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News & updates · conferences · publications
related to needlestick prevention, sharps safety, and occupational exposure prevention 

News:

  • December 2010: NIOSH seeks comment on proposed list of diseases that may pose bloodborne or airborne transmission risks for emergency responders. More.
     
  • November 2010:
    • Center-sponsored national conference Nov. 5-6, "Tenth Anniversary of the Needlestick Safety and Prevention Act: Mapping Progress, Charting a Future Path," features keynote address by John Howard, director of National Institute for Occupational Safety and Health. Conference program, video of keynote address, photos, and speaker presentations are available here.
    • FDA issues guidance document on labeling of lancets (Nov. 29, 2010)
    • WHO and ILO launch international guidelines to protect health workers against HIV and TB. More.
    • September 2010: Center receives official designation as a World Health Organization (WHO) Collaborating Center for Occupational Health. Terms of reference available here. Information on Collaborating Centers in Occupational Health available here.

    • May 2010:
    • April 2010: 
    • March 2010: The European Council approves a directive on the prevention of sharp injuries in healthcare settings which will make use of safety devices a legal requirement in EU countries. Press:
    • February 2010: SHEA releases updated guidelines on management of infected healthcare workers. More .

    • January 2010: OR Manager article on "Blunting sharps injuries." More.

    • December 2009:
      • Chinese delegation visits Center for training in occupational exposure prevention. More.  
      • Ginger Parker conducts EPINet sharps injury surveillance training in Bogota and Medellin, Columbia, awarding 58 EPINet certificates. More.
    • October 2009: Elayne Kornblatt Phillips visits Sao Paulo, Brazil, to attend a WHO/PAHO Collaborating Centers and National Reference Institutions meeting on "Sustainable Development and Environmental Health." More.

    • September 2009:
      • Center partners with Dikembe Mutombo Foundation and BD to help support new Occupational Safety Center for Health Workers at Biamba Marie Mutombo Hospital in Kinshasa, Democratic Republic of Congo. More here and here.
      • Ginger Parker travels to Maracay, Venezuela, to participate in the First Regional Meeting for Latin America and the Caribbean on Health Protection for Healthcare Workers. More.

    • August 2009:
      • Center conducts EPINet training at WHO-sponsored healthcare worker safety conference in Riyadh, Saudi Arabia. More.
      • EPINet 2007 data reports now available. More
        August issue of Health Purchasing News discusses trends in sharps safety products, with comments by Jane Perry. Read it  here.

    • June 2009:
      • Russian physicians visit Center for one-week Training Program in Occupational Exposure Prevention. More.

    • June 2009:
      • European healthcare employee and employer trade organizations reach agreement on use of safety devices; European Union expected to pass safety needle legislation by end of 2009. Read more here.
      • A blog on nursingtimes.net by Susan Elden describes conditions for nurses in Swaziland, where the HIV adult population prevalence is 25%. Click here.

    • May 2009: A new tropical disease risk for healthcare workers: Lujo virus. Read more  here.

Center's quarterly newsletters:

Upcoming conferences:

  • Association of periOperative Registered Nurses (AORN) 58th Annual Congress.
    Philadelphia, PA; March 18-24, 2011. Information.

  • Society of Healthcare Epidemiologists of America (SHEA) 2011 Annual Scientific Meeting. Dallas, TX; April 1-4, 2011. Information.

  • Association of Professionals in Infection Control and Epidemiology (APIC) Annual Conference. Baltimore, MD; June 27-29, 2011. Information.

  • First International Conference on Prevention and Infection Control (ICPIC). Geneva, Switzerland; June 29-July 2, 2011. Abstract submission deadline: March 4, 2011. Information.

  • Association of Occupational Health Professionals in Health Care (AOHP) Annual Meeting. Minneapolis, MN; September 14-17, 2011. Information.

  • National Occupational Injury Research Symposium (NOIRS) 2011. Morgantown, WV; October 18-20, 2011. Information.

  • Fifth International Congress of Asia Pacific Society of Infection Control (hosted by Victoria Infection Control Professionals Association). November 8-11, 2011; Melbourne, Australia. Information.

    To add your conference, contact us here.

Recent publications

From the International Healthcare Worker Safety Center:

Increase in sharps injuries in surgical settings versus non-surgical settings after passage of national needlestick legislation.
Authors: Jagger J, Berguer R, Phillips EK, Parker G, Gomaa AE. Published in: Journal of the American College of Surgeons 2010 (April);210(4):496-502.
ABSTRACT: The operating room is a high-risk setting for occupational sharps injuries and bloodborne pathogen exposure. The requirement to provide safety-engineered devices, mandated by the Needlestick Safety and Prevention Act of 2000, has received scant attention in surgical settings. Study design: We analyzed percutaneous injury surveillance data from 87 hospitals in the United States from 1993 through 2006, comparing injury rates in surgical and nonsurgical settings before and after passage of the law. We identified devices and circumstances associated with injuries among surgical team members. Results: Of 31,324 total sharps injuries, 7,186 were to surgical personnel. After the legislation, injury rates in nonsurgical settings dropped 31.6%, but increased 6.5% in surgical settings. Most injuries were caused by suture needles (43.4%), scalpel blades (17%), and syringes (12%). Three-quarters of injuries occurred during use or passing of devices. Surgeons and residents were most often original users of the injury-causing devices; nurses and surgical technicians were typically injured by devices originally used by others. Conclusions: Despite legislation and advances in sharps safety technology, surgical injuries continued to increase during the period that nonsurgical injuries decreased significantly. Hospitals should comply with requirements for the adoption of safer surgical technologies, and promote policies and practices shown to substantially reduce blood exposures to surgeons, their coworkers, and patients. Although decisions affecting the safety of the surgical team lie primarily in the surgeon's hands, there are also roles for administrators, educators, and policy makers.  

The national study to prevent blood exposure in paramedics: rates of exposure to blood. Authors: Boal WL, Leiss JK, Ratcliffe JM, Sousa S, Lyden JT, Li J, Jagger J. Published in: Int Arch Occup Environ Health 2010 83:191-9.
Available at:
http://www.ncbi.nlm.nih.gov/pubmed/19437031?dopt=Abstract .
OBJECTIVE: The purpose of this analysis is to present incidence rates of exposure to blood among paramedics in the United States by selected variables and to compare all percutaneous exposure rates among different types of healthcare workers. METHODS: A survey on blood exposure was mailed in 2002-2003 to a national sample of paramedics. Results for California paramedics were analyzed with the national sample and also separately. RESULTS: The incidence rate for needlestick/lancet injuries was 100/1,000 employee-years [95% confidence interval (CI), 40-159] among the national sample and 26/1,000 employee-years (95% CI, 15-38) for the California sample. The highest exposure rate was for non-intact skin, 230/1,000 employee-years (95% CI, 130-329). The rate for all exposures was 465/1,000 employee-years (95% CI, 293-637). California needlestick/lancet rates, but not national, were substantially lower than rates in earlier studies of paramedics. Rates for all percutaneous injuries among paramedics were similar to the mid to high range of rates reported for most hospital-based healthcare workers. CONCLUSIONS: Paramedics in the United States are experiencing percutaneous injury rates at least as high as, and possibly substantially higher than, most hospital-based healthcare workers, as well as substantially higher rates of exposure to blood on non-intact skin. 

Safety scalpels and sutures have come a long way.
Author: Perry J. Published in: Outpatient Surgery Magazine 2009 (May);10(5):48-51. Available at:
http://www.outpatientsurgery.net/2009/05/safety_scalpels_and_sutures_have_come_a_long_way.php .

•  Chinese EPINet and recall rates for percutaneous injuries: an epidemic proportion of underreporting in the Taiwan healthcare system.
Authors: Shiao JSC, McLaws ML, Lin MS, Jagger J, Chen CJ. Published in: Journal of Occupational Health 2009;51(2).
Summary: As an occupational injury, percutaneous injury (PI) can result in chronic morbidity and death for healthcare workers (HCWs). A pilot surveillance system for PIs using the Chinese version of Exposure Prevention Information Network (EPINet) was introduced in Taiwan in 2003. We compared data from EPINet and recall of PIs using a cross-sectional survey for rates to establish the reliability of the new system. METHODS: HCWs from hospitals that had implemented EPINet for > or =12 months completed a survey for recall of contaminated PIs sustained between October 2004 and September 2005, type of item involved, and reasons for reporting or not reporting the PI. Comparative data from EPINet for the same period were analyzed. RESULTS: The EPINet rate, 36.1/1,000 HCW (95%CI 31.8-41.1) was almost 5 times lower (p<0.0001) than the PI recall rate for 2,464 HCWs of 170/1,000 HCWs (95%CI 155.4-185.5). Approximately 2.5 PIs were recalled for every 1,000 bed-days of care. The recall rate by physicians was 268.3/1,000, 188.5/1,000 for nurses, 88.9/1,000 for medical technologists and 81.3/1,000 for support staff. Hollow-bore needle items most commonly recorded on EPINet includ, disposable needles and syringes were underreported by 81%, vacuum tube holder/needles by 67%, and arterial blood gas needles by 75%. Nearly 63% of the reasons for underreporting were related to the complexity of the reporting process, while 37% were associated with incorrect knowledge about the risks associated with PIs. CONCLUSIONS: EPINet data underestimates a commonplace occupational injury with nearly four in five PIs not reported. Addressing the real barriers to reporting must begin with hospital administrators impressing on HCWs that reporting is essential for designing appropriate safety interventions.

•  Needlestick-prevention devices: we should already be there [letter]
Authors: De Carli G, Puro V, Jagger J. Published in: Journal of Hospital Infection 2009;71(2):183-4.
Summary: Occupational exposure data from Italy's Studio Italiano Rischio Occupazionale da HIV (SIROH) group supports the efficacy of needlestick-prevention devices (NPDs) in reducing sharps injury risk to healthcare workers. Data from 16 hospitals (2003-2006) in which NPDs were implemented indicated that injury rates for NPDs were, on average, 80% lower than for conventional devices. During the same period, in hospitals that had not implemented NPDs 12 cases of occupational hepatitis C infection were reported, and one case of occupationally acquired HIV. Eleven of the 13 injuries that resulted in infection involved devices for which safety alternatives were available. 

•  The impact of U.S. policies to protect healthcare workers from bloodborne pathogens: the critical role of safety-engineered devices.
Authors: Jagger J, Perry J, Gomaa A, Phillips EK. Published in: Journal of Infection and Public Health 2008 (Dec);1(2):62-71.
Summary: In the United States (U.S.), federal legislation requiring the use of safety-engineered sharp devices, along with an array of other protective measures, has played a critical role in reducing healthcare workers' (HCWs) risk of occupational exposure to bloodborne pathogens over the last 20 years. We present the history of U.S. regulatory and legislative actions regarding occupational blood exposures, and review evidence of the impact of these actions. In one large network of U.S. hospitals using the Exposure Prevention Information Network (EPINet) sharps injury surveillance program, overall injury rates for hollow-bore needles declined by 34%, with a 51% decline for nurses. The U.S. experience demonstrates the effectiveness of safety-engineered devices in reducing sharps injuries, and the importance of national-level regulations (accompanied by active enforcement) in ensuring wide-scale availability and implementation of protective devices to decrease healthcare worker risk.

Other publications of interest (non-Center):

• Needlestick injury rates according to different types of safety-engineered devices: results of a French multicenter study.
Authors: Tosini W, Ciotti C, Goyer F, Lolom I, L'Hériteau F, Abiteboul D, Pellissier G, Bouvet E. Published in: Infection Control and Hospital Epidemiology, 2010;31(April):402-7.)

Summary: To evaluate the incidence of needlestick injuries (NSIs) among different models of safety-engineered devices (SEDs) (automatic, semiautomatic, and manually activated safety) in healthcare settings. DESIGN: This multicenter survey, conducted from January 2005 through December 2006, examined all prospectively documented SED-related NSIs reported by healthcare workers to their occupational medicine departments. Participating hospitals were asked retrospectively to report the types, brands, and number of SEDs purchased, in order to estimate SED-specific rates of NSI. Setting. Sixty-one hospitals in France. RESULTS: More than 22 million SEDs were purchased during the study period, and a total of 453 SED-related NSIs were documented. The mean overall frequency of NSIs was 2.05 injuries per 100,000 SEDs purchased. Device-specific NSI rates were compared using Poisson approximation. The 95% confidence interval was used to define statistical significance. Passive (fully automatic) devices were associated with the lowest NSI incidence rate. Among active devices, those with a semiautomatic safety feature were significantly more effective than those with a manually activated toppling shield, which in turn were significantly more effective than those with a manually activated sliding shield (P < .001, chi(2) test). The same gradient of SED efficacy was observed when the type of healthcare procedure was taken into account. CONCLUSIONS: Passive SEDs are most effective for NSI prevention. Further studies are needed to determine whether their higher cost may be offset by savings related to fewer NSIs and to a reduced need for user training.

Occupational injury history and universal precautions awareness: a survey in Kabul hospital staff.
Authors: Salehi AS, Garner P. Published in: BMC Infectious Diseases 2010; 10:19 doi:10.1186/1471-2334-10-19.
Summary: Health staff in Afghanistan may be at high risk of needle stick injury and occupational infection with blood borne pathogens, but we have not found any published or unpublished data. Methods: Our aim was to measure the percentage of healthcare staff reporting sharps injuries in the preceding 12 months, and to explore what they knew about universal precautions. In five randomly selected government hospitals in Kabul a total of 950 staff participated in the study. Data were analyzed with Epi Info 3. Results: Seventy three percent of staff (72.6%, 491/676) reported sharps injury in the preceding 12 months, with remarkably similar levels between hospitals and staff cadres in the 676 (71.1%) people responding. Most at risk were gynaecologist/obstetricians (96.1%) followed by surgeons (91.1%), nurses (80.2%), dentists (75.4%), midwives (62.0%), technicians (50.0%), and internist/paediatricians (47.5%). Of the injuries reported, the commonest were from hollow-bore needles (46.3 %, n=361/780), usually during recapping. Almost a quarter (27.9%) of respondents had not been vaccinated against hepatitis B. Basic knowledge about universal precautions were found insufficient across all hospitals and cadres. Conclusion: Occupational health policies for universal precautions need to be implemented in Afghani hospitals. Staff vaccination against hepatitis B is recommended.

• The prevalence and risk factors for percutaneous injuries in registered nurses in the home health care sector.
Authors: Gershon RR, Pearson JM, Sherman MF, Samar SM, Canton AN, Stone PW. Published in: Am J Infect Control. 2009 Sep;37(7):525-33. Epub 2009 Feb 12.
BACKGROUND: Patients continue to enter home health care (HHC) "sicker and quicker," often with complex health problems that require extensive intervention. This higher level of acuity may increase the risk of percutaneous injury (PI), yet information on the risk and risk factors for PI and other types of exposures in this setting is exceptionally sparse. To address this gap, a large cross-sectional study of self-reported exposures in HHC registered nurses (RNs) was conducted. METHODS: A convenience sample of HHC RNs (N=738) completed a survey addressing 5 major constructs: (1) worker-centered characteristics, (2) patient-related characteristics, (3) household characteristics, (4) organizational factors, and (5) prevalence of PIs and other blood and body fluid exposures. Analyses were directed at determining significant risk factors for exposure. RESULTS: Fourteen percent of RNs reported one or more PIs in the past 3 years (7.6 per 100 person-years). Nearly half (45.8%) of all PIs were not formally reported. PIs were significantly correlated with a number of factors, including lack of compliance with Standard Precautions (odds ratio [OR], 1.72; P=.019; 95% confidence interval [CI]: 1.09-2.71); recapping of needles (OR, 1.78; P=.016; 95% CI: 1.11-2.86); exposure to household stressors (OR, 1.99; P=.005; 95% CI: 1.22-3.25); exposure to violence (OR, 3.47; P=.001; 95% CI: 1.67-7.20); mandatory overtime (OR, 2.44; P=.006; 95% CI: 1.27-4.67); and safety climate (OR, 1.88; P=.004; 95% CI: 1.21-2.91) among others. CONCLUSION: The prevalence of PI was substantial. Underreporting rates and risk factors for exposure were similar to those identified in other RN work populations, although factors uniquely associated with home care were also identified. Risk mitigation strategies tailored to home care are needed to reduce risk of exposure in this setting.

Needlestick injuries among medical students: incidence and implications.
Authors: Sharma GK, Gilson MM, Nathan H, Makary MA. Published in: Acad Med 2009;84(12):1815-21.
Summary: To determine the incidence of needlestick injuries in medical school and to examine the behaviors associated with reporting injuries to an occupational health office. Medical students have underdeveloped surgical skills and are at high risk of needlestick injuries. METHOD: Recent medical school graduates enrolled in a surgery residency at 17 medical centers were surveyed regarding needlestick injuries that they sustained during medical school. The survey asked about the circumstances and cause of injury and postinjury reporting. RESULTS: Of 699 respondents, 415 (59%) reported having sustained a needlestick injury as a medical student; the median number of injuries per injured respondent was 2 (interquartile range: 1-2). Respondents who sustained a needlestick injury in medical school were more likely to sustain a needlestick injury during residency than those who did not experience a needlestick injury in medical school (odds ratio [OR]: 2.57; 95% CI: 1.84, 3.58). Of 89 residents who sustained their most recent needlestick injury during medical school, 42 (47%) did not report their injury to an employee health office. CONCLUSIONS: Needlestick injuries and underreporting of these injuries are common among medical students and place them at risk for hepatitis and human immunodeficiency virus. Strategies aimed at improving reporting systems and creating a culture of reporting should be implemented by medical centers.

Accidental exposures to blood and body fluid in the operation room and the issue of underreporting.
Authors: Nagao M, Iinuma Y, Igawa J, Matsumura Y, Shirano M, Matsushima A, Saito T, Takakura S, Ichiyama S. Published in: Am J Infect Control 2009 (published online 13 April 2009). 
Summary: A retrospective review of all exposure injuries affecting members of the operative care line at a single university hospital between January 2000 and December 2007 was performed. A questionnaire survey on current status of adherence to barrier precautions was also completed by 164 staff members. Of 136 exposure injuries, 87 (64.0%) were in surgeons, and 49 (36.0%) were in scrub nurses. Surgeons were most commonly injured during suturing (49, 56%), followed by "handing over sharps" (7, 8%), whereas scrub nurses were most commonly injured during "counting and sorting of sharps" (15, 41%), followed by "handing over sharps," and "splash." The questionnaire survey revealed that compliance with goggles, face shields, and double gloving was poor, and only 9% of respondents routinely used the hands-free technique. Only 22% of staff who had experienced exposure injuries reported every incident. Because circumstances of exposure injuries in operating rooms differ by profession, appropriate preventive measures should address individual situations. To reduce exposure injuries in the operating room, further efforts are required including education, mentoring, and competency training for operation personnel.

•  Accidental blood and body fluid exposure among doctors.
Authors: Naghavi SH, Sanati KA. Published in: Occup Med (Lond) 2009;59(2):101-6.
Summary: Aim - To study the epidemiology and time trends of blood and body fluids (BBF) exposures among hospital doctors. METHODS: A 3-year study was carried out using data from the Exposure Prevention Information Network of four teaching hospitals in the UK. RESULTS: One hundred and seventy-five cases of BBF exposures in doctors were reported over the 3-year study period. Eighty-one (46%) occurred in senior doctors and 94 (54%) in junior doctors. Junior doctors had a higher rate of BBF exposures compared to senior doctors: 13 versus 4 incidents per 100 person-years, respectively (relative risk 3, 95% confidence interval 2-4). The most frequent setting for BBF exposures among senior doctors was the operating theatre/recovery (59%). Among junior doctors, it was the patient room (48%). The commonest original reason for use of sharps by junior doctors was the taking of blood samples (42%). Among senior doctors, it was suturing (41%). CONCLUSION: While ongoing training efforts need to be directed towards both junior and senior doctors, our data suggest that junior doctors are at higher risk of BBF exposures and may need particular attention in prevention strategies. An improvement in the safety culture in teaching hospitals can be expected to reduce the number of BBF exposures.

  The incidence and reporting rates of needle-stick injury amongst UK surgeons.
Authors: Thomas WJ, Murray JR. Published in: Ann R Coll Surg Engl 2009;91(1):12-17.
Summary: Needle-stick injuries are common. Such accidents are associated with a small, but significant, risk to our career, health, families and not least our patients. National guidelines steer institution-specific strategies to provide a consistent and safe method of dealing with such incidents. Surgeon-specific guidelines are not currently available. We have observed that hospital sharps policy is often considered cumbersome to the surgeon, resulting in on-the-spot decision making with potential long-term implications. By their essence, these decisions are inconsistent, not reproducible and, thus, we believe them to be unsafe. The under-reporting to occupational health departments is well documented. Current surgical practice has the potential to expose the surgeon to unnecessary risk. The aims of this study were to establish the true incidence of contaminations caused by needle-stick injury in our hospital and to assess how well current protocols are really implemented. SUBJECTS AND METHODS: We identified all surgeons of consultant, non-career staff grade (NCSG) and registrar grade working in a large 687-bed district general hospital serving a population of 550,000, in the UK. We designed a retrospective, anonymous 30-second survey. Surgeons' awareness and opinion of local policy was sought in a free-text section. RESULTS: Of the 98 surgeons in the hospital, 77% responded to the questionnaire and 44% anonymously admitted to having a needle-stick injury. Only 3 of the 33 (9%) who sustained an needle-stick injury said that they followed the agreed local policy. Twenty-three surgeons (70%) performed first aid type procedures such as informing scrub nurse, changing needle and gloves. Seven surgeons (21%) simply ignored the incident and continued. Forty-three surgeons commented on the policy's nature with only 9 who regarded it as 'user friendly'. CONCLUSIONS: Needle-stick injury is still a common problem, particularly in the surgical cohort and remains significantly under-reported. The disparity between hospital sharps policy and actual surgical practice is considered and an explanation for the difference sought. Without this awareness of 'real-life' surgical practice, the occupational health figures for sharps injury will always tell a rosy story under-estimating a real problem. We strongly advocate universal precautions in the operating theatre. However, we acknowledge that sharps injuries will occur. We should remain vigilant and act upon contaminations without surgical bravado but with mater-of-fact professionalism. This includes regular review of policy and, particularly, promotion of surgical awareness.

•  Exposures to blood and body fluids in Brazilian primary health care.
Authors: Garcia LP, Facchini LA. Published in: Occup Med (Lond) 2009;59(2):107-13.
Summary: Primary health care workers (HCWs) represent a growing occupational group worldwide. They are at risk of infection with blood-borne pathogens because of occupational exposures to blood and body fluids (BBF). AIM: To investigate BBF exposure and its associated factors among primary HCWs. METHODS: Cross-sectional study among workers from municipal primary health care centres in Florianópolis, Southern Brazil. Workers who belonged to occupational categories that involved BBF exposures during the preceding 12 months were interviewed and included in the data analysis. RESULTS: A total of 1077 workers participated. The mean incidence rate of occupational BBF exposures was 11.9 per 100 full-time equivalent worker-years (95% confidence interval: 8.4-15.3). The cumulative prevalence was 7% during the 12 months preceding the interview. University-level education, employment as a nurse assistant, dental assistant or dentist, higher workload score, inadequate working conditions, having sustained a previous occupational accident and current smoking were associated with BBF exposures (P <or= 0.05). CONCLUSIONS: Primary Health Care Centres are working environments in which workers are at risk of BBF exposures. Exposure surveillance systems should be created to monitor their occurrence and to guide the implementation of preventive strategies.

•  Hands-Free Technique in the Operating Room: Reduction in Body Fluid Exposure and the Value of a Training Video.
Authors: Stringer B, Haines T, Goldsmith CH, Blythe J, Berguer R, Andersen J, De Gara CJ. Published in: Public Health Reports 2009;124 (S1):169-79.
Availabe at:
http://www.publichealthreports.org/userfiles/124_4Supp1/169-179.pdf
Summary: This study sought to determine if (1) using a hands-free technique (HFT)-whereby no two surgical team members touch the same sharp item simultaneously-$75% of the time reduced the rate of percutaneous injury, glove tear, and contamination (incidents); and (2) if a video-based intervention increased HFT use to $75%, immediately and over time. METHODS: During three and four periods, in three intervention and three control hospitals, respectively, nurses recorded incidents, percentage of HFT use, and other information in 10,596 surgeries. The video was shown in intervention hospitals between Periods 1 and 2, and in control hospitals between Periods 3 and 4. HFT, considered used when $75% passes were done hands-free, was practiced in 35% of all surgeries. We applied logistic regression to (1) estimate the rate reduction for incidents in surgeries when the HFT was used and not used, while adjusting for potential risk factors, and (2) estimate HFT use of about 75% and 100%, in intervention compared with control hospitals, in Period 2 compared with Period 1, and Period 3 compared with Period 2. RESULTS: A total of 202 incidents (49 injuries, 125 glove tears, and 28 contaminations) were reported. Adjusted for differences in surgical type, length, emergency status, blood loss, time of day, and number of personnel present for $75% of the surgery, the HFT-associated reduction in rate was 35%. An increase in use of HFT of $75% was significantly greater in intervention hospitals, during the first post-intervention period, and was sustained five months later. CONCLUSION: The use of HFT and the HFT video were both found to be effective.

•  Health care workers' exposure to blood-borne pathogens in Lebanon.
Authors: Musharrafieh UM, Bizri AR, Nassar NT, Rahi AC, Shoukair AM, Doudakian RM, et al. Published in: Occupational Medicine (Oxford) 2008;58:94-8.
Summary: Accidental exposure to blood-borne pathogens (BBPs) is a risk for health care workers (HCWs). AIM: To study the pattern of occupational exposure to blood and body fluids (BBFs) at a tertiary care hospital. Methods: This study reports a 17-year experience (1985-2001) of ongoing surveillance of HCW exposure to BBFs at a 420-bed academic tertiary care hospital. Results: A total of 1,590 BBF exposure-related accidents were reported to the Infection Control Office. The trend showed a decrease in these exposures over the years with an average +/- standard error of 96 +/- 8.6 incidents per year. In the last 6 years, the average rate of BBF exposures was 0.57 per 100 admissions per year (average of needlestick injuries alone was 0.46 per 100 admissions). For 2001, the rates of exposure were found to be 13% for house officers, 9% for medical student, 8% for attending physicians, 5% for nurses, 4% for housekeeping, 4% for technicians and 2% for auxiliary services employees. The reason for the incident, when stated, was attributed to a procedural intervention (29%), improper disposal of sharps (18%), to recapping (11%) and to other causes (5%). Conclusions: The current study in Lebanon showed that exposure of HCWs to BBPs remains a problem. This can be projected to other hospitals in the country and raises the need to implement infection control standards more efficiently. Similar studies should be done prospectively on a yearly basis to study rates and identify high-risk groups.  

•  Hepatitis B virus, hepatitis C virus and other blood-borne infections in healthcare workers: guidelines for prevention and management in industrialised countries.
Authors: FitzSimons D, François G, De Carli G, Shouval D, Prüss-Ustün A, Puro V, Williams I, Lavanchy D, De Schryver A, Kopka A, Ncube F, Ippolito G, Van Damme P. Published in: Occupational and Environmental Medicine 2008;65(7):446-51.
Summary: The Viral Hepatitis Prevention Board (VHPB) convened a meeting of international experts from the public and private sectors in order to review and evaluate the epidemiology of blood-borne infections in healthcare workers, to evaluate the transmission of hepatitis B and C viruses as an occupational risk, to discuss primary and secondary prevention measures and to review recommendations for infected healthcare workers and (para)medical students. This VHPB meeting outlined a number of recommendations for the prevention and control of viral hepatitis in the following domains: application of standard precautions, panels for counselling infected healthcare workers and patients, hepatitis B vaccination, restrictions on the practice of exposure-prone procedures by infected healthcare workers, ethical and legal issues, assessment of risk and costs, priority setting by individual countries and the role of the VHPB. Participants also identified a number of terms that need harmonization or standardisation in order to facilitate communication between experts.

 

 

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