[Hepatitis C dissemination by hemodialysis: default isolation versus universal hygienic precautions (reply)].
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Disease Transmission, Infectious↗
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The use and practice of body substance precautions in sports physiotherapy.
This study examined the use of Universal Precautions in the management of bleeding sports injuries. A survey was used which asked questions on: demographics, hepatitis B vaccination, first aid practices and frequency of blood contact. The national sample consisted of 1800 Australian Physiotherapy Association National Sports Physiotherapy Group members. The response rate was 29.2 per cent. Eighty-five per cent of physiotherapists were exposed to bleeding injuries. The use of rubber gloves in the treatment of bleeding injuries was low (47 per cent using them always/frequently). Only 60 per cent disposed of sharp instruments appropriately. Eighty per cent reported being immunised against hepatitis B. Experience was strongly associated with appropriate first aid practices. The study suggests that physiotherapists in sport are not consistently adhering to Universal Precautions.
Journal Article↗
Bloodborne pathogens risk and precautions among urban fire-rescue workers.
Health care workers are exposed to various infectious agents that can lead to disease transmission during patient care. Emergency first-responders, paramedics, and emergency medical technicians (EMTs) are a subgroup of health care workers particularly at risk for occupational exposure to bloodborne pathogens. The Centers for Disease Control and Prevention has recommended universal precautions to prevent occupational transmission of bloodborne pathogens among health care workers. This cross-sectional study evaluates risks and behaviors for occupational exposure to bloodborne pathogens among urban paramedics and EMTs in Dade County, Florida. Reported exposure via multiple routes was common, especially among paramedics. Knowledge of universal precautions was high, but reported practices were suboptimal because of inadequate information, as well as logistical and access issues. Additional research, administrative effort, and regulation are needed to increase the application of universal precautions in the prehospital setting.
Adult↗
Occupational exposures to blood among emergency medicine residents.
OBJECTIVES: To investigate the epidemiologic characteristics of potentially infectious occupational exposures to blood among emergency medicine (EM) residents. METHODS: A SAEM-sponsored multiple-choice survey was administered anonymously to all EM residents participating in the 1998 American Board of Emergency Medicine in-service examination. Survey questions included resident demographics, use of universal precautions, frequency and types of exposures to blood, and exposure reporting. Residents who experienced at least one exposure were then asked to complete an additional set of questions referring only to their latest exposure. Mean values were calculated for each variable and differences between groups were compared by chi-square analysis. RESULTS: Three thousand one hundred sixty-two surveys were distributed to the resident participants, and 2,985 surveys (94.4%) were returned. Of the participants, 56.1% reported at least one exposure to blood during their EM training. The frequency of this self-reported exposure increased with advancing EM level of training (43% EM-1, 58% EM-2, 64% EM-3, 76% EM-4, p<0.001). Of these residents, 36.6% always followed universal precautions, 54% frequently, and 9.4% sometimes, rarely, or never. Those individuals who "always" followed universal precautions reported significantly fewer exposures than those who did not (p<0.005). The latest exposures were most commonly caused by a solid needle or sharp object (39.4%), by a hollow-bore needle (30.6%), or by eye splashes (17.2%). Of these exposures, 71.7% occurred in the ED setting, and only 46.7% of these exposures were reported to health care providers. CONCLUSION: Emergency medicine residents are frequently exposed to blood, most commonly due to puncture injuries by sharp objects. The rate of exposure reporting is low, which may compromise appropriate postexposure counseling and prophylaxis.
Blood↗
Protection of healthcare workers from bloodborne pathogens.
PURPOSE OF REVIEW: For decades, healthcare workers have been known to be at risk from acquiring a variety of bloodborne pathogen infections as a result of occupational exposure. Primary prevention of exposures, as recommended by universal precautions guidelines, remains the cornerstone of protecting healthcare workers. Nonetheless, a substantial number of parenteral exposures continue to occur. Updated developments are summarized here, and recommendations for the protection of healthcare workers from bloodborne pathogens are provided. RECENT FINDINGS: The predominant evidence suggests that total percutaneous injuries have decreased over the last decade. Thoughtful adherence to universal precautions remains the primary means of preventing occupational exposures and thus of reducing occupational risk of infection with bloodborne pathogens. A number of studies have provided additional evidence for the efficacy of safety devices in reducing specific subsets of injuries when combined with education and administrative interventions. Barriers to and positive predictors of universal precautions compliance have been identified. Postexposure prophylaxis remains the second line of defense; several authorities have now recommended three antiretroviral agents in this setting. SUMMARY: In summary, almost two decades of experience with universal/standard precautions has resulted in a decrease in parenteral injuries, but much work remains to be done. Vaccines, effective infection control procedures, safer procedures, and safer devices will all be necessary, along with a better understanding of factors that influence healthcare worker behaviors that result in injury. In addition, a number of issues relating to the postexposure management of occupational exposures with bloodborne pathogens need to be better understood.
Anti-Infective Agents↗
Hospital protocol for the patient with acquired immunodeficiency syndrome.
This article discusses HIV transmission, prevention, and treatment in a hospital milieu. In a review of all the literature, minimal research has been done on correlating the potency of the virus in terms of transmission with the stage of the disease in an HIV-infected patient. It seems logical that the risk of transmission will increase when the HIV patient has the full blown disease. This might reflect the statistic that 5.3% of all the health care workers infected do not have a determinable cause. Yet it has been proven that seroconversion can occur after nonparenteral exposure. This is confirmed by a recent CDC update that reported seven cases of seroconversion from mucous membrane exposure. More extensive study is needed in developing more accurate statistics on the cumulative risk of health care workers in specific fields of medicine and specific patient communities. Because all the questions on AIDS apparently are not even close to being answered, the importance of using universal precautions cannot be overstressed. Unfortunately, research and experience have shown that compliance in adopting universal precautions is remarkably poor. Training and education must begin at the medical school level with reinforcement through yearly workshops. Prevention seems to be the only hope at this time. The physician's inability to test patients for this virus has only been a deterrent in learning about this dreadful epidemic.
Acquired Immunodeficiency Syndrome↗
Compliance with gloving in anesthesia: an observational study of gloving practice at induction of general anesthesia.
STUDY OBJECTIVE: To gather direct observational data on anesthesiologists' compliance with universal precautions' gloving standards during induction of general anesthesia. DESIGN: Prospective, observational study. SETTING: Operating theaters of an Israeli government teaching hospital. SUBJECTS: Over a four-month period, all "first case of the day" general anesthetics were observed to determine if the anesthesiologist directly administering patient care wore gloves during the period of anesthetic induction. All anesthesia department members were observed and none was aware of the ongoing study. MEASUREMENTS AND MAIN RESULTS: Resident anesthesiologists were found to be more compliant with gloving policy than their attendings (61.8% vs. 33.7%, p < 0.0001). However, the lower compliance among the attendings was entirely attributable to the most senior staff members (over age 55 years) whose compliance rate was 11.5% versus 55.6% for attending staff below age 55 years (p < 0.0001). Departmental compliance as a whole was 49.6%. Compliance in pediatric cases averaged 10% and was equally poor among all department staff. CONCLUSIONS: Although glove use remains inconsistent, in less than one and one half years since institution of a departmental gloving policy, a substantial degree of compliance was achieved. Nevertheless, further efforts are still needed to improve compliance with universal precautions. In this study, glove use was particularly deficient in pediatric cases and among senior staff aged 55 years and older. Pinpointing specific areas of greatest deficiency may prove useful in guiding additional efforts to improve compliance with universal precautions.
Age Factors↗
Infectious hazards in the clinical laboratory: a program to protect laboratory personnel.
The increasing risk of exposure to blood-borne pathogens in the health care setting makes the development of effective infection control programs in the laboratory workplace critical. Central to such programs is the concept of universal precautions. The program described here relates the level of protection or precaution to the potential danger for infection, given the laboratory workstation and task which is to be performed. Four Levels of Protection are described. Implementation of this program requires that each workstation and procedure in each laboratory section be reviewed by the laboratory director and supervisory personnel for risk of exposure. Implementation additionally requires that provisions be made for both the initial and continuing education of laboratory employees. Laboratory directors and supervisors should also monitor the program to ensure compliance. There will certainly be situations unique to individual institutions or laboratory settings that may require precautions or policies over and above those described by universal precautions. Laboratory policies will not gain acceptance if they are developed and implemented without the advice and cooperation of the hospital medical staff. Employee acceptance of infection control policies will be greater if actual development and implementation actively involves the laboratory personnel who will practice them. The program described here is but one approach to the problem. Employers and laboratory directors must understand that it is their responsibility to develop a program that provides appropriate safeguards for workers who may be exposed to infectious agents in the laboratory workplace and to ensure that employees are properly trained and educated in the proper use and application of those safeguards.
Acquired Immunodeficiency Syndrome↗
Absence of HIV transmission from an infected dentist to his patients. An epidemiologic and DNA sequence analysis.
OBJECTIVE: To determine if a general dentist with human immunodeficiency virus (HIV) infection transmitted HIV to any of his patients. DESIGN: A cohort study in which all patients treated by a dentist who developed the acquired immunodeficiency syndrome (AIDS) were identified and attempts were made to contact all patients for HIV antibody testing. SETTING: A general dentistry clinic operated by the Department of Veterans Affairs in southeastern Florida. PARTICIPANTS: All patients treated by a dentist during the 5 3/4 years before he developed AIDS were identified in a computerized registry of dental care. MAIN OUTCOME MEASURES: Attempts were made to contact all living patients for counseling and HIV antibody testing. Living patients with newly identified HIV infection were interviewed, and DNA sequence analysis was performed to compare genetic relatedness of their HIV to that of the dentist. Death certificates were obtained for decreased patients, and the medical records of those with diagnoses suggestive of HIV disease or drug abuse and those dying under the age of 50 years were reviewed in detail. RESULTS: There were 1192 patients who had undergone 9267 procedures, of whom 124 were deceased. A review of the death certificates of the deceased patients identified five who had died with HIV infection, all of whom were either homosexuals or users of illicit intravenous drugs. We were able to locate 962 (92%) of the remaining 1048 patients, and 900 agreed to be tested. Infection with HIV was documented in five of the 900 patients, including four who had clear evidence of risk factors for acquiring HIV infection. One patient who had only a single evaluation by the dentist denied high-risk behavior. Comparative DNA sequence analysis demonstrated that the viruses from the dentist and these five patients were not closely related. CONCLUSION: This study indicates that the risk for transmission of HIV from a general dentist to his patients is minimal in a setting in which universal precautions are strictly observed. Programs to ensure compliance with universal precautions would appear preferable to programs for widespread testing of dentists.
Cohort Studies↗
Occupational exposure of interns to blood in an area of high HIV seroprevalence.
OBJECTIVE: To determine the epidemiology of work-related exposure to blood among interns. DESIGN: Interns were invited to complete anonymously a questionnaire concerning their past percutaneous and mucocutaneous exposures to blood. SETTING: Chris Hani Baragwanath Hospital, Soweto, and Johannesburg Hospital, Gauteng, where HIV infection is common among patients. RESULTS: Ninety-eight interns (96%) were surveyed. Sixty-nine per cent of interns reported one or more percutaneous exposures to blood during the intern year, and 33% of interns recalled accidental percutaneous exposure to HIV-infected blood. Forty-five per cent recalled a mucocutaneous exposure to HIV-positive blood. Only 28 (64%) of 44 percutaneous injuries from HIV-infected patients were reported. During their student clinical training, 56% of interns had suffered a penetrating injury, and 18% recollected needlestick injuries involving HIV-infected patients. The most common mechanisms of injury included unexpected patient movement (23%), needle recapping (17%), and withdrawal of the needle (17%). Half of the injuries occurred during the first 4 months of internship. Only 22% of intern percutaneous exposures could have been avoided by following universal precautions. CONCLUSIONS: Intern and medical student exposure to blood is extremely common, but is markedly underreported. Strict compliance with universal precautions will not prevent the majority of exposures. Priorities should be the introduction of safer techniques and equipment, skills training and methods of reporting blood exposures.
Attitude of Health Personnel↗
Injection practices in Romania: progress and challenges.
OBJECTIVE: To identify breaks in infection control practices that might put Romanians at risk for transmission of hepatitis B virus (HBV) from injections. METHODS: A standardized questionnaire was administered to a systematic sample of the 1,906 nurses in Vâlcea District, Romania, to collect information on their knowledge, attitudes, and practices regarding injection administration and universal precautions. RESULTS: Of the 180 nurses interviewed, 91% (95% confidence interval [CI95], 86% to 95%) reported having attended training for universal precautions; 58% (CI95, 49% to 67%) accurately reported that HBV remains infectious for at least 1 week in the environment; and 4% (CI95, 2% to 8%) knew that HBV is transmitted more efficiently than HIV through percutaneous exposures. No nurses reported reusing syringes or needles on different patients, but 4 (2%; CI, 1% to 6%) would reuse a syringe and 3 (2%; CI95, 0% to 5%) would reuse a needle on the same patient in an emergency. Fifty-three percent (CI95, 44% to 61%) of nurses reported having a dedicated area for the preparation of injectable medications separate from where blood-contaminated items were handled. Shortages of infection control supplies were common. CONCLUSIONS: Although nurses in Vâlcea do not report reusing injection equipment without sterilization, other unsafe practices occur that may facilitate HBV transmission through injections, including preparing injectable medications in areas potentially contaminated with blood. Inadequate knowledge of blood-borne pathogen transmission and shortages of infection control supplies may contribute to these unsafe practices. Addressing these deficits could improve injection safety in Romania.
Adult↗
The surgical looking glass: a readily available safeguard against eye splash injury/contamination during infiltration of anesthesia for cysts and other "porous" lesions of the skin.
BACKGROUND: "Breaks" in barrier precautions are a definite abrogating influence on the effectiveness of "universal precautions." Dermatologists and dermatologic surgeons are exposed to significant infectious agents on a daily basis, especially due to the high number of minor surgical procedures performed. Backsplash, spray, and eye splash of bodily fluids during these procedures place the surgeon at a high risk of contamination/infection via the conjunctival membranes. The surgical looking glass is a simple utility based on inexpensive equipment already in place in the physician's office which protects the eyes and face during infiltrative anesthesia or incision of cysts and other lesions. OBJECTIVE: To offer a simple and inexpensive utility to assist with protection from and reduction of contamination/infection of the ocular mucous membranes during surgical procedures. METHODS: Utilizing one or two readily available microscope slides overlying the injection site during local infiltrative anesthesia, backsplash or spray can be contained. RESULTS: This utility is effective in containment of backsplash or spray of anesthesia or bodily fluids during even minor surgical procedures. CONCLUSION: The surgical looking glass can enhance safety and promote "universal precautions" during even minor surgical procedures or infiltration of anesthesia into more porous areas or lesions for the practicing dermatologist or dermatologic surgeon. The pragmatic, practical, and inexpensive nature of the surgical looking glass invites its use on a daily basis by the practicing dermatologist.
Anesthesia, Local↗
Determinants of emergency department procedure- and condition-specific universal (barrier) precaution requirements for optimal provider protection.
STUDY OBJECTIVE: To determine potential blood and body fluid (B/BF) contacts with specific body areas associated with procedures commonly performed in the emergency department and to thereby delineate appropriate procedure-specific precautions. DESIGN: Prospective, observational study assessing procedure-related B/BF contacts by use of stratified, blocked sampling of shifts. PARTICIPANTS: ED patients in an inner-city tertiary care university hospital. RESULTS: Of 2,529 procedures performed in 1,025 patients, 1,621 (64%) were associated with barrier-protected or unprotected B/BF contact; 92% involved blood or bloody BF. Chest tube placement, lumbar puncture, and examination of the bleeding patient all resulted in B/BF contact with the facial area. All of the 18 procedure categories observed, with the exception of i.m. injection, resulted in B/BF contact with hands. Many procedures resulted in contact with the body or feet. Procedure type, provider, length of time, number of procedures per patient, and successful completion were each independently associated with B/BF contact. Number of attempts, adverse conditions, and triage acuteness were not associated with increased likelihood of contact. CONCLUSION: Virtually all ED procedures require gloves. Barrier protection for the body may be appropriate for all but the simplest procedures. Protection for the face seems appropriate, especially in invasive procedures such as lumbar puncture or physical examination of the bleeding patient. This study, along with other published data, has aided development of detailed guidelines for appropriate barrier precautions to be taken for common ED procedures.
Adolescent↗
The lack of Crimean-Congo hemorrhagic fever virus antibodies in healthcare workers in an endemic region.
We aimed to detect antibodies against Crimean-Congo hemorrhagic fever virus (CCHFV) in healthcare workers (HCWs) in an endemic region. The study was conducted in a tertiary care hospital that had cared for CCHFV infected patients in the period 2002-2003. The sera from the HCWs were collected one month after the last admitted hospital case (October 2003), and sent to the Pasteur Institute, Lyon, France to be studied for CCHF IgM and IgG by ELISA. The total number of HCWs included in the study was 75; the median age was 30, 68% of the subjects were female, and 83% of the HCWs were at risk of exposure to the body fluids of patients. Only one HCW from the group without risk of exposure was CCHF IgG positive. The adherence rate to universal precautions was high. In conclusion, a lack of CCHFV transmission from patients to HCWs was observed. This result could be related to the high rate of compliance to the universal precautions, which are sufficient to protect against CCHFV infection.
Adult↗
New needlestick law means take steps now.
To comply with requirements from the Occupational Safety and Health Administration and a new federal law, you'll need to take steps to prevent and track needlestick injuries: The Needlestick Safety and Prevention Act requires you to keep a sharps injury log listing where and how the injury occurred, and the type and brand of device used. Review data to spot trends in needlestick injuries caused by equipment design flaws and behavior patterns. ED staff must be trained annually in needlestick injury prevention, including proper disposal of sharps, universal precautions, and what to do if a needlestick occurs. To enforce universal precautions, give staff verbal and written warnings and role-model appropriate behavior.
Emergency Service, Hospital↗
[Self protection for nurses. Comparative study].
The nursing personnel at the C.H. Xeral-Cíes participated in a study of various types of self-protection methods over two time spans. The hypotheses investigated were the following: 1. Is there a divergence in the percentage of personnel vaccinated against hepatitis B?, 2. Is there an increase in the level of knowledge about universal precautions?, and 3. Is there any improvement in self-protection methods in the latter study? The statistical analysis used has a variable range of < 0.05. The results indicated significant differences in the percentage of personnel vaccinated against hepatitis B, in knowledge about universal precautions, and in the number of accidental punctures reported to the Preventative Medicine Service.
Cross-Sectional Studies↗
Safety issues, risks, and precautions for dermatologic surgery.
The use of universal precautions can provide an effective barrier to transmission of viral infections. The most common route of occupational human immunodeficiency virus transmission to a health care provider is a self-inflicted needle stick with a contaminated needle. Use of the no-touch suturing technique in dermatologic surgery can lower the risk of such self-inflicted needle sticks.
Ambulatory Surgical Procedures↗
Treatment of patients with acquired immunodeficiency syndrome in a podiatric emergency situation.
All patients should be considered seropositive, and protective measures always should be taken. The mainstays of universal precautions are the use of barrier techniques and protection from inadvertent sharps exposure. Various studies show that emergency room or trauma patients have a higher HIV prevalence than the population as a whole. Several studies of health care workers with known parenteral and mucous membrane exposure to HIV positive patients indicate that the risk of seroconversion is less than 1%. This low percentage, however, should not be used to justify nonadherence to universal precautions.
Acquired Immunodeficiency Syndrome↗