. Participants were interviewed regarding their
occupational history, and they completed a self-administered questionnaire
covering history of non-occupational exposure to blood and country of
birth. Other demographic information was
obtained from the personnel department.
Rates and odds ratios (ORs) were calculated, and multivariate
logistic-regression analyses were performed to adjust for potential confounding
variables.
RESULTS: Anti-HCV was found in 0.9% of employees (37/4,287; 95% confidence
interval, 0.6-1.1), ranging from 0.1% among those born in Israel to 5.7% among
those born in Central Asia. After age,
gender, social status, country of birth, and history of blood transfusion were
controlled for in a logistic regression, occupational exposure to blood »10
years was significantly associated with the presence of antibodies (OR, 2.5; P=.01). Presence of anti-HCV also was associated with
country of birth (range: Israel OR, 1; West OR, 3.8 [P=.1]; Central Asia
OR, 48.6 [P<.0001]) and history of blood transfusion (OR, 2.7; P=.01). No significant associations were found
between anti-HCV and age, gender, social status, history of tattoo,
acupuncture, current occupation, department, exposure to blood in current
occupation, adherence to safety precautions, or history of percutaneous
injury. The association with length of
exposure was stronger (OR, 3.6; P=.01) when the same logistic regression
was run excluding the outlier ethnic group of Central Asia.
CONCLUSIONS: Hospital work does not seem to constitute a major risk factor for
HCV infection in Israel today. A higher
prevalence of anti-HCV among employees with longer versus shorter lengths of
occupational exposure may be due to a cumulative effect of exposure over the
years. Infection control efforts in
recent years may have contributed to this association.
(297) Smith AJ, Cameron SO, Bagg J, Kennedy D.
Management of needlestick injuries in general dental practice. British Dental
Journal 2001; 190(12):645-650.
ABSTRACT: The objective of this paper is to advise on the development of
practical policies for needlestick injuries in general dental practice.
Policies for dealing with occupational exposure to chronic blood borne viruses,
namely, hepatitis B, C and HIV are evolving. This article was particularly
prompted by recent changes in post exposure prophylaxis for HIV infection. A
flow chart is also included which should be of possible use in general dental
practice. Needlestick injuries are of increasing concern to healthcare workers.
Successful prophylaxis requires careful planning in advance. Whilst all
practices should have a policy for sharps injuries, prevention of needlestick
injuries remains the best policy
(298) Srinivasan A, Kraus CN, DeShazer D, Becker PM,
Dick JD, Spacek L et al. Glanders in a military research microbiologist. [see
comments.]. New England Journal of Medicine 2001; 345(4):256-258.
ABSTRACT: Infection with Burkholderia mallei (formerly Pseudomonas mallei) can
cause a subcutaneous infection known as farcy or can disseminate to cause the
condition known as glanders. In humans,
acute infection with B. mallei is characterized by necrosis of the
tracheobronchial tree, pustular skin lesions, and either a febrile pneumonia,
if the organism was inhaled, or signs of sepsis and multiple abscesses, if the
skin was the portal of entry. At the
turn of the 20th century, glanders was an important cause of death among
horses, and there were secondary, often fatal, infections in humans. Because of the lethal and contagious nature
of the disease, B. mallei was considered an ideal agent for biologic warefare
and was used for this purpose by Germany in World War I.
(299) Stratton CW. Occupationally Acquired
Infections: A Timely Reminder. Infect Control Hosp Epidemiol 2001; 22(1):8-9.
ABSTRACT: Healthcare workers (HCWs) are known to be at risk for contracting an
infection from a patient or from a patient specimen. It might be presumed that no one would be
more aware of this risk than HCWs themselves; yet, these risks often are
minimized or even ignored by HCWs who perhaps through long exposure to such
risks have become immune to concern albiet not to infection. It is thus useful for HCWs to be reminded of
these risks from time to time, so that we do not become too complacent. The January 2001 issue of Infection
Control and Hospital Epidemiology begins the new year, and indeed the new
millennium, with a timely reminder that occupationally acquired infections
continue to be a very real risk for HCWs.
This reminder is in the form of three reports that aptly illustrate the
ongoing problems associated with such infections in HCWs. In this editorial, I will comment briefly on
each of these reports, discuss the salient points and suggest an approach that
would avoid, or at least curtail, some of these problems in the future.
(300) Stringer B, Infante-Rivard C, Hanley J.
Quantifying and reducing the risk of bloodborne pathogen exposure. [Review] [79
refs]. AORN Journal 2001; 73(6):1135-1140.
ABSTRACT: The risk of becoming infected with bloodborne pathogens (e.g.,
hepatitis B, hepatitis C, HIV) during surgery is real. The degree of risk for
perioperative personnel is related to factors that include participating in
large numbers of surgical procedures each year; the nature of perioperative
work (e.g., use of different types of sharp instruments): exposure to large
amounts of blood and body fluids; the prevalence of bloodborne pathogens in the
surgical population; the variation in different organisms' ability to be
transmitted; the existence of vaccines and the level of vaccination; the
availability of postexposure treatment; and the consequences of acquiring the
disease. Controlling risks to perioperative personnel can be accomplished by using
the Occupational Safety and Health Administration's three methods of
control--redesigning surgical equipment and procedures, changing work
practices, and enhancing the personal protection equipment of perioperative
personnel. [References: 79]
(301) Stringer B, Infante-Rivard C, Hanley J.
Effectiveness of the hands-free technique in reducing operating room injurires
[ABSTRACT]. Adv Exposure Prev 2001; 5(6):59.
ABSTRACT: CONTEXT: Operating room personnel are at a high risk for transmission
of bloodborne pathogens when passing sharp instruments
(302) Stringer B, Infante-Rivard C, Hanley J.
Quantifying and reducing the risk of bloodborne pathogen exposure. [Review] [79
refs]. AORN Journal 2001; 73(6):1135-1140.
ABSTRACT: The risk of becoming infected with bloodborne pathogens (e.g.,
hepatitis B, hepatitis C, HIV) during surgery is real. The degree of risk for
perioperative personnel is related to factors that include participating in
large numbers of surgical procedures each year; the nature of perioperative
work (e.g., use of different types of sharp instruments): exposure to large
amounts of blood and body fluids; the prevalence of bloodborne pathogens in the
surgical population; the variation in different organisms' ability to be
transmitted; the existence of vaccines and the level of vaccination; the
availability of postexposure treatment; and the consequences of acquiring the
disease. Controlling risks to perioperative personnel can be accomplished by
using the Occupational Safety and Health Administration's three methods of
control--redesigning surgical equipment and procedures, changing work
practices, and enhancing the personal protection equipment of perioperative
personnel. [References: 79]
(303) Study group PHASE (People for Healthcare
Administration SaE. Rischio Biologico e Punture Accidentali Negli Operatori
Sanitari. LAURI ed. Milan, Italy: 2001.
(304) Summers T. Public policy for health care
workers infected with the human immunodeficiency virus.[comment]. JAMA 2001;
285(7):882.
ABSTRACT: To the Editor: Mr Gostin recently described the current policy
of the US Centers for Disease Control and Prevention (CDC) regarding health
care workers infected with the human immunodeficiency virus (HIV). The CDC policy reflects a failure to provide
clear leadership on this politically sensitive public health issue. Similarly tepid stances by the CDC and other
federal public health agencies on syringe exchange programs, HIV prevention for
youth, and HIV surveillance contribute to continuation of a largely preventable
epidemic.
(305) Tan L, Hawk JC, III, Sterling ML. Report of
the Council on Scientific Affairs: preventing needlestick injuries in health
care settings. Arch Intern Med 2001; 161(7):929-936.
ABSTRACT: Needlestick injuries continue to pose a significant risk to health
care workers; however, appropriate use of needlestick prevention devices,
especially in comprehensive prevention programs, can significantly reduce the
incidence of such injuries. Cost analyses indicate that use of these devices will
be cost-effective in the long term. To provide more scientific and cost data on
the efficacy of needlestick prevention devices, recording of needlestick
injuries must be improved. Federal law now requires the use of
safety-engineered sharps devises to protect health care workers, and
state-level legislation on the use and evaluation of needlestick prevention
devices is under consideration. Health care employers should evaluate the
implementation of needlestick prevention devices with the participation of
employees who will use such devices and, where appropriate, introduce such
devices accompanied by the necessary education and training, as part of a
comprehensive sharps injury prevention and control program
(306) Hepatitis B and C virus infections in
healthcare workers.: 2001.
ABSTRACT: Hepatitis B and C virus infections are transmitted by contact with
blood and are therefore of concern in the hospital environment. The prevalence
of both viruses is low in the UK compared to the rest of the world: <0.1%
for HBV and <1% for HCV. Transmission from both infectious patients to staff
and from staff to patients has been described.
The control of these blood borne viruses is dependent on:
(a)
implementation of "control of infection" procedures;
(b)
vaccination against HBV
(c)
restriction of some staff from doing "Exposure prone
procedures" (EPPs).
(307) Tolle-Watts L, Sainsbury ML. Occupational
Exposures to Blood and Body Fluids among Dental Hygiene Students. The Journal
of Dental Hygiene 2001; 75(1):87-88.
ABSTRACT: The purpose of this study was to determine the incidence of
occupational exposures to blood and body fluids in dental hygiene students
reported from 1996 through 1998.
(308)
Tomasina F, Gómez Etchebarne F.
Accidentes laborales en el Hospital de Clínicas. Revista Médica del Uruguay
2001; 17(3):156-160.
ABSTRACT: Resumen
Los trabajadores hospitalarios habitualmente se encuentran expuestos a una
importante variedad de factores de riesgo laborales, que pueden provocar
accidentes de trabajo y enfermedades ocupacionales diversas, dependiendo del
tipo de tareas que desempeñan y puesto de trabajo que ocupan.
El Hospital de Clínicas de Montevideo es un hospital universitario general de
referencia nacional de mediana y alta complejidad.
Se estudiaron todos los accidentes de trabajo notificados ocurridos en el
Hospital de Clínicas en el período 1996-1999.
Se realizó un estudió descriptivo retrospectivo con datos preexistentes
correspondientes a los formularios de notificación interna de accidentes del
período estudiado.
Fueron 299 accidentes de trabajo notificados; el tipo de accidente más
frecuente correspondió a punción (48,5%), seguido de traumatismos (17,1%) y de
heridas cortantes (12,4%).
El 42,8% correspondió al grupo de técnicos en enfermería (incluyen solamente
auxiliares de enfermerìa), seguido por los auxiliares de servicios generales en
24,1%.
Los resultados obtenidos son similares a los de otros centros hospitalarios en
donde el riesgo de punción es el más frecuente.
Dada la posibilidad de transmisión de agentes infecciosos por esta vía
de entrada se destaca la importancia de desarrollar programas preventivos de
este frecuente accidente laboral.
(309) Upfal MJ,
Naylor P, Mutchnick MM. Hepatitis C Screening and Prevalence Among Urban Public
Safety Workers. The Journal of Occupational and Environmental Medicine 2001;
43(4):402-411.
ABSTRACT: This study examines the
prevalence of anti-hepatitis C virus by using an enzyme-linked immunoassay test
(EIA-2) in 2447 volunteers (including 1560 police, 678 fire, and 209 emergency
medical service personnel) and a self-reported questionnaire on potential
occupational and non-occupational risk factors.
Subjects consisted of 76% men, 54.8% blacks, and 40.3% whites. Twenty-eight individuals (1.1%) tested
positive, with prevalence rates of 101% and 1.3%, respectively, among blacks
and whites. Although firefighters and
emergency medical service workers had a higher prevalence (2.3% and 2.8%) than
police (0.6%), the overall prevalence was lower than that typical of urban
populations. In a multivariate analysis,
the most important risk factors were behavioral, with no significant
occupational exposure risk observed.
Previously reported racial differences were not detected in this study,
most likely because the subjects were of similar socioeconomic status.
(310) Ural O, Findik D. The Response of Isolated
Anti-HBc Positive Subjects to Recombinant Hepatitis B Vaccine. Jounral of
Infection 2001; 43(3):187-190.
ABSTRACT: Objective: The aim of this study was to evaluate the response
to hepatitis B vaccination in isolated anti-HBc positive subjects.
Patients and Methods: Forty-eight subjects with persistent isolated core
antibody were included in the study. Fifty healthy people who were negative for
HBsAg, anti-HBs and anti-HBc were included in the study as a control group.
They all were vaccinated with recombinant hepatitis B vaccine at 0, 1 and 2
months.
Results: Thirty days after each dose of vaccination, serum levels over
10IU/l of anti-HBs are found in 50% of the subjects with isolated anti-HBc
after first; in 68.7% after second and in 89.6% after third vaccination. There
were no statistical differences between the two groups (P>0.05). Twenty
subjects in isolated anti-HBc group (41.6%) but none of the subjects from the
control group responded with a titer of >50IU/l after 30 days, which
suggested an anamnestic response due to prior infection and immunity.
Furthermore, 23 subjects in isolated anti-HBc group (47.9%) finally responded
after three doses of vaccination (anti-HBs titer >10IU/l) thus excluding
chronic infection and suggesting initial false positive results.
Conclusions: In isolated anti-HBc subjects false positive results
(primary response) or prior infection by HBV (anamnestic response) can be
detected by anti-HBs response after HBV vaccination. Copyright 2001 The British
Infection Society
(311) Viral Hepatitis Prevention Board (VHPB).
Behavioural issues in hepatitis B vaccination.
Meeting Report, Antwerp, 23--25 March, 2000. Vaccine 2001;
19(7-8):675-679.
ABSTRACT: The VHPB held a workshop in Antwerp, Belgium on 23--25 March 2000 to
review research and experience concerning knowledge and attitude formation by
health professionals and the public about vaccination. The meeting also examined
the development and consequences of recent vaccine "scares," to
understand how unnecessary alarm and inappropriate actions would be avoided in
the event of future allegations, thus minimizing the adverse effects on health
due to a loss of confidence in vaccination.
(312) Weber DJ, Rutala WA. The emerging nosocomial
pathogens Cryptosporidium, Escherichia coli O157:H7, Helicobacter pylori, and
hepatitis C: epidemiology, environmental survival, efficacy of disinfection,
and control measures. Infect Control Hosp Epidemiol 2001; 22(5):306-315.
ABSTRACT: New and emerging infectious diseases pose a threat to public health
and may be responsible for nosocomial outbreaks. Cryptosporidium parvum and
Escherichia coli are gastrointestinal pathogens that have caused nosocomial
infections via person-to-person transmission, environmental contamination, or
contaminated water or food. Helicobacter pylori has been transmitted via
inadequately disinfected endoscopes. Finally, hepatitis C may be acquired by
healthcare personnel by percutaneous or mucous membrane exposure to blood or
between patients by use of contaminated blood products or via environmental
contamination. Rigorous adherence to Standard Precautions, Contact Precautions
for patients with infectious diarrhea, disinfection of environmental surfaces,
and appropriate disinfection of endoscopes are adequate to prevent nosocomial
acquisition of these pathogens
(313) Weber DJ, Rutala WA. Risks and prevention of
nosocomial transmission of rare zoonotic diseases. Clin Infect Dis 2001;
32:446-456.
ABSTRACT: Americans are increasingly exposed to exotic zoonotic diseases
through travel, contact with exotic pets, occupational exposure, and leisure
pursuits. Appropriate isolation precautions are required to prevent nosocomial
transmission of rare zoonotic diseases for which person-to-person transmission
has been documented. This minireview provides guidelines for the isolation of
patients and management of staff exposed to the following infectious diseases
with documented person-to-person transmission: Andes hantavirus disease,
anthrax, B virus infection, hemorrhagic fevers (due to Ebola, marburg, Lassa,
Crimean-Congo hemorrhagic fever, Argentine hemorrhagic fever, and Bolivian
hemorrhagic fever viruses, monkeypox, plague, Q fever and rabies. Several of
these infections may also be encountered as bioterrorism hazards (i.e.,
anthrax, hemorrhagic fever viruses, plague, and Q fever). Adherence to
recommended isolation precautions will allow for proper patient care while
protecting the health care workers who provide care to patients with known or
suspected zoonotic infections capable of nosocomial transmission.
(314) Yerly S, Quadri R, Negro F, Barbe KP, Cheseaux
J, Burgisser P et al. Nosocomial Outbreak of Multiple Bloodborne Viral
Infections. J Infect Dis 2001; 184(3):369-372.
ABSTRACT: In resource-limited countries, nosocomial transmission of bloodborne
pathogens is a major public health concern.
After a major outbreak of human immunodeficiency virus (HIV) infection
in ~400 children in 1998 in Libya, we tested HIV, hepatitis C virus (HCV), and
hepatitis C virus (HCV), and hepatitis B virus (HBV) markers in 148 children
and collected epidemiological data in a subgroup of 37 children and 46 parents. HIV infection was detected in all children
but one, with HCV or HBV coinfection in 47% and 33%, respectively. Vertical transmission was ruled out by
analysis of parents' serology. The
children visited the same hospital 1-6 times; at each visit, invasive
procedures with potential blood transmission of virus were performed. HIV and HCV genotypic analyses identified a
HIV monophyletic group, where as 4 clusters of HCV sequences were
identified. To our knowledge, this is
the largest documented outbreak of nosocomial HIV transmission.
(315) Yeung LT, King SM, Roberts EA.
Mother-to-infant transmission of hepatitis C virus. [Review] [102 refs].
Hepatology 2001; 34(2):223-229.
ABSTRACT: Hepatitis C virus (HCV) infection is acquired through transfusionof
infected blood or blood products or through routes not related to transfusion,
classified as community-acquired disease.
In developed countries, the predominant transmission route of hepatitis
C is changing. In childhood, hepatitis C
has been largely transfusional. Since
the implementation of blood product screening for HCV in 1991, the incidence of
transfusional hepatitis C has dropped.
As children with post-tranfusional hepatitis C grow up, the prevalence
of community-acquired pediatric hepatitis C will increase.
(316) Young MD, Schneider DL, Zuckerman AJ, Du W,
Dickson B, Maddrey WC et al. Adult hepatitis B vaccination using a novel triple
antigen recombinant vaccine. Hepatology 2001; 34(2):372-376.
ABSTRACT: Present hepatitis B vaccines use multidose prolonged regimens, which
even healthcare workers at risk do not always complete. Moreover, when
vaccination is completed there remain some who fail to achieve adequate
protection. The protection of adults at risk could be improved if there were a
more potent vaccine and/or a shorter vaccination regimen available.
Vaccine-naive adults were randomized to vaccination with either Engerix-B
(SmithKline Biologicals, Rixensart, Belgium) or a novel triple antigen (S,
pre-S1, and pre-S2) recombinant vaccine (Hepacare; Medeva Pharma Plc, Speke, UK).
The primary efficacy parameter was the degree of seroprotection 6 or 7 months
(26 +/- 2 weeks) after beginning vaccination. A total of 304 adults entered the
study. Of these, 16 failed to complete the study (9 on Hepacare and 7 on
Engerix-B). With the Engerix-B standard (0, 1, 6) regimen, 88% of subjects were
protected by month 7, whereas with the triple antigen vaccine a 2-dose regimen
(0, 1) provided equivalent protection (91%) within 6 months and a 3-dose (0, 1,
6) regimen was significantly superior (98% seroprotected by 7 months after
starting vaccination P <.001). With adults at risk for a suboptimal response
(i.e., older adults, the obese, men, and smokers) the triple antigen vaccine
produced a greater degree of protection. The vaccines had similar safety
profiles. Both vaccines were well tolerated. In healthy normal adults, a triple
antigen hepatitis B vaccine containing S and pre-S antigens produced an
enhanced immunologic response and was as effective as a 2- and 3-dose regimen
(317) Zakrzewska JM, Greenwood I, Jackson J.
Introducing safety syringes into a UK dental school--a controlled study. Br
Dent J 2001; 190(2):88-92.
ABSTRACT: AIM: How an appropriate safety syringe was chosen, how the
change-over to it was achieved and what outcome measures were used to measure
the effectiveness of this change. INTRODUCTION: One third of all reported
sharps injuries in dental practice are due to the use of non disposable dental
syringes with most injuries being sustained during removal and disposal of the disposable
needle from the non-disposable syringe. METHOD: After evaluation of all
available disposable safety syringes they were introduced into a dental school
after appropriate education of all staff and students. Risk management provided
data on all reported needle-stick injuries in the dental school and a control
unit using non disposable syringes for a period of two years. RESULTS:
Avoidable needle stick injuries reduced from an average of 11.8 to 0 injuries
per 1,000,000 hours worked per year as compared with a control unit who reduced
their frequency from 26 to 20 injuries per 1,000,000 hours worked. The cost of
safety syringes is comparable to non- disposable syringes but the reduction in
cost of management of needle stick injuries including the psychological effects
are significant. CONCLUSION: Education plays a vitally important role in the
effective implementation of the change to safety syringes which is advocated
for all dentists
(318) Zuckerman JN, Zuckerman AJ, Symington I, Du W,
Williams A, Dickson B et al. Evaluation of a new hepatitis B triple-antigen
vaccine in inadequate responders to current vaccines. Hepatology 2001; 34(4 Pt
1):798-802.
ABSTRACT: In this double-blind, randomized, controlled study, healthcare
professionals with a history of inadequate response to currently available
single-antigen hepatitis B vaccines confirmed by measuring hepatitis B surface
antibody titer before entry to the study were revaccinated with a 20-microg
dose either of a novel triple-antigen (S, pre-S1, and pre-S2) recombinant
vaccine or of a present single-antigen (S only) vaccine. Hepatitis B surface
antibody titers were measured 8 weeks' post revaccination. A