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PubMed1991

Risk of blood contamination and injury to operating room personnel.

The potential for transmission of deadly viral diseases to health care workers exists when contaminated blood is inoculated through injury or when blood comes in contact with nonintact skin. Operating room personnel are at particularly high risk for injury and blood contamination, but data on the specifics of which personnel are at greater risk and which practices change risk in this environment are almost nonexistent. To define these risk factors, experienced operating room nurses were employed solely to observe and record the injuries and blood contaminations that occurred during 234 operations involving 1763 personnel. Overall 118 of the operations (50%) resulted in at least one person becoming contaminated with blood. Cuts or needlestick injuries occurred in 15% of the operations. Several factors were found to significantly alter the risk of blood contamination or injury: surgical specialty, role of each person, duration of the procedure, amount of blood loss, number of needles used, and volume of irrigation fluid used. Risk calculations that use average values to include all personnel in the operating room or all operations performed substantially underestimate risk for surgeons and first assistants, who accounted for 81% of all body contamination and 65% of the injuries. The area of the body contaminated also changed with the surgical specialty. These data should help define more appropriate protection for individuals in the operating room and should allow refinements of practices and techniques to decrease injury.

Blood↗
PubMed2004

Sharps injuries in the home health care setting: risks for home health care workers.

Home health care nurses are at risk of needlesticks and blood exposures, yet few studies have been conducted related to such exposures in the home health care setting. This article describes a cross sectional prevalence pilot study of needlesticks and blood exposures conducted among three home health care agencies in the San Francisco Bay area. Needlestick and blood exposure reports from 1993 to 1996 were submitted from three home health care agencies. The exposures were categorized using an existing categorization system and compiled into a composite report. A total of 52 exposures occurred; nurses sustained 92% of exposures. Twenty-three percent occurred before, during, or after needle disposal; 17% from manipulating intravenous/access ports; 15% from improper disposal; and 13.5% during or after blood draw. Needle safety devices need to be specifically designed for the unique home health care setting and for a standardized rate of calculating needlestick injuries in this setting.

Accidents, Occupational↗
PubMed1992

An aid for insulin needle destruction for people with failing eyesight.

Patients with diabetic retinopathy and failing eyesight have problems in cutting off the needle after insulin injection. We have developed a new aid for attachment to a Becton Dickinson Destruclip needle cutter to simplify needle destruction and make safer handling possible, and studied its effectiveness. The performance time of 10 healthy blindfolded subjects to destroy a needle was compared with and without the aid. The risk of needlestick was also compared. When no aid was used, the time to destroy a needle was on an average: first trial 54 s, second trial 33 s, and third trial 11 s, while with the aid the time was on an average: first trial 16 s, second trial 7 s, and third trial 6 s; thus, the use of the aid shortened the time. Furthermore, without the aid, the frequency of needlestick injury was 1 in 15. With the aid it never occurred. This shows that the new aid for the needle cutter is effective and reduces related injuries.

Adult↗
PubMed1993

Glove perforation during hip arthroplasty. A randomised prospective study of a new taperpoint needle.

Exposure to blood is a hazard for all surgeons. We assessed the incidence of glove perforation and needlestick injury from a new blunt taperpoint needle designed to penetrate tissues other than skin with the minimum of force. We performed a prospective, randomised trial comparing the incidence of perforations of surgical gloves with the new needle and a standard cutting needle during wound closure after hip arthroplasties. There was at least one glove perforation in 46 of 69 such procedures (67%). The use of the taperpoint needle produced a significant decrease in perforations (p = 0.049).

Aged↗
PubMed1997

Universal precautions: attitudes of Australian and New Zealand anaesthetists.

OBJECTIVE: To survey the attitudes of a group of Australasian anaesthetists to the risks of bloodborne infections, and their understanding of Universal Precautions. DESIGN: A questionnaire survey. SETTING: A conference on health risks to anaesthetists in August 1995. PARTICIPANTS: 162 Australian and New Zealand anaesthetists. RESULTS: Two-thirds of anaesthetists favoured preoperative HIV and hepatitis B and C testing; they rarely took "risk" histories from patients preoperatively. Only 37% always wore gloves while administering anaesthetics, and 67% reported they resheathed needles. Thirty-nine per cent had had needlestick injuries in the preceding 12 months; 43% did not always report them. The perceived needlestick accident rate was 1 in 1300 anaesthetics. Most (90%) were immunised against hepatitis B, but 20% of these had never had their serological response checked. Twelve per cent of anaesthetists had had occupational exposure to HIV. A high proportion of the anaesthetists understood the principles of Universal Precautions, but only half of them believed these to be practical. CONCLUSIONS: The current situation of Australasian anaesthetists not complying with Universal Precautions and not taking a risk history for bloodborne pathogens may carry the greatest risk of accidental infection.

Acquired Immunodeficiency Syndrome↗
PubMed1997

The interstitial response to renal injury: fibroblast-like cells show phenotypic changes and have reduced potential for erythropoietin gene expression.

To define the potential for erythropoietin gene expression in injured kidneys, marker gene expression was examined in transgenic mice bearing a homologously recombined erythropoietin--simian virus 40 T antigen (Epo-TAg) transgene. Three types of renal injury were studied: ureteric obstruction, global ischemia following clamping of the renal pedicle, and focal needlestick injury. All modes of injury were associated with an expansion of the interstitial space, which contained an increased number of cells. Alterations observed in the interstitial fibroblast-like cells included an increased number and complexity of cellular processes, enhanced expression of contractile elements, particularly of the intermediate filament desmin, and reduced expression of ecto-5'-nucleotidase. Following each type of injury there was a focal or general reduction in the proportion of such cells that could be stimulated to express Epo-TAg. However, some positively staining cells were present even in severely injured regions and more could be recruited to express Epo-TAg by severe anemic or hypoxic stimulation, indicating that cells with the potential for erythropoietin gene expression were neither absent nor completely refractory to stimulation in these regions. In all injured kidneys, Epo-TAg expression was limited to the fibroblast-like population. Double labeling experiments showed that cells expressing Epo-TAg also expressed increased amounts of desmin, demonstrating that the myofibroblast features which develop in response to injury and the capacity for erythropoietin gene expression are not mutually exclusive.

Animals↗
PubMed2000

Accidental injuries by HIV-contaminated instruments in health provider or research environments: can seroconversion be prevented?

The rate of seroconversion from percutaneous needlestick exposure to HIV infection is approximately 0.3 per cent. To investigate the possibility of local confinement of HIV, 100 to 200 nm Tc-99m sulfur colloid particles were injected in the canine model subcutaneously at the knee level and collected proximally at the groin from the cannulated femoral vein and lymphatic channel. Tourniquet compression (250 mm Hg) was used as an intervention to possibly restrict particle spread. It was found that particles arrived in the blood at 2.81 +/- 0.54 minutes, with later arrival in the lymph at 6.0 +/- 1.47 minutes. Tourniquet application delayed the appearance of the particulate matter in the blood up to 7.11 +/- 1.5 minutes and in lymph up to 40.0 +/- 5.10 minutes. The concentration of radioactivity in the lymph was higher than in the venous blood. The distribution of the particles reflected by flux was comparable in both pathways. The accumulation curves did not reach plateaus during 45 minutes in lymph and 15 minutes in blood. Radioactive scanning revealed that about 90 per cent of the injected particles remained locally with gradual release for at least 45 minutes. Our results suggest that HIV, introduced by needlestick injury, can be contained for possible viricidal treatment if the response includes rapid immobilization and tourniquet of the area.

Analysis of Variance↗
PubMed1997

[Risk of hepatitis C virus infection in medical occupations].

Following the introduction of sensitive and specific tests for the detection of hepatitis C virus (HCV) infection studies could be performed to determine the risk to acquire a HCV infection in medical professions. The aim of this report is to summarize the knowledge in this field, especially regarding the risk of transmission of HC virus by injuries with infected material, such as needles. The risk to acquire a HCV infection following needlestick injuries was found to be markedly lower than the risk for transmission of hepatitis B virus infection. In 7 studies from different countries this risk has been found to be between zero to a maximum of 10% (average 2%). When the frequency of HCV infection was studied in occupational groups in hospital (nurses, technical assistants, doctors), it did not differ significantly compared to the prevalence in general population. These and other findings concerning the risk of transmission of HCV infections (between spouses, mother/newborns) clearly show that the risk of transmission of HCV infection is markedly lower than that of HBV infection. These facts should be considered in judging of applications for the recognition of HCV infection as occupational disease.

Adult↗
PubMed1993

Human immunodeficiency virus infection.

Human immunodeficiency virus (HIV) infection is an important topic for virtually all physicians, but it is especially important to those involved in critical care. Recent surveys indicate that about 5% of all hospitalized patients in the United States are infected, although this rate is highly variable based on geographic location and demographics. Factors of greatest concern to critical care specialists are recognition of HIV infection in the context of diagnostic evaluations, management guidelines for seriously ill patients with late complications, prevention of occupational exposures, and management guidelines when exposures occur. With regard to occupational risks, the major concern is percutaneous injury with exposure to blood or blood body fluid. The efficiency of transmission with a typical needlestick injury is 0.3%. The utility of prophylactic AZT or other nucleoside analogs is not established.

CD4-Positive T-Lymphocytes↗
PubMed2002

Occupational exposures occurring in students in a UK dental school.

BACKGROUND: Students whilst training may encounter a number of incidents where infection from patient body fluids may occur, especially as their manual skills are underdeveloped and their clinical experience is limited. PURPOSE OF STUDY: (a) To assess the nature of the occupational exposures occurring to students in a UK dental school, (b) to assess the rate of reporting of incidents, and (c) to evaluate the association of various factors with these exposures. Students in the third, fourth and final years of the 5-year undergraduate dental course at the University of Birmingham were asked to complete a questionnaire that inquired into personal details, number and nature of incidents, their reporting and follow-up. A 100% response rate was achieved. RESULTS: Across the years, there was no significant correlation (p > 0.01) between sex, dominant hand, use of protective glasses or time of day. Slightly more exposures occurred in males, right-handed students, and in the afternoon. A significant decrease in exposures (p < 0.01) occurred within final year, and when an assistant was employed. Significantly more incidents occurred while a patient was being treated than during operational clean-up procedures. A substantial number of dental students had experienced one or more occupational exposures during training. Of these, percutaneous injuries predominated. Junior students appear to be more likely to experience exposures, and in these students, needlestick injuries are the most common source. CONCLUSIONS: To reduce the incidence of these exposures, more instruction and training may be required in the earlier clinical years and more chairside assistance. Improvements are required in the monitoring of post-screening for seroconversion after HBV immunization, and in the reporting of test results in the event of an exposure incident. Under-reporting of incidents is common and ways to encourage and facilitate reporting should be sought.

Adolescent↗
PubMed1991

Occupational health problems among nurses.

Nurses are an integral component of the health care delivery system. In discharging their duties, nurses encounter a variety of occupational health problems which may be categorized into biological hazards, chemical hazards, physical hazards, and psychosocial hazards. A review of some examples of each of these four types of hazards is presented in this article. Particular attention has been devoted to hepatitis B, acquired immunodeficiency syndrome, tuberculosis, cytotoxic drugs, anesthetic agents, needlestick injury, back pain, and stress.

Communicable Diseases↗
PubMed1993

Impact of new legislation on needle and syringe purchase and possession--Connecticut, 1992.

Human immunodeficiency virus (HIV) and other bloodborne pathogens are transmitted among injecting-drug users (IDUs) through the reuse and sharing of contaminated needles and syringes (NSs). Of the 689 acquired immunodeficiency syndrome (AIDS) cases reported in Connecticut in 1992, 413 (60%) were associated with injecting-drug use. To help reduce IDUs' use of contaminated NSs, Connecticut enacted laws effective July 1, 1992, that allow the purchase without a prescription of up to 10 NSs at one time in pharmacies and the possession of up to 10 clean NSs. Before this date, purchase and possession of NSs without a prescription had been illegal in Connecticut. This report presents preliminary information from the first 5 months of an ongoing evaluation to determine whether the new laws affected pharmacy-based NS sales, IDUs' reported knowledge of the laws and places to obtain NSs, and law enforcement officers' risk for needlestick injuries.

Connecticut↗
PubMed1992

AIDS education strategies: evaluating the fear response.

1. Despite educational interventions, evidence suggests that negative attitudes about AIDS risk persist among clinical hospital staff. In diverse study populations, associations have been found between psychosocial phenomena and on the job accidents and injuries. 2. This article describes a pilot study to explore whether fearful attitudes of clinicians contribute to the adverse behaviors of needlestick injuries and mucosal splashes. The authors sought to demonstrate whether desensitization therapy would be effective in reducing fear response. 3. A serendipitous finding of the study was that organizational and interpersonal conflict frequently provoked fear and anxiety responses. There is a continued need to examine the domain of AIDS related fears among clinical staff, as well as a need to seek a better understanding of this fear as part of the tensions of organizational dynamics in hospitals. 4. Occupational health nurses working in hospitals are in a unique position to uncover relationships among all types of incidents that may indicate fear and anxiety among clinical staff.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Prevention of hepatitis C virus transmission in hemodialysis].

The strategy to prevent hepatitis C virus (HCV) transmission to hemodialysed patients includes the screening of blood donors, the use of erythropoietin and the actual, strict application of Universal Precautions. In particular, articles should not be shared between patients, gloves changed and handwashing performed systematically after caring for a patient. The isolation of anti HCV (+) hemodialysed patients is not warranted. The prevention of HCV transmission to staff members relies mainly on the prevention of accidental needlestick injuries.

Blood Donors↗
PubMed2003

Reducing accidental injuries during surgery.

Extensive clinical investigations have demonstrated that double-gloves and blunt-tipped surgical needles dramatically reduced the risk of accidental injuries during surgery. During the last decade, double-glove hole puncture indication systems have been developed that reduce the clinical risk of accidental needlestick injuries as well as detect the presence of glove hole puncture in the presence of fluids. When the outer glove is punctured, the colored underglove becomes apparent through the translucent outer glove, necessitating glove removal, hand washing, and donning of another double-glove hole puncture Indicator system. This article presents the first biomechanical performance study that documents the puncture resistance of blunt surgical needles in latex and nonlatex single gloves and double-glove hole puncture indication systems. The technique for measuring glove puncture resistance simulates the standard test for material resistance to puncture outlined by the American Society for Testing and Materials. The maximum puncture resistance force was measured by the compression load cell and recorded in grams with a strip chart recorder. Ten puncture resistance measurements for the taper point needle, blunt taper point needle, and blunt needle were taken from five samples of the Biogel Indicator underglove, Biogel Super-Sensitive glove, Biogel glove, Biogel Skinsense N Universal underglove, and Biogel Skinsense Polyisoprene glove; and the Biogel, Biogel Super-Sensitive, and Biogel Skinsense Polyisoprene double-glove hole puncture indication systems. The magnitude of puncture resistance forces recorded was influenced by several factors: glove material, number of glove layers, and type of surgical needle. For each type of curved surgical needle,the resistance to needle penetration by the nonlatex gloves was significantly greater than those encountered by the latex glove materials. The resistance to needle puncture of all three double-glove systems was significantly greater than that of either the nonlatex or latex underglove or outer glove. The taper point needle encountered the lowest puncture resistance forces in the five single gloves and the three double-glove systems. Blunting the sharp end of the taper point needle markedly increased its resistance to glove puncture in the five single gloves and five double-glove systems. The blunt-point surgical needle elicited the greatest needle penetration force in all of the single and double-glove systems.

Accidents, Occupational↗
PubMed1994

Phlebotomists' safety practices. A College of American Pathologists Q-Probes study of 683 institutions.

We report on phlebotomists' safety practices in 683 institutions participating in the College of American Pathologists Q-Probes program. Participants inspected 38,357 phlebotomy tourniquets and 31,952 blood collection tube holders in use and found 2098 tourniquets and 2966 holders visibly contaminated with blood. In 67.8% of the institutions, at least one tourniquet or collection tube holder was contaminated. Needlestick injuries reported by phlebotomists during 1990 through 1992 were analyzed from approximately 11 million inpatient venipuncture procedures. These injuries ranged between 9.2 and 9.8 needlesticks per 100,000 venipunctures per year. Over 99% of the participants had a policy preventing recapping of needles, 45% discarded tourniquets when contaminated with blood, and 3.3% routinely assigned tourniquets to specific patients. Between 1990 and 1992, increasing frequencies of phlebotomists using gloves, replacing gloves between each inpatient phlebotomy, and handwashing after degloving were found. We cite the lack of compliance of handwashing between glove changes as suggesting need for regulatory rereview.

Bloodletting↗
PubMedDate not supplied

Reducing the risk of injuries to staff from insulin pens.

This article describes problems in the use and disposal of sharps used in the administration of insulin therapy in a hospital setting. Subsequent investigation and action taken to reduce the risk of needlestick injuries in staff who administer insulin therapy with an insulin pen delivery system are also discussed.

Accidents, Occupational↗