Asia and Asia Pacific

Bibliography of country-specific and regional needlestick, surveillance, and exposure risk studies

The bibliography is arranged by country in alphabetical order; for each country, references are in chronological order, most recent articles first. Each citation includes an abstract, if available. If you would like to add a citation, contact us here. 

Countries with articles listed: 

 

AFGHANISTAN:

Salehi AS, Garner P. Occupational injury history and universal precautions awareness: a survey in Kabul hospital staff. BMC Infectious Diseases 2010, 10:19 doi:10.1186/1471-2334-10-19. Published 30 January 2010.
ABSTRACT - 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of needle stick injury and occupational infection with blood borne pathogens, but we have not found any published or unpublished data.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.

AUSTRALIA:

Clark BM, Molton JS, Habib T, Williams DT, Weston EL, Smith DW. Dengue virus infection in Australia following occupational exposure: A reflection of increasing numbers of imported cases [letter]. J Clin Virol. 2012 May 21. [Epub ahead of print]
Summary: Nosocomial transmission of dengue virus has been reported infrequently previously, and never in an Australian health care worker (HCW). During a period when higher than normal numbers of individuals returned to Western Australia with dengue virus infection, particularly from Bali, such a case occurred.

Fuentes H, Collier J, Sinnott M, Whitby M. Scalpel safety: modeling the effectiveness of different safety devices' ability to reduce scalpel blade injuries. Int J Risk Saf Med 2008;20(1-2):83-9.
ABSTRACT - Background: The objective of this study was to analyse and compare the potential effectiveness of two safety strategies in reducing scalpel blade injuries. The two strategies examined were safety scalpel vs. a single-handed scalpel blade remover combined with a hands free passing technique (HFPT) (e.g. passing tray or neutral zone). Methods: This was a retrospective study involving review of a 550-bed adult metropolitan tertiary referral hospital's sharps injuries database, chart review, and hypothetical modelling of the data to determine potential preventable injuries. The modelling was done twice, firstly assuming 100% effectiveness of each safety device and secondly using previously published activation rates for "active" safety devices which were considered to be a more accurate reflection of real-life work practices. Results: A total of 141 scalpel injuries were reported between 1987 and 2003. Clinical charts were reviewed for 137 of these injuries. Just under 50% of injuries were sustained while the scalpel was in use and these were assumed to be not preventable. Assuming 100% effectiveness for each safety device resulted in 72 injuries being prevented by safety scalpels and 69 injuries being prevented by a combination of a single-handed scalpel blade remover and an HFPT. When injury prevention was calculated using published data on activation rates for "active" safety devices, the number fell to as low as 12 for safety scalpel and to 61 for the combination of a single-handed scalpel blade remover and an HFPT. Conclusion: Both safety strategies are potentially effective in reducing scalpel blade injuries. However the safety scalpels are active devices and as such are subject to widely variable activation rates. We recommend use of a single-handed scalpel blade remover in combination with an HFPT as this can potentially prevent 5 times as many injuries as safety scalpels.

Sinnott M, Shaban R. "Scalpel safety," not "safety scalpel": a new paradigm in staff safety. Perioperative Nursing Clinics 2010;5(1):59-67.
ABSTRACT - Summary: Scalpel injuries account for between 7% and 12% of all sharps injuries. Efforts to increase the awareness of potential hazards of sharps injuries and related prevention efforts began in the early 1980s. Research shows convincingly that a single-handed scalpel blade remover combined with a hands-free passing technique (HFPT) is a safe alternative choice to the safety scalpel. The concept of "scalpel safety" is based on providing nurses the freedom of choice to select the best safety device for their individual needs on a case-by-case basis. Team members can now choose between a safety scalpel and a single-handed scalpel blade remover combined with a HFPT to achieve the correct balance between patient safety and staff safety.

Sinnott M, Wall D. "Scalpel safety": how safe (or dangerous) are safety scalpels? [letter] Int J Surg 2008;6(2):176-7.

Watt A, Patkin M, Sinnott M, Black R, Maddern G. Scalpel safety in the operative setting: A systematic review. Surgery 2010;147(1):98-106.
ABSTRACT - Background: The complex environment of the operative setting provides multiple opportunities for health care workers to sustain scalpel injuries; scalpels are the second most frequent source of sharps injuries in this setting. Little evidence has been published detailing the effectiveness of proposed safety procedures and devices. Methods: A systematic search strategy was used to identify relevant studies. Studies were included based on the application of a predetermined protocol, an independent assessment by 2 reviewers, and a consensus decision. Nineteen articles formed the evidence base for this review. Results: Little high-level evidence was available. The results of studies reporting on 5 different devices/procedures were identified: the use of cut-resistant gloves/liners decreased the number of glove perforations in comparison with double latex gloves alone but lessened the wearer's dexterity and tactile sensation; the benefit derived from the use of the hands-free passing technique seemed equivocal; "sharpless surgery" was found to be feasible; a single-handed blade remover prevented at least as many injuries as a safety scalpel; and some shoe materials provided superior foot protection. Conclusion: The lack of available evidence highlights the need for the generation of a methodologically rigorous, clinically relevant, and statistically valid body of primary research in this area to support appropriate and effective safety interventions.

Bi P, Tully PJ, Boss K, Hiller JE. Sharps injury and body fluid exposure among health care workers in an Australian tertiary hospital. Asia-Pacific Journal of Public Health 2008;20:139-47.
ABSTRACT- To examine sharps injury and body fluid exposure among health care workers, a descriptive epidemiological study was conducted in a 1000-bed tertiary hospital between 2000 and 2003 using surveillance data of all reported sharps injuries and body fluid exposures. A total of 640 sharps injuries and body fluid exposures were reported from hospital and nonhospital staff, although no seroconversions to HIV, hepatitis B virus, or hepatitis C virus were observed during the study period. Nurses reported 47% of sharps injuries and 68% of body fluid exposures, medical staff reported 38% and 16%, and other nonmedical staff notified 5% and 4%, respectively, while nonhospital staff reported the rest. Hollow-bore needles accounted for 56% of sharps injuries, while 11% of the incidents were sustained during recapping and inappropriate disposal. Further research into Australian work practices, disposal systems, education strategies, and the use of safety sharps should be emphasized to implement strategies to reduce work-related injuries among health care workers.

Larney S, Dolan K. An exploratory study of needlestick injuries among Australian prison officers. International Journal of Prison Health 2008;4(3):164-8.
ABSTRACT - Prison officers face multiple occupational hazards including needlestick injuries, which may result in the transmission of blood-borne viral infections. This study aimed to assess the prevalence of needlestick injuries, the circumstances under which needlestick injuries occur and the responses of injured prison officers. Cross-sectional data were collected from prison officers in two Australian jurisdictions between January and May 2006, using a self-report questionnaire. Descriptive analyses were conducted. Of 246 prison officers who completed the survey, two-thirds had found needles and syringes in the workplace. Seventeen officers (7%) reported having experienced a needlestick injury. Most injuries occurred during searches. Serological testing for blood-borne viral infections following injury was common, but less than half the injured officers accessed support services. Needlestick injuries appear to be a relatively rare occurrence, but may be further reduced by improving search techniques and equipment and regulating needles and syringes in prisons.

Watt AM, Patkin M, Sinnott MJ, Black RJ, Maddern GJ. Scalpel injuries in the operating theatre [editorial]. British Medical Journal 2008;336(7652):1031.

Whitby M, McLaws ML, Slater K. Needlestick injuries in a major teaching hospital: The worthwhile effect of hospital-wide replacement of conventional hollow-bore needles. American Journal of Infection Control 2008;36:180-6.
ABSTRACT- Background: Needlestick injury (NSI) with hollow-bore needles remains a significant risk of bloodborne virus acquisition in health care workers. The impact on NSI rates after substantial replacement of conventional hollow-bore needles with the simultaneous introduction of safety-engineered devices (SEDs) including retractable syringes, needle-free intravenous (IV) systems, and safety winged butterfly needles was examined in an 800-bed Australian university hospital. Methods: NSIs were prospectively monitored for 2 years (2005-2006) after the introduction of SEDs and compared with prospectively collected preintervention NSI data (2000-2004). Results: Preintervention hollow-bore NSI rates over 10 years persisted at a constant rate between 3.01 and 3.77 per 100 full-time equivalent employees (FTE) (P = .31). Rates for 2005 (1.93; 95% CI: 1.48-2.47 per 100 FTE) and 2006 (1.50; 95% CI: 1.11-1.97 per 100 FTE) were significantly lower than the average rate for the preintervention years (3.39; 95% CI: 2.7-4.24 per 100 FTE, P = .00004). This represents a fall of 49% (43.1%-55.7%) in hollow-bore NSI, contributed to by the virtual elimination of NSI related to accessing IV lines. More importantly, high-risk injuries were also reduced 57% by retractable syringe use with an overall budgetary increase of approximately US $90,000 per annum. Conclusion: Introduction of SEDs results in an impressive fall in NSI with minimal cost outlay.

Bennett NJ, Bull AL, Dunt DR, Gurrin LC, Russo PL, Spelman DW, Richards MJ. Occupational exposures to bloodborne pathogens in smaller hospitals. [Letter] Infection Control and Hospital Epidemiology 2007;28:896-8.

Haber PS, Young MM, Dorrington L, Jones A, Kaldor J, De Kanzow S, Rawlinson WD. Transmission of hepatitis C virus by needle-stick injury in community settings. Journal of Gastroenterology and Hepatology 2007;22:1882-5.
ABSTRACT- Background: Hepatitis C virus (HCV) is predominantly transmitted by blood-to-blood contact, typically by sharing of needles by injecting drug users. Discarded needles could act as a vector for transmission of this infection. Methods: Two cases of HCV seroconversion following a needle-stick injury in a community setting were identified. The effects of specimen processing and storage conditions on detection of HCV RNA were assessed to provide information about the likelihood of discarded needles containing infectious HCV. Results: Consistent with a role for discarded needles in viral transmission, in vitro studies demonstrated that viral load declined by less than one log following storage for 24 h. Conclusion: All needle-stick injuries should be promptly investigated by serology and HCV-PCR.

Leggat PA, Kedjarune U, Smith DR. Occupational health problems in modern dentistry: a review. Industrial Health 2007;45:611-21.
ABSTRACT- Despite numerous technical advances in recent years, many occupational health problems still persist in modern dentistry. These include percutaneous exposure incidents (PEI); exposure to infectious diseases (including bioaerosols), radiation, dental materials, and noise; musculoskeletal disorders; dermatitis and respiratory disorders; eye injuries; and psychological problems. PEI remain a particular concern, as there is an almost constant risk of exposure to serious infectious agents. Strategies to minimise PEI and their consequences should continue to be employed, including sound infection control practices, continuing education and hepatitis B immunisation. As part of any infection control protocols, dentists should continue to utilise personal protective measures and appropriate sterilisation or other high-level disinfection techniques. Aside from biological hazards, dentists continue to suffer a high prevalence of musculoskeletal disorders (MSD), especially of the back, neck and shoulders. To fully understand the nature of these problems, further studies are needed to identify causative factors and other correlates of MSD. Continuing education and investigation of appropriate interventions to help reduce the prevalence of MSD and contact dermatitis are also needed. For these reasons, it is therefore important that dentists remain constantly informed regarding up-to-date measures on how to deal with newer technologies and dental materials.

Slater K, Whitby M, McLaws ML. Prevention of needlestick injuries: the need for strategic marketing to address health care worker misperceptions. American Journal of Infection Control 2007;35:560-2.
No abstract

Smith DR, Smyth W, Leggat PA, Wang RS. Needlestick and sharps injuries among nurses in a tropical Australian hospital. International Journal of Nursing Practice 2006;12:71-7.
ABSTRACT- Although needlestick and sharps injuries (NSI) represent a major hazard in nursing practice, most studies rely on officially reported data and none have yet been undertaken in tropical environments. Therefore, we conducted a cross-sectional NSI survey targeting all nurses within a tropical Australian hospital, regardless of whether they had experienced an NSI or not. Our overall response rate was 76.7%. A total of 39 nurses reported 43 NSI events in the previous 12 months. The most common causative device was a normal syringe needle, followed by insulin syringe needles, i.v. needles or kits and blood collection needles. Half of the nurses' NSI events occurred beside the patient's bed: drawing up medication was the most common reason. Nurses working in the maternity/neonatal wards were only 0.3 times as likely to have experienced an NSI as their counterparts in the medical or surgical wards. Overall, our study has shown that NSI events represent an important workplace issue for tropical Australian nurses. Their actual rate might also be higher than official reports suggest.

Smith DR, Leggat PA. Needlestick and sharps injuries among nursing students. Journal of Advanced Nursing 2005;51:449-55.
ABSTRACT- This paper reports the first investigation of the prevalence and nature of needlestick injuries among Australian nursing students. Methods: A questionnaire-based methodology adapted from other international investigations was conducted among nursing students. We recruited a complete cross-section of students from a large university nursing school in North Queensland, Australia, in March 2004, and analysed needlestick and sharps events as a percentage of all students and also as a proportion of all cases. Risk factors were evaluated using logistic regression. Results: From a group of 319 students, 274 successfully completed questionnaires were obtained (overall response rate 85·9%). A total of 38 students (13·9%) reported a needlestick or sharps injury during the previous 12 months. By causative item, 6·2% of students had been injured by a normal hollow-bore syringe needle, 3·6% by a glass item and 3·3% by an insulin syringe needle. Regarding prior usage, 81·6% of all injuring items were unused, 15·8% had been used on a patient and the status of 2·6% was unknown. Most needlestick injuries occurred either in the nursing laboratory (45%) or the teaching hospital (37%). Opening the needle cap was the most common causative event (28% of all cases). A total of 39·5% of needlestick injuries were not reported. The main reason for non-reporting was that the item was unused (42%). Logistic regression analysis revealed that students in the third year were 14·8 times more likely to have experienced a needlestick injury than their counterparts in other years (odds ratio 14·8, 95% confidence interval 5·2-50·3, P < 0·01). These injury rates were higher among Australian nursing students than in other international studies. Conclusions: Although hepatitis B vaccination coverage among the students was excellent, it is important that the principles of infection-control training and reporting of all needlestick and sharps continue to be emphasized throughout undergraduate nursing education.

Smith DR, Leggat PA, Takahashi K. Percutaneous exposure incidents among Australian hospital staff. International Journal of Occupational Safety and Ergonomics 2005;11:323-30.
ABSTRACT- We investigated all reported percutaneous exposure incidents (PEI) among staff from a large Australian hospital in the 3-year period, 2001-2003. There were a total of 373 PEI, of which 38.9% were needlestick injuries, 32.7% were cutaneous exposures and 28.4% sharps-related injuries. Nurses were the most commonly affected staff members, accounting for 63.5% of the total, followed by doctors (18.8%) and other staff (17.7%). Needlestick injuries were responsible for the majority of nurses' PEI (44.7%). Sharps injuries constituted the major category for doctors (44.3%). Most needlestick injuries (67.6%) were caused by hollow-bore needles, while the majority of cutaneous exposures involved blood or serum (55.8%). Most sharps injures were caused by unknown devices (35.9%) or suture needles (34.9%). Overall, our investigation suggests that PEI is a considerable burden for health care workers in Australia. Further research is now required to determine the relationships, if any, between workers who suffer PEI and those who do not.

Watson KJ. Surgeon, test (and heal) thyself: sharps injuries and hepatitis C risk. Medical Journal of Australia 2004;181:366-7.
Open access: http://www.mja.com.au/public/issues/181_07_041004/wat10427_fm.html
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.

Charles PG, Angus PW, Sasadeusz JJ, Grayson ML. Management of healthcare workers after occupational exposure to hepatitis C virus. Medical Journal of Australia 2003;179: 153-7.
Open access: http://www.mja.com.au/public/issues/179_03_040803/cha10198_fm.html
ABSTRACT: The increasing rate of hepatitis C virus (HCV) infection in the community means that there is increased risk of occupational exposure for healthcare workers. In metropolitan hospitals in Victoria, we found that 80-150 healthcare workers have occupational exposures from HCV-infected patients annually. As there is a 1.8%-3% risk of transmission of HCV from a needlestick injury, two to five healthcare workers are likely to acquire HCV each year in Victoria. These needlestick injuries pose a personal, legal and professional risk to healthcare workers and their patients. Recent information shows that early antiviral treatment of acute HCV infection has high cure rates. Current local and international protocols for management of healthcare workers exposed to HCV do not address these issues. We propose a management protocol after needlestick injury that is stratified according to the likelihood of HCV acquisition and potential risk of staff-to-patient transmission, and that is consistent with the current legal and clinical context of HCV infection in Australia.

Jagger JC. Are Australia's healthcare workers stuck with inadequate needle protection? [Editorial] Medical Journal of Australia 2002;177:405-6.
Open access: http://www.mja.com.au/public/issues/177_08_211002/jag10486_fm.html

Whitby RM, McLaws ML. Hollow-bore needlestick injuries in a tertiary teaching hospital: epidemiology, education and engineering. Medical Journal of Australia 2002;177:418-22.
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.

Bowden S, Druce J, Kelly H, Victorian Infectious Disease Reference Laboratory. Stability of blood-borne viruses in the environment and the risk of infection. Victorian Infectious Diseases Bulletin 1999;2(4):71-2.
ABSTRACT- The hepatitis B virus (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV) are blood-borne viruses and represent potential occupational hazards to health care workers and environmental hazards to other people. Exposure is usually due to sharps or needlestick injuries. HBV appears to be more efficiently transmitted than HCV, which in turn is more efficiently transmitted than HIV. In the health care setting, immunisation against HBV and adherence to universal blood and body fluid guidelines help to minimize the risk of transmission. The risk of transmission of these viruses following accidental environmental exposure partly depends on their stability in the environment.

de Vries B, Cossart Y. Needlestick injury in medical students. Medical Journal of Australia 1994;160:398-400.
ABSTRACT- Objective: To determine the incidence of needlestick injuries and the prevalence of hepatitis B vaccination among medical students, dentistry students, and hospital staff. Design and subjects: Anonymous survey of final year medical students and dentistry students enrolled at Sydney University in 1992, and nursing staff and doctors employed in the wards and emergency department of Royal Prince Alfred Hospital, Sydney. Results: During their clinical training, 22% of medical students and 72% of dentistry students had received one or more contaminated, penetrating "sharps" injuries. Of hospital staff, 50% of ward nurses, 71% of ward doctors, and 50% of emergency staff had received this type of injury during the previous two years. Students were significantly more likely to be vaccinated against hepatitis B than hospital staff (P < 0.001)--98% of medical students and 95% of dentistry students had received a full course of vaccination. The rate of vaccination among hospital staff ranged from 79% in emergency staff to 85% in ward nurses. Conclusions: Clinical students sustain needlestick injuries at a rate comparable with hospital personnel and therefore face a significant risk of exposure to transmissible pathogens, including hepatitis B virus, HIV, and hepatitis C virus. The rate of hepatitis B vaccination is high among clinical hospital staff and almost universal among medical and dentistry students.

Bowden FJ, Pollett B, Birrell F, Dax EM. Occupational exposure to the human immunodeficiency virus and other blood-borne pathogens. A six-year prospective study. Medical Journal of Australia 1993;158:810-12.
ABSTRACT- Objective: To prospectively study occupational exposures to human immunodeficiency virus (HIV) and other blood-borne pathogens. Design and setting: Detailed clinical information was collected and follow-up was performed on all health care workers with occupational exposures to potentially infected substances at Fairfield Infectious Diseases Hospital during the period January 1985 to September 1991. Results: There were 230 occupational exposures reported. One hundred and forty-one were considered "significant" or "potentially significant"; these involved exposure (or the potential for exposure) to blood or body fluids by the parenteral route or contamination of non-intact skin or mucous membranes. Needle/syringe assemblies accounted for 59% of the "significant" injuries, "butterfly" needles for 21% and lancets for 8%. "Butterfly" needles were over-represented relative to their degree of use. Seventy-seven of the 230 exposures were HIV-related and 27 of these were considered "significant". The number of HIV positive patients attending the hospital increased progressively over the survey period but the rate of HIV-related exposures fell during that time. After 1988, 13 individuals with "significant" exposure to HIV received a six-week prophylactic course of zidovudine. No health care workers seroconverted for HIV, hepatitis B or hepatitis C during the survey period. Conclusions: The risk of acquiring HIV (and other blood-borne diseases) through occupational exposure is very low and this risk can be further reduced by adopting safe work practices.

Mallon D, Shearwood W, Lallal S, French M, Dawkins R. Exposure to blood borne infections in health care workers. Medical Journal of Australia. 1992;157:592-5.
ABSTRACT- Objective: To determine the incidence and nature of occupational exposures to blood and body fluids in health care workers. Design: 332 reports of occupational exposure were analysed and are presented. Setting: A major teaching hospital. Participants: All staff at Royal Perth Hospital who reported an occupational exposure to blood or body fluids to the Department of Clinical Immunology between 1 January 1990 and 31 August 1991. Outcome measures: The rate of reported occupational exposure according to staff category, nature of exposure, HIV status of source patient, activity at the time of exposure and compliance with infection control measures. Results: 332 reports from 323 health care workers were received, giving an overall incidence of 6.1 per 100 full time equivalent (FTE) years. Nursing staff (9.4/100 FTE years) and medical staff (9.0/100 FTE years) reported exposure more frequently than housekeeping staff (2.5/100 FTE years) or paramedical staff (2.3/100 FTE years) (P < 0.001). The rate of exposure to HIV antibody positive patients was only 0.24/100 FTE years. Needlestick or other blood contaminated sharps injuries accounted for 83.4% (277/332) of reports and failure to observe universal precautions for 34.0% of reports. Insertion and operation of parenteral lines (24%) and performing operations (15.4%) were the activities most often associated with occupational exposure. No occupationally acquired infections were observed. Despite the immediate availability of zidovudine, acceptance by health care workers with high risk occupational exposure was low (18.8%). Conclusions: Occupational exposure to blood and body fluids is common among health care workers but most exposures confer a low risk of blood borne infection. The introduction of an occupational exposure assessment program has many benefits, including optimal management of injuries and acquisition of data on infection control measures, and may protect health care institutions from false claims for compensation.

BANGLADESH:

Hassan MM, Ahmed SA, Rahman KA, Biswas TK. Pattern of medical waste management: existing scenario in Dhaka City, Bangladesh. BioMed Central [BMC] Public Health 2008;26:36.
ABSTRACT- Background: Medical waste is infectious and hazardous. It poses serious threats to environmental health and requires specific treatment and management prior to its final disposal. The problem is growing with an ever-increasing number of hospitals, clinics, and diagnostic laboratories in Dhaka City, Bangladesh. However, research on this critical issue has been very limited, and there is a serious dearth of information for planning. This paper seeks to document the handling practice of waste (e.g. collection, storage, transportation and disposal) along with the types and amount of wastes generated by Health Care Establishments (HCE). A total of 60 out of the existing 68 HCE in the study areas provided us with relevant information. Methods: The methodology for this paper includes empirical field observation and field-level data collection through inventory, questionnaire survey and formal and informal interviews. A structured questionnaire was designed to collect information addressing the generation of different medical wastes according to amount and sources from different HCE. A number of in-depth interviews were arranged to enhance our understanding of previous and existing management practice of medical wastes. A number of specific questions were asked of nurses, hospital managers, doctors, and cleaners to elicit their knowledge. The collected data with the questionnaire survey were analysed, mainly with simple descriptive statistics; while the qualitative mode of analysis is mainly in narrative form. Results: The paper shows that the surveyed HCE generate a total of 5,562 kg/day of wastes, of which about 77.4 per cent are non-hazardous and about 22.6 per cent are hazardous. The average waste generation rate for the surveyed HCE is 1.9 kg/bed/day or 0.5 kg/patient/day. The study reveals that there is no proper, systematic management of medical waste except in a few private HCE that segregate their infectious wastes. Some cleaners were found to salvage used sharps, saline bags, blood bags and test tubes for resale or reuse. Conclusion: The paper reveals that lack of awareness, appropriate policy and laws, and willingness are responsible for the improper management of medical waste in Dhaka City. The paper also shows that a newly designed medical waste management system currently serves a limited number of HCE. New facilities should be established for the complete management of medical waste in Dhaka City.

CHINA:

Zhang MX, Yu Y. A study of the psychological impact of sharps injuries on health care workers in China. [letter] Am J Infect Control 2012 Jul 13. [Epub ahead of print].

Chen L, Zhang M, Yan Y, Miao J, Lin H, Zhang Y, Wang H, Du X, Li T. Sharp object injuries among health care workers in a Chinese province. AAOHN J 2009;57(1):13-16.
ABSTRACT - Health care workers in nine hospitals in Fujian were surveyed between December 2005 and February 2006 regarding the occurrence of sharp object injuries (SOIs). Survey results indicated that 71.3% of the health care workers had sustained SOIs during the past year. The rates of SOIs among surgeons, nurses, anesthesiologists, and clinical laboratory workers were 68.7%, 76.9%, 88.1%, and 40.2%, respectively. Approximately 50% of the SOIs occurred while devices were being used. Disposable syringes caused most of the injuries. A lack of protective and safe devices, heavy workloads, and carelessness contributed to SOIs. SOIs can be reduced among health care workers by decreasing unnecessary manipulation, using safety devices, disposing of used objects properly, and reasonably allocating workloads.

Lu J, Zhou Y, Lin X, Jiang Y, Tian R, Zhang Y, Wu J, Zhang F, Zhang Y, Wang Y, Bi S. General epidemiological parameters of viral hepatitis A, B, C, and E in six regions of China: a cross-sectional study in 2007. PLoS One. 2009 Dec 24;4(12):e8467. DOI: 10.1371/journal.pone.0008467.
BACKGROUND: Viral hepatitis is a serious health burden worldwide. To date, few reports have addressed the prevalence of hepatitis A, B, C, and E in China. Therefore, the general epidemiological parameters of viral hepatitis remain unknown. PRINCIPAL FINDINGS: In this cross-sectional study, we performed a serological prevalence analysis of viral hepatitis A, B, C, and E in 8,762 randomly selected Chinese subjects, which represented six areas of China.
The overall prevalence of anti-Hepatitis C virus antibody (anti-HCV) was 0.58%, which was much lower than was estimated by WHO. The prevalences of Hepatitis B virus surface antigen (HBsAg), anti- Hepatitis B virus surface protein antibody (HBsAb), and anti-Hepatitis B virus core protein antibody (HBcAb) were 5.84%, 41.31%, and 35.92%, respectively, whereas in the group of subjects less than 5 years old, these prevalences were 1.16%, 46.77%, and 8.69% respectively, which suggests that the Hepatitis B virus (HBV)-carrier population is decreasing, and the nationwide HBV vaccine program has contributed to the lowered HBV prevalence in the younger generation in China. Meanwhile, a large deficit remains in coverage provided by the national HBV immune program. In addition, our data suggested the possibility that HBsAb may not last long enough to protect people from HBV infection throughout life.
The overall prevalence of anti-Hepatitis A virus antibody (anti-HAV) and anti-Hepatitis E virus antibody (anti-HEV) were as high as 72.87% and 17.66%, respectively. The indices increased with age, which suggests that a large proportion of Chinese adults are protected by latent infection. Furthermore, the pattern of HEV infection was significantly different among ethnic groups in China. CONCLUSIONS: Our study provided much important information concerning hepatitis A, B, C, and E prevalence in China and will contribute to worldwide oversight of viral hepatitis.

Lin C, Li L, Wu Z, Wu S, Jia M. Occupational exposure to HIV among health care providers: a qualitative study in Yunnan, China. Journal of the International Association of Physicians in AIDS Care (JIAPAC) 2008;7(1):35-41. DOI: 10.1177/1545109707302089.
SUMMARY - With the HIV/AIDS epidemic spreading, health care providers (HCPs) in China are facing a growing risk of occupational exposure to and infection with HIV. There is a need to describe occupational exposure cases and compliance with postexposure prophylaxis (PEP) guidelines among HCPs. Qualitative in-depth interviews were conducted with 33 HCPs in Yunnan Province, China. Information about occupational exposures the HCPs and their co-workers experienced was collected and analyzed using ATLAS. Most occupational exposure accidents happened during emergencies, when HCPs did not have time to consider self protection. Exposure to HIV caused exposed HCPs severe adverse psychological pressure, such as stress and anxiety. Compliance with PEP guidelines among participants was poor; barriers to better compliance were identified. This study underscored the importance of institutional support in promoting compliance with PEP guidelines among exposed providers. Further training and emphasis on universal precautions and PEP guidelines may reduce the risk of occupational infections.

Wu S, Li L, Wu Z, Cao H, Lin C, Yan Z, Jia M, Cui H. Universal precautions in the era of HIV/AIDS: perception of health service providers in Yunnan, China. AIDS and Behavior 2008;12(5):806-14.
ABSTRACT - With a rising HIV/AIDS epidemic, it has become especially important for health service providers in China to understand and correctly adhere to universal precautions. Using qualitative interview data, perspectives from both health administrators and service providers working at all levels of China's health care system were examined. Service providers admitted selective adherence and non-adherence to universal precautions in their daily medical practice, and gave their explanations for such behaviors. Lack of time to put on protective gear, gear's interference with medical procedures, lack of administrative support, heavy workload in hospitals, inaccurate risk assessment, and beliefs that compliance with universal precautions is unnecessary, time consuming and costly were mentioned as reasons behind noncompliance. Effective universal precaution interventions need to target both administrators and providers, and address both structural barriers and individual attitudinal and behavioral factors.

(Hong Kong) Surveillance of exposure to blood-borne viruses (HIV, HBV, HCV) and its management, 1999 - 2004. Hong Kong: Special Preventive Programme, Centre for Health Protection, Department of Health; January 2006.

Smith DR, Wei N, Zhang YJ, Wang RS. Needlestick and sharps injuries among a cross-section of physicians in Mainland China. American Journal of Industrial Medicine 2006;49:169-74.
ABSTRACT- Background: Although needlestick and sharps injuries (NSI) represent a significant occupational hazard for physicians worldwide, their epidemiology has not been previously examined in Mainland China. This study describes the prevalence, distribution, and risk factors for NSI among a cross-section of Chinese physicians. Methods: Data was obtained by an anonymous, self-reporting survey administered to all 361 physicians at a university teaching hospital, during 2004. Results: Seventy-nine percent of the physicians responded. Among them, 64% had experienced an NSI in the previous 12 months, 50.3% of which involved contaminated devices. By device, 22.8% were caused by hollow-bore syringe needles, 19.1% by suture needles, and 12.1% by scalpel blades. Surgical procedures accounted for 27.9% of all injuries. Only 15.3% of physicians had officially reported their NSI to management, of which 10% went unreported because the individual felt they were not unlucky enough to get a disease. A statistically significant correlation was demonstrated between NSI and working in the intensive care unit (adjusted odds ratio: 5.3, 95% CI: 1.7-23.4). Conclusions: Although this study suggests that NSI are an important workplace hazard for Chinese physicians, future measures should consider the unique cultural beliefs of Chinese people and its effect on preventive behaviors. The concept of luck, and its relationship with NSI reporting in particular, may also need to be addressed. Am. J. Ind. Med. © 2006 Wiley-Liss, Inc.

Huang J, Jiang D, Wang X, Liu Y, Fennie K, Burgess J, Williams AB. Changing knowledge, behavior, and practice related to universal precautions among hospital nurses in China. J Contin Educ Nurs. 2002; 33:217-24.
PURPOSE: To evaluate the effect of an educational training program for hospital nurses on universal precautions in Changsha, Hunan Province, People's Republic of China. METHOD: Using a quasi-experimental design, 50 of 100 randomly selected hospital nurses were randomly assigned to receive an educational intervention. Questionnaires were administered to the 100 nurses prior to and 4 months after the training. FINDINGS: Knowledge, practice, and behaviors related to universal precautions and the prevalence of hepatitis B immunization improved among nurses in the group who received training. No significant change in the frequency of glove use was found. Underreporting of sharps injuries to hospital authorities continued in both groups. CONCLUSION: Although educational training significantly improved Chinese nurses' knowledge, practice, and behavior related to universal precautions, there remains room for improvement in glove use and needlestick injury reporting.

Phipps W, Honghong W, Min Y, Burgess J, Pellico L, Watkins CW, Guoping H, Williams A. Risk of medical sharps injuries among Chinese nurses. American Journal of Infection Control. 2002;30:277-82.
ABSTRACT- The purpose of this cross-sectional descriptive study was to determine current knowledge, attitudes, and practices among nurses in Changsha, Hunan Province, People's Republic of China in relation to occupational exposure to bloodborne pathogens. In addition, the study sought to examine the relationships among nurses' characteristics, work unit, and nursing practices with the likelihood of a self-reported percutaneous injury in the past year. The long-term goal was to identify factors associated with nurses' risk of exposure to bloodborne pathogens for the development of educational programs that promote effective Universal Precautions practices and safe use of medical sharps in these and other Chinese hospitals.

INDIA:

Bali R, Sharma P, Garg A. Incidence and patterns of needlestick injuries during intermaxillary fixation. Br J Oral Maxillofac Surg. 2010 May 18. [Epub ahead of print]
ABSTRACT: Intermaxillary fixation (IMF) carries an appreciable risk of occupational exposure to bloodborne viruses. Our aim was to establish the incidence and patterns of needlestick injuries during IMF at DAV Dental College. We surveyed 12 residents working in the Department of Maxillofacial Surgery for 1 year (December 2008 to December 2009) to find out how many injuries occurred during IMF. A total of 40 needlestick injuries were recorded during 172 IMF procedures (23%). Most injuries occurred in the maxillary left quadrant (n=16, 40%). Procedures done during the night had a much higher incidence (13/29, 45%) compared with 27/153 (18%) done during the day. Of the 40 injuries, 31 (78%) were recorded as superficial, the rest being deep. All injuries affected the non-working hand, and 39 (98%) were caused by a wire. Surgeons are at high risk of occupational exposure to bloodborne viruses from needlestick injuries during IMF. Detailed attention to the pattern of these injuries could help to develop improved strategies to minimise the incidence.

Chakravarthy M, Singh S, Arora A, Sengupta S, Munshi N. The EPINet data of four Indian hospitals on incidence of exposure of healthcare workers to blood and body fluid: a multicentric prospective analysis. Indian J Med Sci. 2010 Dec;64(12):540-8.
ABSTRACT - BACKGROUND: Sharps injury (SI) and blood and body fluid exposure are occupational hazards to healthcare workers (HCWs). Although data from the developed countries have shown the enormity of the problem, data from developing countries, such as India, arelacking. Purpose : The purpose of this study was to cumulate data from fourmajor hospitals in India and analyze the incidence of SI and blood and body fluid exposure in HCWs. MATERIALS AND METHODS: Four Indian hospitals (hospital A, B, C and D) from major cities of India participated in this multicentric study. Data ranging from 6 to 26 months were collected from these hospitals using Exposure Prevention Information network (EPINet) which is the database created by International Healthcare Worker Safety Research and Resource Center, University of Virginia. RESULTS: Two hundred and forty-three sharp injuries and 22 incidents of blood or body fluid exposure were encountered in the cumulated 50 months of our study. The incidence of SIswas thehighestamong nurses (55%) of allthe HCWs, akin to the global data. An injury rate of nearly 20% among housekeeping staff seems to be specific to the Indian data. Patient's room followed by operation theater appeared to be common locations of injury in our study. The source of the injury was identified in majority (64%) of the injuries. A major part of the group was not the primary users of the sharp (38%). Disposable needles caused nearly half of the injuries. Suture needles contributed to a reasonable number of injuries in one of the hospitals. CONCLUSIONS: The incidence of SI is the highest among nurses and the housekeeping staff (>30% each). A substantial number of injuries are avoidable.

Mehta A, Rodrigues C, Singhal T et al. Interventions to reduce needle stick injuries at a tertiary care centre. Indian J Med Microbiol 2010; 28(1):17-20.
BACKGROUND: Occupational exposure to blood/body fluids is associated with risk of infection with blood borne pathogens like human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). MATERIALS AND METHODS: We carefully document needle stick injuries (NSI) and implement post-exposure prophylaxis (PEP). We report a four-year continuing surveillance study where 342 healthcare workers (HCWs) sustained NSI. PEP was given to HCWs injured from seropositive sources. If the source was HbsAg positive, HCWs were given a hepatitis B immunization booster. If the HCW was antiHBs negative, both hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine were administered. For HCWs who sustained injuries from HIV positive sources, antiretroviral therapy was started. Follow-up was done after three and six months of exposure. Recent interventions by the infection control committee at our hospital reduced NSI considerably during intravenous line administration and glucose monitoring. RESULTS AND DISCUSSION: Of 342 injuries, 254 were from known sources and 88 from unknown sources. From known sources, 37 were seropositive; 13 for HIV, 15 for HCV, nine for HBV. Sixty six sharp injuries were sustained through garbage bags, 43 during IV line administration, 41 during injection administration, 35 during needle recapping, 32 during blood collection, 27 during blood glucose monitoring, 24 from OT instruments, 17 during needle disposal, 16 while using surgical blade, 7 during suturing and 34 from miscellaneous sources. CONCLUSION: No case of seroconversion has taken place, so far, as a result of needle stick injuries at our centre.

Muralidhar S, Singh PK, Jain RK, Malhotra M, Bala M. Needle stick injuries among health care workers in a tertiary care hospital of India. Indian J Med Res 2010;131:405-10. 
ABSTRACT - Background & objectives: Percutaneous injuries caused by needlesticks pose a significant risk of occupational transmission of bloodborne pathogens. Their incidence is considerably higher than current estimates, and hence a low injury rate should not be interpreted as a non-existent problem. The present study was carried out to determine the occurrence of NSI among various categories of health care workers (HCWs), and the causal factors, the circumstances under which these occur, and to explore the possibilities of measures to prevent these through improvements in knowledge, attitude and practice. Methods: The study group consisted of 428 HCWs of various categories of a tertiary care hospital in New Delhi, and was carried out with the help of an anonymous, self-reporting questionnaire structured specifically to identify predictive factors associated with NSIs. Results: The commonest clinical activity to cause the NSI was blood withdrawal (55%), followed by suturing (20.3%) and vaccination (11.7%). The practice of recapping needles after use was still prevalent among HCWs (66.3%). Some HCWs also revealed that they bent the needles before discarding (11.4%). It was alarming to note that only 40% of the HCWs knew about the availability of PEP services in the hospital and 75% of exposed nursing students did not seek PEP. Interpretation & conclusions: The present study showed a high occurrence of NSI in HCWs with a high rate of ignorance and apathy. These issues need to be addressed, through appropriate education and other interventional strategies by the hospital infection control committee.

Rodrigues C. Needlestick injuries and the health care worker -- the time to act is now [commentary]. Indian J Med Res 2010;131:384-6. 

Jayanth ST, Kirupakaran H, Brahmadathan KN, Gnanaraj L, Kang G. Needle stick injuries in a tertiary care hospital. Indian J Med Microbiol 2009;27:44-7. Available from: http://www.ijmm.org/text.asp?2009/27/1/44/45168.
ABSTRACT - Background: Accidental needle stick injuries (NSIs) are an occupational hazard for healthcare workers (HCWs). A recent increase in NSIs in a tertiary care hospital lead to a 1-year review of the pattern of injuries, with a view to determine risk factors for injury and potential interventions for prevention. Methods: We reviewed 1-year (July 2006-June 2007) of ongoing surveillance of NSIs. Results: The 296 HCWs reporting NSIs were 84 (28.4%) nurses, 27 (9.1%) nursing interns, 45 (21.6%) cleaning staff, 64 (21.6%) doctors, 47 (15.9%) medical interns and 24 (8.1%) technicians. Among the staff who had NSIs, 147 (49.7%) had a work experience of less than 1 year ( P < 0.001). The devices responsible for NSIs were mainly hollow bore needles ( n = 230, 77.7%). In 73 (24.6%) of the NSIs, the patient source was unknown. Recapping of needles caused 25 (8.5%) and other improper disposal of the sharps resulted in 55 (18.6%) of the NSIs. Immediate post-exposure prophylaxis for HCWs who reported injuries was provided. Subsequent 6-month follow-up for human immunodeficiency virus showed zero seroconversion. Conclusion: Improved education, prevention and reporting strategies and emphasis on appropriate disposal are needed to increase occupational safety for HCWs.

Bali R, Sharma P, Angi S, Shruti. Needle stick injuries in health care providers. Nurs J India 2008 99(11):251-4. [Indexed in: Index Medicus for South-East Asia/IMSEAR.]
ABSTRACT: The study  included 140  health care workers in 10 hospitals for a period of one year. They were required to answer open-ended questions designed to elicit information on the number of injuries sustained, types of devices involved, procedure which led to the injury and, if injury occurred, whether or not  it was reported and the status of post-exposure prophylaxis. Another eight open-ended questions focused on the role of the health care setup and its sharps handling policy with respect to prevention of needlestick injuries. RESULTS: Out of 66 (48%) males and 74 (52%) females studied, 84 (60%) of the subjects had immunization against Hepatitis B. A total of 24 (17%) individuals admitted to having needlestick injuries( table I and figure I), 20 (83%) reported one needlestick injury each, whereas 4 (16.4%) had two injuries each. Waste handlers (42%), followed by nurses (33%), were the main victims of needlestick injuries among all HCWs. Only 4 (16.6%) respondents out of the  24 reported their  injuries to the concerned occupational health specialist; these included 1 (4.16%) resident, 1 (4.16%) specialist and 2 (8.33%) nurses. All the injuries reported were deep. All four reported cases received post exposure prophylaxis. Other 20 respondents did not receive any PEP as they never reported the injury. One specialist reported of a colleague who had died of hepatitis B after getting exposed to needlestick injury, 18(12.8%) of the 140 respondents who had received sharp management training were residents, specialists or nurses. None of the institutions had maintained the record of sharps injuries. Only 40 (28.5%) respondents acknowledged that their set up provided safe working environment in terms of sharps safety and could take care of PEP in case of such injuries. 

Joardar GK, Chatterjee C, Sadhukhan SK, Chakraborty M, Dass P, Mandal A. Needle sticks injury among nurses involved in patient care: a study in two medical college hospitals of West Bengal. Indian J Public Health. 2008;52(3):150-2.
ABSTRACTt: A hospital-based retrospective study on a sample of 228 nurses involved in patient care, in two medical college hospitals of West Bengal, showed that 61.4% of them sustained at least one Needle Stick Injury (NSI) in last 12 months. The risk of such injuries per 1000 nurses per year was found to be 3,280. Out of the most recent injuries among 140 nurses, 92.9% remained unreported to appropriate authorities; in 52.9% events hand gloves were worn by the nurses; only 5% of those nurses received hepatitis B vaccine, 2.1% hepatitis B immunoglobulin and none of them received post exposure prophylaxis for HIV.

Masih L, Chandra H. Health care providers and hospital acquired infections. Nurs J India 2008;99(1):8-9.

Singru SA, Banerjee A. Occupational exposure to blood and body fluids among health care workers in a teaching hospital in Mumbai, India. Indian Journal of Community Medicine 2008;33:26-30.
ABSTRACT- Objective: Exposure to blood and body fluids is one of the hidden hazards faced by health care workers (HCWs). The objective of the present study was to estimate the incidence of such exposure in a teaching hospital. Materials and Methods: A cross-sectional study among a random sample of residents, interns, nurses and technicians ( n = 830) was carried out in a teaching hospital to estimate the incidence of exposure to blood and body fluids in the preceding 12-month period. Self-reported occurrence and the circumstances of the same were recorded by face-to-face interviews using a semi-structured questionnaire. Results: The response rate to the study was 89.76%. Occupational exposure to blood and body fluids in the preceding 12 months was reported by 32.75% of the respondents. The self-reported incidence was the highest among the nurses. Needle-stick injury was the most common mode of such exposures (92.21% of total exposures). Index finger and thumb were the commonest sites of exposure. Only 50% of the affected individuals reported the occurrence to concerned hospital authorities. Less than a quarter of the exposed persons underwent post-exposure prophylaxis (PEP) against HIV, although the same was indicated in about 50% of the affected HCWs based on the HIV status of the source patient. Conclusions: Occupational exposure to blood and body fluids was a common occurrence in the study sample. There was gross under-reporting of such incidents leading to a lack of proper PEP against HIV in 50% of those in whom the same appeared to be indicated.

Sukriti, Pati NT, Sethi A, Agrawal K, Agrawal K, Kumar GT, Kumar M, Kaanan AT, Sarin SK. Low levels of awareness, vaccine coverage, and the need for boosters among health care workers in tertiary care hospitals in India. J Gastroenterol Hepatol 2008;23(11):1710-15.
ABSTRACT - BACKGROUND AND AIM: The risk of acquiring hepatitis B virus (HBV) infection through exposure to blood or its products is highest amongst health care workers (HCWs). Despite potential risks, a proportion of HCWs never get vaccinated. India is second to China in the numbers of people with chronic HBV. This study aimed to investigate the vaccination practices and the prevalence of HBV infection in HCWs in India. METHODS: A total of 2162 HCWs were screened for the presence of serological markers of HBV and hepatitis C virus (HCV). Occult HBV infection was tested by detection of HBV-DNA for surface and core regions by nested polymerase chain reaction in HBsAg-negative and IgG anti-hepatitis core antigen-positive subjects. RESULTS: Only 1198 (55.4%) of the 2162 HCWs screened had been vaccinated; and 964 (44.6%) were not vaccination-status conscious; of these HCWs, 600 (27.7%) had never been vaccinated and 364 (16.4%) were unaware of their vaccination status. Protective (> 10 IU/mL) anti-hepatitis B surface (anti-HBs) antigen titers were seen in only 61.7%. The anti-HBs titers were found to be lower with the passage of time; the median anti-HBs titers in subjects who were vaccinated > 10 years ago were significantly lower than those who had been vaccinated < 5 years ago (P < 0.001). One percent of HCWs were HBsAg-positive, and 24.7% of 700 HCWs screened had past exposure (IgG-anti-HBc-positive). Occult HBV was detected in 5% of 120 positive subjects with past exposure; all had anti-HBs titers > 10 IU/mL. CONCLUSIONS: Even today, 28% HCWs in India are unvaccinated and 17% are unaware of their vaccination status. This data suggests that use of hepatitis B immune globulin be mandatory in needle-pricked HCWs in India, and that implementation of awareness strategies is urgent. Since the anti-HBs titers decline in a fair proportion, there is justification for giving a booster dose of vaccine 10 years after primary vaccination to HCWs in India.

Bairy I, Rao SP, Dey A. Exposure to blood-borne viruses among healthcare workers in a tertiary care hospital in south India [letter]. J Postgrad Med 2007;53(4):275-6.

Chacko J, Isaac R. Percutaneous injuries among medical interns and their knowledge and practice of post-exposure prophylaxis for HIV. Indian Journal of Public Health 2007;51:127-9.
ABSTRACT- This was a prospective, questionnaire-based study to determine the incidence of percutaneous injury among medical interns in a tertiary care hospital in Punjab. The incidence of percutaneous injury among interns was found to be 157.89 per 100 person-years. Of 38 interns, 31 (81.6%) experienced a lot of anxiety with regard to their occupational risk of contracting HIV, 23 (60.5%) felt that there was no easy availability of materials in the wards to take universal precautions and 17 (44.7%) felt they were not well informed about what to do in case of an occupational exposure to HIV. 7.9% interns always took universal precautions with every patient. Lack of time, lack of materials and emergency situations were the major reasons why universal precautions were not taken at times. 12 out of 38 (31.6%)interns correctly knew when PEP should ideally be initiated.

Lal P, Singh MM, Malhotra R, Ingle GK. Perception of risk and potential occupational exposure to HIV/AIDS among medical interns in Delhi. Journal of Communicable Diseases 2007;39:95-9.
ABSTRACT- A cross sectional study was conducted among 129 medical interns of Maulana Azad Medical College, New Delhi for assessing the perceived levels of risk of acquiring HIV infection in the health care settings among medical interns, reasons for the same and their exposure to situations having potential of HIV transmission. Majority of the interns (68.3%) perceived themselves to be at a very high/high risk of acquiring HIV infection during their medical career. The common reasons for perceived risk of acquiring HIV infection were getting injuries due to needle pricks/cuts during surgical procedures (32.4%), frequent exposure to the blood/ secretions of patients (28.5%) and insufficient availability of gloves (17.6%). Some (23.2%) were of the opinion that students in future might lose interest in the medical profession due to increasing risk of HIV infection and few (3.1%) were even considering to leave the medical profession for the same reason. Majority of the interns (72.9%) had experienced needle pricks and more than half (53.7%) of them even had had blood splashes in their eyes/ nose/ mouth during surgical procedures. The findings of the study call for efforts for bringing a reduction in the risk perception of the interns through awareness campaigns and reorientation trainings, ensuring availability of gloves and other items necessary for observing universal work precautions and proper disposal of potentially contaminated articles.

Muller N, Steele M, Balaji KA, Krishna M, Berman AP, Robertson J, Vail J. Evaluating the use and acceptability of a needle-remover device in India. Tropical Doctor 2007;37:133-5.
ABSTRACT- The objective of this study was to assess the effect of the use of a manually operated needle remover on sharps-waste management practices in clinical settings in India - specifically, evaluating its acceptability and performance. Thirty-one Balcan Mini-Destructor needle removers were introduced into seven health facilities in two cities in India - Delhi and Jaipur. One hundred and nineteen health workers, including auxiliary nurse midwives, nurses, and laboratory staff, used the device. Data were prospectively collected by observation and interview on device usage, malfunction and acceptability over a 23-week period. Focus group discussions on current practices were conducted prior to study initiation and, after completion, on device acceptability and performance. The manual needle remover was well accepted. Devices were seen as easy to use and durable. In total, 88,719 needles were removed. In conclusion, the needle-remover device was considered an acceptable method of preventing needle reuse and isolating infectious sharps waste in clinical settings.

Muralidhar V, Muralidhar S. Safety and risk management. In: Muralidhar V, Muralidhar S, eds. Hospital acquired infections: power strategies for clinical practice. New Delhi: Viva Books, 2006. p. 110. 

Tetali S, Choudhury PL. Occupational exposure to sharps and splash: Risk among health care providers in three tertiary care hospitals in South India. Indian J Occup Environ Med 2006;10:35-40.
ABSTRACT - Occupational exposure to blood and body fluids places Health care providers at risk of infection with blood borne viruses including HIV. To understand Health Care Providers' (HCP*) perception of risk of occupational exposure to needles, blood and body fluids, to find out the correlates of exposure and to identify groups of HCP at high risk of sustaining maximum number of such exposures. A cross sectional survey was conducted on HCP in three tertiary care hospitals in Kerala, between August 20th and October 30th, 2004 Chi square test, independent-sample T test and one-way ANOVA was used for analysis. Overall, 74.5% (95% CI 71.3 to 78.2) of the respondents were exposed at least once in the last 12 months. Surgeons were exposed most frequently, with a mean of 3.8 injuries per person per year. Injection needles were responsible for 68% of the injuries. Those who underwent the in-service training program on needle safety were less injured ( P =0.001). Only 4% of surgeons had undergone needle safety training. Almost half the surgeons, anesthetists and medical students did not know the reporting procedure and only 10% of anesthetists knew about the provision of Post Exposure Prophylaxis (PEP). A considerable proportion of respondents (85%) (95% CI- 81.2 to 88.5) were concerned about acquiring blood borne infections and 90% were immunized against Hepatitis B. Training of Health care providers is absolutely essential for injury reduction and should take into account the varying incidence of exposure across different occupation groups.

Wanchu A, Singh S, Bambery P, Varma S. Possible occupationally acquired HIV infection in two Indian healthcare workers. Medscape General Medicine 2006;8:56.
ABSTRACT- In developing countries like India, the risk of occupational transmission of blood-borne pathogens is increased by excessive handling of contaminated needles that result from some common, unsafe practices. These include the administration of unnecessary injections on demand, the reuse of nonsterile needles, capping needles, and the unregulated disposal of hazardous waste. Such practices pose risks of disease transmission to HCW, patients, and communities at large. We believe that this represents the first report of possible occupationally acquired HIV infection from this region.

Kermode M, Jolley D, Langkham B, Thomas MS, Crofts N. Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings. American Journal of Infection Control 2005;33:34-41.
ABSTRACT- Background: Approximately 3 million health care workers (HCWs) experience percutaneous exposure to bloodborne viruses (BBVs) each year. This results in an estimated 16,000 hepatitis C, 66,000 hepatitis B, and 200 to 5000 human immunodeficiency virus (HIV) infections annually. More than 90% of these infections are occurring in low-income countries, and most are preventable. Several studies report the risks of occupational BBV infection for HCWs in high-income countries where a range of preventive interventions have been implemented. In contrast, the situation for HCWs in low-income countries is not well documented, and their health and safety remains a neglected issue. Objective: To describe the extent of occupational exposure to blood and the risk of BBV infection among a group of HCWs in rural north India. Methods: A cross-sectional survey of HCWs from 7 rural health settings gathered data pertaining to occupational exposure to blood and a range of other relevant variables (eg, demographic information, compliance with Universal Precautions, perception of risk, knowledge of BBVs). A mass action model was used to estimate the risk of occupational BBV infection for these HCWs over a 10-year period. Results: A total of 266 HCWs returned questionnaires (response rate, 87%). Sixty-three percent reported at least 1 percutaneous injury (PI) in the last year (mean no. = 2.3) and 73% over their working lifetime (mean no. = 4.2). Predictors of PI during the last year were hospital site, job category, perception of risk, and compliance with Universal Precautions. Conclusion: The high level of occupational exposure to blood found among this group of rural north Indian HCWs highlights the urgent need for interventions to enhance their occupational safety to prevent unnecessary nosocomial transmission of BBVs.

Mehta A, Rodrigues C, Ghag S, Bavi P, Shenai S, Dastur F. Needlestick injuries in a tertiary care centre in Mumbai, India. Journal of Hospital Infection 2005;60:368-73.
ABSTRACT- Accidental exposure from blood/body fluid of patients is a risk to health care workers (HCWs). Percutaneous injury is the most common method of exposure to bloodborne pathogens. A policy was formulated at our institute, a tertiary care centre in central Mumbai, India, and we report a six-year (1998-2003) ongoing surveillance of needlestick injuries. Of the 380 HCWs who reported needlestick injuries, 45% were nurses, 33% were attendants, 11% were doctors, and 11% were technicians. On source analysis, 23, 15, and 12 were positive for hepatitis B surface antigen (HBsAg), human immunodeficiency virus (HIV), and hepatitis C virus (HCV), respectively. Immediate action following potential exposure included washing the wound with soap and water, encouraging bleeding, and reporting the incident to the emergency room. Analysis of the source of injuries revealed that known sources accounted for 254 injuries, and unknown sources from garbage bags and Operating Theatre instruments accounted for 126 injuries. Most needlestick injuries occurred during intravenous line insertion (N=112), followed by blood collection (N=69), surgical blade injury (N=36), and recapping needles (N=36). Immediate postexposure prophylaxis (PEP) for HCWs who sustained injuries with hepatitis-B-virus-positive patients included booster hepatitis B immunization for those positive for anti-HBs. A full course of immunization with hepatitis B immunoglobulin was given to those who were anti-HBs negative. All staff who sustained injury with HIV were given immediate antiretroviral therapy (AZT 600 mg/day) for six weeks. Subsequent six-month follow-up showed zero seroconversion.

Chitnis V, Chitnis DS, Patil S, Chitnis S. Hypochlorite (1%) is inefficient in decontaminating blood-containing hypodermic needles. Indian Journal of Medical Microbiology 2002;20(4):215-18.
ABSTRACT: Infectious biomedical waste and sharps have a potential hazard of transmission of pathogens. Among sharps, used needles form a major share and disinfection by 1 % hypochlorite is recommended in biomedical waste management rules of India. The aim of the present study was to evaluate the efficacy of hypochlorite for the decontamination of needles. Needles (16 g) filled with suspensions of standard strains and clinical isolates of gram positive and gram negative bacteria in plain normal saline and in human blood containing anticoagulant, were exposed to 1% hypochlorite and the surviving bacteria were subjected to viable counts. The observations indicated that 85 - 90 % of the needles filled with bacterial suspensions in saline are disinfected to a level of >5 log bacterial reduction (standard disinfection) on exposure to hypochlorite but only 15 to 30% needles contaminated with the challenge bacteria suspended in blood showed >5 log reduction in viable counts. Thus, hypochlorite treatment is inadequate for disinfecting needles contaminated with pathogenic bacteria in presence of blood and should not be recommended as an option for disinfection of the needles.

Chogle NL, Chogle MN, Divatia JV, Dasgupta D. Awareness of post-exposure prophylaxis guidelines against occupational exposure to HIV in a Mumbai hospital. National Medical Journal of India 2002;5:69-72.
ABSTRACT- Background: Exposure to the human immunodeficiency virus (HIV) is a matter of concern for healthcare workers. We conducted a survey to determine the level of awareness amongst operating room personnel regarding post-exposure prophylaxis in case of needlestick injuries from confirmed or suspected cases of HIV. Methods: A structured questionnaire was presented to 39 anaesthetists and 31 surgical residents. Questions were related to identification of high risk fluids, risk of transmission, drugs, costs and procedure to be adopted for post-exposure prophylaxis. Results: Fourteen respondents (20%) were aware of the true risk of transmission. About one-third identified all high risk fluids correctly. Fifty-five respondents (78%) correctly stated that washing the site with soap and water was the initial measure, but less than a third knew whom to contact immediately after a needlestick injury. Though 45 respondents (64%) correctly stated that prophylaxis should be initiated within 1 hour of injury, none knew exactly which drugs were to be used. Thirty respondents (42%) were aware of the use of zidovudine but none were aware of the second or third drugs used for post-exposure prophylaxis. Only 4 respondents (6%) knew the correct duration of post-exposure prophylaxis. Five respondents (7%) knew that the drugs were available in medical stores and 7 knew the approximate cost of therapy. Conclusion: There is surprisingly poor knowledge of post-exposure prophylaxis against HIV. Ongoing awareness and training programmes are necessary to improve the same.

Rele M, Mathur M, Turbadkar D. Risk of needle stick injuries in health care workers - A report. Indian Journal of Medical Microbiology 2002;20:206-7.
ABSTRACT- Health care workers (HCW) are at a risk of occupational acquisition of Human Immunodeficiency Virus (HIV) infection, primarily due to accidental exposure to infected blood and body fluids. In our general public hospital, over a period of one year (June 2000 - 2001) a total number of 38 self reported incidences of needlestick injuries and other exposures to patient's blood and body fluids were reported by HCWs. A greater incidence of occupational exposure was seen in surgery residents as compared to medicine residents. Till date, i.e. in one and a half-year follow up period, no seroconversion was seen in any of the reported accidental injury cases. This data emphasizes, that needle stick injuries present the single greatest risk to medical personnel and the importance of increased awareness and training in universal safety precautions (USP), for prevention of nosocomial infection.

Richard VS, Kenneth J, Ramaprabha P, Kirupakaran H, Chandy GM. Impact of introduction of sharps containers and of education programmes on the pattern of needle stick injuries in a tertiary care centre in India. J Hosp Infect. 2001 Feb;47(2):163-5.
ABSTRACT - Documentation of needlestick injuries was started in the Christian Medical College Hospital, Vellore in 1993. In 1995 large sharps containers were introduced, accompanied by an intensive education programme. Details of documented injuries from 1993 to 1999 were analysed using the Epi-Info software. A total of 347 injuries occurred, mainly due to improper disposal of needles, re-capping and carelessness during use. The percentage of injuries attributed to disposal fell from 69.2% in 1995 to 38.5% in 1996 (after the education programme). A further decrease was noted after the additional introduction of small sharps containers. In 1995, 73% of injuries involved housekeeping staff, this fell to 12% in 1998. Relatively simple interventions decreased the numbers of injuries, and we recommend that all healthcare institutions should have a system of documenting needlestick injuries, and take measures to decrease their incidence.

Menon V, Bharucha K.Acquired immunodeficiency syndrome and health care professionals. J Assoc Physicians India 1994;42(1):22-3.
ABSTRACT - As health care professionals, we face a grave risk of acquiring HIV infection in the course of our work. But how many of us really know the precautions to be applied in the hospital set up in dealing with HIV infected patients? A knowledge, attitude and practice (KAP) study was conducted in Pune hospitals to assess the current status. Among the results 65% servants had not heard of AIDS, 85% nursing staff did not apply the Universal Safety Precautions (USP) approach, 13.5% resident thought that the HIV was not transmitted by blood, 30% consultants would avoid contact with an HIV positive patient. This study has shown that definite lacunae exist in knowledge specific to the particular population in question. A proposal for an education programme which is target specific and one of constant renewal is sought.

JAPAN:

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

Sakamoto F. Effect of safety-engineered device implementation on needlestick injury rates. Kankyokanseishi [Japanese Journal of Environmental Infections] 2009;24(2):100-5. [in Japanese with English abstract]
ABSTRACT: The effects of four types of safety-engineered devices (SEDs) on needlestick injury (NI) rates were evaluated during a six-year period (2002-2007) at a 520-bed teaching hospital. The devices were winged steel needles (WSNs), IV catheters (IVCs), lancets (LANs), and implantable port access needles (IPNs). A total of 471 NIs were reported, of which more than 60% were caused by hollow-bore needles. Device-specific NI rates were significantly lower for SEDs than non-SEDs in the use of WSNs (11.0 vs. 25.1 per 100,000 devices delivered, p<0.01) and IVCs (1.0 vs. 6.6 per 100,000 devices delivered, p<0.01). Use of SEDs was also associated with significantly lower risks of NIs in the use of WSN (RR 0.44; 95% CI, 0.31 to 0.61) and IVC (RR = 0.16, 95% CI, 0.05-0.50). There were strong (r = -0.94, p<0.01) and moderate (r = - 0.53, p=0.15) negative correlations between yearly SED use rates and NI rates in the use of WSNs and IVCs, respectively. Safety-engineered LANs and IPNs had been used for less than 1 year, and although NI rates for SEDs were lower than non-SEDs (LAN = 0.0 vs. 0.8 per 100,000 devices delivered, p = 0.42; IPN = 0.0 vs. 41.2 per 100,000 devices delivered, p = 0.19), the differences were not significant. In addition to introducing SEDs, promoting their use to replace non-SEDs is effective in reducing NI rates.

Mizuta N, Kurahashi K. [Incidence of a needle stick injury occurring in a needleless intravenous system][Article in Japanese] Masui 2008;57(5):635-6.
ABSTRACT - A needle stick injury occurred with a needleless intravenous system. When a nurse picked up a disposable glove left on the floor of an operating room to discard it, there was an intravenous needle left under the glove and caused a needle stick injury to the nurse. Although the needle was designed as a needleless intravenous system, we found after a close observation that there is a potential hazard for a needle stick injury regarding the needle. The incidence happened due to the negligence of standard precaution by another health care provider (a doctor); leaving the contaminated needle on the floor. Unfortunately, the disposable glove fell on the needle for some reason and concealed it. Should the doctor follow the standard precaution properly, i.e. discard it in a puncture-resistant sharps container immediately, this incidence might not have happened. Any safety device may not prevent incidence 100%, we have to always heed and follow a standard precaution.

Nagao Y, Matsuoka H, Kawaguchi T, Ide T, Sata M. HBV and HCV infection in Japanese dental care workers. Int J Mol Med 2008;21(6):791-9.
ABSTRACT - Protective measures against occupational exposure to the hepatitis B virus (HBV) and hepatitis C virus (HCV) must be taken in order to prevent infection in dental care workers. To determine the best way to protect these workers, our study examined viral hepatitis infection in dental care workers in regions with a high prevalence of HCV infections in Japan. In total, 141 dental care workers (including dentists, dental hygienists and dental assistants) were enrolled. After a questionnaire to elicit demographic information was administered by an oral surgeon, hepatitis B surface antigen (HBsAg), antibody to HBs (anti-HBs), antibody to hepatitis B core antigen (anti-HBc) and antibody to HCV (anti-HCV) were measured. When necessary, HBeAg, anti-HBe, levels of HBV DNA, anti-HBc IgM and HCV RNA in serum were measured. Of the dental care workers included, 68 (48.2%) had been immunized with a HBV vaccine. Only 9 wore a new pair of gloves for each new patient being treated, 36 changed to a new pair only after the old gloves were torn and 24 did not wear any gloves at all. No one was positive for HBsAg or anti-HCV, though 73 (51.8%) and 17 (12.1%) workers were respectively positive for anti-HBs and anti-HBc. The positive rate of anti-HBc varied directly with worker age and experience. Of the 68 workers immunized with HBV vaccine, 51 (75%) were positive for anti-HBs. Of the 63 workers who were not so immunized, 17 (27%) were positive for anti-HBs and 15 of these were also positive for anti-HBc. Immunized workers were more protected against HBV infection than non-immunized workers, indicating that HBV vaccine was a useful measure for protection against the infection. The anti-HBc positive rate was significantly higher among dental care workers than general blood donors, suggesting that frequency of exposure to HBV was greater in dental care workers. HBV vaccination should be made compulsory for all dental care workers who handle sharp instruments. 

Wada K, Sakata Y, Fujino Y, Yoshikawa T, Tanaka K, Miyajima E, Watanabe M,
Aizawa Y. The Association of Needlestick Injury with Depressive Symptoms among
First-year Medical Residents in Japan. Industrial Health 2008;45:750-5.
ABSTRACT- Depressive symptoms among medical residents are common. The objective of this study was to determine the association of depressive symptoms with needlestick injury among first-year medical residents (so-called "intern"). We conducted a prospective cohort study among 107 medical residents in 14 training hospitals. The baseline survey was conducted in August 2005 and the follow-up survey was conducted in March 2006. Depressive symptoms were based on the Center for Epidemiological Study of Depression. Factors associated with depressive symptoms were examined using logistic regression analysis. For medical residents without depressive symptoms at the baseline survey, needlestick injury events were associated with depressive symptoms at the follow-up survey (corrected odds ratio [cOR]=2.98; 95% confidence interval [CI], 1.16-3.70). Because it was not possible to determine when the medical residents developed depressive symptoms, it is not possible to definitely determine causality between needlestick injury and depressive symptoms, although these findings are suggestive. Therefore, it would seem prudent to suggest the provision of mental health services to medical residents sustaining a needlestick injury since this may be helpful in identifying and treating depression.

Nagao Y, Baba H, Torii K, Nagao M, Hatakeyama K, Iinuma Y, et al. A long-term study of sharps injuries among health care workers in Japan. American Journal of Infection Control 2007;35:407-11.
ABSTRACT- Background: The risk of transmission of occupational blood-borne infection is a serious problem for health care workers (HCWs) in Japan. Although the Japanese version of Exposure Prevention Information Network (EPINet) was introduced in 1997, no published data in the clinical setting have been available yet. Objective: To examine the epidemiology of occupational sharps injuries of HCWs in a university hospital using EPINet and to analyze the trends and changes in epidemiologic characteristics of needlestick injuries in a detailed situation. Methods: The HCWs were requested to report sharps injury incidents to the Infection Control Nurse when the incidents occurred. Those who were involved in the incidents were required to personally complete an EPINET form. Results: A total of 259 cases of sharps injuries occurred during the 7-year period. Registered nurses accounted for 72.2% of the cases, constituting the largest group of the HCWs. The incidents occurred most frequently in the hospital wards. Thirty-three cases (55.9%) of the injuries with syringe-needle units occurred "after use before disposal,"whereas 34 cases (73.9%) of the injuries with suture needles occurred"during use of device." More than half of the injuries with a winged steel needle occurred despite the protective mechanism. Discussion: There was no apparent difference in the characteristics of the subjects compared with other reports. The circumstances of the injuries varied with the kinds of instruments. This fact may provide useful information for planning measures to sharps injuries. Conclusions: With the problem of underreporting aside, a detailed study, such as ours, comprising by job category and by kind of instrument or the like would provide more useful and effective information in terms of sharps injury prevention.

Wada K, Narai R, Sakata Y, Yoshikawa T, Tsunoda M, Tanaka K, Aizawa Y. Occupational exposure to blood or body fluids as a result of needlestick injuries and other sharp device injuries among medical residents in Japan. [letter] Infect Control Hosp Epidemiol 2007;28:507-509.
SUMMARY: The aim of this study was to determine the monthly incidence rate of needlestick and/or sharps injury among medical residents at 14 training hospitals in Japan and to compare the incidence rate among first-year medical residents with that among second-year medical residents.

Yano K. [Management of Occupational Exposures to HBV, HCV, HIV, and TB.] [in Japanese] Nippon Rinsho 2007;65 Suppl 2 Pt. 1:657-60.

Yoshikawa T, Kidouchi K, Kimura S, Okubo T, Perry J, Jagger J. Needlestick injuries to the feet of Japanese healthcare workers: a culture-specific exposure risk. Infection Control and Hospital Epidemiology 2007 (Feb.);28(2):215-18.

Iinuma Y, Igawa J, Takeshita M, Hashimotob Y, Fujiharaa N, Saitoa T, Takakuraa S, Ichiyamaet S. Passive safety devices are more effective at reducing needlestick injuries [letter]. Journal of Hospital Infection 2005;61:360-1.
ABSTRACT: Healthcare workers (HCWs) who use or who are exposed to needles are at risk of receiving needlestick injuries. Such injuries can lead to serious infections with blood-borne pathogens such as human immunodeficiency virus, hepatitis B virus or hepatitis C virus. To reduce needlestick injuries, hospitals should replace their needles with needle-free safety technology (primary prevention). Where needles cannot be replaced, a safety engineered needle that covers the sharp after use should be used (secondary prevention). There are two categories of safety engineered devices: user-activated safety devices and passive safety devices. A user-activated device requires HCWs to activate a safety mechanism and cover the sharp themselves, and a passive safety device features a design that automatically covers the sharp during use.

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 (4th edition). Baltimore, MD: Lippincott Williams & Wilkins, 2003; p 430-66.

Kidouchi K. [Occupational exposure prevention (needlestick injuries) to blood and body fluid.] [Japanese] Nippon Rinsho. 2002;60:2137-43.

Kidouchi K, Kashiwamata M, Nakamura C, Katoh T, Mizuno Y, Watanabe S. [The basics for establishing a needlestick injury prevention program in hospitals] [in Japanese]. Kansenshogaku Zasshi 1997;71:108-15.
ABSTRACT- Although the risk of occupationally acquired infection is a matter of considerable concern for health care workers, the problem of needlestick injuries has yet to be fully understood in Japan. We investigated 257 cases of needlestick injuries in five Nagoya Municipal Hospitals from 1989 to 1994 using the Japan EPInet. The number of needlestick injuries increased each year of the study. In one of these hospitals, the Higashi Municipal Hospital, a specialist committee began activities in April, 1993, and protective equipment and devices were also introduced during 1994. HCV contamination injuries accounted for 70%-80% of the total number of injuries reported during the 1991-1994 period at the four hospitals and during 1991-1992 period at the Higashi Municipal Hospital. At the Higashi Municipal Hospital, HCV contamination injuries decreased from 22 cases (48%) in 1993, to 15 cases (25%) in 1994. The use of the Japanese EPINet for analytical purposes enabled us to clearly identify the causes and status of needlestick injuries, resulting in the establishment of an effective prevention program.

Homma S, Toshima K, Shima H, Inadama E, Sato C, Kuwano T, Sato Y, Toda G. HCV viremia immediately after accidental needle stick. Int Hepatol Commun 1994;2:166-9.
ABSTRACT - Seven hospital workers (nurses) experienced accidental needle stick with needles contaminated by blood from chronic hepatitis C patients. HCV-RNA was detected in blood collected from two of these cases within an extremely short time after the accident, 10 min and 120 min. The two nurses subsequently became negative for HCV-RNA, never tested positive for HCV antibody, and never developed acute hepatitis C. HCV viremia can be readily established within an extremely short period of time after a HCV-contaminated needle stick accident.

KOREA:

Cho E, Lee H, Choi M, Park SH, Yoo IY, Aiken L. Factors associated with needlestick and sharp injuries among hospital nurses: A cross-sectional questionnaire survey. Int J Nurs Stud. 2012 Jul 30. [Epub ahead of print]
Abstract - BACKGROUND: The current status of needlestick or sharp injuries of hospital nurses and factors associated with the injuries have not been systematically examined with representative registered nurse samples in South Korea. OBJECTIVE: To examine the incidence to needlestick or sharp injuries and identify the factors associated with such injuries among hospital nurses in South Korea. DESIGN, SETTINGS AND PARTICIPANTS: A cross-sectional survey of hospital nurses in South Korea. Data were collected from 3079 registered nurses in 60 acute hospitals in South Korea by a stratified random sampling method based on the region and number of beds. METHODS: The dependent variable was the occurrence of needlestick or sharp injuries in the last year, and the independent variables were protective equipment, nurse characteristics, and hospital characteristics. This study employed logistic regression analysis with generalized estimating equation clustering by hospital to identify the factors associated with needlestick or sharp injuries. RESULTS: The majority (70.4%) of the hospital nurses had experienced needlestick or sharp injuries in the previous year. The non-use of safety containers for disposal of sharps and needles, less working experience as a registered nurse, poor work environments in regards to staffing and resource adequacy, and high emotional exhaustion significantly increased risk for needlestick or sharp injuries. Working in perioperative units also significantly increased the risk for such injuries but working in intensive care units, psychiatry, and obstetrics wards showed a significantly lower risk than medical-surgical wards. CONCLUSIONS: The occurrence of needlestick or sharp injuries of registered nurses was associated with organizational characteristics as well as protective equipment and nurse characteristics. Hospitals can prevent or reduce such injuries by establishing better work environments in terms of staffing and resource adequacy, minimizing emotional exhaustion, and retaining more experienced nurses. All hospitals should make safety-engineered equipment available to registered nurses. Hospitals as well as specific units showing higher risk for needlestick and sharp injuries should implement organizational strategies to prevent such injuries. It is also necessary to establish a monitoring system of needlestick and sharp injuries at a hospital level and a reporting system at the national level in South Korea.

Park S, Jeong I, Huh J, Yoon Y, Lee S, Choi C. Needlestick and sharps injuries in a tertiary hospital in the Republic of Korea. Am J Infect Control 2008;36:439-43. ABSTRACT - Background: The high incidence of hepatitis B virus (HBV) in the Republic of Korea has focused attention on monitoring the occurrence and characteristics of needlestick and sharps injuries (NSIs) as part of an effort to reduce the occupational exposure to bloodborne pathogens such as HBV. This study investigated NSIs reported in a tertiary referral hospital in Busan, Republic of Korea over a 6-year period (2001 to 2006). Method: Data on the number of NSIs, places where NSIs occurred, devices causing injury, purpose of using sharps, and circumstances surrounding NSIs were collected from the study hospital's NSI database. The incidence of NSIs per 100 full-time equivalent (FTE) employees was calculated by year and by profession. Results: A total of 221 NSI cases were reported during the study period. Overall incidence was 2.6 cases per 100 FTE employees per year, with the highest rate occurring in interns (17.7 cases per 100 FTE interns per year). Some 34% of cases occurred in the ward, needles were the most common device causing injury (73%), and the most common circumstance surrounding an NSI was after sharps use and before disposal (24%). Conclusion: The pattern of NSI occurrence found in this study was comparable to that reported in previous studies. However, the overall incidence of NSIs was significantly lower than that in previous studies, apparently related to underreporting of NSIs. Further research to investigate reasons for this underreporting is recommended. Considering the high incidence of NSIs in interns, in-service training for this group should be enhanced.

Smith DR, Choe MA, Jeong JS, Jeon MY, Chae YR, An GJ. Epidemiology of needlestick and sharps injuries among professional Korean nurses. Journal of Professional Nursing 2006;22:359-66.
ABSTRACT- Although needlestick and sharps injuries (NSI) are known to affect professional nurses at high rates, most studies depend on officially reported data and few have been undertaken in Korea. Thus, we surveyed a large cross-section of nurses from a hospital in Gangneung (response rate, 97.9%). Four hundred thirty-two incidents of NSI were reported by 263 nurses (79.7%) in the previous 12-month period (average, 1.31 events/nurse/year). Syringe needles were the most common devices, affecting 67.3% and comprising 52% of all NSI events. Sixty percent of all NSI events involved contaminated devices. Opening an ampoule or vial was the most common cause (affecting 35.2% of all nurses and accounting for 15.9% of all NSI events). Logistic regression indicated that nurses working in "other" departments were 5.4 times more likely to suffer any NSI (odds ratio [OR] = 5.4; 95% confidence interval [95% CI] = 2.0-15.2; P < .05) and 4.7 times more likely to incur a syringe-needle injury than nurses in intensive care units or inpatient departments (OR = 4.7; 95% CI = 2.0-11.6; P < .05). Younger-than-average nurses (< 27 years) were 4.5 times more likely to suffer NSI (OR = 4.5; 95% CI = 1.7-12.6; P < .05) and 3.1 times more likely to incur a syringe-needle injury (OR = 3.1; 95% CI = 1.4-7.0; P < .05). Working mixed shifts also increased the risk of any NSI (OR = 4.0; 95% CI = 1.7-10.4; P < .05) or syringe-needle NSI (OR = 4.4; 95% CI = 2.0-10.1; P < .05). Overall, our study suggests that NSI are common among Korean hospital nurses and represent a significant occupational burden for this large Asian demographic. Intervention and preventive strategies to help reduce their NSI exposures are urgently required in this country.

MALAYSIA:

Ng YW, Hassim IN. Needlestick injury among medical personnel in Accident and Emergency Department of two teaching hospitals. Medical Journal of Malaysia 2007; 62:9-12.
ABSTRACT- Needlestick injury has been recognized as one of the occupational hazards which results in transmission of bloodborne pathogens. A cross-sectional study was carried out among 136 health care workers in the Accident and Emergency Department of two teaching hospitals from August to November 2003 to determine the prevalence of cases and episodes of needlestick injury. In addition, this study also assessed the level of knowledge of blood-borne diseases and Universal Precautions, risk perception on the practice of Universal Precautions and to find out factors contributing to needlestick injury. Prevalence of needlestick injury among the health care workers in the two hospitals were found to be 31.6% (N = 43) and 52.9% (N = 87) respectively. Among different job categories, medical assistants appeared to face the highest risk of needlestick injury. Factors associated with needlestick injury included shorter tenure in one's job (p < 0.05). Findings of this study support the hypothesis that health care workers are at risk of needlestick injury while performing procedures on patients. Therefore, comprehensive infection control strategies should be applied to effectively reduce the risk of needlestick injury.

Chan KY, Singh VA, Oun BH, To BH. The rate of glove perforations in orthopaedic procedures: single versus double gloving. A prospective study. Medical Journal of Malaysia. 2006;61 Suppl B:3-7.
ABSTRACT: Glove perforation during surgery has always been a matter of concern as it increases the infection rate and the risk of transmission of blood borne diseases. To determine the common causes, the site and the awareness of glove perforations in orthopaedic surgery, a prospective study was conducted to assess the rate of glove perforation during 130 consecutive orthopaedic operations. All gloves worn by the surgical team were assessed after the surgery using the water-loading test. A total of 1452 gloves were tested, and the rate of perforation was 3.58%. Most of these perforations (61.5%) were unnoticed. The main surgeons had the most perforations (76.9%), followed by first assistants (13.5%) and second assistants (9.6%). Most perforations occurred at the non-dominant hand. The commonest site of perforation was the index finger followed by the thumb. Shearing force with instruments accounted for 45% of the noticed perforations. Majority of these occurred during nailing procedures (33%) and internal fixation without the use of wires (19%). Our rate of glove perforation is similar to other series. Most of them went unnoticed and were mainly due to shearing injuries rather than perforation by sharps. Therefore, there is an increased risk of contamination and break in asepsis during surgery.

NEPAL:

Gurubacharya DL, Mathura KC, Karki DB. Knowledge, attitude and practices among health care workers on needle-stick injuries. Kathmandu Univ Med J (KUMJ) 2003;1(2):91-4.
ABSTRACT - OBJECTIVE: This study aimed to assess the knowledge, attitude and practices among health care workers on needle stick injuries. METHODS: A 15-item questionnaire was administered to seventy health care workers including nurses and paramedical staffs from different departments of Kathmandu Medical College and Teaching Hospital to measure knowledge, attitude and practices on needle stick injuries. RESULTS: Results showed that 4% and 61% of health care workers, respectively, were unaware of the fact that hepatitis B and hepatitis C can be transmitted by needle-stick injuries. 52 subjects (74%) had a history of needle-stick injuries and only 21% reported the injuries to the hospital authority. Only 23% were in the habit of using gloves for phlebotomy procedures all the time. 79% were of the impression that needle should be recapped after use. Only 66% were aware of Universal Precaution Guidelines. 16 subjects (23%) were negative for HBsAg, Anti-HCV and Anti-HIV and 54 subjects (77%) do not know about their immune status. 42 subjects (60%) had been vaccinated against hepatitis B, while 28 subjects (40%) were not vaccinated against hepatitis B. Only 6 subjects (14%) had been tested for Anti-HBs antibody after hepatitis B vaccination. CONCLUSION: The survey revealed that knowledge of health care workers about the risk associated with needle-stick injuries and use of preventive measures was inadequate. A standing order procedure (SOP) should be formulated regarding needle-stick injuries in all the health institutions. It should outline precautions to be taken when dealing with blood and body fluids. It should also contain reporting of all needle-stick injuries. Health care workers should be made aware of hazards, preventive measures and post-exposure prophylaxis to needle-stick injuries. A hospital-wide hepatitis immunization programme should also be started.

NEW ZEALAND:

Laing RM. Int J Occup Saf Ergon. 2008;14(1):107-15. Protection provided by clothing and textiles against potential hazards in the operating theatre.
Summary: The typical hospital and operating theatre present multiple potential hazards to both workers and patients, and protection against some of these is provided through use of various forms of clothing and textiles. While many standards exist for determining the performance of fabrics, most
tests are conducted under laboratory conditions and against a single hazard. This paper provides an overview of selected developments in the principal properties of fabrics and garments for use in these workplaces, identifies the key standards, and suggests topics for further investigation.

PAKISTAN:

Mengal HU, Howteerakul N, Suwannapong N, Rajatanun T. Factors relating to acceptance of hepatitis B virus vaccination by nursing students in a tertiary hospital, Pakistan. J Health Popul Nutr 2008;26(1):46-53.
ABSTRACT - This cross-sectional study aimed at assessing the prevalence of, and factors relating to, the acceptance of hepatitis B virus (HBV) vaccination by nursing students in a tertiary hospital in Pakistan. In total, 210 nursing students of Year 2 to Year 4 were invited to participate in the study; of them, 196 (93.3%) returned completed questionnaires. Overall, the prevalence of acceptance of HBV vaccination among them was 75.0%. Of these, 37.2% (73/196) were completely vaccinated, and 25.0% (49/196) had not been vaccinated at all. More than half (27/49, 55.1%) of the unvaccinated nursing students stated that they would accept vaccination if offered. Multiple logistic regression analysis indicated three variables significantly related to acceptance of HBV vaccination: history of accidental exposure to blood or blood products, acceptable knowledge about HBV infection, and adequate budget for HBV vaccination. Health institutions should allocate adequate budgets to vaccinate their nursing students. Effective intervention programmes designed to increase knowledge about HBV infection and adhering to universally-accepted precautions are needed.

Zafar A, Aslam N, Nasir N, Meraj R, Mehraj V. Knowledge, attitudes and practices of health care workers regarding needlestick injuries at a tertiary care hospital in Pakistan. J Pak Med Assoc 2008;58(2):57-60.
ABSTRACT - OBJECTIVE: To assess the knowledge, attitude and practices of HCWs regarding needle stick injuries at the Aga Khan University Hospital. METHODS: A cross-sectional study was conducted on medical personnel. A structured pre-tested questionnaire was administered during June-July 2003. The data was analysed by SPSS 13.0. Percentages of the categorical variables were computed and compared by Chi square test at a 5% level of significance. Odds ratios and their 95% CIs were also computed. RESULTS: Of 80 participants, 29 were doctors and 51 were registered nurses. About 45% reported having a needle stick injury in the past. Frequency of injury was significantly higher among doctors (p < 0.001). The most common reason identified was stress or being over burdened followed by careless attitude. More than 50% of the injuries occurred while injecting or drawing blood samples. The risk of getting infections was well known amongst both the groups. Two third of participants were familiar with the prevention protocols and practices of nurses were generally safer than doctors (p < 0.001). CONCLUSION: Despite knowing the risks, frequency of needle stick injury was generally higher especially among doctors reflecting bad practice and careless attitude towards work. Mandatory reporting, proper follow-up and constant reinforcement are recommended to reduce the rate of nosocomial transmission to health care workers.

Zafar A. Blood and body fluid exposure and risk to health care workers [editorial]. Journal of Pakistan Medical Association 2006;56(10):428-9.

Mujeeb SA, Khatri Y, Khanani R. Frequency of parenteral exposure and seroprevalence of HBV, HCV, and HIV among operation room personnel. J Hosp Infect 1998;38(2):133-7.
ABSTRACT - A study was designed to determine the frequency of needle-stick injuries, immunization status for hepatitis B virus (HBV) and sero-prevalence of HBV, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections among operation room personnel. Self-assessment questionnaires were completed and blood tested for HBsAg, anti-HBc (total), anti-HCV and anti-HIV. Of 114 operation room personnel studied, the majority (58.8%) reported more than four needle-stick injuries per year, 36.8% one to three needle-stick injuries per year, while 4.4% reported no needle-stick injury in the last five years. Thirty-six percent of personnel had received a complete course of hepatitis B vaccination. There was serological evidence of hepatitis HBV virus and/or HCV infections in 31% of the studied population. Four percent were reactive for HCV infection, 7.5% for HBsAg infection and 25.43% for anti-HBc (total); none was HIV positive. Eighty percent of the HCV positive and 55% of the anti-HBc (total) positive personnel had more than four needle-stick injuries per year in the last five years, while 75% HBsAg-reactive personnel had received one to three needle-stick injuries per year. This study indicates a need for continued efforts to minimize the risk of blood-borne infection by enhancing the compliance of operation room personnel with HBV vaccination and adherence to infection control measures.

SINGAPORE:

Ng LN, Lim HL, Chan YH, Bachok DB. Analysis of sharps injury occurrences at a hospital in Singapore. International Journal of Nursing Practice 2002;8:274-81.
ABSTRACT- Relatively little attention has been directed to investigating the risks of sharps injuries in Singapore. This study examines the epidemiology and causes of sharps injuries at a university teaching hospital. The type of instruments, site of injuries and personnel involved in each sharps injury were determined retrospectively by reviewing the Incident Reports forms and Infection Control records between 1997 and 2000. Descriptive information on the forms and records were extracted and collected on standard charts. The data were then analysed using SPSS Windows software. The rates of sharps injuries were 11.0 per 100 medical staff and 6.9 per 100 nursing staff. Medical staff yielded highest proportion of sharps injuries rendering 33 cases (40.2%), followed by 24 cases involving nursing staff (29.3%) and 12 cases of nursing students (14.6%). In total, 62.2% of injuries were caused by hollow bore needles (51 cases). Non-hollow bore needle injuries only accounted for 17.1% of total injuries (14 cases). Hollow bore needles accounted for the highest proportion of sharps injuries in this study, corresponding to findings in other studies. Rates of injuries were similar to the rates found at another local hospital. At the hospital studied, sharps with safety features had effectively produced no reported cases of sharps injuries.

TAIWAN:

Shiao JS, Lin MS, Shih TS, Jagger J, Chen CJ. National incidence of percutaneous injury in Taiwan healthcare workers. Res Nurs Health 2008 Apr;31(2):172-9.
Summary: We established a standardized surveillance system using the Chinese Exposure Prevention Information Network to estimate the frequency of percutaneous injuries (PCIs) in Taiwanese healthcare workers (HCWs). Fourteen hospitals employing 8,132 HCWs participated and a total of 583 PCIs were reported. The annual number was estimated to be 8,058 PCIs per hospital size, 8,100 per HCWs, and 8,286 per inpatient-day; indicating similar estimates using different denominators. The estimated annual frequency of pathogen-specific PCIs was 1,168 for hepatitis B, 1,263 for hepatitis C, and 59 for HIV. This study documents the annual incidence of PCI among HCWs showing important potential exposure to viral hepatitis and HIV in Taiwan.

Yang YH, Liou SH, Chen CJ, Yang CY, Wang CL, Chen CY, Wu TN. The effectiveness of a training program on reducing needlestick injuries/sharp object injuries among soon graduate vocational nursing school students in southern Taiwan. Journal of Occupational Health 2007;49:424-9.
ABSTRACT- Needlestick/sharp injuries (NSIs/SIs) are a serious threat to medical/nursing students in hospital internships. Education for preventing NSIs/SIs is important for healthcare workers but is rarely conducted and evaluated among vocational school nursing students. We conducted an educational intervention for such students after their internship rotations before graduation. This program consisted of a lecture to the students after the internship training and a self-study brochure for them to study before their graduation. This study used the pre-test questionnaires completed by all students and the post-test questionnaires completed by 107 graduates after work experience as licensed nurses to assess the effectiveness of the intervention. After educational intervention, the incidence of NSIs/SIs decreased significantly from 50.5% pre-test to 25.2% post-test, and the report rate increased from 37.0% to 55.6%, respectively. In conclusion, this intervention significantly reduced the incidence of NSIs/SIs and increased the report rate of such events.  

Shiao JS, Guo YL, McLaws M. Estimation of the risk of bloodborne pathogens to health care workers after a needlestick injury in Taiwan. American Journal of Infection Control 2002;30:15-20.
ABSTRACT- Objectives: To estimate the number of health care workers (HCWs) in Taiwan at risk annually for contracting hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV after a needlestick and sharps injury (NSI) with a used hollow-bore needle. Methods: All patients hospitalized in 1 tertiary hospital between September 1997 and June 1998 had routine pathological work-ups. On the first day of the months of September 1997, December 1997, March 1998, and June 1998, 1805 samples of deidentified residual sera randomly sampled from 18,474 inpatients older than 6 years were serologically tested for antigens to HBV (HBsAg and HBeAg) and antibodies to HCV (anti-HCV) and HIV (anti-HIV) with enzyme-linked immunosorbent assay reagents. The frequency of NSIs with contaminated devices in HCWs from 16 public teaching hospitals between July 1996 and June 1997 and the serologic results were used to extrapolate the estimated annual rate of seroconversion in HCWs after an NSI. Results: Of the 1805 samples tested, 16.7% were seropositive for HBsAg (of which 1.7% were positive for HBeAg), 12.7% were positive for anti-HCV, and 0.8% were positive for anti-HIV. Of the 7550 NSIs reported by 8645 HCWs, 66.7% involved a contaminated hollow-bore needle. From these data, 308 to 924 HCWs were estimated to be at risk for contracting HBV; 334 to 836 were at risk for contracting HCV; and, at the most, 2 were at risk for contracting HIV. The estimated annual number of contaminated NSIs sustained by 4 categories of HCWs ranged from 0.3 to 0.7, resulting in 543 nurses, 113 technicians, 80 physicians, and 66 supporting staff to be at risk annually of acquiring HBV infection. The numbers of HCWs estimated to be at risk of acquiring HCV were 596 nurses, 90 physicians, 84 technicians, and 30 supporting staff. The risk of acquiring HIV was low, with 1 nurse and possibly 1 other staff potentially exposed annually. Conclusions: Our estimates of the risk for seroconversion after an NSI have demonstrated that an occult risk can be formulated into a quantifiable risk. The number of susceptible HCWs at risk for seroconversion is as many as 1762 annually. With the number of nurses employed and the frequency with which they use sharps and sustain an NSI, 64.7% of all possible seroconversions will be in the nursing staff. This is a salient reminder of the importance of the introduction of early training in safe-needle-handling techniques before nurses enter their internship in countries where safety equipment, safety instructions, and staff vaccination programs are absent.

Guo YL, Shiao J, Chuang YC, Huang KY. Needlestick and sharps injuries among health-care workers in Taiwan. Epidemiology and Infection 1999;122:259-65.
ABSTRACT- Sharps injuries are a major cause of transmission of hepatitis B and C viruses and human immunodeficiency virus in health-care workers. To determine the yearly incidence and causes of sharps injuries in health-care workers in Taiwan, we conducted a questionnaire survey in a total of 8645 health care workers, including physicians, nurses, laboratory technicians, and cleaners, from teaching hospitals of various sizes. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 per person in the past 12 months, respectively. Of most recent episodes of needlestick/sharps injury, 52.0% were caused by ordinary syringe needles, usually in the patient units. The most frequently reported circumstances of needlestick were recapping of needles, and those of sharps injuries were opening of ampoules/vials. Of needles which stuck the health-care workers, 54.8% had been used in patients, 8.2% of whom were known to have hepatitis B or C, syphilis, or human immunodeficiency virus infection. Sharps injuries in health-care workers in Taiwan occur more frequently than generally thought and risks of contracting blood-borne infectious diseases as a result are very high.

Shiao JS, McLaws ML, Huang KY, Ko WC, Guo YL. Prevalence of nonreporting behavior of sharps injuries in Taiwanese health care workers. American Journal of Infection Control 1999;27:254-7.
ABSTRACT- Background: Health care workers (HCWs) were surveyed to identify factors associated with nonreporting behavior of sharps injuries (SIs) in Taiwan. Methods: We surveyed 10,469 full-time medical, nursing, technical, and supporting personnel employed at 16 randomly selected hospitals from 132 available accredited teaching hospitals in Taiwan. Information about the most recent injury and reporting behavior after an SI were collected from July 1996 to June 1997 by using a pretested structured questionnaire. Eleven categories, including an open-ended option, were provided for participants to explain their nonreporting behavior. Results: Questionnaires were completed by 82.6% (8645) of our sample, of whom 87.3% reported to have experienced a recent SI. A used item was the most commonly (P <. 001) involved item in an SI, and SIs with a used item were significantly more likely (odds ratio 3.6; CI 95%, 3.03-4.26; P <. 001) to be reported compared with an SI that involved unused items. A total of 81.8% of injuries were not reported, with job category significantly affecting reporting behavior (P <.001). Medical staff had the highest nonreporting rate (85.2%). Although attendees of a prevention program were statistically more likely (P <.001) to report an injury compared with nonattendees, the level of reporting in both groups was not encouraging (21.3% and 17.2%, respectively). All reasons given for nonreporting were disconcerting, but none more so than the use of subjective assessment of risk by 21.7% of HCWs who did not report their injuries. Other reasons for not reporting SIs included that the item was unused (34%) and that the HCW was too busy to report the SI (14.9%), unaware of reporting requirements (14. 4%), or immune to hepatitis B virus (12.4%). Conclusions: With 82% of SIs in Taiwanese HCWs going unreported, the expected national incidence will be seriously underestimated and impact the appropriateness of prevention programs. The very low rate of reporting suggests that the current reporting system requires simplification. Because most injuries involved used items, the reporting systems also should include a more responsive management component. The results also suggest that the current prevention programs, currently provided by the general nursing department, require expert content knowledge in infection control if nonreporting and SIs are to be reduced.

THAILAND:

Apisarnthanarak A, Babcock HM, Fraser VJ. The effect of nondevice interventions to reduce needlestick injuries among health care workers in a Thai tertiary care center. [Letter] American Journal of Infection Control 2008;36:74-5.

Hiransuthikul N, Hiransuthikul P, Kanasuk Y. Human immunodeficiency virus postexposure prophylaxis for occupational exposure in a medical school hospital in Thailand. Journal of Hospital Infection 2007;67:344-9.
ABSTRACT- This is a retrospective review of occupational exposure to human immunodeficiency virus (HIV) and subsequent postexposure prophylaxis (PEP) among healthcare workers (HCWs) in King Chulalongkorn Memorial Hospital (KCMH), Bangkok, Thailand. From January 2002 to December 2004, data were collected from incident reports, the hospital's infectious diseases unit and the emergency department. There were 315 reported episodes of occupational exposure among 306 HCWs. Nurses (34.0%) were the HCWs most frequently exposed and percutaneous injury (91.4%) was the most common type of exposure. One-third of the source patients tested were infected with HIV. PEP was initiated following 200 (63.5%) of the 315 exposures and was started within 24h in >95% of cases. The most commonly prescribed PEP regimen was zidovudine, lamivudine and nelfinavir. Fifty-six percent of HCWs given PEP completed a four-week course but the remainder discontinued PEP prematurely due to side-effects, or after negative results from the source, or following informed risk reassessment or from their own accord. No exposed HCW acquired HIV during the study period. Appropriate counselling and careful risk assessment are important in achieving effective HIV PEP among HCWs.

Hiransuthikul N, Tanthitippong A, Jiamjarasrangsi W. Occupational exposures among nurses and housekeeping personnel in King Chulalongkorn Memorial Hospital. Journal of the Medical Association of Thailand 2006;89(Suppl 3):S140-9.
ABSTRACT- Objectives: To determine the incidence and related factors of blood and body fluid exposure (BBFE)among nurses and housekeeping personnel in King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Material and method: A retrospective survey of BBFE among 858 nurses and housekeeping personnel who were working in the year 2004 was done. Data were collected by a self-administered questionnaire. Results: The annual incidence rate of BBFE was 31.9% (by person) and 45.5 exposures per 100 persons (by event). The highest incidence rate was observed in percutaneous exposure. Graduated nurses had the greatest risk of all exposures, but housekeeping personnel had the highest rate ofpercutaneous exposure. The highest incidence of BBFE was observed in the emergency room. Most BBFE occurred after using a medical instrument. 76.9% of BBFE were not reported. Conclusion: The incidence of BBFE among nurses and housekeeping personnel in King Chulalongkorn Memorial Hospital was high. Systematic control measures and good organization of the work and workplace should be urgently implemented.

Kiertiburanakul S, Wannaying B, Tonsuttakul S, Kehachindawat P, Apivanich S, Somsakul S, Malathum K. Use of HIV Postexposure Prophylaxis in healthcare workers after occupational exposure: a Thai university hospital setting. J Med Assoc Thai 2006;89(7):974-8.
ABSTRACT - BACKGROUND: PostExposure Prophylaxis (PEP) is widely used after exposures to Human Immunodeficiency Virus (HIV) to reduce the risk of infection in the healthcare setting. Few data are available on the safety and tolerability of Anti Retro Viral drugs (ARV) among Health Care Workers (HCWs) who are prescribed prophylaxis. OBJECTIVE: To collect information about the safety and compliance of taking ARV for HIV PEP among HCWs. MATERIAL AND METHOD: Retrospective review on registry data regarding occupational HIV exposures, the PEP regimens used, and the adverse events associated with PEP was performed. RESULTS: During a five year-period, 820 episodes with occupational blood or body fluid exposures were reported Nurses (27%) were the largest group at risk. The most common type of exposure was percutaneous injuries (82%). Only 125 (15%) HCWs had occupational exposures to HIV, 64 HCWs were prescribed HIV PEP and 32 (50%) HCWs did not complete the PEP regimen as initially prescribed. The commonly prescribed ARV was zidovudine (38%), lamivudine (33%), and indinavir (11%). Overall, 18 (28%) HCWs reported symptoms while on PEP such as nausea (89%), vomiting (55%), and dizziness (39%). None of the HCWs had HIV seroconversion. CONCLUSIONS: Adverse effects from HIV PEP were very common. Clinicians prescribing HIV PEP need to discuss with HCWs about PEP efficacy and side effects. Education efforts aimed at occupational exposure prevention are still important issues.

Danchaivijitr S, Kachintorn K, Sangkard K. Needlesticks and cuts with sharp objects in Siriraj Hospital 1992. Journal of the Medical Association of Thailand 1995;78 Suppl 2:S108-11.
ABSTRACT- A study on needlesticks and cuts with sharp objects was done by a set of questionnaires in Siriraj Hospital in March 1992. The response rate of 3,600 sets of questionnaires was 80.8%. The recalled incidence rate of injuries in the previous 6 months was 51.5%. Needlesticks were the commonest accident followed by cuts by broken glass and medical equipment respectively. Bore needles were the most important cause of injury. Recapping and improper disposal of used needles were prevalent. With the same incidence rate of such injuries, it was estimated that 5.9 persons will be HIV infected annually in Thailand.

VIETNAM:

Sohn AH, Thu LT, Thoa VT, Van DT, Tien NP, Hai HH, Chiarello LA, Cardo DM. Occupational blood exposures and perception of HIV transmission risk among Vietnamese hospital personnel. [Abstract] International AIDS Conference 2004;15: abstract no. ThPeC7512.
ABSTRACT- Background: The frequency of occupational blood exposures to healthcare personnel (HP) and perceptions of occupational HIV transmission risk in Vietnam are unknown. As greater than 50% of new HIV diagnoses are made in hospitals, it is important to understand the epidemiology of exposures in this setting to ensure appropriate management and guide prevention programs. Methods: In 2001, we conducted an anonymous survey of HP at Cho Ray Hospital, Ho Chi Minh City to assess the frequency and reporting of occupational blood exposures through percutaneous injuries (PI), and HP perceptions of HIV transmission risks from these events. Two-thirds of non-clinical (housekeeping, laboratory) and clinical (nursing, physician) staff were randomly selected to participate. Results: Of 1011 surveys distributed, 866 (86%) were returned. A total of 330 (38%) HP recalled sustaining one or more PIs during 2000; 86 (35%) reported their exposures to supervisors or infection control. Most common reasons for not reporting included not being aware of the importance of reporting (32%), knowing that source patients were HIV-negative (27%), and concerns for confidentiality of testing results (22%). Of the most recent PIs described in the survey, 53% were from hollow-bore needles. Injuries occurred during suturing (24%), giving medications (19%), and recapping needles (16%). Source patient HIV status was known for 25% of these exposures or tested afterwards in 37%. Perceptions regarding risks of HIV transmission varied by occupation. Overall, HP believed the risk of HIV transmission to be 1-10% (median). However, 25% of clinical staff reported they did not know the rate of HIV transmission after PI. Conclusions: Occupational PIs are common in Vietnamese HP and are seldom reported. Improved reporting compliance could be achieved through 1) training on the importance of and procedures for exposure prevention, management, and reporting, and 2) assuring confidentiality for post-exposure testing.

 
EPINet data for 2010 and 2011
Consensus Statement and Call to Action on Sharps Safety released March 2012